As I read through one particular healthcare-related news item recently, the lyrics to the old “If you’re happy and you know it” song just plain took over my subconscious thinking.
You know the one I’m talking about: “If you’re happy and you know it, then your face will surely show it.”
It may not come as any great surprise that smiles aren’t adorning the faces of too many doctors these days, what with Medicare payment cuts, the looming impact of healthcare reform, skyrocketing malpractice premiums and other lesser complaints and concerns.
But all that notwithstanding, it was just short of astounding to read the results of a recent survey of more than 5,000 physicians by The Doctors Company, a Napa, California-based cooperative that is the nation’s largest medical malpractice insurer.
In response to questions probing the future of healthcare in America, nine out of 10 respondents indicated an unwillingness to recommend healthcare as a profession. I repeat: fully 90% of those respondents who are currently earning a living in the healthcare field said they would not recommend that field to someone looking to start a career.
Yikes! I mean, Mike Rowe of Dirty Jobs fame surely would come up with a better stick-with-it percentage than that, even if he were polling sewage workers or trash collectors.
And we’re not talking just “wouldn’t recommend it.” The physician respondents actually said they would “actively discourage friends and family members from pursuing careers in medicine.”
Perhaps not surprisingly given the level of hopelessness expressed, the Doctors Company survey also saw 43% of respondents – more than four of every 10 – say that they are contemplating retiring within the next five years.
With some 32 million newly insured patients scheduled to enter the U.S. healthcare system by 2016 under various provisions of what goes by the shorthand tag of Obamacare, an already shorthanded cadre of healthcare professionals is anticipating even more strain on a stressed-out system.
The Doctors Company said the added insureds will increase the number of patients treated per physician, in turn exacerbated by an anticipated shortage of primary care physicians and nurses, “making it nearly impossible to maintain or improve the quality of patient outcomes.” And in the new world of healthcare coverage, patient outcomes are the coin of the realm.
“Sixty-five percent of respondents believe the current legislative initiatives designed to reduce healthcare expenses are insufficient to effectively address the underlying causes of costly defensive medicine,” the Doctors Company said. “Furthermore, the physicians surveyed expressed concern that the increase in patient volume will reduce the attention they are able to give to each patient, with 60% of respondents indicating that the pressures to increase patient volume will negatively impact the level of care they can provide. Fifty-one percent of respondents feel their ability to grow and maintain patient relationships will be adversely affected.”
In all, 60% of the respondents said healthcare reform will have a negative impact on patient care; 20% said the impact would be positive. As for the bottom line, 78% said Obamacare will negatively affect their earnings.
Richard Anderson, MD, chairman/CEO of The Doctors Company, said the response to the survey was “stunning.” While he noted that “we recognized that changes in healthcare delivery were impacting all facets of our members’ practice, the vehement, negative reactions are of real concern.”
He added that in reviewing the complete survey results, “the overarching sentiment is that current legislation will likely have a negative impact on the practice of medicine and will not address the scourge of defensive medicine in America.”
Expressing similar worries was Donald Palmisano, MD, a former president of the American Medical Association and a member of The Doctors Company board of governors. “The physician sentiments expressed in the Future of Health Care Survey are deeply concerning and disheartening,” he said.
Given the shortage of healthcare professionals, Palmisano said, “We are perilously close to a true crisis as newly insured Americans enter the healthcare system and our population continues to age. Unfortunately, we may be facing a shift from a ‘calling,’ which has been the hallmark for generations among physicians, that could threaten the next generation of healthcare professionals.”
Ironically, this negative reflection on healthcare as an occupation comes at a time when, according to the Association of American Medical Colleges, the number of applicants to medical schools is at an all-time high and numerous new medical schools are in various stages of development.
Maybe the survey just arrived on a particularly bad day.
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)
In the March 15 issue of Medical Device Daily, there were two stories that discussed the medical technology industry in the U.S., and neither of them cast a particularly flattering light on the current state of affairs. In fact, it appears that this once proud and successful domestic industry is on life support.
Perhaps the most credible criticism came from Tom Fogarty, a legendary entrepreneur in the medical device field. In a story written by Senior Staff Writer Amanda Pedersen, Fogarty asserted that “it’s reached a point in the field of medicine that we in the U.S. are no longer the leaders in medical technology.”
He noted that U.S. physicians go overseas to learn from physicians in other countries who have more experience with the latest technologies because they’ve had earlier access. “That is an upsetting situation, not just for our economy, but for our patients. It’s horrible.”
A story about a panel at the Southeastern Medical Device Association (Norcross, Georgia) annual meeting written by Staff Writer Omar Ford, noted that more companies are going to Europe and overseas to launch their products.
“One of the things we look for is predictability,” Robert Crutchfield, a partner at Harbert Venture Partners, said during the panel at SEMDA. “I think that’s one of the challenges with the U.S. market today. From my perspective, we don’t mind complexity as long as there is some predictability around the complexity, so you can jump through the hoops. So I think that Europe still has sort of a predictable process.”
Another panel member noted that thanks to the cultural change at FDA investing in medical device technology in the U.S. does not hold the appeal it did in the past. “We think there are a lot of positive things about the medical device space primarily to bio-tech or pharma,” panelist Robert Morff partner with Hatteras Venture Partners, said. He noted that while it is still easier to get a product though clinical trials in the U.S., That’s “less true than it was a number of years ago and one of the issues in particular was that the medical device approval pathways are getting longer and they’re requiring more clinical studies.”
Several issues have helped to create this perfect storm for the U.S. med-tech industry. There is a great uncertainty in the FDA process and very little clarity on current healthcare reform efforts. Additionally, the industry will have to deal with the 2.5% Medical Device excise tax which is scheduled to begin in January 2013.
So what should be done to get the U.S. back on the right track to reclaiming its leadership position in medical technology? Fogarty said it will have to start with a cultural change on all sides – industry, FDA, CMS, and physicians.
“I think it’s reached a point that regulators and industry have become severe and fierce combatants,” he said. “We have to understand that we should be not competitive, but compatible. We must respect one another and once you establish that, then I think we can move forward.”
What do you think, is a lot of this talk just doom and gloom on the part of industry, or is there real trouble brewing for the medical technology industry in the U.S.?
[caption id="attachment_1457" align="alignleft" width="150" caption="Thomas Fogarty, MD, founder of the Fogarty Institute of Innovation"][/caption]
At Medical Device Daily we’re usually fortunate enough to talk to a lot of the movers and shakers in the medical device industry. Company CEOs, doctors, researchers, and other industry leaders who are truly on the front lines of medical innovation are regular sources for our daily stories.
But every once in a while we get to talk to someone who has had such a massive impact on this industry that it leaves us a little bit star struck to have the opportunity to speak with them one on one.
Last year my star-struck moment came when I received a phone call from industry legend and the father of drug delivery, Robert Langer, PhD.
Langer, the David H. Koch Institute Professor in the Department of Chemical Engineering at the Massachusetts Institute of Technology (Cambridge) is a renowned expert in developing polymers for biomedical applications. He called me last July about a story I was working on about a new type of gel material that could be implanted into scarred vocal chords to restore their normal function – a project Langer himself was involved with.
This week my star-struck moment came when I had the opportunity to interview Thomas Fogarty, MD, over the phone about his recent induction into the National Academy of Inventors as the organization’s first NAI Fellow in the newly established Fellow membership category.
Fogarty, founder of the Fogarty Institute for Innovation (Mountain View, California), is the man who invented the balloon catheter and the widely used Aneurx Stent Graft that replaces open surgery for aortic aneurysm.
Going into the interview, I already knew about most of Fogarty’s professional accomplishments, which can be found in his bio on the Fogarty Institute’s web site. But within just a few minutes of our phone conversation, I felt like I had a pretty firm grasp on Tom Fogarty as a person - some things that not many people would know unless they’ve met or worked with him personally.
For starters, the man has a great sense of humor. Before my questions even began, he had made a quip about getting shot during the interview – to which I promptly assured him it would be a non-lethal interview. And at the end of our conversation, when I thanked him for his time and told him what an honor it had been to speak with him, he showed his humor again by saying, “you might want to wait until you’ve met me in person before you say that.”
I also quickly learned during the conversation that Fogarty is not only a brilliant inventor, but an incredibly humble and caring individual. While he clearly appreciated the NAI’s recognition of his professional accomplishments, he quickly told me that the patients are the real heroes, especially the patients who agree to have new procedures performed on them. “Without them, we wouldn’t have new technology,” he pointed out.
Another quality I appreciated about Fogarty is his willingness to shoot straight from the hip. He spoke candidly about the direction that innovation in the U.S. is headed. “The fact is, it’s reached a point in the field of medicine that we in the U.S. are no longer the leaders in medical technology,” he said. He added that no wonder medical tourism has become so popular among U.S. patients, because other countries have better drugs, better devices, and better trained physicians, because they have been dealing with the new technology for up to ten years earlier than U.S. physicians had access to it.
It is clear to me that Fogarty does not do what he does for recognition but to make a real difference in other people's lives. And while he may be too humble to admit it, it really was an honor to speak with him.
It’s hard to believe by looking at the 11.5” cultural icon, but Barbie is celebrating her 53rd birthday today. Perhaps her life in plastic is the reason she looks so great for her age but the Society for Vascular Surgery is putting a different spin on the doll’s birthday – noting that Barbie has always maintained an active lifestyle.
The organization is using the milestone to highlight the importance of women’s vascular health issues.
“Women in their 50s should remain active,” said Kellie Brown, MD, a member of the Society for Vascular Surgery. “Thirty minutes of exercise daily, eating healthy, not smoking, and maintaining a healthy body weight are key to good health.”
The organization points out that since Barbie’s debut in 1959, great strides have been made in women’s healthcare.
In the past 53 years researchers have acknowledged that the smaller neck arteries (carotid and vertebral) in women result in quicker buildup of plaque which restricts blood flow, leading to strokes and heart attacks.
Women over the age of 65 are also more likely to develop clogged or narrowed arteries in the legs without displaying peripheral arterial disease (PAD) symptoms, the society says. Women with PAD have four times the risk of stroke and heart attack.
Another stride researchers have made in the area of women’s vascular health, according to the Society for Vascular Surgery, is recognizing that women’s smaller arteries result in more fatalities from abdominal aortic aneurysms, which continue to be under diagnosed in women. Because of this, the organization says non-invasive vascular screenings are even more important for women.
“In many instances, an active lifestyle may prevent life-threatening vascular conditions,” Brown said. “Physical activity such as walking, swimming, aerobics, and dancing can help reduce blood pressure and keep the body healthy. Better still, maintaining a healthy lifestyle is a great example to set for our daughters.”
The FDA medical device review mechanism has come under fire from many quarters for some time now, but one of the criticisms of the 510(k) and PMA programs is that the reviews are funded by user fees, a claim that can be made of pharmaceuticals, biotech and now even FDA’s overview of food production. Opponents can complain all they want about user fees, but what can they do about them?
As has been widely reported, the Obama administration has proposed that FDA’s total budget for FY 2013 would rise by double-digit percentages, but 98% of that increase comes from user fees. Call me a cynic, but I have a tough time believing that Congress will be able to keep its hands off that last 2% – or more – of appropriated monies in an effort to get a handle on the amazingly large U.S. federal budget deficit. That’s an understandable move in the current climate, but past congresses and presidents don’t have that fig leaf to explain their lassitude where the FDA budget is concerned.
So opponents of user fees currently face a fairly immovable budgetary object, but it won’t always be that way (we hope). This raises the question, however, of why the expression of these adversarial views has had no effect. After all, it's not just outside groups who don’t like user fees. Industry doesn’t rant about them but device makers can’t be fond of them, especially the smaller firms with limited financial resources.
One way of looking at this is that nothing gets the attention of the folks on Capitol Hill like a call from a constituent. And nothing lights a fire under their behinds faster than multiple calls from constituents on a particular matter. Would that work for user fees?
I’m not claiming that outrage from the heartland would necessarily put an end to user fees, but it’s tough to see how they could be eliminated without such an outcry. And the thing I find most conspicuous about this discussion is how it always involves the same message delivered by the same faces living in the same zip codes. The conversation is all inside the Beltway.
Like it or not, Congress won’t end user fees unless someone tries to get the citizenry involved, but ask yourself this: When was the last time you heard someone with the necessary credibility (or bankroll) propose “taking it to the people”? The Alliance for a Stronger FDA is probably the best hope for such an undertaking, but I doubt seriously its member organizations are prepared to fork over the cash needed for such an effort, and the Alliance might not be interested in fighting that fight in the first place.
Ergo, we can only conclude that the effort will not be undertaken, and therefore FDA user fees are the necessary evil with which we must all live. So get over it already.
By JIM STOMMEN
Medical Device Daily Contributing Writer
The recent decision by the Obama administration to propose big-time funding cuts for medical prevention and wellness programs is, like many of the decisions that come out of Washington, puzzling to say the least.
Done as part of the extension of the payroll tax cut, the prevention/wellness cuts supposedly are the political quid pro quo for the lawmakers agreeing to maintain Medicare payments to physicians at existing levels for the remainder of this year — the so-called “Doc fix.”
With a snip-snip here and a snip-snip there, seemingly worthwhile wellness efforts such as those aimed at diabetes prevention, smoking cessation and getting school-aged children to eat more fruits and vegetables were goners. In all, $5 billion worth of prevention/wellness programs have been deemed expendable from the Prevention and Public Health Fund, or roughly one-third of its present funding.
The goal of the fund, created as part of the healthcare reform law, is to provide communities around the country with billions of dollars over the next decade to invest in prevention efforts against heart ailments, cancer and strokes and to target obesity and cut tobacco use (something that might be useful to President Obama, as well as tens of millions of others).
The Oakland, California-based Prevention Institute said that federal funding “is critical to support the health . . . of our communities,” and added that such expenditures offer some form of salvation for “a struggling economy being sunk by healthcare expenditures for preventable conditions.”
Without prevention programs, it said “our workforce will be less healthy and productive, our chronic disease and injury rates will continue to climb, and hundreds of thousands of children, families and communities will still be isolated from healthy foods, safe places to play and smoke-free environments.”
The institute trumpeted: “We need more investment in prevention, not less.”
Part of the reason these programs are vulnerable to being cut is that their results, if achieved, are achieved over long periods of time and tend to be relatively obscured. As Rick Mayes of the University of Richmond told the Washington Post recently, “Public health professionals, programs, and policies are largely invisible to the public and taken for granted.”
Merrill Goozner, who authors a popular healthcare blog known as GoozNews.com, had an apt response to the vote: “Would you sell your home’s storm doors to pay for this winter’s heating bills? That’s what Congress did Friday to pay for part of a 10-month ‘doc fix.’”
Lisa Aliferis, writing in the KQED State of Health Blog from KQED, a Northern California-centered public radio/TV station, said, “Lawmakers figured out a ‘Doc Fix,’ but at the cost of the Prevention and Public Health Fund, part of the healthcare reform law. The deal is not yet final, but it looks like lawmakers will slice $5 billion — or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail.”
She quoted Mary Pittman, president of the Oakland-based Public Health Institute: “I know we’re at a place where difficult decisions have to be made, but it just doesn’t make sense that all of the difficult decisions end up focused on prevention. If we’re to change the way we think about health and we’re trying to find a way to reduce cost, all directions point to prevention.”
Sana Chehimi, program director for the Prevention Institute, told Aliferis that it costs “each and every one of us every day as taxpayers, as residents of communities, when we say we’re going to let people get sick first and then deal with it afterwards.” That’s unnecessary,” she said. “We know how to prevent illness. If we do that, we’re making sure that people don’t have to go to the doctor or emergency room. So it makes our healthcare system that much more efficient.”
As to whether prevention money is well spent, Aliferis cited American Heart Association research from last year that such funds can yield a dramatic return on investment, with community programs to increase physical activity, improve nutrition and prevent smoking being credited with saving more than $5 on every dollar spent within five years.
The AHA added that lifestyle changes reduced the incidence of diabetes by 58%, vs. 31% for drug therapy, and that building bike and pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails.
As part of his lament at the budget-cutting, Goozner rolled out comments from a couple of other interested parties. “The idea of paying for a 10-month fix in physician payments with a 10-year cut in prevention programs is the ultimate penny-wise, pound-foolish move,” said Richard Hamburg, deputy director of Trust for America’s Health, which lobbies for community prevention programs and more funding for state and local health departments.
Kenneth Thorpe, director of the Partnership to Fight Chronic Disease and a professor at Emory University in Atlanta, said, “We’re robbing from the one place in the Affordable Care Act where we can really do something about prevention. The fact that it ends up propping up a collapsing fee-for-service system is the ultimate irony.”
Speaking of ironies, the Prevention Institute noted that, even as the administration’s budget cuts were revealed, the Senate Appropriations Committee voted to support a proposed budget that includes a more than doubling of Community Transformation Grants, which are part of the Prevention and Public Health Fund. “These mixed messages make one thing clear,” the institute said. “Our government sees the value of prevention, but this funding continues to be vulnerable.”
That seems very true, and lamentably so.
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)