Physician Practice Roundup—Physician salaries play into cost of U.S. healthcare; Paul Keckley says physician shortage is a myth

Physician salaries play into cost of U.S. healthcare

A new report published in JAMA finds the United States spent nearly twice as much on healthcare in 2016 as 10 other high-income countries did. At the same time, many population health outcomes health were worse, including the highest maternal and infant mortality rates and the lowest life expectancy.

One factor driving that difference in spending are labor costs, including physician salaries. Generalist physicians in the U.S. had the highest salary of any country in the study, making $218,173 on average—nearly double the mean remuneration in all 11 countries. That is compared with a range of $86,607 in Sweden to $154,126 in Germany, which had the next highest salary. The remuneration for specialists was also higher in the U.S. at $316,000 compared with other countries, ranging from $98,452 in Sweden to $202,291 in Australia. (JAMA, Fierce Healthcare)

Paul Keckley says physician shortage is a myth

Healthcare industry expert Paul Keckley, Ph.D., says it’s a “myth” that there’s a physician shortage in the United States.

On his website, Keckley describes why he isn’t buying the Association of American Medical Colleges’ dire forecast that the U.S. will face a shortage of between 40,800 and 104,900 physicians by 2020. He thinks the group is overstating the shortage given trends that are changing the role, scope and demand for physician services. Those trends include an increased supply of alternatives to traditional physician services such as retail and urgent care clinics which are expected to double in the next five years, hospital employment of doctors which has resulted in expanded roles for professionals such as health coaches and nurse educators, and clinical innovations that change how healthcare is delivered.

“It’s a myth that there’s a dramatic shortage of physicians unless one believes the future of health—the roles physicians play and the roles consumers play—is only a modest change from our past. The evidence from the marketplace is otherwise,” he writes. (The Keckley Report)

House fails to pass ‘right-to-try’ bill

In a move that took some by surprise, the House failed Tuesday to pass “right-to-try” legislation that would have allowed terminally ill patients access to experimental treatment from a drugmaker before it receives Food and Drug Administration approval.

In a 259-140 vote, the House failed to get the two-thirds majority needed to send the bill to the Senate after Democrats expressed safety concerns over how the measure would let patients bypass FDA regulations. House Majority Leader Kevin McCarthy said Republicans will try again to pass legislation, which has the support of President Donald Trump and Vice President Mike Pence. (The Hill, FierceBiotech)

Family medicine residents focus on social determinants of health

Family medicine is rooted in the principles of caring for patients in the context of their family and community, says Deborah S. Clements, M.D., a member of the board of directors of the Association of Family Medicine Residency Directors. As such, it’s important to understand the role of social determinants of health (SDH) and how environmental, social and economic factors and behaviors can lead to health disparities.

Only family medicine training programs specifically require residents to assess community, environmental and family influences on health, a recent review of Accreditation Council for Graduate Medical Education residency program requirements found, Clements said. “As we prepare the future generations of family physicians, teaching these principles with a renewed focus on the role of SDH in wellness is critical to both the health of our communities and the future of our specialty,” she wrote. (Annals of Family Medicine)

Canadian doctors say no to pay raises

Hundreds of doctors, medical specialists and residents in the Canadian province of Quebec have signed a petition protesting their own pay raises.

The medical professionals, joined by medical students, instead want the money, which totals $700 million, to be reallocated to fund more nurses and make care more affordable for patients in need. The raises were negotiated by the medical federations that represent the doctors with the provincial government. More than 700 people have signed the petition since it was published Feb. 25. (CNN)

A Michigan health system’s plan to add a concierge medical model to its offerings is drawing fire from the medical staff who argue the hefty price for the service reinforces the idea that the organization caters to wealthy patients.

Michigan Medicine, a health system owned by the University of Michigan, recently rolled out its Victors Care program, a concierge model that provides patients willing to pay the $2,700 annual fee (which will go up to $3,600 a year for those who enroll after July 1). The fee covers all primary care services and procedures, including office visits, with no copays or deductibles.

A letter signed by 200 doctors and staff told the health system’s administration that the University of Michigan is a public institution that aims to service the public, not a private few who are able to pay the hefty yearly fee. (Fierce Healthcare)

Unlike primary literature and clinical guidelines, the authors of biomedical textbook used to train physicians, pharmacists and dentists do not typically disclose potential financial conflicts of interest.

A new study found an appreciable subset of authors, in fact, have patents and have received remuneration from medical product companies—information not disclosed to readers. The study authors say their findings indicate that full transparency of financial conflicts of interest should be standard practice.

A separate study from researchers at the University of British Columbia says more diversity is needed in medical school textbooks. The study suggested that depictions of race and skin tone in anatomy textbooks widely used in medical schools in North America could contribute to racial bias in medical treatment. (AJOB Empirical Bioethics study, Social Science & Medicine study)

The National Quality Forum is calling on clinicians to make shared decision-making a common standard of care for all patients, settings and conditions. 

In addition to calling for providers, patients, payers and policymakers to push for patient-physician models that encourage two-way communication, the NQF also released a guide offering specific guidance on how to implement shared decision-making in clinical practice. (Fierce Healthcare)