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‘Why did I choose this?’ Tackling burnout in oncology
MADRID – “Why did I choose this?”
That is the core question a Portuguese oncologist posed from the audience during a session at the annual meeting of the European Society for Medical Oncology (ESMO) that was dedicated to building a sustainable oncology workforce.
“Ten, twenty years ago, being a doctor was a dream,” she said, but right now doctors are underpaid, under strain, and have very few resources.
This oncologist is hardly alone.
A survey from ESMO conducted almost a decade ago found that more than 50% of oncologists across Europe, many of whom were early in their careers, reported being burned out.
This, Dr. Lim said, “was the starting point,” well before the COVID pandemic struck.
More recently, the pandemic has taken its own toll on the well-being of oncologists. A survey presented at ESMO 2020 revealed that 38% of participants, spanning 101 countries, reported experiencing burnout, and 66% said they were not able to perform their job.
Medscape’s 2023 Physician Burnout and Depression Report highlighted similar burnout rates, with 53% of U.S. physicians and 52% of oncologists saying they felt burned out, compared with about 42% in 2018, before the pandemic.
The oncology workforce is in crisis in every country, said Dr. Lim, from the Cancer Dynamics Lab, the Francis Crick Institute, London.
Burnout, characterized by emotional exhaustion, depersonalization or feelings of cynicism, and a low sense of personal accomplishment, can result in a poor work-life balance as well as poor mental and physical health. Factors linked to burnout include social isolation, increased workload, reduced quality of work, lack of control over work, and stressful professional experiences.
Together, these factors can affect patient care and further exacerbate staffing issues, Dr. Lim said.
Staffing shortages are common. Oncologists often work long hours or on weekends to cover gaps caused by staffing shortages. Recent data revealed that in high-income countries, there are on average 0.65 medical oncologists and 0.25 radiation oncologists per 100 patients — a situation made worse by professionals taking early retirement or leaving medicine during the pandemic.
“We have seen that the shortage of human resources in many countries as well as the increasing workload related to the increasing number of cancers,” as well as patients surviving longer, have increased pressures on the healthcare system, Andrés Cervantes, MD, PhD, president of ESMO, explained in a press conference.
While tackling these oncology workforce problems requires smaller, local changes to a physician’s daily routine, “the real change,” Dr. Lim said, lies at an infrastructure level.
In response to this chronic and growing problem, ESMO launched its Resilience Task Force in 2020 to evaluate burnout and well-being. The task force plans to publish a position paper in which it will propose a set of recommendations regarding the psychosocial risks of burnout as well as flexible work patterns, well-being resources, and targeted support.
A panel of experts at the meeting touched on some of these solutions.
Dealing with staff shortages is a must, said Jean-Yves Blay, MD, PhD, during the session. “It’s a simple mathematical equation,” Dr. Blay said. “We must increase the number of doctors in medical schools and the number of nurses and healthcare professionals in all schools.” Improving staffing would also help reduce chronic workload issues.
Resilience training should also be incorporated into physician training starting in medical school. Teaching oncologists how to deal with bad news and to cope when patients dies is particularly important.
“I was not taught that,” said the oncologist from Portugal. “I had to learn that at my own cost.”
The good news is that it’s possible to develop resiliency skills over time, said Claire Hardy, PhD, from Lancaster University, United Kingdom, who agreed that training programs could be one approach to improve oncologists’ work life.
However, a person’s needs are determined by their institution and personal responsibilities. “No one knows your job better than you,” Dr. Hardy said. “No one knows better than you where the inefficiencies are, where the bureaucracy is that could be taken away, or it could be done by somebody whose role it is to sort all that out.”
But having this understanding is not enough. Physician also need to feel “psychological safety to be able to speak out and say that something isn’t working right now or is too much,” or, “I’m spending too much time doing this.”
In other words, oncologists need to be able to set boundaries and say no.
Dr. Hardy said this concept “has been around a while, but it’s really gaining momentum,” and being able to discuss these issues in a forum such as the ESMO Congress is a promising start.
Dr. Lim has relationships with Janseen and SEOM. No other relevant financial relationships were disclosed.
A version of this article first appeared on Medscape.com.
MADRID – “Why did I choose this?”
That is the core question a Portuguese oncologist posed from the audience during a session at the annual meeting of the European Society for Medical Oncology (ESMO) that was dedicated to building a sustainable oncology workforce.
“Ten, twenty years ago, being a doctor was a dream,” she said, but right now doctors are underpaid, under strain, and have very few resources.
This oncologist is hardly alone.
A survey from ESMO conducted almost a decade ago found that more than 50% of oncologists across Europe, many of whom were early in their careers, reported being burned out.
This, Dr. Lim said, “was the starting point,” well before the COVID pandemic struck.
More recently, the pandemic has taken its own toll on the well-being of oncologists. A survey presented at ESMO 2020 revealed that 38% of participants, spanning 101 countries, reported experiencing burnout, and 66% said they were not able to perform their job.
Medscape’s 2023 Physician Burnout and Depression Report highlighted similar burnout rates, with 53% of U.S. physicians and 52% of oncologists saying they felt burned out, compared with about 42% in 2018, before the pandemic.
The oncology workforce is in crisis in every country, said Dr. Lim, from the Cancer Dynamics Lab, the Francis Crick Institute, London.
Burnout, characterized by emotional exhaustion, depersonalization or feelings of cynicism, and a low sense of personal accomplishment, can result in a poor work-life balance as well as poor mental and physical health. Factors linked to burnout include social isolation, increased workload, reduced quality of work, lack of control over work, and stressful professional experiences.
Together, these factors can affect patient care and further exacerbate staffing issues, Dr. Lim said.
Staffing shortages are common. Oncologists often work long hours or on weekends to cover gaps caused by staffing shortages. Recent data revealed that in high-income countries, there are on average 0.65 medical oncologists and 0.25 radiation oncologists per 100 patients — a situation made worse by professionals taking early retirement or leaving medicine during the pandemic.
“We have seen that the shortage of human resources in many countries as well as the increasing workload related to the increasing number of cancers,” as well as patients surviving longer, have increased pressures on the healthcare system, Andrés Cervantes, MD, PhD, president of ESMO, explained in a press conference.
While tackling these oncology workforce problems requires smaller, local changes to a physician’s daily routine, “the real change,” Dr. Lim said, lies at an infrastructure level.
In response to this chronic and growing problem, ESMO launched its Resilience Task Force in 2020 to evaluate burnout and well-being. The task force plans to publish a position paper in which it will propose a set of recommendations regarding the psychosocial risks of burnout as well as flexible work patterns, well-being resources, and targeted support.
A panel of experts at the meeting touched on some of these solutions.
Dealing with staff shortages is a must, said Jean-Yves Blay, MD, PhD, during the session. “It’s a simple mathematical equation,” Dr. Blay said. “We must increase the number of doctors in medical schools and the number of nurses and healthcare professionals in all schools.” Improving staffing would also help reduce chronic workload issues.
Resilience training should also be incorporated into physician training starting in medical school. Teaching oncologists how to deal with bad news and to cope when patients dies is particularly important.
“I was not taught that,” said the oncologist from Portugal. “I had to learn that at my own cost.”
The good news is that it’s possible to develop resiliency skills over time, said Claire Hardy, PhD, from Lancaster University, United Kingdom, who agreed that training programs could be one approach to improve oncologists’ work life.
However, a person’s needs are determined by their institution and personal responsibilities. “No one knows your job better than you,” Dr. Hardy said. “No one knows better than you where the inefficiencies are, where the bureaucracy is that could be taken away, or it could be done by somebody whose role it is to sort all that out.”
But having this understanding is not enough. Physician also need to feel “psychological safety to be able to speak out and say that something isn’t working right now or is too much,” or, “I’m spending too much time doing this.”
In other words, oncologists need to be able to set boundaries and say no.
Dr. Hardy said this concept “has been around a while, but it’s really gaining momentum,” and being able to discuss these issues in a forum such as the ESMO Congress is a promising start.
Dr. Lim has relationships with Janseen and SEOM. No other relevant financial relationships were disclosed.
A version of this article first appeared on Medscape.com.
MADRID – “Why did I choose this?”
That is the core question a Portuguese oncologist posed from the audience during a session at the annual meeting of the European Society for Medical Oncology (ESMO) that was dedicated to building a sustainable oncology workforce.
“Ten, twenty years ago, being a doctor was a dream,” she said, but right now doctors are underpaid, under strain, and have very few resources.
This oncologist is hardly alone.
A survey from ESMO conducted almost a decade ago found that more than 50% of oncologists across Europe, many of whom were early in their careers, reported being burned out.
This, Dr. Lim said, “was the starting point,” well before the COVID pandemic struck.
More recently, the pandemic has taken its own toll on the well-being of oncologists. A survey presented at ESMO 2020 revealed that 38% of participants, spanning 101 countries, reported experiencing burnout, and 66% said they were not able to perform their job.
Medscape’s 2023 Physician Burnout and Depression Report highlighted similar burnout rates, with 53% of U.S. physicians and 52% of oncologists saying they felt burned out, compared with about 42% in 2018, before the pandemic.
The oncology workforce is in crisis in every country, said Dr. Lim, from the Cancer Dynamics Lab, the Francis Crick Institute, London.
Burnout, characterized by emotional exhaustion, depersonalization or feelings of cynicism, and a low sense of personal accomplishment, can result in a poor work-life balance as well as poor mental and physical health. Factors linked to burnout include social isolation, increased workload, reduced quality of work, lack of control over work, and stressful professional experiences.
Together, these factors can affect patient care and further exacerbate staffing issues, Dr. Lim said.
Staffing shortages are common. Oncologists often work long hours or on weekends to cover gaps caused by staffing shortages. Recent data revealed that in high-income countries, there are on average 0.65 medical oncologists and 0.25 radiation oncologists per 100 patients — a situation made worse by professionals taking early retirement or leaving medicine during the pandemic.
“We have seen that the shortage of human resources in many countries as well as the increasing workload related to the increasing number of cancers,” as well as patients surviving longer, have increased pressures on the healthcare system, Andrés Cervantes, MD, PhD, president of ESMO, explained in a press conference.
While tackling these oncology workforce problems requires smaller, local changes to a physician’s daily routine, “the real change,” Dr. Lim said, lies at an infrastructure level.
In response to this chronic and growing problem, ESMO launched its Resilience Task Force in 2020 to evaluate burnout and well-being. The task force plans to publish a position paper in which it will propose a set of recommendations regarding the psychosocial risks of burnout as well as flexible work patterns, well-being resources, and targeted support.
A panel of experts at the meeting touched on some of these solutions.
Dealing with staff shortages is a must, said Jean-Yves Blay, MD, PhD, during the session. “It’s a simple mathematical equation,” Dr. Blay said. “We must increase the number of doctors in medical schools and the number of nurses and healthcare professionals in all schools.” Improving staffing would also help reduce chronic workload issues.
Resilience training should also be incorporated into physician training starting in medical school. Teaching oncologists how to deal with bad news and to cope when patients dies is particularly important.
“I was not taught that,” said the oncologist from Portugal. “I had to learn that at my own cost.”
The good news is that it’s possible to develop resiliency skills over time, said Claire Hardy, PhD, from Lancaster University, United Kingdom, who agreed that training programs could be one approach to improve oncologists’ work life.
However, a person’s needs are determined by their institution and personal responsibilities. “No one knows your job better than you,” Dr. Hardy said. “No one knows better than you where the inefficiencies are, where the bureaucracy is that could be taken away, or it could be done by somebody whose role it is to sort all that out.”
But having this understanding is not enough. Physician also need to feel “psychological safety to be able to speak out and say that something isn’t working right now or is too much,” or, “I’m spending too much time doing this.”
In other words, oncologists need to be able to set boundaries and say no.
Dr. Hardy said this concept “has been around a while, but it’s really gaining momentum,” and being able to discuss these issues in a forum such as the ESMO Congress is a promising start.
Dr. Lim has relationships with Janseen and SEOM. No other relevant financial relationships were disclosed.
A version of this article first appeared on Medscape.com.
FROM ESMO 2023
Employment vs. private practice: Who’s happier?
Alexandra Kharazi, MD, a California-based cardiothoracic surgeon, previously worked as an employed physician and is now in private practice. Though she appreciates that there are some trade-offs to working with her small group of three surgeons, Dr. Kharazi has no qualms about her choice.
“For me, it’s an issue of autonomy,” she said. “While I have to work a lot of hours, I don’t have to adhere to a strict schedule. I also don’t have to follow specific policies and rules.”
In contrast, Cassandra Boduch, MD, an employed psychiatrist with PsychPlus in Houston, is very satisfied with working as an employee. “I looked into private practice, but no one really prepares you for the complications that come with it,” she said. “There’s a lot more that goes into it than people realize.”
By hanging up her own shingle, Dr. Kharazi may be living a rapidly shrinking dream. According to the American Medical Association, between 2012 and 2022, the share of physicians working in private practice fell from 60% to 47%. The share of physicians working in hospitals as direct employees or contractors increased from about 6% to about 10% during the same time period.
, according to the AMA.
Though the traditional dream of owning your own practice may be slipping away, are employed physicians less happy than are their self-employed peers? By many measures, the answer is no.
In Medscape’s Employed Physicians Report 2023, doctors weighed in on the pros and cons of their jobs.
When asked what they like most about their jobs, employed physician respondents reported “not having to run a business” as their number-one benefit, followed closely by a stable income. The fact that employers pay for malpractice insurance ranked third, followed by work-life balance.
“We get no business classes in medical school or residency,” said one employed physician. “Having a good salary feels good,” said another. Yet another respondent chimed in: “Running a practice as a small business has become undoable over the past 10-12 years.”
And 50% of employed physicians said that they were “very satisfied/satisfied” with their degree of autonomy.
Still, employed physicians also had plenty to say about the downsides of their jobs.
Many pointed to “feeling like a cog in the machine,” and one doctor pointed to the hassle of dealing with bureaucracy. Others complained about the fact that nonphysicians ran the business and lacked an understanding of what physicians really need from their jobs. When asked whether administrative rules made sense, 63% of physician respondents said that yes, the rules make sense for the business; but, only 52% said that the rules make sense for the doctors themselves.
Other complaints included the requirement to reach high productivity targets and too low an income potential. In the 9 years since Medscape’s 2104 Employed Physicians Report, the share of employed doctors paid on a straight salary has declined from 46% to 31%. Those compensated on a base salary plus productivity targets and other performance metrics rose from 13% in 2014 to 32% now.
“Many doctors go into private practice because of the freedom it brings and the potential financial incentives,” added Dr. Boduch. “I know that many doctors have a dream of working for themselves, and in many cases, that works out great for them.”
Dr. Boduch noted that in her job as chief medical officer at PsychPlus, she still has flexibility plus the perks of working with a bigger practice. In this scenario, Dr. Boduch said, the company can negotiate with insurance companies, allowing her the financial rewards of private practice.
What’s right for you?
“I think it might be somewhat generational,” said Cody Futch, senior recruiting executive at AMN Healthcare. “It used to be that fewer hospitals offered employment, so private practice was the way to go. Now, there are fewer privates because hospitals and corporations are buying them up.”
This reality has potentially shaped the way younger generations approach their workplace. Also, Gen Z tends to have less intention to stay with a current employer for the long term than did their parents. “Older physicians were trained to expect they’d run their own business and build it over the years,” said Mr. Futch. “The younger generations look at it as a job, something they may want to switch in a few years. It’s a combination of candidates wanting more options, and also the fact that there are more options to be employed.”
Along those lines, younger generations in general tend to place work-life balance as a higher priority than do older generations, and employed physicians place this equation high on the list as well. In the Employed Physicians Report 2023, 54% said that they are satisfied or better with their work-life balance, up from 51% in the 2022 report.
With that in mind, Dr. Kharazi noted that flexibility is one of the chief reasons why she likes private practice. “If my kid has an event I want to attend, I don’t have to adhere to a strict schedule,” she said.
Satisfaction as an employee vs. employed doctor sometimes changes based on the type of medicine you practice too. With specialties that tend to be primarily outpatient, such as dermatology and allergy, private practice may be the best option regardless. “Hospitals don’t seek out those specialists as much and the specialists can operate successfully without a hospital,” said Mr. Futch.
Hospitals try to incentivize doctors with perks like hefty sign-on bonuses, student loan forgiveness, plenty of vacation time, and more. They also put money into marketing their doctors, a time-consuming and expensive aspect that is tough to shoulder in private practice, especially in the early years. Mr. Futch adds that many doctors view employment as a more stable option. “As the government changes reimbursement policies, the income from private practice fluctuates,” he said. “So many doctors worry that if they buy into a private practice, it is a risky endeavor.”
Hospitals aren’t always a sure bet in that regard, either: They go through tough financial times, lay off staff, or make salary cuts. Historically, however, employment tends to be the safer route, which can make it an attractive option.
Ultimately, the pros and cons of each scenario are individual. It’s up to physicians to do their own math and balance sheet before making a decision.
A version of this article first appeared on Medscape.com.
Alexandra Kharazi, MD, a California-based cardiothoracic surgeon, previously worked as an employed physician and is now in private practice. Though she appreciates that there are some trade-offs to working with her small group of three surgeons, Dr. Kharazi has no qualms about her choice.
“For me, it’s an issue of autonomy,” she said. “While I have to work a lot of hours, I don’t have to adhere to a strict schedule. I also don’t have to follow specific policies and rules.”
In contrast, Cassandra Boduch, MD, an employed psychiatrist with PsychPlus in Houston, is very satisfied with working as an employee. “I looked into private practice, but no one really prepares you for the complications that come with it,” she said. “There’s a lot more that goes into it than people realize.”
By hanging up her own shingle, Dr. Kharazi may be living a rapidly shrinking dream. According to the American Medical Association, between 2012 and 2022, the share of physicians working in private practice fell from 60% to 47%. The share of physicians working in hospitals as direct employees or contractors increased from about 6% to about 10% during the same time period.
, according to the AMA.
Though the traditional dream of owning your own practice may be slipping away, are employed physicians less happy than are their self-employed peers? By many measures, the answer is no.
In Medscape’s Employed Physicians Report 2023, doctors weighed in on the pros and cons of their jobs.
When asked what they like most about their jobs, employed physician respondents reported “not having to run a business” as their number-one benefit, followed closely by a stable income. The fact that employers pay for malpractice insurance ranked third, followed by work-life balance.
“We get no business classes in medical school or residency,” said one employed physician. “Having a good salary feels good,” said another. Yet another respondent chimed in: “Running a practice as a small business has become undoable over the past 10-12 years.”
And 50% of employed physicians said that they were “very satisfied/satisfied” with their degree of autonomy.
Still, employed physicians also had plenty to say about the downsides of their jobs.
Many pointed to “feeling like a cog in the machine,” and one doctor pointed to the hassle of dealing with bureaucracy. Others complained about the fact that nonphysicians ran the business and lacked an understanding of what physicians really need from their jobs. When asked whether administrative rules made sense, 63% of physician respondents said that yes, the rules make sense for the business; but, only 52% said that the rules make sense for the doctors themselves.
Other complaints included the requirement to reach high productivity targets and too low an income potential. In the 9 years since Medscape’s 2104 Employed Physicians Report, the share of employed doctors paid on a straight salary has declined from 46% to 31%. Those compensated on a base salary plus productivity targets and other performance metrics rose from 13% in 2014 to 32% now.
“Many doctors go into private practice because of the freedom it brings and the potential financial incentives,” added Dr. Boduch. “I know that many doctors have a dream of working for themselves, and in many cases, that works out great for them.”
Dr. Boduch noted that in her job as chief medical officer at PsychPlus, she still has flexibility plus the perks of working with a bigger practice. In this scenario, Dr. Boduch said, the company can negotiate with insurance companies, allowing her the financial rewards of private practice.
What’s right for you?
“I think it might be somewhat generational,” said Cody Futch, senior recruiting executive at AMN Healthcare. “It used to be that fewer hospitals offered employment, so private practice was the way to go. Now, there are fewer privates because hospitals and corporations are buying them up.”
This reality has potentially shaped the way younger generations approach their workplace. Also, Gen Z tends to have less intention to stay with a current employer for the long term than did their parents. “Older physicians were trained to expect they’d run their own business and build it over the years,” said Mr. Futch. “The younger generations look at it as a job, something they may want to switch in a few years. It’s a combination of candidates wanting more options, and also the fact that there are more options to be employed.”
Along those lines, younger generations in general tend to place work-life balance as a higher priority than do older generations, and employed physicians place this equation high on the list as well. In the Employed Physicians Report 2023, 54% said that they are satisfied or better with their work-life balance, up from 51% in the 2022 report.
With that in mind, Dr. Kharazi noted that flexibility is one of the chief reasons why she likes private practice. “If my kid has an event I want to attend, I don’t have to adhere to a strict schedule,” she said.
Satisfaction as an employee vs. employed doctor sometimes changes based on the type of medicine you practice too. With specialties that tend to be primarily outpatient, such as dermatology and allergy, private practice may be the best option regardless. “Hospitals don’t seek out those specialists as much and the specialists can operate successfully without a hospital,” said Mr. Futch.
Hospitals try to incentivize doctors with perks like hefty sign-on bonuses, student loan forgiveness, plenty of vacation time, and more. They also put money into marketing their doctors, a time-consuming and expensive aspect that is tough to shoulder in private practice, especially in the early years. Mr. Futch adds that many doctors view employment as a more stable option. “As the government changes reimbursement policies, the income from private practice fluctuates,” he said. “So many doctors worry that if they buy into a private practice, it is a risky endeavor.”
Hospitals aren’t always a sure bet in that regard, either: They go through tough financial times, lay off staff, or make salary cuts. Historically, however, employment tends to be the safer route, which can make it an attractive option.
Ultimately, the pros and cons of each scenario are individual. It’s up to physicians to do their own math and balance sheet before making a decision.
A version of this article first appeared on Medscape.com.
Alexandra Kharazi, MD, a California-based cardiothoracic surgeon, previously worked as an employed physician and is now in private practice. Though she appreciates that there are some trade-offs to working with her small group of three surgeons, Dr. Kharazi has no qualms about her choice.
“For me, it’s an issue of autonomy,” she said. “While I have to work a lot of hours, I don’t have to adhere to a strict schedule. I also don’t have to follow specific policies and rules.”
In contrast, Cassandra Boduch, MD, an employed psychiatrist with PsychPlus in Houston, is very satisfied with working as an employee. “I looked into private practice, but no one really prepares you for the complications that come with it,” she said. “There’s a lot more that goes into it than people realize.”
By hanging up her own shingle, Dr. Kharazi may be living a rapidly shrinking dream. According to the American Medical Association, between 2012 and 2022, the share of physicians working in private practice fell from 60% to 47%. The share of physicians working in hospitals as direct employees or contractors increased from about 6% to about 10% during the same time period.
, according to the AMA.
Though the traditional dream of owning your own practice may be slipping away, are employed physicians less happy than are their self-employed peers? By many measures, the answer is no.
In Medscape’s Employed Physicians Report 2023, doctors weighed in on the pros and cons of their jobs.
When asked what they like most about their jobs, employed physician respondents reported “not having to run a business” as their number-one benefit, followed closely by a stable income. The fact that employers pay for malpractice insurance ranked third, followed by work-life balance.
“We get no business classes in medical school or residency,” said one employed physician. “Having a good salary feels good,” said another. Yet another respondent chimed in: “Running a practice as a small business has become undoable over the past 10-12 years.”
And 50% of employed physicians said that they were “very satisfied/satisfied” with their degree of autonomy.
Still, employed physicians also had plenty to say about the downsides of their jobs.
Many pointed to “feeling like a cog in the machine,” and one doctor pointed to the hassle of dealing with bureaucracy. Others complained about the fact that nonphysicians ran the business and lacked an understanding of what physicians really need from their jobs. When asked whether administrative rules made sense, 63% of physician respondents said that yes, the rules make sense for the business; but, only 52% said that the rules make sense for the doctors themselves.
Other complaints included the requirement to reach high productivity targets and too low an income potential. In the 9 years since Medscape’s 2104 Employed Physicians Report, the share of employed doctors paid on a straight salary has declined from 46% to 31%. Those compensated on a base salary plus productivity targets and other performance metrics rose from 13% in 2014 to 32% now.
“Many doctors go into private practice because of the freedom it brings and the potential financial incentives,” added Dr. Boduch. “I know that many doctors have a dream of working for themselves, and in many cases, that works out great for them.”
Dr. Boduch noted that in her job as chief medical officer at PsychPlus, she still has flexibility plus the perks of working with a bigger practice. In this scenario, Dr. Boduch said, the company can negotiate with insurance companies, allowing her the financial rewards of private practice.
What’s right for you?
“I think it might be somewhat generational,” said Cody Futch, senior recruiting executive at AMN Healthcare. “It used to be that fewer hospitals offered employment, so private practice was the way to go. Now, there are fewer privates because hospitals and corporations are buying them up.”
This reality has potentially shaped the way younger generations approach their workplace. Also, Gen Z tends to have less intention to stay with a current employer for the long term than did their parents. “Older physicians were trained to expect they’d run their own business and build it over the years,” said Mr. Futch. “The younger generations look at it as a job, something they may want to switch in a few years. It’s a combination of candidates wanting more options, and also the fact that there are more options to be employed.”
Along those lines, younger generations in general tend to place work-life balance as a higher priority than do older generations, and employed physicians place this equation high on the list as well. In the Employed Physicians Report 2023, 54% said that they are satisfied or better with their work-life balance, up from 51% in the 2022 report.
With that in mind, Dr. Kharazi noted that flexibility is one of the chief reasons why she likes private practice. “If my kid has an event I want to attend, I don’t have to adhere to a strict schedule,” she said.
Satisfaction as an employee vs. employed doctor sometimes changes based on the type of medicine you practice too. With specialties that tend to be primarily outpatient, such as dermatology and allergy, private practice may be the best option regardless. “Hospitals don’t seek out those specialists as much and the specialists can operate successfully without a hospital,” said Mr. Futch.
Hospitals try to incentivize doctors with perks like hefty sign-on bonuses, student loan forgiveness, plenty of vacation time, and more. They also put money into marketing their doctors, a time-consuming and expensive aspect that is tough to shoulder in private practice, especially in the early years. Mr. Futch adds that many doctors view employment as a more stable option. “As the government changes reimbursement policies, the income from private practice fluctuates,” he said. “So many doctors worry that if they buy into a private practice, it is a risky endeavor.”
Hospitals aren’t always a sure bet in that regard, either: They go through tough financial times, lay off staff, or make salary cuts. Historically, however, employment tends to be the safer route, which can make it an attractive option.
Ultimately, the pros and cons of each scenario are individual. It’s up to physicians to do their own math and balance sheet before making a decision.
A version of this article first appeared on Medscape.com.
Employed physicians: A survival guide
The strike by health care workers at Kaiser Permanente may not involve physicians (yet). But as more doctors in the United States are finding themselves working as salaried employees, physicians can – and probably will – become a powerful force for change in a health care system that has shown itself to be increasingly hostile to employee concerns over issues involving patient care, wages and benefits, safety, and well-being.
Salaried employment has its challenges. Physician-employees may have less autonomy and voice in decision-making that affects patients. They may splinter into fragmented work groups; feel isolated; and have different imperatives based on who they are, what they want, and where they work. They may feel more removed from their patients and struggle to build strong relationships, with their employers in the way.
Yet important opportunities exist for doctors when embracing their employee side. Examples of these interests include adequate compensation, wellness, job security, patient and worker safety, health care quality, reasonable workloads and schedules, and fair treatment by employers, including the need to exhibit a strong collective voice in organizational decision-making.
Some believe that physician-employees must be unionized to maximize their rights and power as employees. Many expect physician unionization to take hold more fully over time. Medical residents, the doctors of tomorrow, are already considering unionization in greater numbers. Some are also doing it in the same employment setting alongside other health professionals, such as nurses.
Having studied doctors and their employment situations for years, I am convinced that whether through unionization or another approach, physicians must also change how they think about control; train and learn alongside other health care workers who share similar interests; and elevate at an early career stage their knowledge of the business side of health care.
Adopt a more pragmatic definition of autonomy
Doctors must embrace an updated definition of autonomy – one that matches their status as highly paid labor.
When I have spoken to physicians in my research about what autonomy means to them, many seem unable to reconceptualize it from a vague and absolute form of their profession’s strategic control over their economic fates and technical skills toward an individualized control that is situation-specific, one centered on winning the daily fights about workplace bread-and-butter issues such as those mentioned above.
But a more pragmatic definition of autonomy could get doctors focused on influencing important issues of the patient-care day and enhance their negotiating power with employers. It would allow physicians to break out of what often seems a paralysis of inaction – waiting for employers, insurers, or the government to reinstate the profession’s idealized version of control by handing it back the keys to the health care system through major regulatory, structural, and reimbursement-related changes. This fantasy is unlikely to become reality.
Physician-employees I’ve talked to over the years understand their everyday challenges. But when it comes to engaging in localized and sustained action to overcome them, they often perform less well, leading to feelings of helplessness and burnout. Valuing tactical control over their jobs and work setting will yield smaller but more impactful wins as employees intent on making their everyday work lives better.
Train alongside other health care professionals
Physicians must accept that how they are trained no longer prepares them for the employee world into which most are dropped. For instance, unless doctors are trained collaboratively alongside other health care professionals – such as nurses – they are less likely to identify closely with these colleagues once in practice. There is strength in numbers, so this mutual identification empowers both groups of employees. Yet, medical education remains largely the same: training young medical students in isolation for the first couple of years, then placing them into clerkships and residencies where true interprofessional care opportunities remain stunted and secondary to the “physician as captain of the team” mantra.
Unfortunately, the “hidden curriculum” of medicine helps convince medical students and residents early in their careers that they are the unquestioned leaders in patient care settings. This hierarchy encourages some doctors to keep their psychological distance from other members of the health care team and to resist sharing power, concerns, or insights with less skilled health care workers. This socialization harms the ability of physicians to act in a unified fashion alongside these other workers. Having physicians learn and train alongside other health professionals yields positive benefits for collective advocacy, including a shared sense of purpose, positive views on collaboration with others in the health setting, and greater development of bonds with nonphysician coworkers.
Integrate business with medical training in real time
Medical students and residents generally lack exposure to the everyday business realities of the U.S. health care system. This gap hinders their ability to understand the employee world and push for the types of changes and work conditions that benefit all health care workers. Formal business and management training should be a required part of every U.S. medical school and residency curriculum from day one. If you see it at all in medical schools now, it is mostly by accident, or given separate treatment in the form of standalone MBA or MPH degrees that rarely integrate organically and in real time with actual medical training. Not every doctor needs an MBA or MPH degree. However, all of them require a stronger contextual understanding of how the medicine they wish to practice is shaped by the economic and fiscal circumstances surrounding it – circumstances they do not control.
This is another reason why young doctors are unhappy and burned out. They cannot push for specific changes or properly critique the pros and cons of how their work is structured because they have not been made aware, in real time as they learn clinical practice, how their jobs are shaped by realities such as insurance coverage and reimbursement, the fragmentation of the care delivery system, their employer’s financial health , and the socioeconomic circumstances of their patients. They aren’t given the methods and tools related to process and quality improvement, budgeting, negotiation, risk management, leadership, and talent management that might help them navigate these undermining forces. They also get little advance exposure in their training to important workplace “soft” skills in such areas as how to work in teams, networking, communication and listening, empathy, and problem-solving – all necessary foci for bringing them closer to other health care workers and advocating alongside them effectively with health care employers.
Now is the time for physicians to embrace their identity as employees. Doing so is in their own best interest as professionals. It will help others in the health care workforce as well as patients. Moreover, it provides a needed counterbalance to the powerful corporate ethos now ascendant in U.S. health care.
Timothy Hoff, PhD, is a professor of management and healthcare systems at Northeastern University, Boston, and an associate fellow at the University of Oxford, England. He disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
The strike by health care workers at Kaiser Permanente may not involve physicians (yet). But as more doctors in the United States are finding themselves working as salaried employees, physicians can – and probably will – become a powerful force for change in a health care system that has shown itself to be increasingly hostile to employee concerns over issues involving patient care, wages and benefits, safety, and well-being.
Salaried employment has its challenges. Physician-employees may have less autonomy and voice in decision-making that affects patients. They may splinter into fragmented work groups; feel isolated; and have different imperatives based on who they are, what they want, and where they work. They may feel more removed from their patients and struggle to build strong relationships, with their employers in the way.
Yet important opportunities exist for doctors when embracing their employee side. Examples of these interests include adequate compensation, wellness, job security, patient and worker safety, health care quality, reasonable workloads and schedules, and fair treatment by employers, including the need to exhibit a strong collective voice in organizational decision-making.
Some believe that physician-employees must be unionized to maximize their rights and power as employees. Many expect physician unionization to take hold more fully over time. Medical residents, the doctors of tomorrow, are already considering unionization in greater numbers. Some are also doing it in the same employment setting alongside other health professionals, such as nurses.
Having studied doctors and their employment situations for years, I am convinced that whether through unionization or another approach, physicians must also change how they think about control; train and learn alongside other health care workers who share similar interests; and elevate at an early career stage their knowledge of the business side of health care.
Adopt a more pragmatic definition of autonomy
Doctors must embrace an updated definition of autonomy – one that matches their status as highly paid labor.
When I have spoken to physicians in my research about what autonomy means to them, many seem unable to reconceptualize it from a vague and absolute form of their profession’s strategic control over their economic fates and technical skills toward an individualized control that is situation-specific, one centered on winning the daily fights about workplace bread-and-butter issues such as those mentioned above.
But a more pragmatic definition of autonomy could get doctors focused on influencing important issues of the patient-care day and enhance their negotiating power with employers. It would allow physicians to break out of what often seems a paralysis of inaction – waiting for employers, insurers, or the government to reinstate the profession’s idealized version of control by handing it back the keys to the health care system through major regulatory, structural, and reimbursement-related changes. This fantasy is unlikely to become reality.
Physician-employees I’ve talked to over the years understand their everyday challenges. But when it comes to engaging in localized and sustained action to overcome them, they often perform less well, leading to feelings of helplessness and burnout. Valuing tactical control over their jobs and work setting will yield smaller but more impactful wins as employees intent on making their everyday work lives better.
Train alongside other health care professionals
Physicians must accept that how they are trained no longer prepares them for the employee world into which most are dropped. For instance, unless doctors are trained collaboratively alongside other health care professionals – such as nurses – they are less likely to identify closely with these colleagues once in practice. There is strength in numbers, so this mutual identification empowers both groups of employees. Yet, medical education remains largely the same: training young medical students in isolation for the first couple of years, then placing them into clerkships and residencies where true interprofessional care opportunities remain stunted and secondary to the “physician as captain of the team” mantra.
Unfortunately, the “hidden curriculum” of medicine helps convince medical students and residents early in their careers that they are the unquestioned leaders in patient care settings. This hierarchy encourages some doctors to keep their psychological distance from other members of the health care team and to resist sharing power, concerns, or insights with less skilled health care workers. This socialization harms the ability of physicians to act in a unified fashion alongside these other workers. Having physicians learn and train alongside other health professionals yields positive benefits for collective advocacy, including a shared sense of purpose, positive views on collaboration with others in the health setting, and greater development of bonds with nonphysician coworkers.
Integrate business with medical training in real time
Medical students and residents generally lack exposure to the everyday business realities of the U.S. health care system. This gap hinders their ability to understand the employee world and push for the types of changes and work conditions that benefit all health care workers. Formal business and management training should be a required part of every U.S. medical school and residency curriculum from day one. If you see it at all in medical schools now, it is mostly by accident, or given separate treatment in the form of standalone MBA or MPH degrees that rarely integrate organically and in real time with actual medical training. Not every doctor needs an MBA or MPH degree. However, all of them require a stronger contextual understanding of how the medicine they wish to practice is shaped by the economic and fiscal circumstances surrounding it – circumstances they do not control.
This is another reason why young doctors are unhappy and burned out. They cannot push for specific changes or properly critique the pros and cons of how their work is structured because they have not been made aware, in real time as they learn clinical practice, how their jobs are shaped by realities such as insurance coverage and reimbursement, the fragmentation of the care delivery system, their employer’s financial health , and the socioeconomic circumstances of their patients. They aren’t given the methods and tools related to process and quality improvement, budgeting, negotiation, risk management, leadership, and talent management that might help them navigate these undermining forces. They also get little advance exposure in their training to important workplace “soft” skills in such areas as how to work in teams, networking, communication and listening, empathy, and problem-solving – all necessary foci for bringing them closer to other health care workers and advocating alongside them effectively with health care employers.
Now is the time for physicians to embrace their identity as employees. Doing so is in their own best interest as professionals. It will help others in the health care workforce as well as patients. Moreover, it provides a needed counterbalance to the powerful corporate ethos now ascendant in U.S. health care.
Timothy Hoff, PhD, is a professor of management and healthcare systems at Northeastern University, Boston, and an associate fellow at the University of Oxford, England. He disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
The strike by health care workers at Kaiser Permanente may not involve physicians (yet). But as more doctors in the United States are finding themselves working as salaried employees, physicians can – and probably will – become a powerful force for change in a health care system that has shown itself to be increasingly hostile to employee concerns over issues involving patient care, wages and benefits, safety, and well-being.
Salaried employment has its challenges. Physician-employees may have less autonomy and voice in decision-making that affects patients. They may splinter into fragmented work groups; feel isolated; and have different imperatives based on who they are, what they want, and where they work. They may feel more removed from their patients and struggle to build strong relationships, with their employers in the way.
Yet important opportunities exist for doctors when embracing their employee side. Examples of these interests include adequate compensation, wellness, job security, patient and worker safety, health care quality, reasonable workloads and schedules, and fair treatment by employers, including the need to exhibit a strong collective voice in organizational decision-making.
Some believe that physician-employees must be unionized to maximize their rights and power as employees. Many expect physician unionization to take hold more fully over time. Medical residents, the doctors of tomorrow, are already considering unionization in greater numbers. Some are also doing it in the same employment setting alongside other health professionals, such as nurses.
Having studied doctors and their employment situations for years, I am convinced that whether through unionization or another approach, physicians must also change how they think about control; train and learn alongside other health care workers who share similar interests; and elevate at an early career stage their knowledge of the business side of health care.
Adopt a more pragmatic definition of autonomy
Doctors must embrace an updated definition of autonomy – one that matches their status as highly paid labor.
When I have spoken to physicians in my research about what autonomy means to them, many seem unable to reconceptualize it from a vague and absolute form of their profession’s strategic control over their economic fates and technical skills toward an individualized control that is situation-specific, one centered on winning the daily fights about workplace bread-and-butter issues such as those mentioned above.
But a more pragmatic definition of autonomy could get doctors focused on influencing important issues of the patient-care day and enhance their negotiating power with employers. It would allow physicians to break out of what often seems a paralysis of inaction – waiting for employers, insurers, or the government to reinstate the profession’s idealized version of control by handing it back the keys to the health care system through major regulatory, structural, and reimbursement-related changes. This fantasy is unlikely to become reality.
Physician-employees I’ve talked to over the years understand their everyday challenges. But when it comes to engaging in localized and sustained action to overcome them, they often perform less well, leading to feelings of helplessness and burnout. Valuing tactical control over their jobs and work setting will yield smaller but more impactful wins as employees intent on making their everyday work lives better.
Train alongside other health care professionals
Physicians must accept that how they are trained no longer prepares them for the employee world into which most are dropped. For instance, unless doctors are trained collaboratively alongside other health care professionals – such as nurses – they are less likely to identify closely with these colleagues once in practice. There is strength in numbers, so this mutual identification empowers both groups of employees. Yet, medical education remains largely the same: training young medical students in isolation for the first couple of years, then placing them into clerkships and residencies where true interprofessional care opportunities remain stunted and secondary to the “physician as captain of the team” mantra.
Unfortunately, the “hidden curriculum” of medicine helps convince medical students and residents early in their careers that they are the unquestioned leaders in patient care settings. This hierarchy encourages some doctors to keep their psychological distance from other members of the health care team and to resist sharing power, concerns, or insights with less skilled health care workers. This socialization harms the ability of physicians to act in a unified fashion alongside these other workers. Having physicians learn and train alongside other health professionals yields positive benefits for collective advocacy, including a shared sense of purpose, positive views on collaboration with others in the health setting, and greater development of bonds with nonphysician coworkers.
Integrate business with medical training in real time
Medical students and residents generally lack exposure to the everyday business realities of the U.S. health care system. This gap hinders their ability to understand the employee world and push for the types of changes and work conditions that benefit all health care workers. Formal business and management training should be a required part of every U.S. medical school and residency curriculum from day one. If you see it at all in medical schools now, it is mostly by accident, or given separate treatment in the form of standalone MBA or MPH degrees that rarely integrate organically and in real time with actual medical training. Not every doctor needs an MBA or MPH degree. However, all of them require a stronger contextual understanding of how the medicine they wish to practice is shaped by the economic and fiscal circumstances surrounding it – circumstances they do not control.
This is another reason why young doctors are unhappy and burned out. They cannot push for specific changes or properly critique the pros and cons of how their work is structured because they have not been made aware, in real time as they learn clinical practice, how their jobs are shaped by realities such as insurance coverage and reimbursement, the fragmentation of the care delivery system, their employer’s financial health , and the socioeconomic circumstances of their patients. They aren’t given the methods and tools related to process and quality improvement, budgeting, negotiation, risk management, leadership, and talent management that might help them navigate these undermining forces. They also get little advance exposure in their training to important workplace “soft” skills in such areas as how to work in teams, networking, communication and listening, empathy, and problem-solving – all necessary foci for bringing them closer to other health care workers and advocating alongside them effectively with health care employers.
Now is the time for physicians to embrace their identity as employees. Doing so is in their own best interest as professionals. It will help others in the health care workforce as well as patients. Moreover, it provides a needed counterbalance to the powerful corporate ethos now ascendant in U.S. health care.
Timothy Hoff, PhD, is a professor of management and healthcare systems at Northeastern University, Boston, and an associate fellow at the University of Oxford, England. He disclosed no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
Prior authorization software: Saves time but hurdles remain
New England Baptist Hospital has been grappling with a serious problem facing health care today: insurers demanding prior authorizations for services ordered by physicians. Meeting payers’ requirements eats up time, delays treatment, and can be a costly drain on doctors’ practices.
To deal with this problem, the Boston orthopedic hospital has opted to automate submission of prior authorization requests on behalf of more than 100 mostly orthopedic surgeons on staff.
After 5 years using this system, “we can say that automation definitely works,” said Lidiya Hadzhieva, director of patient access at the hospital. The software has reduced write-offs by 30% and staff costs by 25%. Prior authorization gets approved 3 days after scheduling, compared with 11 days previously, she said.
“This software not only saves staff time, but it can also more accurately predict when prior authorization is needed,” she added.
For practices deluged with required prior authorizations by insurers, automation is emerging as a way for practices to make the process less time-consuming and save money. However, the software can be costly and may not be adoptable to many practices, and many physicians are not even aware it exists.
So far, the software is mainly used at large organizations like hospital systems. But as word gets out and the software becomes easier to use, private practices and other smaller entities may join the automation trend.
There is definitely a need to automate prior authorization. The American Medical Association reports that physicians spend 16 hours per week on prior authorizations. In a recent AMA survey, more than 60% of physicians indicated that it’s difficult to know when prior authorization is needed. And 93% of physicians reported care delays while waiting for authorization, the AMA said.
Experts estimate that 80% of prior authorization work could be automated, but most practices still use the phone or fax, even as numbers of prior authorizations continue to increase.
How it works
Automation software connects directly to the practice’s electronic health record (EHR). “When the doctor places an order in the EHR, the process starts automatically,” Ms. Hadzhieva said. “The doctor may not even notice it.”
In addition to using an EHR connection, many software products can communicate with the payer through its portal or by fax or phone, while still automating other parts of the process.
The software’s first step is to decide whether prior authorization is needed. This requires having an updated list of the rules that each payer uses for prior authorization. Manually keeping track of payer rules is very time-consuming, but automation uses bots to visit each payer site to look for rules changes. One vendor, Infinitus, uses a voice-based bot called Eva that calls up each payer and speaks with a representative.
“Automatically updating payer rules is not a new technology,” said YiDing Yu, MD, chief product officer at Olive, the automation vendor for New England Baptist. “What is new in the last 5 years is extracting the information needed for the prior authorization out of the clinical notes.”
This is challenging because each doctor has different ways to describe each step of clinical work. To identify this shorthand, Dr. Yu said Olive uses natural language processing, which is a form of artificial intelligence that learns how each doctor describes things.
Dr. Yu asserts that Olive is actually better than a practice’s staff at digging out clinical information. She said staff without much clinical training may miss terms that the software can catch, and they don’t have the time to go back many months into the record to find valuable information. But automation can do that.
In some instances, however, the software may not be able to find the information, in which case it alerts staff through a prompt in the EHR and the information is retrieved manually, Dr. Yu said.
Next, the Olive software puts the information it found into the request form and sends it to the payer. After submission, the software constantly checks on the status of each request, again visiting payer sites with a bot.
At New England Baptist, the software is used mainly by physicians in fairly small private practices who are on staff. They are using the software on the hospital’s dime, but it only works inside the hospital, Ms. Hadzhieva said. For their work outside of the hospital, they would have to purchase the Olive software on their own, she said.
Automation hasn’t spread to practices yet
Despite the promising outcomes for products like Olive, automation software is still primarily used by large organizations. Vendors say very few private practices have bought it yet. “The technology works, but it is still in the early-adopter phase,” Dr. Yu said.
For one thing, the software can be expensive. Very few vendors reveal their prices, but Dr. Yu did so. She said Olive normally costs about $50,000 a year for even a small organization. She insisted, however, that the savings from avoiding just one denial each month for a hip surgery would justify the expense.
On the other hand, some automation software is free, such as the Surescripts product for prior authorization of prescriptions. But it is unclear whether Surescripts does as much as Olive. Vendors’ descriptions of their products tend to be vague.
Also, Surescripts and Olive have entirely separate functions. Dr. Yu said Olive is limited to procedures, so it benefits specialties like oncology, neurosurgery, colorectal surgery, vascular surgery, and cardiology. Olive does not cover prescriptions, because they operate on a different technology.
Dr. Yu said another hurdle for adopting the software is the kind of EHR systems that doctors use. At this point, only a few EHR systems – such as Epic, Cerner, and Athena – are compatible with Olive. Large organizations tend to use Epic and Cerner, while many practices often use Athena or a variety of other systems, she said.
Despite stunted demand, there is no shortage of companies offering automation software for medical (that is, non-prescription) prior authorization. One compilation lists 25 such vendors, including companies like Myndshft, Rhyme, Infinitus, Infinx, and Waystar. As with any start-up technology, companies occasionally buy each other out.
In addition to issues like cost, specialty, and EHR compatibility, another hurdle is that few doctors even know the technology exists. Vendors say marketing focuses on larger provider organizations, not smaller practices.
Even many tech-savvy doctors, like Adam Bruggeman, MD, an orthopedist and CEO of Texas Spine Care Center in San Antonio, say they know little about the technology. “There is definitely a need to automate prior authorization,” he said. “But I don’t know of any colleagues who use it.” He has only just begun to explore vendors, he said.
Many medical practice consultants also have not yet explored the technology. “Automation makes a lot of sense, because there are a lot of repetitive tasks in prior authorization,” said Jill Arena, CEO of Portland, Ore.–based Health e Practices. “But I haven’t looked into it yet, and none of my clients has even asked about it.”
“I could see how it could be an easier sell for large organizations,” she added. “They have an IT person and a CFO who can explore the issue. Smaller practices usually don’t have that kind of expertise.”
Where does automation go from here?
Until now, clinicians who want to fully automate prior authorizations would have to buy two products – one for medical procedures and one for prescriptions. This has to do with incompatible electronic transmission standards, which are used to digitize information, said Susan Lawson-Dawson, content marketing strategist for the vendor Myndshft Health.
Myndshft has long been selling automation software for medical prior authorizations, but now it is introducing a product for prescriptions, Ms. Lawson-Dawson said. She said Myndshft will then be the only vendor to automate both kinds of prior authorizations.
Ms. Lawson-Dawson said Myndshft has 685 customers to date and is looking for more business. Recently the company entered the Google Cloud Marketplace. Google Cloud customers can now direct their committed spend with Google to purchasing Myndshft, meaning they could get it at a discount.
Software like Olive and Myndshft can operate independently of payers, but a vendor called Rhyme depends on payers for its software to function, said Rhyme CEO Joe Anstine. He said more than 300 payers have agreed to install the Rhyme system, and Rhyme has signed up a number of large health systems to use the product. Initially, he said, clinicians paid for the service, but now Rhyme is beginning to find payers to foot the costs and to let clinicians use it for free, which would open Rhyme up to smaller practices.
EHR companies themselves are beginning to offer automation, too. Epic, for example, has created a tool for prior authorization as part of its Epic Payer Platform. Like Rhyme, it requires payer cooperation, because information goes back and forth between clinician and payer in what is called bi-directional exchange.
The Epic product is still in its pilot phase. Epic reported that several large health systems were using its product in conjunction with a specific payer – for instance, Mayo Clinic with Blue Cross and Blue Shield of Minnesota and Ochsner Health with Humana. According to Epic, the arrangement reduced Mayo’s denials due to additional documentation requests by 63% for professional billing.
Automating with just one payer still means the clinician has to deal with manual processes at other payers, but a large clinician could have sufficient volume with that one payer to make the arrangement useful.
Will payers automate prior authorization?
Ultimately, payers may take the automation business away from vendors, offering a free product to all clinicians. But don’t hold your breath. Payers first have to rebuild their electronic systems to accommodate an electronic connection with providers. Even then, some payers might hold back from automating, forcing practices to continue manually processing some prior authorizations.
Efforts are underway, however, to mandate payers to support prior authorization automation. For this to happen, payers would have to revamp their data so that it could be easily read by practices’ EHRs. This would mean adopting a specific interoperability standard called Health Level 7 Fast Healthcare Interoperability Resources (FHIR).
Toward this goal, the Centers for Medicare & Medicaid Services proposes to require payers to adopt FHIR by January 2026. (CMS still has to finalize the rule.) Experts say the two-year ramp-up time is needed because it takes extensive work for payers to translate their data into FHIR.
The only payer so far to switch to FHIR for prior authorization is Regence in Washington state. In a pilot project, it has automated prior authorization with just one provider, MultiCare Connected Care, an accountable care organization (ACO), also in Washington state.
Anna Taylor, associate vice president of population health and value-based care at MultiCare, explained how the arrangement works. “Two separate entities are sharing one operational process,” she told this news organization. “That means they can have a digital conversation back and forth, so it is much easier to resolve prior authorization issues.”
Unlike many vendor products, the Regence service is free. And while the vendors market only to large organizations, most doctors in the MultiCare arrangement are in independent practices. Ms. Taylor said these doctors have been “enthusiastic” about the arrangement.
The results of the pilot are impressive. Ms. Taylor said automation has resulted in a 233% productivity gain for MultiCare clinicians, and 89% of submissions to Regence get an immediate response.
There is a potential downside, however, to working directly with payers. A direct connection to clinicians allows payers to access the doctor’s clinical notes, which could make many doctors uneasy. But Ms. Taylor said Regence only has access to the “discrete data fields” on MultiCare’s EHR dashboard, not to the notes themselves.
The ultimate goal of the Regence-Multicare project is to include more payers and clinicians. Ms. Taylor said two of the 27 other payers that MultiCare works with are “highly interested,” but it would take a lot of work for them to get connected with practices and other clinicians.
Ultimately, payers could offer automation and third-party vendors might then fade away. However, physicians may resist working directly with payers if the arrangement requires full access to their medical records.
A version of this article first appeared on Medscape.com.
New England Baptist Hospital has been grappling with a serious problem facing health care today: insurers demanding prior authorizations for services ordered by physicians. Meeting payers’ requirements eats up time, delays treatment, and can be a costly drain on doctors’ practices.
To deal with this problem, the Boston orthopedic hospital has opted to automate submission of prior authorization requests on behalf of more than 100 mostly orthopedic surgeons on staff.
After 5 years using this system, “we can say that automation definitely works,” said Lidiya Hadzhieva, director of patient access at the hospital. The software has reduced write-offs by 30% and staff costs by 25%. Prior authorization gets approved 3 days after scheduling, compared with 11 days previously, she said.
“This software not only saves staff time, but it can also more accurately predict when prior authorization is needed,” she added.
For practices deluged with required prior authorizations by insurers, automation is emerging as a way for practices to make the process less time-consuming and save money. However, the software can be costly and may not be adoptable to many practices, and many physicians are not even aware it exists.
So far, the software is mainly used at large organizations like hospital systems. But as word gets out and the software becomes easier to use, private practices and other smaller entities may join the automation trend.
There is definitely a need to automate prior authorization. The American Medical Association reports that physicians spend 16 hours per week on prior authorizations. In a recent AMA survey, more than 60% of physicians indicated that it’s difficult to know when prior authorization is needed. And 93% of physicians reported care delays while waiting for authorization, the AMA said.
Experts estimate that 80% of prior authorization work could be automated, but most practices still use the phone or fax, even as numbers of prior authorizations continue to increase.
How it works
Automation software connects directly to the practice’s electronic health record (EHR). “When the doctor places an order in the EHR, the process starts automatically,” Ms. Hadzhieva said. “The doctor may not even notice it.”
In addition to using an EHR connection, many software products can communicate with the payer through its portal or by fax or phone, while still automating other parts of the process.
The software’s first step is to decide whether prior authorization is needed. This requires having an updated list of the rules that each payer uses for prior authorization. Manually keeping track of payer rules is very time-consuming, but automation uses bots to visit each payer site to look for rules changes. One vendor, Infinitus, uses a voice-based bot called Eva that calls up each payer and speaks with a representative.
“Automatically updating payer rules is not a new technology,” said YiDing Yu, MD, chief product officer at Olive, the automation vendor for New England Baptist. “What is new in the last 5 years is extracting the information needed for the prior authorization out of the clinical notes.”
This is challenging because each doctor has different ways to describe each step of clinical work. To identify this shorthand, Dr. Yu said Olive uses natural language processing, which is a form of artificial intelligence that learns how each doctor describes things.
Dr. Yu asserts that Olive is actually better than a practice’s staff at digging out clinical information. She said staff without much clinical training may miss terms that the software can catch, and they don’t have the time to go back many months into the record to find valuable information. But automation can do that.
In some instances, however, the software may not be able to find the information, in which case it alerts staff through a prompt in the EHR and the information is retrieved manually, Dr. Yu said.
Next, the Olive software puts the information it found into the request form and sends it to the payer. After submission, the software constantly checks on the status of each request, again visiting payer sites with a bot.
At New England Baptist, the software is used mainly by physicians in fairly small private practices who are on staff. They are using the software on the hospital’s dime, but it only works inside the hospital, Ms. Hadzhieva said. For their work outside of the hospital, they would have to purchase the Olive software on their own, she said.
Automation hasn’t spread to practices yet
Despite the promising outcomes for products like Olive, automation software is still primarily used by large organizations. Vendors say very few private practices have bought it yet. “The technology works, but it is still in the early-adopter phase,” Dr. Yu said.
For one thing, the software can be expensive. Very few vendors reveal their prices, but Dr. Yu did so. She said Olive normally costs about $50,000 a year for even a small organization. She insisted, however, that the savings from avoiding just one denial each month for a hip surgery would justify the expense.
On the other hand, some automation software is free, such as the Surescripts product for prior authorization of prescriptions. But it is unclear whether Surescripts does as much as Olive. Vendors’ descriptions of their products tend to be vague.
Also, Surescripts and Olive have entirely separate functions. Dr. Yu said Olive is limited to procedures, so it benefits specialties like oncology, neurosurgery, colorectal surgery, vascular surgery, and cardiology. Olive does not cover prescriptions, because they operate on a different technology.
Dr. Yu said another hurdle for adopting the software is the kind of EHR systems that doctors use. At this point, only a few EHR systems – such as Epic, Cerner, and Athena – are compatible with Olive. Large organizations tend to use Epic and Cerner, while many practices often use Athena or a variety of other systems, she said.
Despite stunted demand, there is no shortage of companies offering automation software for medical (that is, non-prescription) prior authorization. One compilation lists 25 such vendors, including companies like Myndshft, Rhyme, Infinitus, Infinx, and Waystar. As with any start-up technology, companies occasionally buy each other out.
In addition to issues like cost, specialty, and EHR compatibility, another hurdle is that few doctors even know the technology exists. Vendors say marketing focuses on larger provider organizations, not smaller practices.
Even many tech-savvy doctors, like Adam Bruggeman, MD, an orthopedist and CEO of Texas Spine Care Center in San Antonio, say they know little about the technology. “There is definitely a need to automate prior authorization,” he said. “But I don’t know of any colleagues who use it.” He has only just begun to explore vendors, he said.
Many medical practice consultants also have not yet explored the technology. “Automation makes a lot of sense, because there are a lot of repetitive tasks in prior authorization,” said Jill Arena, CEO of Portland, Ore.–based Health e Practices. “But I haven’t looked into it yet, and none of my clients has even asked about it.”
“I could see how it could be an easier sell for large organizations,” she added. “They have an IT person and a CFO who can explore the issue. Smaller practices usually don’t have that kind of expertise.”
Where does automation go from here?
Until now, clinicians who want to fully automate prior authorizations would have to buy two products – one for medical procedures and one for prescriptions. This has to do with incompatible electronic transmission standards, which are used to digitize information, said Susan Lawson-Dawson, content marketing strategist for the vendor Myndshft Health.
Myndshft has long been selling automation software for medical prior authorizations, but now it is introducing a product for prescriptions, Ms. Lawson-Dawson said. She said Myndshft will then be the only vendor to automate both kinds of prior authorizations.
Ms. Lawson-Dawson said Myndshft has 685 customers to date and is looking for more business. Recently the company entered the Google Cloud Marketplace. Google Cloud customers can now direct their committed spend with Google to purchasing Myndshft, meaning they could get it at a discount.
Software like Olive and Myndshft can operate independently of payers, but a vendor called Rhyme depends on payers for its software to function, said Rhyme CEO Joe Anstine. He said more than 300 payers have agreed to install the Rhyme system, and Rhyme has signed up a number of large health systems to use the product. Initially, he said, clinicians paid for the service, but now Rhyme is beginning to find payers to foot the costs and to let clinicians use it for free, which would open Rhyme up to smaller practices.
EHR companies themselves are beginning to offer automation, too. Epic, for example, has created a tool for prior authorization as part of its Epic Payer Platform. Like Rhyme, it requires payer cooperation, because information goes back and forth between clinician and payer in what is called bi-directional exchange.
The Epic product is still in its pilot phase. Epic reported that several large health systems were using its product in conjunction with a specific payer – for instance, Mayo Clinic with Blue Cross and Blue Shield of Minnesota and Ochsner Health with Humana. According to Epic, the arrangement reduced Mayo’s denials due to additional documentation requests by 63% for professional billing.
Automating with just one payer still means the clinician has to deal with manual processes at other payers, but a large clinician could have sufficient volume with that one payer to make the arrangement useful.
Will payers automate prior authorization?
Ultimately, payers may take the automation business away from vendors, offering a free product to all clinicians. But don’t hold your breath. Payers first have to rebuild their electronic systems to accommodate an electronic connection with providers. Even then, some payers might hold back from automating, forcing practices to continue manually processing some prior authorizations.
Efforts are underway, however, to mandate payers to support prior authorization automation. For this to happen, payers would have to revamp their data so that it could be easily read by practices’ EHRs. This would mean adopting a specific interoperability standard called Health Level 7 Fast Healthcare Interoperability Resources (FHIR).
Toward this goal, the Centers for Medicare & Medicaid Services proposes to require payers to adopt FHIR by January 2026. (CMS still has to finalize the rule.) Experts say the two-year ramp-up time is needed because it takes extensive work for payers to translate their data into FHIR.
The only payer so far to switch to FHIR for prior authorization is Regence in Washington state. In a pilot project, it has automated prior authorization with just one provider, MultiCare Connected Care, an accountable care organization (ACO), also in Washington state.
Anna Taylor, associate vice president of population health and value-based care at MultiCare, explained how the arrangement works. “Two separate entities are sharing one operational process,” she told this news organization. “That means they can have a digital conversation back and forth, so it is much easier to resolve prior authorization issues.”
Unlike many vendor products, the Regence service is free. And while the vendors market only to large organizations, most doctors in the MultiCare arrangement are in independent practices. Ms. Taylor said these doctors have been “enthusiastic” about the arrangement.
The results of the pilot are impressive. Ms. Taylor said automation has resulted in a 233% productivity gain for MultiCare clinicians, and 89% of submissions to Regence get an immediate response.
There is a potential downside, however, to working directly with payers. A direct connection to clinicians allows payers to access the doctor’s clinical notes, which could make many doctors uneasy. But Ms. Taylor said Regence only has access to the “discrete data fields” on MultiCare’s EHR dashboard, not to the notes themselves.
The ultimate goal of the Regence-Multicare project is to include more payers and clinicians. Ms. Taylor said two of the 27 other payers that MultiCare works with are “highly interested,” but it would take a lot of work for them to get connected with practices and other clinicians.
Ultimately, payers could offer automation and third-party vendors might then fade away. However, physicians may resist working directly with payers if the arrangement requires full access to their medical records.
A version of this article first appeared on Medscape.com.
New England Baptist Hospital has been grappling with a serious problem facing health care today: insurers demanding prior authorizations for services ordered by physicians. Meeting payers’ requirements eats up time, delays treatment, and can be a costly drain on doctors’ practices.
To deal with this problem, the Boston orthopedic hospital has opted to automate submission of prior authorization requests on behalf of more than 100 mostly orthopedic surgeons on staff.
After 5 years using this system, “we can say that automation definitely works,” said Lidiya Hadzhieva, director of patient access at the hospital. The software has reduced write-offs by 30% and staff costs by 25%. Prior authorization gets approved 3 days after scheduling, compared with 11 days previously, she said.
“This software not only saves staff time, but it can also more accurately predict when prior authorization is needed,” she added.
For practices deluged with required prior authorizations by insurers, automation is emerging as a way for practices to make the process less time-consuming and save money. However, the software can be costly and may not be adoptable to many practices, and many physicians are not even aware it exists.
So far, the software is mainly used at large organizations like hospital systems. But as word gets out and the software becomes easier to use, private practices and other smaller entities may join the automation trend.
There is definitely a need to automate prior authorization. The American Medical Association reports that physicians spend 16 hours per week on prior authorizations. In a recent AMA survey, more than 60% of physicians indicated that it’s difficult to know when prior authorization is needed. And 93% of physicians reported care delays while waiting for authorization, the AMA said.
Experts estimate that 80% of prior authorization work could be automated, but most practices still use the phone or fax, even as numbers of prior authorizations continue to increase.
How it works
Automation software connects directly to the practice’s electronic health record (EHR). “When the doctor places an order in the EHR, the process starts automatically,” Ms. Hadzhieva said. “The doctor may not even notice it.”
In addition to using an EHR connection, many software products can communicate with the payer through its portal or by fax or phone, while still automating other parts of the process.
The software’s first step is to decide whether prior authorization is needed. This requires having an updated list of the rules that each payer uses for prior authorization. Manually keeping track of payer rules is very time-consuming, but automation uses bots to visit each payer site to look for rules changes. One vendor, Infinitus, uses a voice-based bot called Eva that calls up each payer and speaks with a representative.
“Automatically updating payer rules is not a new technology,” said YiDing Yu, MD, chief product officer at Olive, the automation vendor for New England Baptist. “What is new in the last 5 years is extracting the information needed for the prior authorization out of the clinical notes.”
This is challenging because each doctor has different ways to describe each step of clinical work. To identify this shorthand, Dr. Yu said Olive uses natural language processing, which is a form of artificial intelligence that learns how each doctor describes things.
Dr. Yu asserts that Olive is actually better than a practice’s staff at digging out clinical information. She said staff without much clinical training may miss terms that the software can catch, and they don’t have the time to go back many months into the record to find valuable information. But automation can do that.
In some instances, however, the software may not be able to find the information, in which case it alerts staff through a prompt in the EHR and the information is retrieved manually, Dr. Yu said.
Next, the Olive software puts the information it found into the request form and sends it to the payer. After submission, the software constantly checks on the status of each request, again visiting payer sites with a bot.
At New England Baptist, the software is used mainly by physicians in fairly small private practices who are on staff. They are using the software on the hospital’s dime, but it only works inside the hospital, Ms. Hadzhieva said. For their work outside of the hospital, they would have to purchase the Olive software on their own, she said.
Automation hasn’t spread to practices yet
Despite the promising outcomes for products like Olive, automation software is still primarily used by large organizations. Vendors say very few private practices have bought it yet. “The technology works, but it is still in the early-adopter phase,” Dr. Yu said.
For one thing, the software can be expensive. Very few vendors reveal their prices, but Dr. Yu did so. She said Olive normally costs about $50,000 a year for even a small organization. She insisted, however, that the savings from avoiding just one denial each month for a hip surgery would justify the expense.
On the other hand, some automation software is free, such as the Surescripts product for prior authorization of prescriptions. But it is unclear whether Surescripts does as much as Olive. Vendors’ descriptions of their products tend to be vague.
Also, Surescripts and Olive have entirely separate functions. Dr. Yu said Olive is limited to procedures, so it benefits specialties like oncology, neurosurgery, colorectal surgery, vascular surgery, and cardiology. Olive does not cover prescriptions, because they operate on a different technology.
Dr. Yu said another hurdle for adopting the software is the kind of EHR systems that doctors use. At this point, only a few EHR systems – such as Epic, Cerner, and Athena – are compatible with Olive. Large organizations tend to use Epic and Cerner, while many practices often use Athena or a variety of other systems, she said.
Despite stunted demand, there is no shortage of companies offering automation software for medical (that is, non-prescription) prior authorization. One compilation lists 25 such vendors, including companies like Myndshft, Rhyme, Infinitus, Infinx, and Waystar. As with any start-up technology, companies occasionally buy each other out.
In addition to issues like cost, specialty, and EHR compatibility, another hurdle is that few doctors even know the technology exists. Vendors say marketing focuses on larger provider organizations, not smaller practices.
Even many tech-savvy doctors, like Adam Bruggeman, MD, an orthopedist and CEO of Texas Spine Care Center in San Antonio, say they know little about the technology. “There is definitely a need to automate prior authorization,” he said. “But I don’t know of any colleagues who use it.” He has only just begun to explore vendors, he said.
Many medical practice consultants also have not yet explored the technology. “Automation makes a lot of sense, because there are a lot of repetitive tasks in prior authorization,” said Jill Arena, CEO of Portland, Ore.–based Health e Practices. “But I haven’t looked into it yet, and none of my clients has even asked about it.”
“I could see how it could be an easier sell for large organizations,” she added. “They have an IT person and a CFO who can explore the issue. Smaller practices usually don’t have that kind of expertise.”
Where does automation go from here?
Until now, clinicians who want to fully automate prior authorizations would have to buy two products – one for medical procedures and one for prescriptions. This has to do with incompatible electronic transmission standards, which are used to digitize information, said Susan Lawson-Dawson, content marketing strategist for the vendor Myndshft Health.
Myndshft has long been selling automation software for medical prior authorizations, but now it is introducing a product for prescriptions, Ms. Lawson-Dawson said. She said Myndshft will then be the only vendor to automate both kinds of prior authorizations.
Ms. Lawson-Dawson said Myndshft has 685 customers to date and is looking for more business. Recently the company entered the Google Cloud Marketplace. Google Cloud customers can now direct their committed spend with Google to purchasing Myndshft, meaning they could get it at a discount.
Software like Olive and Myndshft can operate independently of payers, but a vendor called Rhyme depends on payers for its software to function, said Rhyme CEO Joe Anstine. He said more than 300 payers have agreed to install the Rhyme system, and Rhyme has signed up a number of large health systems to use the product. Initially, he said, clinicians paid for the service, but now Rhyme is beginning to find payers to foot the costs and to let clinicians use it for free, which would open Rhyme up to smaller practices.
EHR companies themselves are beginning to offer automation, too. Epic, for example, has created a tool for prior authorization as part of its Epic Payer Platform. Like Rhyme, it requires payer cooperation, because information goes back and forth between clinician and payer in what is called bi-directional exchange.
The Epic product is still in its pilot phase. Epic reported that several large health systems were using its product in conjunction with a specific payer – for instance, Mayo Clinic with Blue Cross and Blue Shield of Minnesota and Ochsner Health with Humana. According to Epic, the arrangement reduced Mayo’s denials due to additional documentation requests by 63% for professional billing.
Automating with just one payer still means the clinician has to deal with manual processes at other payers, but a large clinician could have sufficient volume with that one payer to make the arrangement useful.
Will payers automate prior authorization?
Ultimately, payers may take the automation business away from vendors, offering a free product to all clinicians. But don’t hold your breath. Payers first have to rebuild their electronic systems to accommodate an electronic connection with providers. Even then, some payers might hold back from automating, forcing practices to continue manually processing some prior authorizations.
Efforts are underway, however, to mandate payers to support prior authorization automation. For this to happen, payers would have to revamp their data so that it could be easily read by practices’ EHRs. This would mean adopting a specific interoperability standard called Health Level 7 Fast Healthcare Interoperability Resources (FHIR).
Toward this goal, the Centers for Medicare & Medicaid Services proposes to require payers to adopt FHIR by January 2026. (CMS still has to finalize the rule.) Experts say the two-year ramp-up time is needed because it takes extensive work for payers to translate their data into FHIR.
The only payer so far to switch to FHIR for prior authorization is Regence in Washington state. In a pilot project, it has automated prior authorization with just one provider, MultiCare Connected Care, an accountable care organization (ACO), also in Washington state.
Anna Taylor, associate vice president of population health and value-based care at MultiCare, explained how the arrangement works. “Two separate entities are sharing one operational process,” she told this news organization. “That means they can have a digital conversation back and forth, so it is much easier to resolve prior authorization issues.”
Unlike many vendor products, the Regence service is free. And while the vendors market only to large organizations, most doctors in the MultiCare arrangement are in independent practices. Ms. Taylor said these doctors have been “enthusiastic” about the arrangement.
The results of the pilot are impressive. Ms. Taylor said automation has resulted in a 233% productivity gain for MultiCare clinicians, and 89% of submissions to Regence get an immediate response.
There is a potential downside, however, to working directly with payers. A direct connection to clinicians allows payers to access the doctor’s clinical notes, which could make many doctors uneasy. But Ms. Taylor said Regence only has access to the “discrete data fields” on MultiCare’s EHR dashboard, not to the notes themselves.
The ultimate goal of the Regence-Multicare project is to include more payers and clinicians. Ms. Taylor said two of the 27 other payers that MultiCare works with are “highly interested,” but it would take a lot of work for them to get connected with practices and other clinicians.
Ultimately, payers could offer automation and third-party vendors might then fade away. However, physicians may resist working directly with payers if the arrangement requires full access to their medical records.
A version of this article first appeared on Medscape.com.
Working with industry in private practice gastroenterology
In this video, Dr. Nadeem Baig of Allied Digestive Health in West Long Branck, N.J., discusses why he chose private practice gastroenterology and how his organization works with industry to support its mission of providing the best care for patients.
He has no financial conflicts relative to the topics in this video.
In this video, Dr. Nadeem Baig of Allied Digestive Health in West Long Branck, N.J., discusses why he chose private practice gastroenterology and how his organization works with industry to support its mission of providing the best care for patients.
He has no financial conflicts relative to the topics in this video.
In this video, Dr. Nadeem Baig of Allied Digestive Health in West Long Branck, N.J., discusses why he chose private practice gastroenterology and how his organization works with industry to support its mission of providing the best care for patients.
He has no financial conflicts relative to the topics in this video.
CHEST philanthropy: Moving into the future
In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.
In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.
Milestones are a good time to reevaluate
Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.
This is amazing work, but it was time to ask:
- What can CHEST provide that others cannot?
- Where are the gaps we can fill?
- What is our community passionate about changing?
Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.
Focusing on significant change means narrowing our scope
Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:
1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.
2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.
3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.
With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.
In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.
These pillars were approved by the Board of Regents at their spring leadership meeting.
Giving goals without support are just dreams
This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.
“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”
Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.
“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”
For frequently asked questions about the transition, please visit our website.
In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.
In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.
Milestones are a good time to reevaluate
Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.
This is amazing work, but it was time to ask:
- What can CHEST provide that others cannot?
- Where are the gaps we can fill?
- What is our community passionate about changing?
Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.
Focusing on significant change means narrowing our scope
Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:
1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.
2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.
3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.
With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.
In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.
These pillars were approved by the Board of Regents at their spring leadership meeting.
Giving goals without support are just dreams
This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.
“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”
Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.
“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”
For frequently asked questions about the transition, please visit our website.
In an ideal world, change would be progressive, the direction would be clear, and adoption would be easy. We learned in these past few years that sometimes change cannot wait. The vulnerabilities of the health care system were laid bare by the pandemic, including vast disparities in treatment and the urgent need to grow our profession.
In the light of these truths, CHEST looked within and asked a difficult question: Are we doing everything we can? This question probably sounds very familiar – one you ask every day, one you know the importance of asking. It was time we asked it of ourselves.
Milestones are a good time to reevaluate
Philanthropy is not new to CHEST. We celebrated 25 years of the CHEST Foundation in Nashville during CHEST 2022. Stories about community and clinical research grants were circulated in website blogs, emails, and newsletters and on social media for years. Our committee member volunteers worked hard developing accurate and credible patient education content for the CHEST Foundation website. Because of our faithful donors, communities around the world had access to better medical care and healthier environments.
This is amazing work, but it was time to ask:
- What can CHEST provide that others cannot?
- Where are the gaps we can fill?
- What is our community passionate about changing?
Working collectively, CHEST and CHEST Foundation leadership, along with staff, rigorously reviewed the success of our past fundraising efforts, areas of commitment our donors had specified, and the direction of interest our membership was leading us toward – like social accountability, growth and diversification of our profession, grassroots community impact, and partnerships to expand our reach. The process took nearly a year to complete – but, in the realm of big changes, that’s equal to the time needed for one good, deep breath.
Focusing on significant change means narrowing our scope
Meeting these goals would mean changing how we worked and letting go of areas better served elsewhere. CHEST needed to:
1. Align philanthropy with our mission to elevate the value placed on giving, making it a core priority and responsibility of CHEST as an organization.
2. Consolidate philanthropy under CHEST to reduce administrative costs and create efficiencies, allowing more funds to go directly to our philanthropic efforts.
3. Establish clear and transparent areas of giving that resonate with our members as a way to grow our impact and make real change.
With the full support of the CHEST Board of Regents, the CHEST Foundation Board of Advisors – under the guidance of Advisory Chair, Robert De Marco, MD, FCCP, and CHEST Foundation President, Ian Nathanson, MD, FCCP – approved a merger of the CHEST Foundation with CHEST.
In order to increase our impact and create greater awareness of CHEST philanthropic efforts, the Board of Advisors got to work defining a giving strategy that would meet the philanthropic goals and priorities of the CHEST membership. Four areas were defined and are referred to as our philanthropic pillars: clinical research, community impact, support of the profession, and dedication to education.
These pillars were approved by the Board of Regents at their spring leadership meeting.
Giving goals without support are just dreams
This transition puts the responsibility for funding the giving pillars in the hands of CHEST. The first step is ensuring the members see the impact of their donations.
“When you see your donation in action, you never doubt that you made a good decision,” said CHEST CEO, Robert A. Musacchio, PhD. “If we can show that to every member, the next 25 years of CHEST philanthropy are limitless.”
Helping connect donors to that experience is Meggie Cramer, the new Director of Philanthropy and Advancement , who has experience working directly with health care systems like Rush University Medical Center in Chicago and Hospital Sister Health System in Green Bay, Wisconsin.
“When you are giving to programs you are passionate about, you feel good about being a part of making a difference,” explained Cramer. “That’s my goal – to help our members find areas they care about and know their gift is part of creating real change.”
For frequently asked questions about the transition, please visit our website.
CT simulation not needed in palliative radiotherapy planning
, according to a results from a randomized trial presented at the annual meeting of the American Society for Radiation Oncology.
The aim of this same-day CT scan, called a CT simulation scan, is to optimize radiation targeting by mimicking the conditions under which radiation is delivered using the latest information on the size and location of lesions.
But investigators reported that skipping the CT simulation scan saves patients hours in the clinic, allows patients to experience pain relief faster, and saves radiation oncologists time without compromising dosimetric coverage of cancerous lesions.
“This is huge in a symptomatic patient population,” said Melissa O’Neil, an advanced practice radiation therapist at the London, Ont., Health Sciences Centre and the lead investigator on the trial, dubbed DART (Diagnostic CT-Enabled Radiation Therapy).
“Diagnostic CT-based radiation planning substantially reduces time in the [treatment] center without a detriment in plan deliverability or quality,” Ms. O’Neil said.
In addition, patients are exposed to less radiation, and staff doesn’t have to spend as much time tending to symptomatic patients before treatment. Omitting this scan “should be considered for patients with a recent diagnostic CT scan who are undergoing simple palliative radiation,” Ms. O’Neil said.
CT simulation scans are standard of care in cases involving palliative radiation, but they create bottlenecks in the workflow. When a CT simulation is performed on the day of treatment, patients must wait hours as the results are translated into a treatment plan.
In the DART analysis, 33 patients with 42 treatment sites were randomly assigned to CT simulation planning or diagnostic CT planning.
Patients received up to 30 Gy in up to 10 fractions for bone or soft tissue metastases or primary tumor targets in the thorax, abdomen, pelvis, or proximal limbs. Single-fraction treatments were most common.
Three-quarters of the patients were men (median age, 72 years). Lung cancer was the most common type of primary tumor, followed by prostate and breast cancer.
The eight participants for whom the CT simulation approach was used waited 3-4 hours for treatment planning and overall spent a median of 4.8 hours in the cancer center on their day of treatment.
The 25 patients for whom diagnostic CT planning was used spent a median of 0.4 hours, or about 24 minutes, in the center on their day of treatment because radiation plans were completed before they arrived. The median time between their diagnostic CTs and radiation treatment was 13 days (range, 8-22 days).
Ms. O’Neil and her team found that if the original diagnostic CT was performed within 28 days, lesion anatomy would not have changed enough to warrant a new scan.
On the day of treatment, the study team used surface-guided radiation therapy techniques to ensure patients in the diagnostic CT planning group were positioned within 3 mm of where they were during their diagnostic scans, an essential step to ensure that radiation is delivered to the correct location. Ms. O’Neil noted that other investigators have used anatomic landmarks, a simpler approach, to achieve these results.
Overall, radiation oncologists rated radiation dose distribution as “acceptable” in about 80% of cases in both arms of DART and “acceptable with minor deviation” in the remaining 20% of cases.
Every radiation oncologist and medical physicists in the trial gave the workflow with diagnostic CT planning a 5 out of 5 rating for acceptability, and 90% of patients in this group rated the amount of time they spent for treatment as “acceptable.”
In contrast, only half of patients in the simulation arm said the amount of time spent was acceptable.
These findings align with several previous studies that support the diagnostic approach.
Jacob Scott, MD, a radiation oncologist at the Cleveland Clinic, said, “The comparable results using a recent diagnostic CT in place of a CT simulation for palliative radiation is an exciting step forward in radiation oncology. We may soon be in a world where we no longer need simulations.”
Dr. Scott also noted that combining diagnostic scans with cone beam or surface-guided positioning in lieu of CT simulations could further save “the health system and patients time and money.”
No external funding for the study was reported. The investigators, Ms. O’Neil, and Dr. Scott have disclosed no relevant financial relationships. One investigator reported receiving honoraria from Knight Therapeutics, AbbVie, Tersera, and Eisai and owns stock in Myovant.
A version of this article first appeared on Medscape.com.
, according to a results from a randomized trial presented at the annual meeting of the American Society for Radiation Oncology.
The aim of this same-day CT scan, called a CT simulation scan, is to optimize radiation targeting by mimicking the conditions under which radiation is delivered using the latest information on the size and location of lesions.
But investigators reported that skipping the CT simulation scan saves patients hours in the clinic, allows patients to experience pain relief faster, and saves radiation oncologists time without compromising dosimetric coverage of cancerous lesions.
“This is huge in a symptomatic patient population,” said Melissa O’Neil, an advanced practice radiation therapist at the London, Ont., Health Sciences Centre and the lead investigator on the trial, dubbed DART (Diagnostic CT-Enabled Radiation Therapy).
“Diagnostic CT-based radiation planning substantially reduces time in the [treatment] center without a detriment in plan deliverability or quality,” Ms. O’Neil said.
In addition, patients are exposed to less radiation, and staff doesn’t have to spend as much time tending to symptomatic patients before treatment. Omitting this scan “should be considered for patients with a recent diagnostic CT scan who are undergoing simple palliative radiation,” Ms. O’Neil said.
CT simulation scans are standard of care in cases involving palliative radiation, but they create bottlenecks in the workflow. When a CT simulation is performed on the day of treatment, patients must wait hours as the results are translated into a treatment plan.
In the DART analysis, 33 patients with 42 treatment sites were randomly assigned to CT simulation planning or diagnostic CT planning.
Patients received up to 30 Gy in up to 10 fractions for bone or soft tissue metastases or primary tumor targets in the thorax, abdomen, pelvis, or proximal limbs. Single-fraction treatments were most common.
Three-quarters of the patients were men (median age, 72 years). Lung cancer was the most common type of primary tumor, followed by prostate and breast cancer.
The eight participants for whom the CT simulation approach was used waited 3-4 hours for treatment planning and overall spent a median of 4.8 hours in the cancer center on their day of treatment.
The 25 patients for whom diagnostic CT planning was used spent a median of 0.4 hours, or about 24 minutes, in the center on their day of treatment because radiation plans were completed before they arrived. The median time between their diagnostic CTs and radiation treatment was 13 days (range, 8-22 days).
Ms. O’Neil and her team found that if the original diagnostic CT was performed within 28 days, lesion anatomy would not have changed enough to warrant a new scan.
On the day of treatment, the study team used surface-guided radiation therapy techniques to ensure patients in the diagnostic CT planning group were positioned within 3 mm of where they were during their diagnostic scans, an essential step to ensure that radiation is delivered to the correct location. Ms. O’Neil noted that other investigators have used anatomic landmarks, a simpler approach, to achieve these results.
Overall, radiation oncologists rated radiation dose distribution as “acceptable” in about 80% of cases in both arms of DART and “acceptable with minor deviation” in the remaining 20% of cases.
Every radiation oncologist and medical physicists in the trial gave the workflow with diagnostic CT planning a 5 out of 5 rating for acceptability, and 90% of patients in this group rated the amount of time they spent for treatment as “acceptable.”
In contrast, only half of patients in the simulation arm said the amount of time spent was acceptable.
These findings align with several previous studies that support the diagnostic approach.
Jacob Scott, MD, a radiation oncologist at the Cleveland Clinic, said, “The comparable results using a recent diagnostic CT in place of a CT simulation for palliative radiation is an exciting step forward in radiation oncology. We may soon be in a world where we no longer need simulations.”
Dr. Scott also noted that combining diagnostic scans with cone beam or surface-guided positioning in lieu of CT simulations could further save “the health system and patients time and money.”
No external funding for the study was reported. The investigators, Ms. O’Neil, and Dr. Scott have disclosed no relevant financial relationships. One investigator reported receiving honoraria from Knight Therapeutics, AbbVie, Tersera, and Eisai and owns stock in Myovant.
A version of this article first appeared on Medscape.com.
, according to a results from a randomized trial presented at the annual meeting of the American Society for Radiation Oncology.
The aim of this same-day CT scan, called a CT simulation scan, is to optimize radiation targeting by mimicking the conditions under which radiation is delivered using the latest information on the size and location of lesions.
But investigators reported that skipping the CT simulation scan saves patients hours in the clinic, allows patients to experience pain relief faster, and saves radiation oncologists time without compromising dosimetric coverage of cancerous lesions.
“This is huge in a symptomatic patient population,” said Melissa O’Neil, an advanced practice radiation therapist at the London, Ont., Health Sciences Centre and the lead investigator on the trial, dubbed DART (Diagnostic CT-Enabled Radiation Therapy).
“Diagnostic CT-based radiation planning substantially reduces time in the [treatment] center without a detriment in plan deliverability or quality,” Ms. O’Neil said.
In addition, patients are exposed to less radiation, and staff doesn’t have to spend as much time tending to symptomatic patients before treatment. Omitting this scan “should be considered for patients with a recent diagnostic CT scan who are undergoing simple palliative radiation,” Ms. O’Neil said.
CT simulation scans are standard of care in cases involving palliative radiation, but they create bottlenecks in the workflow. When a CT simulation is performed on the day of treatment, patients must wait hours as the results are translated into a treatment plan.
In the DART analysis, 33 patients with 42 treatment sites were randomly assigned to CT simulation planning or diagnostic CT planning.
Patients received up to 30 Gy in up to 10 fractions for bone or soft tissue metastases or primary tumor targets in the thorax, abdomen, pelvis, or proximal limbs. Single-fraction treatments were most common.
Three-quarters of the patients were men (median age, 72 years). Lung cancer was the most common type of primary tumor, followed by prostate and breast cancer.
The eight participants for whom the CT simulation approach was used waited 3-4 hours for treatment planning and overall spent a median of 4.8 hours in the cancer center on their day of treatment.
The 25 patients for whom diagnostic CT planning was used spent a median of 0.4 hours, or about 24 minutes, in the center on their day of treatment because radiation plans were completed before they arrived. The median time between their diagnostic CTs and radiation treatment was 13 days (range, 8-22 days).
Ms. O’Neil and her team found that if the original diagnostic CT was performed within 28 days, lesion anatomy would not have changed enough to warrant a new scan.
On the day of treatment, the study team used surface-guided radiation therapy techniques to ensure patients in the diagnostic CT planning group were positioned within 3 mm of where they were during their diagnostic scans, an essential step to ensure that radiation is delivered to the correct location. Ms. O’Neil noted that other investigators have used anatomic landmarks, a simpler approach, to achieve these results.
Overall, radiation oncologists rated radiation dose distribution as “acceptable” in about 80% of cases in both arms of DART and “acceptable with minor deviation” in the remaining 20% of cases.
Every radiation oncologist and medical physicists in the trial gave the workflow with diagnostic CT planning a 5 out of 5 rating for acceptability, and 90% of patients in this group rated the amount of time they spent for treatment as “acceptable.”
In contrast, only half of patients in the simulation arm said the amount of time spent was acceptable.
These findings align with several previous studies that support the diagnostic approach.
Jacob Scott, MD, a radiation oncologist at the Cleveland Clinic, said, “The comparable results using a recent diagnostic CT in place of a CT simulation for palliative radiation is an exciting step forward in radiation oncology. We may soon be in a world where we no longer need simulations.”
Dr. Scott also noted that combining diagnostic scans with cone beam or surface-guided positioning in lieu of CT simulations could further save “the health system and patients time and money.”
No external funding for the study was reported. The investigators, Ms. O’Neil, and Dr. Scott have disclosed no relevant financial relationships. One investigator reported receiving honoraria from Knight Therapeutics, AbbVie, Tersera, and Eisai and owns stock in Myovant.
A version of this article first appeared on Medscape.com.
FROM ASTRO 2023
NCCN survey shows ongoing chemo drug shortages
Although access to carboplatin and cisplatin has improved slightly since June, when 93% and 70% of 27 NCCN member institutions reported shortages of the two agents, supplies remain limited and other anticancer drugs remain scarce, an NCCN follow-up survey shows.
Of 29 institutions surveyed last month, 86% reported having difficulty obtaining at least one anticancer drug, and 72% and 59% reported ongoing shortages of carboplatin and cisplatin, respectively – drugs recommended for treating patients involved in hundreds of different cancer scenarios, according to the NCCN.
“Drug shortages aren’t new, but the widespread impact makes this one particularly alarming,” NCCN’s chief executive officer, Robert W. Carlson, MD, said in a press statement. “It is extremely concerning that this situation continues despite significant attention and effort over the past few months.”
The latest survey, conducted between Sept. 6 and 27, was sent to the 33 NCCN member institutions. Overall, most respondents reported “being able to continue treating every patient who needs carboplatin or cisplatin, despite lowered supply, primarily by implementing strict waste management strategies,” the network noted, adding that “the responses may not reflect any additional challenges experienced by smaller community practices serving rural and marginalized patients.”
In addition to carboplatin and cisplatin shortages, the survey results also revealed that centers are experiencing shortages of a host of other drugs, including methotrexate (66%), 5-flourouracil (55%), fludarabine (45%), hydrocortisone (41%), and dacarbazine (28%), according to the press release.
“These drug shortages are the result of decades of systemic challenges,” noted Alyssa Schatz, senior director of policy and advocacy for NCCN, in a press release. “We recognize that comprehensive solutions take time, and we appreciate everyone who has put forth proposals to improve investment in generics and our data infrastructure. At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today.”
Following the June survey, the NCCN called for action from the federal government, the pharmaceutical industry, providers, and payers, encouraging them “to work together to ensure quality, effective, equitable, and accessible cancer care” and has since worked with multiple stakeholders and policymaking organizations to “advocate for short- and long-term fixes.”
“These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency,” Ms. Shatz added.
A version of this article first appeared on Medscape.com.
Although access to carboplatin and cisplatin has improved slightly since June, when 93% and 70% of 27 NCCN member institutions reported shortages of the two agents, supplies remain limited and other anticancer drugs remain scarce, an NCCN follow-up survey shows.
Of 29 institutions surveyed last month, 86% reported having difficulty obtaining at least one anticancer drug, and 72% and 59% reported ongoing shortages of carboplatin and cisplatin, respectively – drugs recommended for treating patients involved in hundreds of different cancer scenarios, according to the NCCN.
“Drug shortages aren’t new, but the widespread impact makes this one particularly alarming,” NCCN’s chief executive officer, Robert W. Carlson, MD, said in a press statement. “It is extremely concerning that this situation continues despite significant attention and effort over the past few months.”
The latest survey, conducted between Sept. 6 and 27, was sent to the 33 NCCN member institutions. Overall, most respondents reported “being able to continue treating every patient who needs carboplatin or cisplatin, despite lowered supply, primarily by implementing strict waste management strategies,” the network noted, adding that “the responses may not reflect any additional challenges experienced by smaller community practices serving rural and marginalized patients.”
In addition to carboplatin and cisplatin shortages, the survey results also revealed that centers are experiencing shortages of a host of other drugs, including methotrexate (66%), 5-flourouracil (55%), fludarabine (45%), hydrocortisone (41%), and dacarbazine (28%), according to the press release.
“These drug shortages are the result of decades of systemic challenges,” noted Alyssa Schatz, senior director of policy and advocacy for NCCN, in a press release. “We recognize that comprehensive solutions take time, and we appreciate everyone who has put forth proposals to improve investment in generics and our data infrastructure. At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today.”
Following the June survey, the NCCN called for action from the federal government, the pharmaceutical industry, providers, and payers, encouraging them “to work together to ensure quality, effective, equitable, and accessible cancer care” and has since worked with multiple stakeholders and policymaking organizations to “advocate for short- and long-term fixes.”
“These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency,” Ms. Shatz added.
A version of this article first appeared on Medscape.com.
Although access to carboplatin and cisplatin has improved slightly since June, when 93% and 70% of 27 NCCN member institutions reported shortages of the two agents, supplies remain limited and other anticancer drugs remain scarce, an NCCN follow-up survey shows.
Of 29 institutions surveyed last month, 86% reported having difficulty obtaining at least one anticancer drug, and 72% and 59% reported ongoing shortages of carboplatin and cisplatin, respectively – drugs recommended for treating patients involved in hundreds of different cancer scenarios, according to the NCCN.
“Drug shortages aren’t new, but the widespread impact makes this one particularly alarming,” NCCN’s chief executive officer, Robert W. Carlson, MD, said in a press statement. “It is extremely concerning that this situation continues despite significant attention and effort over the past few months.”
The latest survey, conducted between Sept. 6 and 27, was sent to the 33 NCCN member institutions. Overall, most respondents reported “being able to continue treating every patient who needs carboplatin or cisplatin, despite lowered supply, primarily by implementing strict waste management strategies,” the network noted, adding that “the responses may not reflect any additional challenges experienced by smaller community practices serving rural and marginalized patients.”
In addition to carboplatin and cisplatin shortages, the survey results also revealed that centers are experiencing shortages of a host of other drugs, including methotrexate (66%), 5-flourouracil (55%), fludarabine (45%), hydrocortisone (41%), and dacarbazine (28%), according to the press release.
“These drug shortages are the result of decades of systemic challenges,” noted Alyssa Schatz, senior director of policy and advocacy for NCCN, in a press release. “We recognize that comprehensive solutions take time, and we appreciate everyone who has put forth proposals to improve investment in generics and our data infrastructure. At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today.”
Following the June survey, the NCCN called for action from the federal government, the pharmaceutical industry, providers, and payers, encouraging them “to work together to ensure quality, effective, equitable, and accessible cancer care” and has since worked with multiple stakeholders and policymaking organizations to “advocate for short- and long-term fixes.”
“These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency,” Ms. Shatz added.
A version of this article first appeared on Medscape.com.
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.
Advanced practice radiation therapists: Are they worth it?
An innovative care model involving in the radiation oncology department of Mount Sinai Health System in New York.
At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.
In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.
The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.
A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.
At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.
A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.
“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.
“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.
Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”
Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.
An innovative care model involving in the radiation oncology department of Mount Sinai Health System in New York.
At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.
In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.
The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.
A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.
At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.
A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.
“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.
“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.
Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”
Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.
An innovative care model involving in the radiation oncology department of Mount Sinai Health System in New York.
At a time when clinician burnout is rampant, a novel approach that brings value to both patients and health systems – and helps advance the careers of highly educated and skilled practitioners – represents a welcome step forward, according to Samantha Skubish, MS, RT, chief technical director of radiation oncology and Mount Sinai.
In the new care model, APRTs work alongside radiation oncologists and support “the care of resource-intensive patient populations,” according to the Association of Community Cancer Centers, which recently recognized the Mount Sinai Health System program as a 2023 ACCC Innovator Award winner.
The new and improved “model for continuity of care” with the APRT role has “helped improve the patient experience and create a more streamlined, efficient process while also alleviating some of the burden on our physicians,” Ms. Skubish said in the ACCC press release. She explained that APRTs possess the skills, knowledge, and judgment to provide an elevated level of care, as evidenced by decades of international research.
A 2022 systematic review of APRT-based care models outside the United States explored how the models have worked. Overall, the research shows that such models improve quality, efficiency, wellness, and administrative outcomes, according to investigators.
At Mount Sinai, the first health system to develop the APRT role in the United States, research to demonstrate the benefits of APRT model continues. In 2021, an APRT working group was established to “garner a network of individuals across the country focused on the work to prove the advanced practice radiation therapy model in the U.S.,” according to Danielle McDonagh, MS, RT, Mount Sinai’s clinical coordinator of radiation sciences education and research.
A paper published in May by Ms. McDonagh and colleagues underscored the potential for “positive change and impact” of the APRT care model in radiation oncology.
“We’re all in this current and longstanding crisis of clinician shortages,” Kimberly Smith, MPA, explained in a video introducing the Mount Sinai program.
“If you look at your therapists’ skill set and allow them to work at the top of their license, you can provide a cost-saving solution that lends itself to value-based care,” said Ms. Smith, vice president of radiation oncology services at Mount Sinai.
Indeed, Sheryl Green, MBBCh, professor and medical director of radiation oncology at Mount Sinai, noted that “the APRT has allowed us to really improve the quality of care that we deliver, primarily in the aspects of optimizing and personalizing the patient experience.”
Ms. Skubish and Ms. Smith will share details of the new care model at the ACCC’s upcoming National Oncology Conference.