AMA Wire® http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page Mon, 08 Feb 2016 18:13:00 GMT Graduating students: Tell us where you match http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_graduating-students-tell-match Mon, 08 Feb 2016 18:13:00 GMT <p> Tell us where you match for a chance to win one of the following prizes in the AMA’s Match Day 2016-Survive Your First Week of Residency Sweepstakes:</p> <ul> <li> A two-week meal subscription plan gift card from Blue Apron, Inc. (estimated value $120)</li> <li> An AMA branded water bottle (estimated value $10)</li> <li> An AMA branded gym bag (estimated value $20)</li> </ul> <p> A total of sixty (60) winners will be chosen in a random drawing. Winners will be notified directly by email on or about April 19, 2016.</p> <p> Here’s how to enter the sweepstakes:</p> <ol> <li> Write your match location on the back of the card you received from the AMA.</li> <li> Post a photo of yourself with the card on Match Day and tweet it to <a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">@AmerMedicalAssn</a> using #Match2016.</li> <li> Enjoy your day—you’ve earned it!</li> </ol> <p> If you need any assistance, or have questions about your membership or member benefits, <u><a href="mailto:member.service@ama-assn.org" rel="nofollow">email</a></u> or call AMA Member Relations at (800) 262-3211.</p> <p>  </p> <p> <span style="font-size:8px;">NO PURCHASE NECESSARY. VOID WHERE PROHIBITED. Entrants must include both @AmerMedicalAssn and #Match2016 in order to participate in Sweepstakes. The Match Day 2016 - Survive Your First Week of Residency Sweepstakes entry period begins at 12:00 a.m. on February 8, 2016 and ends at 11:59 p.m. CST on April 18, 2016. Sweepstakes is only open to fourth (4) year medical students who are members of the American Medical Association, have been matched at medical residency program, received an invitation to participate the Match Day 2016 - Survive Your First Week of Residency Sweepstakes, a legal resident of the United States and 18 years or older. Limit one entry and one prize per person. For complete Sweepstakes Rules please see the "Official Rules" accessible by going to Official Rules site link at: <a href="http://www.ama-assn.org/go/surviveresidencysweeps">ama‑assn.org/go/surviveresidencysweeps</a> (includes alternate method of entry). This promotion is in no way sponsored, endorsed or administered by, or associated with Blue Apron, Inc.</span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:094e0a30-5e6d-4050-8c2f-7bc9e2bbd6bf What you need to know about the new Zika guidelines http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-new-zika-guidelines Fri, 05 Feb 2016 22:00:00 GMT <p> Following confirmation of sexual transmission of Zika virus to a non-traveler in the continental United States, the Centers for Disease Control and Prevention (CDC) has issued new interim guidance on preventing transmission and caring for women who are pregnant or of reproductive age. We’ve outlined several key facts you need to know.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/9/f5c246b4-a0a8-4147-a92a-97ad8b59dfe7.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/9/f5c246b4-a0a8-4147-a92a-97ad8b59dfe7.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The CDC Friday issued two interim guidelines—one for the <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_e" rel="nofollow">prevention of sexual transmission</a> and one for health care professionals who are <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_ehttp://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_ehttp://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_e" rel="nofollow">caring for pregnant women or women of reproductive age</a> with possible exposure to the Zika virus.</p> <ul> <li> <strong>Zika virus remains a mild illness, but it has been tied to serious birth defects.</strong><br /> <span style="font-size:12px;">Only one in five people infected with Zika virus exhibits symptoms, which are generally mild and self-limited. In other cases, the virus generally is asymptomatic. The primary concern is the possible association between maternal Zika virus infection and an increased risk for congenital microcephaly and other abnormalities of the brain and eye, according to the CDC.</span></li> </ul> <ul> <li> <strong>The period for possible sexual transmission of Zika virus is unknown.</strong><br /> <span style="font-size:12px;">For that reason, the guidelines advise that men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.</span><br /> <br /> <span style="font-size:12px;">The guidelines encourage pregnant women to discuss their male partner’s potential exposures and history of Zika-like illness with their physician.</span><br /> <br /> <span style="font-size:12px;">The guidelines also advise that couples in which the man has traveled to an area of active Zika virus transmission may consider using condoms consistently and correctly during sex or abstaining from sexual activity to avoid transmission of the virus..</span></li> </ul> <ul> <li> <strong>Clinical protocols should be followed for women with possible Zika virus exposure.</strong><br /> <span style="font-size:12px;">The new guidelines outline appropriate protocols for testing pregnant women. These include testing pregnant women who have symptoms consistent with Zika virus, when to test asymptomatic women and how to incorporate testing and monitoring with prenatal care.</span><br /> <br /> <span style="font-size:12px;">The guidelines include recommendations for counseling women of reproductive age who reside in areas with ongoing transmission.</span></li> </ul> <p> Visit the AMA’s <a href="https://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page">Zika Resource Center</a> to learn more about the virus and access the latest information and resources from infectious disease and public health experts.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8b68614d-b05b-4007-8844-c567ce11c80c How one ED uses telemedicine in the ambulance http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-ed-uses-telemedicine-ambulance Fri, 05 Feb 2016 21:09:00 GMT <p> When you think of telemedicine, what comes to mind? Often the answer is a split screen—physician and patient in separate locations on their computers or tablets. But one health system has shown the true breadth of telemedicine’s reach by using the technology to treat patients during the critical early moments of a stroke. Find out how.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/a9095d18-1b36-4d9e-82ae-4bc638652650.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/a9095d18-1b36-4d9e-82ae-4bc638652650.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> The risk of damage and disability in patients who are experiencing a stroke increases with any delay in care delivery. Two emergency physicians at the University of Virginia (UVA) Health System understood the need for speed when it comes to caring for patients in the midst of acute stroke and designed a streamlined telemedicine system to begin treatment on way to the hospital.</p> <p> Nina Solenski, MD, and Andy Southerland, MD, designed the “telestroke” model using low-cost, “off-the-shelf” technology: A mobile device, 4G commercial broadband and HIPAA-compliant encrypted software for patient privacy.</p> <p> <strong>How the “telestroke” model works</strong></p> <p> The portable system is deployed in the ambulance to facilitate a livestream neurological exam with the remote on-call neurologist during the ambulance ride to the hospital. Valuable time is saved by enabling treatment prior to the patient’s arrival at the ED.</p> <p> These systems are “really designed to help support patients from rural communities to get the care they need quickly,” said David Cattell-Gordon, director of the UVA Telemedicine Office. “With a stroke, every minute matters. With this telestroke model, we’re applying the blazing speed of the Internet to life-saving decisions about therapy while patients are en route to the hospital.”</p> <p> As the patient arrives at the ED, pulling a Stat-Pak® envelope rapidly activates an acute stroke alert. The envelope contains a pilot list of instructions for each member of the care team. A single toll-free phone call alerts the remote telestroke neurologist so that live videoconferencing with the patient and family can start within minutes. Telemedicine technicians in the background continuously monitor the audio-video quality and facilitate the transmission of vital brain CT scan images.</p> <p> “We are in a golden age of mobile telecommunications,” Dr. Southerland said. “We can take advantage of these rapidly evolving media to effect change in medicine. We were able to reach out more rapidly to acute stroke patients in low-access areas … before they ever reach the hospital.”</p> <p> <strong>Learn how to adopt telemedicine in your practice</strong></p> <p> A <a href="https://www.stepsforward.org/modules/adopting-telemedicine" target="_blank" rel="nofollow">new module</a> from the AMA’s <a href="https://www.stepsforward.org/modules/adopting-telemedicine" target="_blank" rel="nofollow">STEPS Forward</a>™ collection can help you use telemedicine in your practice. In the module, you will find the four steps you need to adopt telemedicine and navigate the benefits and challenges of remotely monitoring patients.</p> <p> Visit <em>AMA Wire®</em> for <a href="http://www.ama-assn.org/ama/ama-wire/post/questions-telemedicine-answered" target="_blank">answers to your telemedicine questions</a> and to see how the AMA is <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-telemedicine-bolster-care-delivery" target="_blank">addressing the top telemedicine issues</a>. Also, learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-physicians-prepping-telemedicines-success" target="_blank">three ways physicians are prepping for telemedicine’s success</a>, and find out <a href="http://www.ama-assn.org/ama/ama-wire/post/one-health-insurer-embracing-telemedicine" target="_blank">why one health insurer is embracing telemedicine</a>.</p> <p> You also can take some of your team members to the AMA-MGMA Collaborate in Practice Meeting, March 20-22 in Colorado Springs, to gather leadership techniques to help propel you and your practice team toward future success. Former U.S. Sen. Bill Bradley, D-N.J., and Richard Deem, AMA senior vice president of advocacy, will speak on leadership and the changing health care landscape. <a href="http://www.mgma.com/education/conferences/collaborate" target="_blank" rel="nofollow">Register online</a>, and receive a discount when you register two or more of your team members.</p> <p> More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9ef0aa22-370e-4258-a777-05752022612e Changing the face of med ed: 5 keys to student diversity http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_changing-face-of-med-ed-5-keys-student-diversity Thu, 04 Feb 2016 18:47:00 GMT <p> <object align="right" data="http://www.youtube.com/v/vF9dxycOTOs" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/vF9dxycOTOs" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/vF9dxycOTOs" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/vF9dxycOTOs" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object>Looking to spearhead diversity solutions at your school? One physician educator shares five steps educators can take to develop effective programs that increase the number of underrepresented students in medicine.</p> <p> <strong>Why medical schools need new diversity solutions</strong></p> <p> Despite <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-this-years-medical-class-looks-like" target="_blank">medical classes becoming more diverse</a>, the rate in which underrepresented minorities enter medical school still significantly lags behind those who are traditionally well-represented. Among students in certain racial and ethnic groups, enrollment has even declined. This is particularly true for <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">African-American men in medicine</a>, William McDade, MD, PhD, former chair of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page?" target="_blank">AMA Council on Medical Education</a> and deputy provost for research and minority issues at the University of Chicago, told a group of educators at the AMA’s CHANGEMEDED conference in October.</p> <p> “There were only 500 black men nationally who matriculated into medical school this past year … and it’s not just a one-off [incident] because you can see that 2013 and 2014 data” from the Association of American Medical Colleges shows roughly the same enrollment numbers, Dr. McDade said.</p> <p> He also noted that there are currently twice as many African-American women in medical school than black males and that the number of Latino physicians in medicine has actually worsened over the past 30 years, according to <a href="http://journals.lww.com/academicmedicine/Abstract/2015/07000/Latino_Physicians_in_the_United_States,_1980_2010_.20.aspx" rel="nofollow" target="_blank">recent research</a> published in <em>Academic Medicine</em>.</p> <p> But beyond drastic declines in underrepresented minorities, these numbers underscore a greater issue at hand: “You might even ask yourself, ‘What difference does it make if we don’t change the face of medicine?’” Dr. McDade said. “There’s strong evidence that suggests that racial, ethnic and linguistic diversity in health care providers is correlated with better access to and quality care of minority populations.”</p> <p> <strong>How medical schools can diversify student enrollment, address health care disparities </strong></p> <p> “A central goal of the physician workforce of tomorrow should be to eliminate health care disparities,” and medical schools are well-positioned to help accomplish this, Dr. McDade said. Schools looking to create new diversity solutions and train culturally-competent physicians can:</p> <p style="margin-left:.75in;"> <strong>1.  </strong><strong>Develop curricular innovations that focus on health care disparities and the social determinants of health. </strong><br /> Schools must “[recognize] that all physicians in any future scenario will have to learn about cultural and social determinants of health and be trained accordingly,” Dr. McDade said, noting that the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education</a> initiative has already begun spearheading such curricular developments.</p> <p style="margin-left:.75in;"> For instance, schools that focus on population health and big data are creating new ways for students to measure health care disparities, Dr. McDade said. Last year, New York University School of Medicine, one of the founding members of the AMA’s Accelerating Change in Medical Education Consortium, launched a novel toolset, <a href="http://education.med.nyu.edu/ace/curriculum/" rel="nofollow" target="_blank">Health Care by the Numbers</a>, which allows students to analyze real clinical data for more than 2.5 million patients from 29 hospitals in New York and answer population health questions.</p> <p style="margin-left:.75in;"> Dr. McDade said curricula <a href="http://www.ama-assn.org/ama/ama-wire/post/new-med-students-diving-health-care-delivery-science" target="_blank">that immerse students in health care delivery science</a> and teach quality improvement and cultural competency also will prepare future physicians to care for diverse patients in the country’s rapidly evolving health care system.</p> <p style="margin-left:.75in;"> <strong>2.  </strong><strong>Use the new Liaison Committee on Medical Education (LCME) Standards to garner institutional support for diversity pipeline programs. </strong> <br /> The <a href="http://www.lcme.org/publications.htm" rel="nofollow" target="_blank">2015-2016 LCME Standards</a> urge educators to diversify medical training by creating effective pipeline programs to prepare applicants in their defined diversity categories. Educators can reference these standards during key conversations with medical school leaders about the importance of creating actionable diversity solutions, Dr. McDade said.</p> <p style="margin-left:.75in;"> For example, “LCME Standard 3.3 asks medical schools to make sure they are focused on increasing diversity outcomes with respect to students, staff, senior admin staff and other relevant matter [for the] academic community,” Dr. Mc Dade said.</p> <p style="margin-left:.75in;"> He also recommends referencing LCME Standard 7.6, which asks schools to ensure that medical schools graduates know how to address issues related to racial and gender bias within system-based practice.  </p> <p style="margin-left:.75in;"> <strong>3. </strong><strong>Create premedical post-baccalaureate programs that offer a pathway for underrepresented students to enter medical training after college. </strong><br /> Why? While enriching diversity among medical students, <a href="https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v026/26.3.mcdougle.pdf" rel="nofollow" target="_blank">research shows</a> that graduates of premedical post-baccalaureate programs also are more likely to enter medical residencies in underserved communities.</p> <p style="margin-left:.75in;"> Dr. McDade noted that a large percentage of students training in these underserved areas also pursued residencies within primary care specialties, such as family medicine and internal medicine.</p> <p style="margin-left:.75in;"> <strong>4.  </strong><strong>Enhance admissions processes to promote diversity. </strong><br /> Schools can adapt a <a href="https://www.aamc.org/initiatives/holisticreview/about/" rel="nofollow" target="_blank">holistic review process</a>, which offers a way to relieve “some of the cognitive pressure” that emerges when schools only admit medical students based on a narrow range of application criteria, such as GPAs and test scores, Dr. McDade said.</p> <p style="margin-left:.75in;"> Some medical schools have already adapted holistic review processes that are proving effective. For instance, <a href="http://urbanuniversitiesforhealth.org/media/documents/Holistic_Admissions_in_the_Health_Professions.pdf" rel="nofollow" target="_blank">a national study</a> of admissions in university health programs in 2014 found that students admitted to medical school through a holistic review process performed just as well as those who were not. Schools that used a holistic review process “experienced increased diversity, no change to student success metrics and an improved teaching and learning environment,” according to the study.</p> <p style="margin-left:.75in;"> <strong>5.  </strong><strong>Develop a research agenda that measures and promotes the results of diversity-based programs. </strong><br /> If your institution offers diversity- based programs, be sure to ask: Has an increase in racial diversity within medical school led to improved educational outcomes? “If you can show this, that’s fabulous, and we need you to come up with studies that indicate the value of diversity in a quantitative way,” Dr. McDade said.   </p> <p style="margin-left:.75in;"> He encouraged educators to explore research projects that quantify the impact of diversity programs in medical schools. When creating a research proposal, Dr. McDade recommended starting with <a href="http://med-ed-online.net/index.php/meo/article/view/20531" rel="nofollow">this list</a> of 10 expert questions to ensure your research project effectively assesses diversity changes at your institution.</p> <p> <strong>Learn more ways to promote med school diversity and minority health with these resources:</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/one-med-schools-innovative-approach-diversity" target="_blank">how one school successfully created</a> and implemented a strategic diversity action plan. Plus, five key steps educators can take to create a diversity action plan at their own school.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">why the number of black men in medicine</a> hasn’t increased since 1978, and follow these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-boost-diversity-medical-community" target="_blank">5 med ed solutions</a> to help boost diversity.</li> <li> Learn how one school’s holistic solution <a href="http://www.ama-assn.org/ama/ama-wire/post/schools-holistic-solution-boosting-hispanic-students-medicine" target="_blank">is boosting the number of Hispanic physicians</a>.</li> <li> See <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/med-schools-tackling-challenges-health-disparities" target="_blank">how these medical schools are tackling challenges</a> in health disparities and cultural competencies.</li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">the 21 medical students</a> the AMA Foundation recently selected as future minority physician leaders. Read their unique perspectives on being students of color in medical school and <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">how they plan to succeed while promoting diversity in medicine</a>.</li> <li> Educate yourself and your peers on the <a href="http://www.ama-assn.org/ama/ama-wire/post/debunking-5-myths-diversity-medical-education" target="_blank">5 myths of diversity in med ed</a>.</li> <li> Watch <a href="https://www.youtube.com/watch?v=KG6GCc3Pu2s&list=PL7ZHBCvG4qsf4HalVXnQ-cdg48xlLgz3S" rel="nofollow" target="_blank">this Google Hangout</a> to learn more ways schools and students are promoting diversity in medical education.</li> <li> Visit the AMA Minority Affairs Section <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us.page?" target="_blank">Web page</a>, which features the latest on AMA policies, news and events to promote diversity in medicine and public health. You also can <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us/minority-affairs-consortium-membership/mac-membership-registration.page" target="_blank">join the section</a> to get more involved.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eb2ec994-0fd8-4362-ad45-066a541de06f From hospitalist to rapper: The story of ZDoggMD http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_hospitalist-rapper-story-of-zdoggmd Wed, 03 Feb 2016 22:48:00 GMT <p> You may have heard of ZDoggMD—the rapping doctor whose parody music videos on medical topics like electronic health records (EHR), re-admission and sepsis have acquired millions of views. But who is the physician behind the persona?</p> <p> Primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, sat down with Zubin Damania, MD, to talk about burnout, discuss EHRs and find out how he came to be the <a href="https://www.youtube.com/user/ZDoggMD" rel="nofollow" target="_blank">YouTube rapping sensation ZDoggMD</a>.</p> <p> <strong>The burnout story that started it all</strong></p> <p> <strong>Dr. Rakotz:</strong> “When did you first realize that you were facing burnout?”</p> <p> <strong>Dr. Damania:</strong> “For me it was really a slow creep. I started my career in hospital medicine …. I had a wonderful hospital job with mentorship with interns, medical students, residents.”</p> <p> <object align="right" data="http://www.youtube.com/v/xB_tSFJsjsw" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/xB_tSFJsjsw" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/xB_tSFJsjsw" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/xB_tSFJsjsw" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> “We had an electronic record, but [it was used] only [for] reading … the labs, and everything else was on paper. It was this beautiful collusion of being able to help people, like I intended when I went to medical school …. They tolerated me making jokes and using humor as a way to bring people together; it worked really well. But what started happening is … what we see in most of health care, which is increasing pressure on a financial level to produce to perform.”</p> <p> <strong>Dr. Rakotz: </strong>“So you experienced the hospital’s EHR transition first hand?”</p> <p> <strong>Dr. Damania:</strong> “I was on call the night our first EHR went live …. Say what you will about EHRs, they’re wonderful at storing data and potentially improving outcomes, but the fact is—from a ground-level experience—suddenly my day got so long and so complicated just clicking boxes. And with those boxes came an increased requirement to click more boxes.”</p> <p> “It became increasingly difficult. The productivity requirements went up, so we had less house staff coverage. Suddenly I was overwhelmed with the number of patients. And what really snapped for me is … I realized I wasn’t able to spend the time with the patient that actually obtained an outcome that was something other than some knee-jerk nonsense that would have them bounce back in 30 days.”</p> <p> <strong>Dr. Rakotz:</strong> “What was the last straw that took you in the direction that led you to where you are today?”</p> <p> <strong>Dr. Damania:</strong> “There was a patient in his 30s who had cancer. He was one of 30 patients I had in the hospital at the time. It was signed out to me like [he] was a difficult patient, doesn’t take their medications, multiple rounds of chemotherapy but still wants more, totally irrational. And I’m looking at this going this is an engineer, I don’t think irrational is necessarily part of the deal here, so what’s going on?”</p> <p> “I get in the room, and I feel this wave.  [As a physician] you build a wall around yourself to function, but for the first time this wall was wobbling. I did something I had no business doing: I sat down in the room instead of doing my five minute U-turn … and an hour went by.”</p> <p> “No one was coordinating their care. He wanted … to be home with his kids, but he couldn’t because his pain wasn’t controlled. What the wife really wanted was some balance, but he said, ‘If I get admitted for another round of chemotherapy since the visiting hours are so crappy, my family, my kids won’t see me … and I’ll die in the hospital.” … Luckily, we were able to have a great outcome with him by getting him home because I was able to get the team together. But that was an exception.”</p> <p> “Finally, I felt so disempowered. There were so many pressures on our time struggling between the record and the regulations and the patient volume, and it just broke me.”</p> <p> “When I really started getting burned out, I started to reconnect with who I was.  YouTube was a thing all of a sudden, [and] I said I’m going to make these silly videos … in a way to reach patients, educate them and also satirize the system that is so dysfunctional.”</p> <p> “I kept doing it.  Suddenly awakened in me was this idea that this is who I am.”</p> <p> “We did a Michael Jackson parody about testicular self-exam, and I was getting these messages from student health clinics playing it in their waiting room, and kids were catching early testicular tumors.  I asked, ‘How is it that I’m more empowered to prevent disease in this way than I was in the hospital?’ … That opened the door.”</p> <p> <strong>Enter … ZDoggMD</strong></p> <p> <strong>Dr. Rakotz:</strong> “So I would like to talk to ZDoggMD now if we can.”</p> <p> Without hesitation Dr. Damania flipped on his shades and effectively transformed into <a href="https://twitter.com/AmerMedicalAssn/status/695329371914108928" rel="nofollow">ZDoggMD—and Dr. Rakotz</a> joined him.</p> <p> <strong>Dr. Rakotz:</strong> “What comes first—do you pick a song to parody, or do you have an idea in mind and go looking for a song to remix?”</p> <p> <object align="left" data="http://www.youtube.com/v/aS3xaXsh6vo" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/aS3xaXsh6vo" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/aS3xaXsh6vo" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/aS3xaXsh6vo" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> <strong>ZDoggMD:</strong> “It’s a mix of things. For example, we did a song called ‘Re-admission,’ which was a parody of the [R. Kelly] song ‘Ignition.’ I forgot how dope that song is … I listened through it and I thought, I just want to go to the hospital and lip-sync this song in various medical spots, and then I started working on the lyrics. I realized they fit so perfectly.”</p> <p> <strong>Dr. Rakotz:</strong> “Who are you trying to reach … physicians, residents, students?”</p> <p> <strong>ZDoggMD:</strong> “We struggled in the beginning [to identify the audience], and then I realized we just have to make the videos and then figure out who the audience is. The truth is, I found I couldn’t censor myself as a doc. I had to speak in this language that is the tribal language of physicians. And then what ended up happening was nurses, docs, PAs, dentists, vets started becoming the fans.”</p> <p> “At first I wanted to be broader than that. I wanted to reach laypeople. But then I said … there is so much suffering in our own tribe, let’s focus on them and give them something that they can say, ‘this is my anthem.’”</p> <p> <strong>Dr. Rakotz:</strong> "What’s next for ZDoggMD?”</p> <p> <strong>ZDoggMD:</strong> “I want to try to help give a voice to people in health care that don’t really have much of a voice.  When I think about that, I think about the lab. Those guys, they’re down in the basement … doing their thing … people always kind of dump on them … so we did a parody of 50 Cent’s ‘In Da Club,’ called ‘In Da Lab.’”</p> <p> “It goes: ‘Go go go, go redraw, there’s no birthdate, you didn’t label it, there’s no birthdate, it’s in the wrong tube, and yo there’s no birthdate, and you know we don’t draw no blood without no birthdate … You can find me in the lab, bottle full of cr@p, but, homie, I got the plates if you’re in to growin’ that ….”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0beb8fd0-9cd1-4d8b-a2cd-55c665aa0b12 Ward off burnout: Your peer network may impact more than you think http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ward-off-burnout-peer-network-may-impact-think Wed, 03 Feb 2016 21:40:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/94cdd024-614d-4593-882d-9c1ea25fac71.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/94cdd024-614d-4593-882d-9c1ea25fac71.Large.jpg?1" style="float:right;margin:15px;" /></a>Can skipping social events with peers increase your chances for burnout? A <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00038.1" rel="nofollow" target="_blank">recent study</a> provides key findings on how loneliness and connectivity impact residents’ emotional well-being. </p> <p> Burnout often is thought of as an “individual affliction,” but authors note that connections between individual residents create social networks, and these ties also allow individuals to influence each other. The study findings regarding social networks, burnout and loneliness were recently published in <em>Academic Medicine. </em>“Residency programs represent unique social networks, and we sought to investigate the relationship between burnout and loneliness.”</p> <p> Authors of the study “hypothesized that residents with greater loneliness would have greater burnout, and that residents who are more central within their social network have less burnout.”</p> <p> They tested their hypothesis on internal medicine residents using a survey containing the Maslach Burnout Inventory (MBI), a three-question loneliness scale and a social connectivity component.</p> <p> <strong>The results: High burnout rates linked to greater loneliness among residents  </strong></p> <p> Many residents in the study reported “significant burnout” based on their MBI scores related to emotional exhaustion and depersonalization. Among respondents, 45 percent met the significant burnout criteria related to emotional exhaustion, 49 percent met the criteria for depersonalization and 33 percent met the criteria for both.</p> <p> Study authors found that their hypothesis proved true: Residents reporting significant burnout also had higher loneliness scores based on responses to three questions on a three-point Likert scale, with responses “hardly ever” (representing one point), “some of the time” (two points) and “often” (three points). Questions on the loneliness scale measured residents’ “lack of perceived connection to others.” The questions were:</p> <ul> <li> How often do you feel that you lack companionship?</li> <li> How often do you feel left out?</li> <li> How often do you feel isolated from others?</li> </ul> <p> Broken down by symptom, residents reporting significant burnout had higher loneliness scores than those who did not report significant burnout, which included:</p> <ul> <li> Residents reporting high emotional exhaustion also reported a 5.6 loneliness score, versus 4.5 for those who did not report significant burnout</li> <li> Residents reporting high depersonalization also reported a 5.4 loneliness score, versus 4.6</li> <li> Residents reporting both high emotional exhaustion and high depersonalization reported a 5.8 versus loneliness score, versus 4.6</li> </ul> <p> <strong>Why personal accomplishment may lead to a more active peer network </strong></p> <p> To explore how residency programs may function as “social networks,” authors of the study also “had residents rate their connectivity to all other residents and used [the] data to generate two categories of social network outcomes: Degree (number of connections) and centrality (location and/or role within the network),” according to the study.</p> <p> The study found that residents who had higher scores for personal accomplishment on the MBI survey also had greater “centrality within the residency” program and were more connected to their social network.</p> <p> “Our study is the first to demonstrate a relationship between loneliness and burnout,” study authors wrote. “Those with greater burnout—meeting burnout criteria by both emotional and depersonalization—had higher loneliness scores. There was no significant relationship between social network measures of degree or centrality and emotional exhaustion and/or depersonalization scores. However, high personal accomplishment scores were associated with several social network measures.”</p> <p> Although the study was limited to a single residency program, the authors noted that these findings provide a “starting point for future research to assess the effect of group and social networks on trainee burnout.”</p> <p> Read the <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00038.1" rel="nofollow" target="_blank">full study</a> for additional observations.</p> <p> <strong>Additional resources to help boost your personal well-being</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/want-eat-healthy-budget-5-student-friendly-tips" target="_blank">five tips for eating healthy on a budget</a>, offered by a medical trainee and registered dietician.</li> <li> Access a variety of <a href="http://www.ama-assn.org/ama/ama-wire/blog/Financial_Issues/1" target="_blank">expert financial advice</a> for physicians, from managing medical school debt to planning for retirement.</li> <li> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">ways residents have found to conquer burnout</a>.</li> <li> Discover <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">three key tips for physicians in medical marriages</a> to strengthen your connection with your partner as your career and relationship progress.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:43630734-5ff5-41dd-8341-c2780a172e68 4 physician-recommended steps to work- and home-life balance http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-physician-recommended-steps-work-home-life-balance Tue, 02 Feb 2016 23:35:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/7/27a668ce-3580-4c40-87fd-df713cbbe874.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/7/27a668ce-3580-4c40-87fd-df713cbbe874.Large.jpg?1" style="float:right;margin:15px;" /></a>Physicians often strive for “work-life balance,” but how do you define it? Getting the time you need may require a different approach. One physician and wellness expert recommends these four self-driven solutions to help you redefine balance and maintain a successful home and work life.</p> <p> Family physician Sara Taylor, MD, has learned valuable lessons of her own as a mother of two teenaged children, practicing physician, part-time practice owner, blogger and wife of a fellow physician. When she’s not balancing this full roster, she writes about physician wellness, personal development and social media.</p> <p> She recently shared some of her insights in <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank">this month’s issue</a> of AMA Alliance Publication <em>Physician Family Magazine.</em> Here are some of the ways she’s learned to sort work-life and home-life into two balanced, productive spheres:</p> <p> <strong>1.  </strong><strong>Prioritize what you value, and plan for it.</strong> Early on, Dr. Taylor took a valuable lesson from Stephen Covey’s book <em>First Things First</em>: “My take-away message from this invaluable book is that if we spend more time dealing with things that are important such as planning, preparing and personal development, we spend less time in the ‘crisis/deadline’ mode that lends itself to feeling frenzied and imbalanced,” she wrote.</p> <p> Dr. Taylor also noted that “Covey cleverly describes urgency addiction as ‘a self-destructive behavior that temporarily fills the void created by unmet needs.’”</p> <p> Focusing on weekly goals is one way to effectively prioritize. “This does not mean to keep an exhaustive to-do list (like I used to), but rather to write down three ‘must-dos’ each day,” she wrote. “You can either do this for work-life and home-life separately, or as I do, approach it more globally.”</p> <p> <strong>2.  </strong><strong>Still give yourself time to “just be” and feel rooted in the moment.</strong> “In the book, <em>An Eight-Week Plan for Finding Peace in a Frantic World</em>, Dr. Mark Williams and Danny Penman describe our common state of ‘doing mode’ versus ‘being mode,’” Dr. Taylor wrote.<br /> <br /> Being in a constant state of “‘doing’ ends up depleting us, leading to exhaustion and burnout,” she wrote. “By consciously attending to ‘being,’ or mindfulness, we are more able to give both our body and mind what they need to be nourished.”<br /> <br /> One tip she recommended: Try meditating to help practice mindfulness and channel a sense of calm.<br /> <br /> <strong>3.  </strong><strong>Learn to say “no” to certain tasks.</strong> “It not only helps us set boundaries but also prevents us from falling prey to other people’s agendas,” Dr. Taylor wrote. She said saying “no” is an essential step to finding balance and ensuring you have time to prioritize your well-being.</p> <p> <strong>4.  </strong><strong>Practice self-care, focusing on small actionable steps. </strong>Start by exercising, getting proper sleep and setting digital limits from work or peers, so you can properly rejuvenate, Dr. Taylor said. If you don’t have time for yoga classes or the gym, online exercise classes or instruction can be other options.</p> <p> Get more solutions and insights from Dr. Taylor in <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank">this month’s issue</a>.</p> <p> <strong>Also, don’t miss these resources for physician families:</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">these 3 tips</a> for maintaining happiness in a medical marriage.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">these expert insights</a> to ensure you’re successfully partnering with your spouse.</li> <li> Learn more about <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">the benefits of a medical marriage</a> and why physicians often marry fellow physicians.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <em><a href="http://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:98ec831e-d65a-4380-a788-3f78082df4f4 Avoid meaningful use penalties: Apply for exemption by March 15 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_avoid-meaningful-use-penalties-apply-exemption-march-15 Tue, 02 Feb 2016 23:13:00 GMT <p> Physicians have until March 15 to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year. Those who don’t apply could face up to a 3 percent cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period. The good news is that exemptions will be granted broadly this year.  </p> <p> <strong>Everyone should apply</strong></p> <p> The Centers for Medicare & Medicaid Services (CMS) has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">Stage 2 meaningful use modifications rule</a>, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.</p> <p> This inclusive approach to hardship exemptions is a result of the Patient Access and Medicare Protection Act, passed just before Congress adjourned for the holidays, <a href="http://www.ama-assn.org/ama/ama-wire/post/bill-gives-blanket-approval-meaningful-use-exemptions" target="_blank">which directed CMS to make AMA-supported changes</a> to the previously limited exemption process.</p> <p> All physicians should apply for the exemption since there isn’t a downside to doing so. Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply. Submitting an application for a hardship exemption will not prevent those who qualify from receiving an incentive payment.</p> <p> <strong>How to apply</strong></p> <p> Physicians should be sure to submit their applications before midnight Eastern time March 15. To get started, <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html" rel="nofollow" target="_blank">download an application</a> from CMS and consult <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-avoiding-2017-penalty.pdf" target="_blank">step-by-step instructions</a> (log in) the AMA compiled to help simplify the submission process.</p> <p> New this year, individuals can apply on behalf of a group of physicians.</p> <p> While CMS has given a deadline for applications, it has not yet indicated when physicians will receive confirmation of their exemption status.</p> <p align="right"> <em>By AMA Wire editor <a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0e4eac9a-40a2-421b-9e31-bd634657d9ae What you need to know about away electives and the Match http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-away-electives-match Mon, 01 Feb 2016 22:59:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/6697cc25-9b02-41e8-bf46-2f97bfbdd1e1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/6697cc25-9b02-41e8-bf46-2f97bfbdd1e1.Full.jpg?1" style="float:right;margin:15px;" /></a>Do away electives really give students an edge in the Match? Before committing to an away elective or audition, review these five key facts about away electives to help you make an informed decision. Plus, check out an infographic to help you break down the average cost of away electives.</p> <p> Authors of a recent <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Going__Fourth__From_Medical_School___Fourth_Year.98756.aspx" rel="nofollow" target="_blank">study</a> published in <em>Academic Medicine </em>surveyed 1,367 students about away electives and auditions. The study found that: </p> <p style="margin-left:40px;"> <strong>1. The primary reasons students pursued away electives were to evaluate specific residency programs and increase their chances of matching to their program of choice.</strong><br /> In fact, 90 percent of students agreed that the primary reason to pursue an away elective is to evaluate the residency program and 81.8 percent agreed that increasing the likelihood of matching at that residency program should also motivate students to pursue away electives.</p> <p style="margin-left:40px;"> <strong>2. Most students took away electives, and the number of students taking them varied by specialties. </strong><br /> “More than half of the students completed at least one monthlong away or audition elective in their career specialty of choice,” the study authors wrote.</p> <p style="margin-left:40px;"> “The number of students taking away electives varied by career specialty, ranging from approximately 42 percent for internal medicine to approximately 89 percent for emergency medicine,” the study said. “Overall, surgery and emergency medicine applicants were significantly more likely to complete an away elective than students applying to all other specialties.”</p> <p style="margin-left:40px;"> Study authors also noted that away electives were more expensive for students taking electives in nonprimary care residencies.</p> <p style="margin-left:40px;"> <strong>3. Electives aren’t cheap—some students had to limit their options. </strong><br /> “The majority of students who completed away or audition electives spent between $1,000 and $4,000 to complete these electives,” according to the study.<br /> <br /> Approximately 35 percent of students reported limiting the number of away electives they took because of financial constraints.</p> <p style="margin-left:40px;"> <strong>4. Away electives significantly impacted how students ranked their programs.  </strong><br /> Nearly 89 percent of students who completed an away elective felt that the elective affected their ranking of a program. This didn’t vary significantly across specialties, according to the study.</p> <p style="margin-left:40px;"> <strong>5. While away electives influenced how students ranked their programs, their impact on the Match is still unclear.</strong> <br /> Among students who completed an away elective, 34.1 percent matched to the programs at which they had done an away elective.<br /> <br /> “As only approximately one-third of students matched at a program where they had done an away or audition elective, it is unclear whether these electives enhance the likelihood of matching,” study authors wrote. “It may be that so many students in certain specialties complete away electives that any potential benefit to a single student is diluted.”<br /> <br /> In the National Resident Matching Program’s <a href="http://www.nrmp.org/2014-program-director-survey-report-now-available/" rel="nofollow" target="_blank">2014 Program Director’s Survey</a>, 63 percent of program directors valued students taking away electives or auditions in their departments and cited electives as a factor when selecting applicants for residency interviews. However, only 55 percent of program directors cited applicants having completed an away rotation or audition within their specific programs as a factor when ranking applicants.</p> <p> <strong>Want tips on choosing away electives or auditions?</strong> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-answer-top-student-questions-away-rotations" target="_blank">these answers to the top questions</a> students asked residents about away electives and auditions.</p> <p> <strong>Want more tips for applying to residency? Check out these resources</strong></p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/top-questions-ask-during-residency-program-interview" target="_blank">this must-have list</a> of questions the Association of American Medical Colleges recommends students ask program directors and residents during their residency program interviews.</li> <li> Get <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-ace-video-interviews-residency" target="_blank">six key tips</a> to help you excel on video interviews for residency.</li> <li> Learn how to write a competitive CV using <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">these six strategic steps</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty)</li> <li> Check out <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_blank">this essential checklist</a> for fourth-year students featuring key tasks and deadlines to prioritize as you apply for residency.</li> </ul> <p style="margin-left:18.75pt;">  </p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5c85cd7f-fde5-4552-a979-d9a8c9e7e4ab 5 ways to promote better heart health among your patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-ways-promote-better-heart-health-among-patients Mon, 01 Feb 2016 20:47:00 GMT <div> American Heart Month starts today. Find out how can you participate as a physician and help your patients focus on their heart health throughout the next four weeks.</div> <div>  </div> <div> <strong>How you and your patients can raise awareness for heart health this month</strong></div> <div> Uncontrolled hypertension is one of the leading causes of death in the country. This February, help turn the tide and improve heart health across the nation.</div> <div>  </div> <div> Here are the five ways to promote better heart health during American Heart Month:</div> <div>  </div> <div> <strong>1. Learn insights from experts on hypertension</strong></div> <div> Take part in a Google Hangout focused on the latest compelling information, research and technology on diagnosing and managing hypertension. All you need to participate in this AMA-hosted event is a Gmail account and a desire to discuss improving heart health to build <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/healthier-nation/build-a-healthier-nation.page" target="_blank">#AHealthierNation</a>. On Feb. 25 at 2 p.m. Eastern time, primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, will moderate the conversation among heart health experts: </div> <div>  </div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span>Harlan M. Krumholz, MD, professor at Yale University, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, and frequent contributor to the New York Times Well blog</div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span>Ray Townsend, MD, professor of medicine and director of the hypertension program at the Hospital of the University of Pennsylvania</div> <div>  </div> <div> <strong>2. Make a statement in red</strong></div> <div> Another important day this month, sponsored by the American Heart Association, is the <a href="http://www.heart.org/HEARTORG/Affiliate/13th-Annual-National-Wear-Red-Day_UCM_456034_Event.jsp#.VqkzOPkrKUk" rel="nofollow" target="_blank">13th Annual National Wear Red Day</a>, taking place Feb. 5. Make a life-saving fashion statement by donning your favorite red outfit to raise awareness to help prevent heart disease and stroke—the leading causes of death in the nation. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/9d2133bd-2179-460d-bf5b-27e813482d66.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/9d2133bd-2179-460d-bf5b-27e813482d66.Large.jpg?1" style="margin:15px;float:right;" /></a></div> <div>  </div> <div> <strong>3. Participate in Million Hearts® weekly health activities</strong></div> <div> <a href="http://millionhearts.hhs.gov/" rel="nofollow" target="_blank">Million Hearts®</a>, a national initiative to prevent 1 million heart attacks and strokes in the United States by 2017, will focus on one aspect contributing to heart health each of the four weeks of American Heart Month. You and your patients can use the next four weeks as a launch pad to establishing lifelong—not just monthlong—healthy heart habits, including:</div> <div>  </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Eating healthy</div> <div style="margin-left:40px;"> •   Being physically active</div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Setting goals to improve your health</div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Maintaining healthy blood pressure</div> <div>  </div> <div> <strong>4. Get timely information from physician commenters</strong></div> <div> Throughout the month, several heart health-focused organizations and individuals will be active on Twitter under the hashtag <a href="https://twitter.com/search?q=%23HeartMonth&src=typd" rel="nofollow" target="_blank">#HeartMonth</a>. Follow the AMA (<a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">@AmerMedicalAssn</a>) and the American Heart Association (<a href="https://twitter.com/American_Heart" rel="nofollow" target="_blank">@American_Heart</a>) for resources and information on what’s happening during American Heart Month and resources that can help you advocate for heart health. </div> <div>  </div> <div> Also, follow these physician experts and health journalists:</div> <div>  </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/sandnsurf" rel="nofollow" target="_blank">Mike Cadogan, MD</a>, an emergency medicine physician in Perth, Australia </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/Doctor_V" rel="nofollow" target="_blank">Bryan Vartabedian, MD</a>, a pediatric gastroenterologist at Baylor College of Medicine in Houston</div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/BarbaraFicarra" rel="nofollow" target="_blank">Barbara Ficarra</a>, a leading nurse voice in health journalism and writer for the <em>Huffington Post</em></div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/ShelleyWood2" rel="nofollow" target="_blank">Shelley Wood</a>, a quality health systems administrator at 3M Healthcare </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/cardiobrief" rel="nofollow" target="_blank">Larry Husten</a>, a health news writer and editor of cardiobrief.org </div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/taraparkerpope" rel="nofollow" target="_blank">Tara Parker Pope</a>, editor of the <em>New York Times’ Well </em>blog </div> <div>  </div> <div> <strong>5. Access resources for getting the best blood pressure readings</strong></div> <div> Watch <em>AMA Wire</em>® for heart health information throughout the month, and learn what you need to know to <a href="http://www.ama-assn.org/ama/ama-wire/blog/Self_Measured_BP/1">implement successful self-measured blood pressure</a> with your patients. Also, check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-video-need-accurate-blood-pressure-readings" target="_blank">one video you need for accurate blood pressure readings</a>.</div> <div>  </div> <div style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a452d92e-f0d8-44b0-bb99-58401656fd1e How medical liability reforms will be advanced, challenged in 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-liability-reforms-will-advanced-challenged-2016 Sat, 30 Jan 2016 01:00:00 GMT <p> The existing medical liability system continues to drain health care resources that could be devoted instead to improved quality of care and access for patients—all while putting many physicians at unnecessary emotional, reputational and financial risk. Thankfully, positive medical liability reform efforts will continue this year to address both existing and developing issues.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/f253ed22-a659-448e-be93-39d519a84eb4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/f253ed22-a659-448e-be93-39d519a84eb4.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The AMA is pursuing legislative solutions at both the federal and state levels to address these issues and is continuing collaboration with state medical associations and national medical specialty societies to advocate for its new medical liability reform legislation and defend existing reforms.</p> <p> <strong>Implementing new ideas and protecting existing strengths</strong></p> <p> Three states recently passed new bills to create early disclosure systems that expedite the resolution of meritorious claims, provide more consistent damage awards and reduce the practice of defensive medicine.</p> <p> In 2015, Iowa put their “Candor” law into action. The act facilitates communication between a physician or health facility and a patient following an adverse health care incident, with the understanding that disclosing adverse medical outcomes to patients can prevent the unnecessary expenditure of resources and be an effective form of risk management. Massachusetts and Oregon passed similar legislation in 2012 and 2013, respectively.</p> <p> Several other states will look to Iowa, Massachusetts and Oregon as they design their own systems to engage in early discussion with patients following adverse health care incidents to prevent the unnecessary escalation of such claims.</p> <p> States will also work to establish and protect existing traditional medical liability reforms in 2016. As of January, about one-half of states have enacted some variation of a cap on noneconomic damages, while six states place a cap on total damages. However, the caps in these states vary greatly by amount, exceptions and causes of action covered.</p> <p> Last year, Missouri’s governor signed a bill that created two caps on noneconomic damages, a primary limit of $400,000 and a higher cap of $700,000 for catastrophic personal injury or death. Both are subject to an annual 1.7 percent index for inflation. The state’s previous $350,000 cap was struck down in 2012.</p> <p> Despite many legal challenges, one of the nation’s leading medical liability reform laws was <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-damages-cap-upheld" target="_blank">upheld again</a> in November 2014. California’s historic tort reform law, the Medical Injury Compensation Reform Act, will remain in place with a $250,000 cap on noneconomic damages in medical liability lawsuits.</p> <p> <strong>A new threat to medical liability reform</strong></p> <p> Movements are underway in several states to adopt a patient compensation system for medical liability—a “no-fault” system similar in concept to the worker’s compensation system, in which patients would be compensated automatically for an adverse medical event, even if it was not the fault of the physician. Advocates of this model have made numerous claims about its advantages, according to the Physician Insurers Association of America (PIAA). “While the current system has flaws and is in need of reform, no-fault is not the answer,” the PIAA said in a statement.</p> <p> “Patient compensation systems would result in more doctors being reported more often to the National Practitioner Data Bank,” said Michael C. Stinson, vice president of government relations and public policy at the PIAA. Approximately 70 percent of all medical liability claims filed are found to be meritless and result in no payment, he added.</p> <p> “With the [patient compensation] system being based on adverse medical outcomes, and not on the fault of a health care professional, the number of claims being paid would skyrocket,” Stinson said. “And every one of those would get reported, wildly misrepresenting the health care professional’s record of practice.”</p> <p> Tennessee, Florida, Georgia and Maine are both expecting patient compensation systems legislation this year. The AMA is currently studying these proposals and will issue a report to the House of Delagates at the 2016 Interim Meeting.</p> <p> <strong>Federal efforts to achieve national medical liability reform</strong></p> <p> Significant medical liability reform was achieved with enactment of the Medicare Access and CHIP Reauthorization Act of 2015 in April. The law includes the Standard of Care Protection Act, which prohibits federal quality program standards and performance metrics from establishing a “standard of care” in medical liability actions.</p> <p> The AMA will advocate this year for the Sports Medicine Licensure Clarity Act. This legislation would protect sport medicine professionals, including physicians, when they travel with their teams or athletes and provide care in another state by ensuring they are covered by their liability insurance across state lines.</p> <p> Another bill coming down the line is the Good Samaritan Health Professionals Act. Under this bill’s protections, health care professionals who volunteer during a federally declared disaster would be protected from liability exposure. Another bill, the Family Health Care Accessibility Act legislation, would provide Federal Tort Claims Act medical liability coverage to all qualified health care professionals who volunteer at community health centers, or through offsite programs or events carried out by such centers. Under the bill, these volunteers would be deemed covered employees of the Public Health Service for liability purposes.</p> <p> The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, is a comprehensive liability reform package that includes a federal cap on non-economic damage awards if a state does not have its own cap. Assisting members of the U.S. Senate and House of Representatives who are considering revisions to the HEALTH Act will continue to be a focus for the AMA this year.</p> <p> <strong>Standing up for reform in that nation’s courts</strong></p> <p> Physicians also are firmly supporting medical liability reforms in the midst of various legal challenges.</p> <p> For instance, a <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reform-risk-state-supreme-court-case" target="_blank">case before the Supreme Court of the State of New Mexico</a> calls into question whether Texas’ medical liability reforms should apply when New Mexicans seek care from physicians practicing in their neighbor state. A New Mexico Court of Appeals previously ruled in favor of holding Texas physicians to New Mexico law, which offers fewer protections for both physicians and patients. Many New Mexicans could lose the vital access to medical care provided by Texas physicians on which they rely.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> filed an amicus brief in support of reversing the appeals court’s decision. The case puts “Texas doctors, nurses and hospitals seeing New Mexico patients at an even greater litigation risk,” the brief said. Increased litigation risk brings with it an increase in the frequency of lawsuit filings and an increase in the size of awards and settlements.</p> <p> Other ongoing medical liability legal challenges in which the AMA Litigation Center has been involved include:</p> <ul> <li> <em>Volk v. DeMeerleer</em>, a medical liability case before the Washington Supreme Court that also <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-threatens-physician-patient-confidentiality" target="_blank">threatens physician-patient confidentiality</a></li> <li> <em>Bayer v. Dobbins</em>, a case before a Wisconsin court of appeals that calls into question the admissibility of expert evidence</li> <li> <em>Seifert v. Balink</em>, a case on appeal to the Wisconsin Supreme Court weighs the standards of admissibility for expert testimony</li> </ul> <p> The 2016 edition of <a href="https://download.ama-assn.org/resources/doc/arc/x-pub/mlr-now.pdf">“Medical Liability Reform–Now!”</a> (log in) provides liability reform advocates with the information they need to advance and defend medical liability reform legislation. It includes background information, proven solutions and innovative reforms that could complement traditional medical liability provisions.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7c85290b-4552-4f53-9125-542bf5feb824 What you need to know about Zika virus http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-zika-virus Fri, 29 Jan 2016 22:00:00 GMT <div> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/911228d6-eec6-4f00-98dd-4873482c2c10.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/911228d6-eec6-4f00-98dd-4873482c2c10.Large.jpg?1" style="margin:15px;float:right;" /></a>With global infection rates increasing rapidly, physicians should be prepared to handle possible cases of Zika virus and answer patients’ questions. No locally transmitted cases of the virus have been reported in the continental United States, but more than 30 cases have been confirmed in returning travelers.</div> <div>  </div> <div> Prepare your practice and your patients with resources developed by infectious disease experts and assembled by the AMA in one convenient location. </div> <div>  </div> <div> Visit the AMA’s online <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_blank">Zika Virus Resource Center</a> for information from the CDC and other public health groups. Resources cover:</div> <div>  </div> <ul> <li> <span style="font-size:14px;">Understanding the virus</span></li> <li> <span style="font-size:14px;">Managing and reporting Zika virus infections</span></li> <li> <span style="font-size:14px;">Caring for pregnant women during a Zika virus outbreak</span></li> <li> <span style="font-size:14px;">Evaluating and testing infants</span></li> </ul> <div> The resource center will be updated regularly to give you, your practice staff and your patients the most up-to-date information you need. </div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cf3ea061-50db-4c75-826b-04db5a2551d7 What EHRs need: Physicians offer solutions at town hall http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehrs-need-physicians-offer-solutions-town-hall Fri, 29 Jan 2016 20:38:00 GMT <p> How can electronic health records (EHR) and regulations be designed to positively affect you in your practice? With the meaningful use program reportedly on the cusp of change, physicians gathered in Seattle for a town hall meeting to discuss both the difficulties and benefits of EHRs while also citing ways that they can be improved. Find out what your colleagues on the West Coast had to say.</p> <p> The meaningful use program has been successful in “forcing the adoption of EHRs … but they weren’t ready for prime time,” said AMA President Steven J. Stack, MD, Tuesday night during the town hall meeting on EHRs at the Swedish Medical Center in Seattle. This is the third AMA town hall on EHRs and was co-hosted by the Washington State Medical Association (WSMA).</p> <p> The focus of this special session: What is wrong with current EHRs and how they could be designed to benefit physicians in practice.</p> <p> Earlier this month Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt said the <a href="http://www.ama-assn.org/ama/ama-wire/post/cms-chief-vows-replace-meaningful-use-better-policy" target="_blank">agency is changing its culture</a> to focus more on listening to physician needs and will implement better policy in place of the meaningful use program when the new streamlined Medicare reporting program is created. With this statement, there’s never been a better time to speak up and offer constructive solutions to regulatory missteps that have stolen time from physicians that they would rather have spent with patients.</p> <p> <strong>Taking control: Regulations should not hinder care</strong></p> <p> As it did in <a href="http://www.ama-assn.org/ama/ama-wire/post/regulations-sidelining-patients-physicians-talk-ehrs" target="_blank">Boston</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank">Atlanta</a> last year, the physician voice resounded through Seattle during Tuesday night’s town hall, emphasizing that EHR design should be focused on usability and interoperability and the physician voice must be heard.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/52d0ddd6-fae0-4c51-97d9-f3e3ebadd7d3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/52d0ddd6-fae0-4c51-97d9-f3e3ebadd7d3.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “Administrative burdens are strangling medical practice and creating unnecessary and costly inefficiencies in health care delivery while adding stress to physicians and their teams,” said WSMA president Ray Hsiao, MD, kicking off the discussion. “It can make a cynic out of the happiest people and can lead to discouragement, professional dissatisfaction and burnout, and even drive physicians to leave the profession. We cannot let that happen.”</p> <p> Regulations force physicians to do “a lot of busy work that has nothing to do with the quality of care we provide,” said Jane Fellner, MD, a primary care physician at the University of Washington School of Medicine. “It needs to stop.”</p> <p> <strong>How we can make EHRs more functional in practice</strong></p> <p> Speaking to what they really need from these tools to help them in their practices, many physicians offered solutions and suggestions for how EHRs should work for the end-users who depend on them daily.</p> <p> Interoperability proved top of mind as the current EHRs struggle to communicate. “My EHR does not necessarily have the tools to interoperate well with other EHRs,” Dr. Fellner said. “But within the universe of the other medical centers who use the same software—it is magic. I can import an entire record from Florida in 20 seconds.” If all EHRs could talk to each other in this way, it would have a very positive effect on the way physicians treat patients nationally, she said. “It has revolutionized the care I provide.”</p> <p> Another focus for improvement during the discussion was the need for more data usage focused on population health to show physicians how their patients’ health compares to national trends.</p> <p> “What we don’t see is our information going in to create this big picture that we can then [see] in real time,” said Reena Koshy, MD, a family physician in Seattle. This capability is currently available but not to everyone using EHRs. Dr. Koshy said it would be very helpful if national patient data coordination were available to all practices.</p> <p> Thomas Payne, MD, medical director of information technology services at the University of Washington School of Medicine and board chair of the American Medical Informatics Association, said he uses his EHR in every patient visit. “We need to address documentation because that is the source of a lot of unnecessary new time that [we] spend,” he said. “Natural language processing is a great example …. As we speak as we are this evening … we can use that same capability to communicate in the medical record and … be able to record what kinds of care people have received.”</p> <p> “When you’re searching for billing codes, you have to type it exactly correct or it boots it out,” said Carrie Horwitch, MD, a primary care physician in Seattle. She suggested physicians could work much more efficiently if EHRs had the same kind of spell-check and search option drop-down menus as Internet search engines.</p> <p> <strong>The effort to change meaningful use and fix EHRs</strong></p> <p> Early last year, the Medicare Access and CHIP Reauthorization Act of 2015 repealed the sustainable growth rate formula and called for the new Merit-Based Incentive Payment System (MIPS), which is intended to sunset the three existing reporting programs and streamline them into a single program.</p> <p> The AMA and 100 state and specialty medical associations recently submitted <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS, and the AMA provided <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue and submitted a <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work" target="_blank">detailed framework</a> for what needs to change.</p> <p> The AMA and MedStar Health’s National Center for Human Factors in Healthcare last year developed an <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_blank">EHR User-Centered Design Evaluation Framework</a> to compare the design and testing processes for optimizing EHR usability. </p> <p> Visit <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a>, the AMA’s grassroots campaign to advocate for ways to solve medicine’s regulatory and legislative challenges.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:21f83409-de1c-4822-978e-b15532e4bea4 What’s new from the AMA Academic Physicians Section http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_whats-new-ama-academic-physicians-section Fri, 29 Jan 2016 15:08:00 GMT <p> During the 2015 AMA Interim Meeting, the AMA House of Delegates adopted changes to the bylaws of the AMA Academic Physicians Section (APS), to codify the section’s name change from “Section on Medical Schools” to “Academic Physicians Section” and clarify the pathways to membership in the AMA-APS.</p> <p> These changes were presented in a <a href="http://www.ama-assn.org/resources/doc/hod/x-pub/i15-ccb-1.pdf" target="_blank">report</a> (log in) from the AMA Council on Constitution and Bylaws, which was subsequently recommended for adoption by the Reference Committee on Amendments to Constitution and Bylaws.</p> <p> In its report, the reference committee wrote, “Testimony for this report was strongly in favor of adoption. The recommendations of the report were universally lauded for their inclusiveness in welcoming more members of the medical community into this section, especially for community physicians who are part-time faculty and may have been excluded previously.”</p> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_blank">Learn more</a> about the AMA-APS, and <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/members.page?" target="_blank">join now</a>. Also, check out a <a href="http://www.ama-assn.org/ama/ama-wire/post/ama-academic-physicians-section-2015-interim-meeting-highlights" target="_blank">summary</a> of the section’s meeting in November.</p> <p> In related news, the Academic Medicine Caucus convened during the 2015 AMA Interim Meeting. A number of issues were discussed, including leadership for the caucus and speeches by candidates for AMA positions. <a href="https://connection.ama-assn.org/sites/MedEd/APS/Documents/Fred's%20folder/i-15-caucus-minutes.docx?Web=1" target="_blank">Read more</a> (log in).</p> <p> Also, save the date for the next caucus meeting: June 13 in Chicago during the 2016 AMA Annual Meeting. Elections for caucus leadership positions will be held during the meeting. Those interested in running for a position on the caucus should email the current caucus chair, <a href="mailto:Donald.Eckhoff@ucdenver.edu" rel="nofollow">Donald Eckhoff, MD</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b451455a-a93e-474f-9931-a43c887c1c3c Nominate a peer for the Excellence in Medicine Awards http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nominate-peer-excellence-medicine-awards Fri, 29 Jan 2016 15:04:00 GMT <p> The AMA Foundation’s Excellence in Medicine Awards program, with support from Pfizer Inc., recognizes physicians who exemplify the highest values of volunteerism, leadership and dedication to underserved populations, and present inspirational physician stories to the medical community and public. Consider nominating a physician you know that exemplifies these attributes. The awards include:</p> <ul> <li style="margin-left:0.25in;"> <strong>The Jack B. McConnell, MD Award for Excellence in Volunteerism</strong> recognizes the work of a senior physician who provides volunteer treatment to patients in the U.S. who lack access to health care.</li> <li style="margin-left:0.25in;"> <strong>The Pride in the Profession Award</strong> honors physicians who practice medicine in areas of crisis or devote their time to volunteerism and public service.</li> <li style="margin-left:0.25in;"> <strong>The Dr. Debasish Mridha Spirit of Medicine Award</strong> recognizes the work of a U.S. physician who has demonstrated altruism and compassion while providing quality health care to marginalized populations.</li> <li style="margin-left:0.25in;"> <strong>The Dr. Nathan Davis International Award in Medicine</strong> honors physicians whose influence reaches international patients for a positive impact on health care in the global arena.</li> </ul> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_blank">Applications</a> to nominate career and senior physicians are now available. The deadline for applications is Feb. 26 at 6 p.m. Eastern time. Award recipients will be honored in conjunction with the 2016 AMA Annual Meeting in Chicago. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b1f4d714-c280-4acb-aec3-4f26621c546e Call for LGBT Advisory Committee nominees http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_call-lgbt-advisory-committee-nominees Fri, 29 Jan 2016 15:02:00 GMT <p> The AMA Board of Trustees is seeking diverse candidates for two at-large positions on the AMA Advisory Committee on Lesbian, Gay, Bisexual and Transgender (LGBT) Issues.</p> <p> The AMA Advisory Committee on LGBT Issues meets twice a year and hosts monthly teleconferences between face-to-face meetings. The committee’s role is to advise the AMA Board of Trustees on LGBT issues and host the LGBT and Allies Caucus and Reception, along with other LGBT educational sessions.</p> <p> Nominees should have expertise and interest in LGBT issues and should have held previous leadership or committee positions. Newly appointed committee members are expected to attend the next committee meeting in Chicago, taking place June 9-11.</p> <p> At-large position nominees must complete and sign an <a href="http://www.ama-assn.org/resources/doc/glbt/x-pub/2016-lgbt-nominations-form.docx" target="_blank">AMA nominations form</a> (log in) along with their executive curricula vitae, not to exceed three pages. Nomination materials should be <a href="mailto:lgbt@ama-assn.org" rel="nofollow">submitted via email</a> by Feb. 29. If you have any questions, please contact <a href="mailto:JMori.Johnson@ama-assn.org" rel="nofollow">J. Mori Johnson of the AMA</a>, or call her at (312) 464-5678.</p> <p> <strong>Providing nonjudgmental care for LGBT populations</strong></p> <p> Lesbian, Gay, Bisexual and Transgender (LGBT) populations are at increased risk for specific health issues across the age spectrum, from depression, suicidality and eating disorders in childhood to substance abuse, sexually transmitted infections and domestic violence issues in adulthood.</p> <p> Yet within the clinical arena, unconscious biases can make patients uncertain or afraid to give sensitive information disclosing their sexual orientation, leading to missed guidance and care opportunities for higher-risk problems. <a href="https://www.reachmd.com/programs/everyday-family-medicine/providing-nonjudgmental-care-lgbt-populations-how-recognize-unconscious-bias/7812/?utm_campaign=RMD_Daily_Newsletter_01142016&utm_medium=Email&utm_source=ExactTarget" target="_blank" rel="nofollow">View</a> a video discussing the topic of unconscious bias in the clinical setting. Available from ReachMD, this education session was recorded on site at the American Osteopathic Association’s annual medical education conference.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:88b0772c-2f38-45b2-acf3-6ae0863c1f4f How video games could soon change med ed http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_video-games-could-soon-change-med-ed Thu, 28 Jan 2016 22:03:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/bf5b6487-859a-443b-9fd2-e50a212a279b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/bf5b6487-859a-443b-9fd2-e50a212a279b.Large.jpg?1" style="float:right;margin:15px;" /></a>Video games are creating new ways to teach physicians in training. One physician educator recently explained how gaming can transform competency-based education and shared three video games that are already helping students master clinical skills.</p> <p> <strong>Transforming student learning</strong></p> <p> “If any of you have teenagers or know millennials, they’re playing these games where they are in the isolation of their environment, but they’re communicating with others playing the same game all over the world,” Suraiya Rahman, MD (pictured right), assistant professor at Keck School of Medicine at University of Southern California, told a group of educators during a presentation at the AMA’s CHANGEMEDED conference in October. “They are coordinating, getting together and building plans. They’re able to adapt different characters, build environments and move in [them].”</p> <p> Dr. Rahman said students can reap the same benefits of massive multiplayer online role playing games by collaborating with their peers and educators in clinical learning environments.</p> <p> “You can create a game to mimic any kind of environment—the academic medical center, the community medical center, the VA center,” she said. Freed from the confines of an actual classroom, educators can use game theory to build environments for students to accomplish individualized goals, test their clinical knowledge and build competencies across care settings.</p> <p> Plus, gaming can appeal to some of the common traits of medical students and physicians. “Video games offer competitive environments, and medical students and physicians are type A. We love to win,” Dr. Rahman said. “We love being really good at something, learning something and getting better at it.” Games offer prime opportunities for self-directed learning.</p> <p> As gamers, she said medical students can test their skills and simultaneously have the freedom to fail and learn from their mistakes, which reinforces the concepts they need to master. Video games also offer unique opportunities for students to conduct risk-benefit analysis and follow tailored learning plans.</p> <p> <strong>3 med ed games students already use</strong></p> <p> Dr. Rahman noted three games that are already helping students master various skills in virtual medical settings:</p> <ul> <li> <strong>“</strong><a href="https://play.google.com/store/apps/details?id=com.medicaljoyworks.prognosis&hl=en" rel="nofollow" target="_blank"><strong>Prognosis</strong></a><strong><u>”</u></strong><strong>:</strong> “This [game] is similar to how we all teach and learn clinical diagnostic reasoning,” Dr. Rahman said. “Prognosis” provides clinical cases with pictorial representations of physical exams. Students can ask for labs and images for a simulated patient, and the game will generate them. This allows students to test their decision-making skills and assess their clinical knowledge in a risk-free virtual environment.<br /> <br /> “The game follows [the physician’s] trail of thinking. It creates that network of thinking that we’re used to,” Dr. Rahman said. “What better way to learn about patterns than to see [them] on screen and take that information in?”</li> </ul> <ul> <li> <strong><a href="http://www.kongregate.com/games/sage880/medical-school" rel="nofollow" target="_blank">“Medical School”:</a></strong> With this video game, premedical students can roam the virtual walls of a medical school, treat patients in clinical settings and order exams. “The game creates an environment where students can imagine they’re walking in and can ask the environment to do something for them .... It tries to simulate some of the work we do and the order [in which] we do it,” Dr. Rahman said.<br />  </li> <li> <strong>“</strong><a href="http://www.microbeinvader.com/" rel="nofollow" target="_blank"><strong>Microbe Invader</strong></a><strong><u>”</u></strong><strong>:</strong> This game lets students operate as busy clinicians in an understaffed virtual hospital. They can “diagnose patients by ordering lab tests and matching the symptoms and history to bacteria that fit the presentation,” according to the game’s official site.<br /> <br /> With a buzzing pager in tow, online characters can explore the hospital and choose from a variety of emoji-style <a href="http://www.microbeinvader.com/microbes/" rel="nofollow" target="_blank">microbes, antibiotics and characters</a> to help treat infectious diseases.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8b2c6209-ab6a-419c-9a94-ae556a745c87 Learning from patient death: One residency program’s solution http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_learning-patient-death-one-residency-programs-solution Wed, 27 Jan 2016 22:32:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/9beb2fa3-4615-4e81-99cf-154447076671.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/9beb2fa3-4615-4e81-99cf-154447076671.Large.jpg?1" style="float:right;margin:15px;" /></a>Patient deaths can trigger challenging emotions and care decisions, yet there are few programs that teach residents how to manage end-of-life care. That’s why one residency program decided to pilot a series of “patient death debriefing sessions” to help residents honestly reflect on patient deaths—and their efforts proved effective. Learn how this unique solution helped residents navigate tough experiences. </p> <p> A team of chief residents and educators introduced the “patient death debriefing sessions” to an inpatient medical oncology rotation at Memorial Sloan Kettering Cancer Center. These sessions led by attending physicians were designed as a “real-time, pragmatic” way to address “the emotional impact of patients’ deaths on residents during an oncology rotation,” according to a <a href="http://www.jgme.org/doi/abs/10.4300/JGME-D-14-00544.1" rel="nofollow" target="_blank">recent report</a> on the debriefing sessions, which was published in the <em>Journal of Graduate Medical Education.</em></p> <p> <strong>How the sessions were conducted</strong><br /> In this program, each attending physician was paired with four residents completing a four-week oncology rotation. The patient death debriefing sessions were conducted throughout the four-week rotation period.</p> <p> Within 24 to 48 hours of a patient’s death, attending physicians hosted discussions with residents for at least 10 minutes. While no formal training for the sessions was required, attending physicians were given a pocket card guide featuring key questions to discuss with residents during the sessions. </p> <p> If no patient deaths occurred, attending physicians were encouraged to hold sessions with residents every one to two weeks, according to the report.</p> <p> “The priority was to create a high-yield, easily integrated program that required minimal faculty and resident preparation and oversight,” authors of the report noted.</p> <p> <strong>Results: How talking about patient death helped residents</strong><br /> Questionnaires on the debriefing sessions were given to residents before and after their four-week rotations, with a 99 percent response rate.</p> <p> “Overall, residents found debriefing sessions helpful, educational and appreciated attending physician leadership,” the report said. “The number of debriefing sessions positively influenced residents’ perception of received support.”</p> <p> Residents also provided open-ended written responses about their experiences in the sessions. When asked to describe the most helpful aspect of having conversations about patient death, some residents wrote:</p> <ul> <li> ‘‘Explor[ing] the emotional aspects of a patient’s death instead of just the medical ones.’’</li> <li> ‘‘Hearing other residents’ reactions and getting instruction from attendings on how they deal with these issues.’’</li> </ul> <p> Residents also noted valuable lessons they gleaned from conversations. For instance, one resident wrote that he learned ‘‘Deaths affect attendings even into a long career.”</p> <p> Another resident remarked on a simple yet helpful lesson for physicians in any phase of their careers: “Grief after the death of a patient is normal ... not something we should be ashamed of … we can have some comfort knowing that we did the best we could.”</p> <p> “Patient death debriefing sessions improved residents’ perception of support and coping, which we believe is a critical first step to effectively dealing with emotional reactions,” authors of the report concluded. “Debriefing frequently and consistently on every patient death may foster a more open forum that normalizes sharing one’s emotions, which we believe is an important, potentially culture-changing aspect of the program.”</p> <p> Review the <a href="http://www.jgme.org/doi/abs/10.4300/JGME-D-14-00544.1" rel="nofollow" target="_blank">report</a> for additional observations about the sessions and the pocket card residents used to discuss questions about patient death during their sessions. Also, read <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00013.1" rel="nofollow" target="_blank">this honest reflection</a> from a first-year resident on the valuable lessons she has learned while grappling with patient death in training.</p> <p> <strong>For more residency program solutions, be sure to:</strong></p> <ul> <li>   Explore this new method one residency program devised to <a href="http://www.ama-assn.org/ama/ama-wire/post/tired-of-miserable-schedules-one-residency-programs-solution" target="_blank">get rid of miserable schedules</a>.</li> <li>   Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/one-residency-program-improved-documentation-reduced-stress" target="_blank">this residency program intervention</a> that improved documentation timeliness and decreased stress.</li> <li> Check out Stanford University School of Medicine’s <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">successful wellness program</a>, and learn why taking time for fun (and the occasional sailing lesson) can improve resiliency in training.</li> <li> Read about <a href="http://www.ama-assn.org/ama/ama-wire/post/making-consults-productive-residents-offer-solution" target="_blank">this resident-led solution</a> to help make consults more productive.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a4a9e69a-cfb4-46d9-bcba-2b07de7ecc71 How physician burnout compares to general working population http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-burnout-compares-general-working-population Wed, 27 Jan 2016 22:23:00 GMT <p> Over just three years, physicians reported a nearly 9 percent increase in burnout rates. But how does physician burnout compare to that of the general working population? A recent national study provides insights, including key findings on work-life balance. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/ba2f630c-72e9-425b-8ab1-c7455058539f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/ba2f630c-72e9-425b-8ab1-c7455058539f.Full.jpg?1" style="width:356px;height:580px;margin:15px;float:right;" /></a></p> <p> <strong>Physicians compared to the general working population</strong><br /> Physician burnout experts at the AMA and the Mayo Clinic conducted a survey of 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014,” according to a <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" rel="nofollow" target="_blank">study</a> recently published in <em>Mayo Clinic Proceedings.</em></p> <p> Compared with the general U.S. population, physicians in 2014:</p> <ul> <li> Were more likely to be married (82.9 percent for physicians versus 67.5 for the general U.S. working population). </li> <li> Worked a median of 10 hours more per week (50 hours versus 40 hours).</li> <li> Displayed higher rates of emotional exhaustion (43.2 percent versus 24.8 percent), depersonalization (23.0 percent versus 14.0 percent) and overall burnout (48.8 percent versus 28.4 percent).</li> <li> Reported lower satisfaction with work-life balance (36.0 percent of physicians reported being satisfied with their work-life balance, compared to 61.3 percent of the general U.S. working population).</li> </ul> <p> “It is notable that the increase in burnout and decrease in satisfaction with work-life balance in physicians over the last three years runs counter to trends in the general U.S. working population over the same interval,” study authors noted.</p> <p> <strong>Gap in work-life balance widens for physicians</strong><br /> Beyond increasing dissatisfaction among physicians, poor work-life balance weighs on physician spouses and families. This is especially true in <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">medical marriages</a> as more physicians continue to have children and juggle high-stakes priorities after training.</p> <p> In fact, satisfaction with work-life balance declined in physicians between 2011 and 2014 (from 48.5 percent to 40.9 percent).</p> <p> “Only 40.9 percent of the physicians felt that their work schedule left enough time for personal and family life, with 14.6 percent neutral and 44.5 percent disagreeing with this assertion,” the study said. Yet satisfaction with work-life balance for the general U.S. working population was slightly more favorable in 2014 than in 2011—up from 55.1 to 61.3 percent, according to the study.</p> <p> “These disparate trends have resulted in a further widening in the rates of burnout and satisfaction with work-life balance among physicians relative to the U.S. working population, even after adjustment for differences in hours worked, age, sex and relationship status,” the study authors noted.</p> <p> Burnout rates also are increasing across all specialties, underscoring the need for community-driven solutions that foster wellness among physicians and physicians in training.</p> <p> “Students start medical school with stronger mental health profiles than their peers,” said Christine Sinsky, MD, AMA vice president of professional satisfaction and an author of the study. “It is especially concerning, then, that through the course of medical school, residency and practice physicians come to experience much higher rates of emotional exhaustion and burnout.”</p> <p> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates" target="_blank">part one</a> of this post for additional observations on specialties with the highest burnout rates and a graphic that breaks down burnout rates across all specialties.</p> <p> <strong>Also, don’t miss these resources on burnout and physician families:</strong></p> <ul> <li>  Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">7 signs of burnout</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">how to prevent them</a> in your practice.</li> <li> Review these <a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" target="_blank">burnout busters</a> to increase physician satisfaction.</li> <li> Check out AMA Alliance <a href="http://www.amaalliance.org/site/news/physician-family-magazine/" rel="nofollow" target="_blank">publication</a> <em>Physician Family,</em> which offers advice for physicians balancing various aspects of their personal lives, careers and families.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">these 3 tips</a> for maintaining happiness in a medical marriage.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">these expert insights</a> to ensure you’re successfully partnering with your spouse.</li> <li> Learn more about <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">the benefits of a medical marriage</a> and why physicians often marry fellow physicians.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="http://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f34454bd-3f02-4869-a5a9-8c3336d2a35c Experts answer questions about best ways to treat LGBT patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_experts-answer-questions-ways-treat-lgbt-patients Tue, 26 Jan 2016 21:55:00 GMT <p> As a physician treating or preparing to treat lesbian, gay, bisexual and transgender (LGBT) patients, you may wonder whether you’re saying the right things or whether your practice environment is welcoming to patients of all sexual orientations. Find out how experts on LGBT care answered questions from your peers.</p> <p> Implementing ways to create a comfortable setting for patients of all sexual orientations, gender identities, gender expressions and sexual practices can help you provide more inclusive care for your patients. Recently, physicians had the opportunity to ask a panel of experts their most pressing questions about treating LGBT patients.</p> <p> Here are four questions physicians asked an expert panel from an education session at the 2015 AMA Interim Meeting in November:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>When patients ask if a practice provides LGBT care, what are some good responses for physicians who might not feel they have the right answer?</strong><br /> <br /> “The humility of acknowledging that you don’t know all of it is more valuable than knowing any ‘magic keywords,’” said Kimberly Acquaviva, PhD, associate dean for faculty affairs and associate professor at the George Washing University School of Nursing. “Then take your commitment to learn more” and educate your practice team. ”Most patients would rather hear ‘I don’t know but I’m willing to learn.”<br /> <br /> “If the inquiries are coming in initially, reach out to the resources in your state and make sure you’re getting the right education to support LGBT patients,” said Brigid Scarbrough, navigation services team leader at The Health Initiative. “Don’t quiz the patient,” learn what you need to know before you begin treating LBGT patients if you can.</p> <p style="margin-left:40px;"> The AMA LGBT Advisory Committee <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page?" target="_blank">Web page</a> offers plenty of resources to help physicians learn how to treat and develop better relationships with LGBT patients and links to several external resources as well.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Transgender individuals have gained a lot of positive PR in the past two years. Has this created a problem in education or caused people to think more about those patients than the wider LGBT group?</strong><br /> <br /> “I see it as a new challenge,” Acquaviva said, “and as someone who is part of the LGBT community, I see it as an obligation as a provider to continue to work with other providers and educators to say that just because we’re seeing inclusion around the LGB issue does not mean that we forget our trans brothers and sisters. Wherever there is that tension, that’s where we need to educate.”<br /> <br /> “I think that the positive PR and the regular PR that trans people are getting is getting more trans people coming out to seek care,” said Jason S. Schneider, MD, associate professor, division of general medicine and geriatrics at Emory University School of Medicine. I think it’s a call to action to the AMA and other to ensure that a variety of physicians and practices are ready to be welcoming.<br /> The incoming generation of physicians may not need the same kind of education in LGBT patient care, Dr. Schneider added. “From the educator perspective, the medical students that I teach … [understand the nuances of] sexual orientation and gender identity. They want to know things like ‘what hormone levels do I use for the trans woman I see?’”<br /> <br /> “They’re light years ahead on many issues,” he continued. “That’s always reassuring to me—I think the challenge for us in practice and medical education, is to meet the needs of our learners and not assume that they need as much teaching as the previous generation did.”</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Are there any specific health issues that should be the focus of LGBT patient care?</strong><br /> <br /> “Take comfort that the super majority of issues that your LGBT patients will have will be the exact same as other patients who walk through the door,” Scarbrough said. “Try placing an LGBT publication in the waiting room to let them know it is a welcoming environment.”</p> <p style="margin-left:40px;"> Panelists recommended that physicians consult the <a href="https://store.acponline.org/eBizATPRO/Default.aspx?TabId=203&ProductId=21572" target="_blank" rel="nofollow">Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health</a>, which addresses important issues facing patients and physicians, including caring for LGBT patients of different age groups, information on the development of gender identity in children, sexual health and HIV prevention.</p> <p style="margin-left:40px;"> Also, if your practice is treating LGBT patients, check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/practice-transgender-friendly-7-things-consider" target="_blank">seven things to consider</a> when making sure your practice is transgender friendly.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>What about elderly LGBT patients? Are there specific issues for these patients that physicians should consider?</strong><br /> <br /> “[Patients] who grew up in a time when being gay could get them fired, or they grew up in a time when they could go to jail or they could be beaten,” Acquaviva said, “may not ever feel comfortable coming out to you. That’s not a failure on your part as a clinician—that’s where they’re at.”</p> <p style="margin-left:40px;"> “Not everyone is going to come out to you,” she continued. “What you want to do is strive, particularly with the older patients, for creating a climate where they’re comfortable being who they are and disclosing the things they need to disclose to you to receive the care they need to receive.”</p> <p style="margin-left:40px;"> For example, Acquaviva said, when you have an elderly women who needs a family member to drive her home, don’t ask if her husband will be picking her up, but rather ask her which family member or friend will be driving her home. </p> <p> This education session was hosted by the AMA LGBT Advisory Committee. Visit the committee’s <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page?" target="_blank">Web page</a> for several <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources/create-lgbt-friendly-practice.page?" target="_blank">resources to help</a> physicians, residents and fellows, and students develop strategies, programs and policy to better care for LGBT patients. A <a href="https://www.dropbox.com/sh/9p14l7kafpth88v/AADX0vhvWHGOS4kHtwPVAd34a?oref=e&preview=LGBT_friendlyPractice_123115_.mp4" target="_blank" rel="nofollow">video of the event</a> is available for download from the AMA LGBT Advisory Committee.</p> <p align="right"> <em>By AMA Wire staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ceec3652-b79e-4428-b55a-88c8518b7a28 How one simple solution helped practices work more efficiently http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-simple-solution-helped-practices-work-efficiently Tue, 26 Jan 2016 21:50:00 GMT <p> Your team may find clear communication and care coordination difficult in a busy practice environment. Find out how a single 10-15 minute addition to the daily schedule helped two physician practices improve team culture, relationships and collaboration to deliver stronger patient care.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/6/64a582c1-387a-4d6b-a6e3-112ded6bd07f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/6/64a582c1-387a-4d6b-a6e3-112ded6bd07f.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> <strong>A simple idea to solve complex issues</strong></p> <p> A practice must be able to coordinate efforts among team members. That’s why Martin’s Point Healthcare in Bangor, Maine, began informal touch-base sessions, which started as quick conversations between a single clinician and his clinical support team to improve communication. Just 10 years later, those sessions have evolved into a 10-15 minute high-energy “huddle” at the beginning of each day, during which the practice team discusses the day’s plan.</p> <p> These huddles define “what we are doing today and how that is moving us closer to our goals,” said practice administrator Paula Eaton. “Every day is an opportunity to make improvements.”</p> <p> The huddle model at Martin’s Point Healthcare has met challenges over its decade-long lifespan. As a solution to several of these challenges, a meeting facilitator role was created to keep huddles on track by tabling and recording issues that needed longer discussions to be held in the already established team meetings. “Huddles are not really meetings,” Eaton said. “The team makes the plan, then off we go.”</p> <p> A <a href="https://www.stepsforward.org/modules/team-huddles" target="_blank" rel="nofollow">new module</a> from the AMA’s <a href="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward</a>™ collection can show you how to use brief daily huddles in your practice by establishing the routine, developing relationships and designating roles that help your team anticipate patient needs and prepare for changes so the day runs more smoothly.</p> <p> <strong>Keeping your plan on track throughout the day</strong></p> <p> A morning huddle can set the schedule for the rest of the day, but in every practice, situations can change in an instant. Clinica Family Health in Denver, Colo., has found that adding a touch-base after lunch helps their practice team come together a second time to coordinate efforts around any problems that arise and throw off the daily plan.</p> <p> Clinica also uses a portion of this time to reinforce data-driven quality improvement efforts. Team members gather at the data board to review performance data and discuss plans of attack for lagging indicators. Under this model, the entire team takes on responsibility for patient health, and Clinca has seen significant improvements in team culture and performance.</p> <p> “When the team comes together to plan care on a regular basis,” said Karen Funk, MD, vice president of clinical services and a practicing family physician at Clinica, “we become more high-functioning and efficient and accomplish so much more with our patients.”</p> <p> <strong>How can your practice improve coordination?</strong></p> <p> The AMA’s STEPS Forward collection offers several modules to enhance your practice team. Learn ways to focus on <a href="http://www.ama-assn.org/ama/ama-wire/post/strengthen-practices-team-culture" target="_blank">strengthening your practice’s team culture</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_blank">address electronic health record woes with team documentation</a> or <a href="http://www.ama-assn.org/ama/ama-wire/post/one-simple-way-streamline-office-visits-improving-care" target="_blank">streamline office visits while improving care</a>.</p> <p> You also can take some of your team members to the AMA-MGMA Collaborate in Practice Meeting, March 20-22 in Colorado Springs, to gather leadership techniques to help propel you and your practice team toward future success. Former U.S. Sen. Bill Bradley, D-N.J., and Richard Deem, AMA senior vice president of advocacy, will speak on leadership and the changing health care landscape. <a href="http://www.mgma.com/education/conferences/collaborate" target="_blank" rel="nofollow">Register online</a>, and receive a discount when you register two or more of your team members.</p> <p> More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:65698b32-72a0-4220-8021-89b36b6d4044 Residency interviews: How much your peers are really spending http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residency-interviews-much-peers-really-spending Mon, 25 Jan 2016 22:50:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/2/aafc30f1-a4c9-4668-b27c-2705b3c74166.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/2/aafc30f1-a4c9-4668-b27c-2705b3c74166.Full.jpg?1" style="margin:15px;width:432px;height:2556px;float:right;" /></a>You hear it all the time: Lodging and transportation for residency program interviews are expensive. But exactly how much are your peers spending on them? A national survey of more than 1,000 fourth-year medical students provides insights, including how much students spend on residency program interviews based on their desired specialties.</p> <p> <strong>A national perspective on applying to residency </strong></p> <p> “Our study is unique in that we describe the number of interviews and the costs associated with the interviews or with completing an away elective and compare those costs by specialty choice,” according to authors of a <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Going__Fourth__From_Medical_School___Fourth_Year.98756.aspx" rel="nofollow" target="_blank">recent study</a> capturing the various activities graduating medical students prioritize as they apply for residency. The study, which was published in <em>Academic Medicine </em>in October<em>, </em>used a sample size of 1,376 students from 20 schools.</p> <p> With such a large sample, study authors were able to examine the influence of career specialty choice, residency program preparation and other factors on the activities of graduating medical students. They also tallied the <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">total number of residency programs students applied to based on specialty</a> and collected data on how residency applications impacted students financially. Residency program interviews and electives were a major part of this analysis.</p> <p> <strong>How much do students pay for residency program interviews? </strong></p> <p> Based on survey data, the majority of students reported spending $1,000-$5,000 to interview for residency programs, according to the study. Yet, while 65.7 percent of students reported expenses within this range, the exact amount of money students spent on interviews varied based on specialty.</p> <p> For instance, “family medicine applicants spent significantly less than those applying to other primary care specialties,” according to the study. In fact, more than 50 percent of students applying to programs in family medicine only spent $1,000-$2,000 on program interviews. See right for a full breakdown of interview costs for students applying to different specialties.</p> <p> When comparing interview costs, study authors also noted these five key trends among residency program applicants:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>The average student traveled to 12.3 interviews</strong>. “On average, students applied to a mean of 36.4 residency programs and interviewed at approximately one-third of the programs to which they applied. The overall number of interviews for all specialties was similar except that radiology applicants interviewed at significantly more programs than applicants to any other specialty,” according to the study.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Students applying for residencies in “hard-to-obtain” specialties spend more time and money on their applications, which can increase interview costs. </strong>Only  8.6 percent of students spent more than $7,000 on residency interviews. “However, almost 20 percent of surgery applicants spent more than $7,000, and surgery applicants spent more than those applying to other specialties,” according to the study. </p> <p style="margin-left:40px;"> One potential explanation for this drastic gap in spending:  “[Students] applying for residencies perceived to be hard to obtain, such as surgical specialties, were more likely to view the fourth year as a time to maximize the likelihood of matching in their residency of choice,” the study authors noted. “In fact, surgery applicants applied to more residency programs, completed more away or auditions, and spent more money on the interview process than applicants in almost every other specialty.”</p> <p style="margin-left:40px;"> <strong>3. </strong><strong>Couples paid more. </strong>For those who participated in the couples match, “the cost to interview was significantly higher” than for those who did not participate as a couple match, according to the study. Only 8.9 percent of students in the survey participated in the couples match.</p> <p style="margin-left:40px;"> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-experience-match-couple" target="_blank">how this couple navigated the Match together</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/navigate-match-couple" target="_blank">their advice</a> for other students applying for residency with a partner.</p> <p style="margin-left:40px;"> <strong>4. </strong><strong>Some students view away electives as part of their interview strategy. </strong>Many students felt that pursing an away elective could help increase their chances of landing an interview in a competitive program or specialty.</p> <p style="margin-left:40px;"> For instance, in a separate study questionnaire on away electives, 72 percent agreed or strongly agreed  that the “primary reason” for choosing an away elective was to obtain an interview for residency, according to the study.</p> <p style="margin-left:40px;"> <strong>5. </strong><strong>Students wanted more time for interviews. </strong>“Flexibility remains an important issue for medical students. More than half of the respondents needed more time to interview, and approximately a quarter needed more time to decide on a career specialty,” the study authors noted.</p> <p> Read the <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Going__Fourth__From_Medical_School___Fourth_Year.98756.aspx" rel="nofollow" target="_blank">study</a> for additional observations about fourth-year students. The purpose of this study was to learn what graduating medical students considered the primary purposes of the fourth year of medical school, their approach to residency selection, and the challenges they faced in meeting their fourth-year goals.</p> <p> <strong>Tell us: </strong>If you’ve already applied for residency, how much did you spend on accommodations for your interviews and were there any tips you used to save money? Share your thoughts in the comments below or the AMA’s Medical Student<strong> </strong><a href="http://www.facebook.com/AMAmedstudents" rel="nofollow" target="_blank">Facebook page</a><strong>.</strong></p> <p> <strong>Want more tips for applying to residency? Check out these resources:</strong></p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/top-questions-ask-during-residency-program-interview" target="_blank">this must-have list</a> of questions the Association of American Medical Colleges recommends students ask program directors and residents during their residency program interviews.</li> <li> Get <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-ace-video-interviews-residency" target="_blank">six key tips</a> to help you excel on video interviews for residency.</li> <li> Learn how to write a competitive CV using <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">these six strategic steps</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty).</li> <li> Check out <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_blank">this essential checklist</a> for fourth-year students featuring key tasks and deadlines to prioritize as you apply for residency.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:05f2c023-9e71-449f-bf2c-163c8d0d5fe5 Solving America’s opioid crisis: Remember the patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_solving-americas-opioid-crisis-remember-patient Mon, 25 Jan 2016 21:43:00 GMT <p> Physicians, medical organizations and public health experts around the nation all have shared reasons why the opioid overdose epidemic must be top of mind in the medical world, and it comes down to one focus—the patient. A panel of experts recently gave recommendations that lead the way to making patient-focused pain management possible.</p> <p> <strong>Reducing the stigma of chronic pain</strong></p> <p> One important aspect of the efforts to combat the opioid epidemic is reducing stigma so that patients with chronic pain do not lose access to the care that they need.</p> <p> “What is our role as physicians in this current problem?” asked John A. Renner, MD, president of the American Academy of Addiction Psychiatry and professor of psychiatry at Boston University School of Medicine, speaking to physician leaders at the AMA State Legislative Strategy Conference earlier this month during a session on the opioid crisis.</p> <p> “This epidemic is not going to be contained until we change practice within medicine,” Dr. Renner said. “Medicine does not shrink from treating these chronic conditions.”</p> <p> There are many things that physicians can do now to begin those changes, he added. “Before prescribing opiates for either acute or chronic pain, the clinician must screen every patient for a history of substance use disorders and for co-occurring psychiatric disorders. A review of the PDMP should be part of every routine assessment.”</p> <p> “Recognize that patients with any history of alcoholism or substance use disorder are at higher risk for abuse, and they should be managed very carefully,” Dr. Renner said. “This means avoiding prescribing opiates if there are other medications that may be more effective, careful[ly] prescribing … opiates if that is necessary, [and] it means monitoring the patient carefully, to look at how the treatment is progressing.”</p> <p> However, this does not mean withholding opiates from patients with acute pain, he said.</p> <p> Dr. Renner cited a case where a patient with a history of addiction needed surgery. The surgeon gave the patient a four-day supply of opioids but also carefully monitored the patient during those four days and the time following to make sure the patient’s pain was managed sufficiently.</p> <p> “Sometimes prescribing [opioid-based] medication is the best way to prevent relapse,” Dr. Renner said. In other cases, “we need to work with primary care physicians as well as pain management specialists to develop alternatives for handling chronic pain without relying on opiates.”</p> <p> “There is a moral imperative to treat pain,” said Myra Christopher, the Kathleen M. Foley chair for pain and palliative care at the Center for Practical Bioethics. “Those who are in the healing professions have ethical and moral obligations to do so.”</p> <p> “That does not mean that there is a moral imperative, an ethical duty or obligation to prescribe opioids,” she added. “It means there is a moral imperative to address this issue [of chronic pain].” One solution, Christopher suggested, is to increase training in pain management.</p> <p> “If you ask any medical school applicant” why they want to go to medical school, “they will say ‘I want to alleviate, or I want to treat pain and suffering,’” Christopher said. “That notion is really the foundation of what it means to be a healing profession.” However, although comprehensive management for chronic pain is necessary for many patients, most physicians have inadequate training on this approach.</p> <p> <strong>Actions physicians can take to end the overdose crisis</strong></p> <p> In conjunction with patient-focused chronic pain management, physicians also need to be vigilant in taking steps to prevent overdose and treat patients who are living with substance use disorder.</p> <p> “Where do we start when there are 44 people dying from opioid-related overdoses every day?” said Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees, who also chairs the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">Task Force to Reduce Prescription Opioid Abuse</a>, during her opening remarks.</p> <p> “This public health crisis related to opioid misuse and heroin addiction results in nearly 30,000 deaths annually and challenges us as physicians to amplify our current efforts and actions,” Dr. Harris said. “We use the word ‘actions’ deliberately [because] we must take concrete actions that will help end this crisis.”</p> <p> The task force focuses on five recommendations for all physicians from “inside the profession,” Dr. Harris said. “These recommendations come from physicians who treat acute pain, chronic pain and patients who have substance use disorder. We must also look inwardly …. As physicians, we run toward the health crisis, not away from it.”</p> <p style="margin-left:.5in;"> <strong>Action No. 1:</strong> Physicians should “voluntarily register for and use [their] state prescription drug monitoring programs (PDMP),” Dr. Harris said.</p> <p style="margin-left:.5in;"> One example of a successful PDMP comes from the Ohio State Medical Association (OSMA). Also speaking on the panel with Christopher and Dr. Harris, Michael Bourn, DO, medical director of pain and palliative services at Doctor’s Hospital in Columbus, Ohio, described the success of his state’s PDMP for physician leaders.</p> <p style="margin-left:.5in;"> The Ohio Automated Rx Reporting System (OARRS) is a tool to track the dispensing and personal furnishing of controlled prescription drugs to patients. OARRS is designed to monitor this information for suspected abuse or diversion and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history to identify high-risk patients who could benefit from early intervention.</p> <p style="margin-left:.5in;"> In 2010 there were about 5,000 Ohio prescribers with a voluntary OARRS account, but that number has increased to over 36,000 presently and counting. Between 2007 and 2014 the number of OARRS reports requested increased 5,900 percent, signifying its expanded use throughout the state in just seven years. In that same seven year period, Ohio experienced an approximately 50 percent decrease in “doctor shoppers” throughout the state and saw a significant drop in the number of patients seeking multiple prescriptions.</p> <p style="margin-left:.5in;"> <strong>Action No. 2:</strong> “Focus on education,” Dr. Harris said. “Encourage yourselves and encourage your colleagues to ask themselves: When was the last time you took CME that was focused on opioid prescribing, to learn how to effectively use your state’s PDMP and to learn how to recognize the signs of abuse?”</p> <p style="margin-left:.5in;"> <strong>Actions Nos. 3 and 4:</strong> “The third and fourth recommendations have to do with the stigma of pain,” Dr. Harris said. It’s important to reduce the stigma that surrounds pain patients in order for those with chronic pain to receive the care and the prescriptions they need to live happier, healthier lives, Dr. Harris said. It is also important to reduce the stigma of substance use disorder and increase access to treatment so patients feel comfortable in seeking that treatment.</p> <p style="margin-left:.5in;"> <strong>Action No. 5:</strong> “Consider co-prescribing naloxone and support broad Good Samaritan protections,” Dr. Harris said. Last year access to naloxone—the life-saving medication that can reverse the effects of an opioid overdose by restoring breathing and preventing death—was increased substantially through new products and availability. “At the end of the day, remember what is most important—our patients.”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8f83ab5d-d74d-4b08-bda2-e5e436c7af9c Top 4 issues physicians will take to state legislatures in 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-4-issues-physicians-will-state-legislatures-2016 Fri, 22 Jan 2016 21:53:00 GMT <p> Throughout the year to come, physicians will see some key issues play out across all 50 states as medical associations and policymakers put forth new legislation and protect existing policy on critical components to the practice of medicine. Four issues weigh heavily at the top of the list.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/7/c5754be1-940e-4859-b756-f6772c5585e3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/7/c5754be1-940e-4859-b756-f6772c5585e3.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> Medical association leaders recently met in Tucson, Ariz., at the 2016 AMA State Legislative Strategy Conference to discuss the most imperative state legislative and regulatory priorities. Leading the 2016 agenda are these four issues:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Ensuring physician-led team-based care.</strong> Many state medical associations plan to strengthen care delivery through legislation that supports physician-led team-based care. The states will be considering AMA model state legislation that encourages flexible, innovative health care teams under a framework of physician leadership to achieve the “triple aim”—providing the highest quality of care at the lowest cost possible while improving patient outcomes.<br /> <br /> The AMA’s STEPS Forward™ collection offers several modules to help physician practices move toward team-based care. These physician-authored modules include instructions for <a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_blank">implementing team documentation</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/strengthen-practices-team-culture" target="_blank">strengthening team culture</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/practice-run-smoothly-effective-team-meetings" target="_blank">conducting effective team meetings</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/set-practice-team-up-successful-change" target="_blank">setting your practice up for successful change</a>.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Improving patient health.</strong> State and national medical specialty societies plan to expand efforts to advance legislation that will promote healthier communities.<br /> <br /> Last year, the assault on the patient-physician relationship continued in many statehouses with legislation that attempted to prescribe the content of information exchanged between physicians and their patients. In the year ahead, 11 state medical associations will promote legislation aimed at protecting the patient-physician relationship. Another big focus will be tobacco use and availability, with legislative efforts in 17 states.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Reducing prescription drug abuse and overdose.</strong> The opioid overdose epidemic has cast a spotlight on pharmaceutical and prescribing issues, drawing the interest of state policymakers and placing considerable focus on prescription drug misuse, diversion, overdose and death.<br /> <br /> 22 state medical associations and two national medical specialty societies plan to consider legislation on the use of prescription drug monitoring programs (PDMP), while 15 states will look to <a href="http://www.ama-assn.org/ama/ama-wire/post/new-naloxone-product-could-save-thousands-of-lives" target="_blank">expand access to naloxone</a> and other overdose and abuse prevention efforts.<br /> <br /> “America’s physicians must do a better job of using all available tools to help stop this epidemic,” Patrice A. Harris, <em>MD, chair-elect of the AMA Board of Trustees, </em><a href="http://www.ama-assn.org/ama/ama-wire/post/its-saving-lives-increasing-access-naloxone" target="_blank">recently wrote</a><em>.</em> “Among the powerful tools in our arsenal that we must regularly use are PDMPs, enhanced education and naloxone.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Managed care and payer issues.</strong> Hard work was done in 2015 to pass reforms and educate lawmakers on issues such as network adequacy, prior authorization, fair contracting and transparency of insurer practices. Expanded efforts and models bills from the AMA’s private payer campaign are intended to further chip away at these issues in the year to come.<br /> <br /> 18 state medical association and seven national medical specialty societies are expected to focus on network adequacy legislation. Additionally, 19 state medical associations plan to pursue legislative changes to prior authorization, which <a href="http://www.ama-assn.org/ama/ama-wire/post/5-tips-minimize-prior-authorization-delays" target="_blank">poses roadblocks to patient care</a>, delays much needed services and can stall the delivery of patients’ treatment.</p> <p> Other issues physicians will be taking to their state lawmakers this year include medical liability reform, Medicaid reform, and the legislative and regulatory environments for telemedicine and telehealth.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc.page?" target="_blank">AMA Advocacy Resource Center</a> will continue to provide relevant legislative support to state and national medical specialty societies to advance these priorities through model bills and state-specific activity. Watch for coverage on these important issues at <em>AMA Wire®.</em></p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bf59e75e-65b0-4daf-a7cc-5c3e935a840d Payment models that can help you better address patients’ needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_payment-models-can-better-address-patients-needs Fri, 22 Jan 2016 21:49:00 GMT <p> Physicians know there are many types of services that could help patients better manage their health conditions, but these services often aren’t paid for by Medicare and most health plans and can cause financial losses for the physician’s practice. Learn the types of alternative payment models (APM) that can give physicians the ability to offer new and improved services to their patients, thanks to new federal legislation supporting physician-focused payment models.</p> <p> <strong>New payment models in the changing health care environment</strong></p> <p> The Medicare Access and CHIP Reauthorization Act (MACRA)—the legislation which repealed the Sustainable Growth Rate formula in 2015—provides incentives and resources to develop APMs that would give physicians the resources and flexibility to deliver care in new and better ways. </p> <p> It’s important for physicians in every medical specialty to begin working now toward APMs that solve the specific barriers they face in the current payment system. To help them in this effort, the AMA worked with Harold Miller at the Center for Healthcare Quality and Payment Reform, who is a member of the new federal Physician-Focused Payment Model Technical Advisory Committee, to develop the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to Physician-Focused Alternative Payment Models</a>.”</p> <p> <strong>Seven payment models that address physician needs</strong></p> <p> No one approach to payment will work for every specialty, for every type of practice or for every type of patient. That’s why the guide describes seven different types of physician-focused APMs that address opportunities to improve care and help physicians overcome payment barriers. The common element of each APM is that they give practices greater resources and flexibility to improve the aspects of costs and quality that they can control or influence.</p> <p> <strong>Physician need: Ability to deliver a high-value service that isn’t currently paid for</strong></p> <p> New APMs that can address this physician need include:</p> <ul> <li style="margin-left:0.25in;"> <strong>Payment for a high-value service.</strong> In this APM, the physician could be paid for currently unbillable, high-value services—such as care management, discharge planning, and shared or educational decision-making processes with patients—if the physician commits to use these services to increase quality and avoid undesirable services, such as hospitalizations.</li> <li style="margin-left:0.25in;"> <strong>Warrantied payment for physician services.</strong> In this APM, the physician practice can be paid more to prevent problems and complications of treatment, rather than being paid more to treat problems after they have occurred as they are today. This is similar to what other industries do when they offer warranties on their products. </li> </ul> <p> <strong>Physician need: Ability to share payments with other physicians and other providers</strong></p> <p> New APMs that can address this physician need include:</p> <ul> <li style="margin-left:0.25in;"> <strong>Multi-physician bundled payment.</strong> In this APM, two or more physicians can share a single, “bundled” payment to enable them to work together to diagnose a patient’s condition or deliver a specific treatment in a coordinated way without concern about individual practice revenue.<br /> <br /> For example, a primary care practice and a psychiatry practice could jointly receive payment for coordinated care of patients with depression.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Physician-facility procedure bundle.</strong> In this APM, a physician could share in savings achieved in the cost of a hospitalization through more efficient scheduling of services, competitive purchasing of medical devices and supplies, and other care improvement and cost-saving efforts. </li> </ul> <p> <strong>Physician need: Flexibility to use lower-cost treatment options to improve outcomes without reducing profit margins</strong></p> <p> New APMs that can address this physician need include:</p> <ul> <li style="margin-left:0.25in;"> <strong>Condition-based payment for a physician’s services.</strong> In this APM, rather than basing the payment on the type of treatment the physician uses, payment is based on the extent of the patient’s needs. Under this model, physicians are no longer limited only to treatment options that can be billed under the current fee-for-service model.</li> <li style="margin-left:0.25in;"> <strong>Episode payment for a procedure.</strong> In this APM, physicians receive a single payment for an “episode of care,” which is defined as all of the care provided during and after a particular procedure or treatment. Physicians would have the flexibility to redesign and better coordinate all of the services during the episode to improve outcomes and efficiency—and could benefit financially if they can eliminate unnecessary spending.<br /> <br /> For example, for a patient receiving surgery, the episode payment would encompass not only the procedure, but the rehabilitation services and treatment of any post-operative complications.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Condition-based payment for all services related to a condition.</strong> In this APM, physicians receive a single payment for all of the care needed to manage a particular health condition or combination of conditions during a particular period of time.<br /> <br /> In addition to the kind of flexibility in the episode payment to redesign care for a particular treatment, the condition-based payment would give the physician the flexibility to use completely different procedures or treatments if they will achieve better outcomes at lower cost. </li> </ul> <p> <strong>How physicians are leading the way in payment reform</strong></p> <p> Just because a payment model is different doesn’t mean it’s better. Many physicians have experienced problems with payer-designed “reforms” that are more focused on reducing spending or shifting risk than improving patient care.<br /> <br /> Physicians are voicing their need for properly-designed alternative payment models that are patient-focused and physician-friendly. More than 100 state and specialty medical associations recently joined the AMA in sending a <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/macra-sign-on-letter-16nov2015.pdf" target="_blank">letter</a> (log in) recommending <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> that the Center for Medicare and Medicaid Services (CMS) should follow in implementing the MACRA, including principles as to how way APMs should be developed and implemented.</p> <p> In order to help accelerate efforts to develop physician-designed APMs in all specialties, the AMA also compiled a step-by-step process that medical specialties can use to develop successful payment models for their physicians. Visit the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Medicare alternative payment models Web page</a> to read more.</p> <p> <strong>Further reading:</strong> Also from the “Guide to physician-focused alternative payment models” are the <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">two most common barriers in current payment systems</a> and the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-traits-of-successful-payment-models" target="_blank">three characteristics that a payment model must have</a> to be successful.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:15b1adfb-f06c-4f4e-bde1-92ba0c939b6a How to prevent diabetes from sneaking up on your patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_prevent-diabetes-sneaking-up-patients Thu, 21 Jan 2016 14:30:00 GMT <p> <em>An </em><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" target="_blank"><em>AMA Viewpoints</em></a><em> post by AMA Board Chair </em><em><a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members/stephen-permut.page" target="_blank">Stephen R. Permut, MD</a></em></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/12/5ea6594e-8fa9-405d-8c39-7810abc3228a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/12/5ea6594e-8fa9-405d-8c39-7810abc3228a.Large.jpg?1" style="margin:15px;float:left;" /></a>A major health threat has been silently taking hold of 86 million Americans, with 90 percent of them unaware of it. A new public health campaign is about to change that—and you’re the key to helping these patients take their health back.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/5e35678e-9b77-40b7-814d-a5b24db764cc.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/5e35678e-9b77-40b7-814d-a5b24db764cc.Full.jpg?1" style="margin:15px;float:right;height:1705px;width:275px;" /></a></p> <p> <strong>A campaign to prevent type 2 diabetes </strong></p> <p> If you’re not already talking to your patients about prediabetes and the risks associated with it, it’s time to start. People with prediabetes—more than 1 in 3 adults—are at higher risk of developing serious health problems such as type 2 diabetes, heart disease and stroke. But the earlier patients know that they have prediabetes and start taking steps to address it, the better their chances of preventing type 2 diabetes and associated complications.</p> <p> That’s why the AMA has partnered with the Centers for Disease Control and Prevention (CDC), the American Diabetes Association and the Ad Council in a highly visible public service ad campaign that clearly delivers an important message: Everyone needs to know whether they have prediabetes or not.</p> <p> The campaign is just getting underway today, and people will begin encountering these ads on their daily commutes, as they watch their favorite TV programs, listen to the radio and go online. Using humor, the ads get people’s attention that there’s no excuse not to find out their prediabetes risk, which they can do through a simple risk assessment at <a href="http://www.doihaveprediabetes.org/" rel="nofollow" target="_blank">DoIHavePrediabetes.org</a>.</p> <p> <strong>What you need to know (before your patients start asking)</strong></p> <p> You’ll probably start getting questions from your patients who have encountered the ads and may even have taken the online risk assessment. Here are key points to remember:</p> <ul> <li> <strong>Prediabetes.</strong> This is a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.<br />  </li> <li> <strong>Prevalence.</strong> More than one-third of the U.S. adult population has prediabetes. Prediabetes is more common in older individuals, affecting more than 50 percent of people older than 65 years.<br />  </li> <li> <strong>Disease risk.</strong> People with prediabetes are at high risk of developing type 2 diabetes: As many as 70 percent of people with prediabetes could develop type 2 diabetes during their lifetime. They also have a 20 percent increased risk of developing cardiovascular disease compared to individuals with normal glucose metabolism.<br />  </li> <li> <strong>Prevention. </strong>A diagnosis of prediabetes doesn’t mean that a patient is destined to develop type 2 diabetes. Taking steps such as losing weight and increasing physical activity can completely prevent or at least delay the onset of type 2 diabetes.</li> </ul> <p> One of the best, evidence-based ways to reduce diabetes risk is to participate in a CDC-recognized diabetes prevention program. Such programs emphasize healthy eating and increased physical activity, and they can reduce the risk of developing diabetes by more than one-half.</p> <p> <strong>What you can do</strong></p> <p> You may have patients in the coming weeks and months who have seen the new ads and are anxious to talk about prediabetes. Even if they haven’t seen the ads, your patients need to hear from you about this health condition. What do you need to do, and how do you incorporate new steps into your busy practice?</p> <p> There’s an easy way to remember, and it comes with practical resources for your practice: <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" target="_blank">Prevent Diabetes STAT: Screen, Test, Act—Today™</a>. This joint initiative of the AMA and the CDC outlines three important steps:</p> <ol> <li> Screen patients for prediabetes using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test</li> <li> Test for prediabetes using one of three blood tests</li> <li> Act by referring patients with prediabetes to a nearby <a href="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx" rel="nofollow" target="_blank">diabetes prevention program</a></li> </ol> <p> As a family physician, I know that adding one more thing to an already heavy workload can be an overwhelming prospect. But this initiative provides the <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html" target="_blank">resources you need</a> to easily incorporate these steps into your practice.</p> <p> Depending on what makes the most sense for your practice, there are two different options for how your practice team can identify patients with prediabetes and refer them to the prevention program they need. Members of your practice team can either screen and test patients at the point of care, or they can do so retrospectively by generating a registry of at-risk patients via your electronic health record system.</p> <p> The <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html" target="_blank">Prevent Diabetes STAT toolkit</a> offers everything you need for either approach, including:</p> <ul> <li> Patient handouts</li> <li> Risk assessments</li> <li> Prediabetes identification algorithm and patient flow process for engaging patients at the point of care</li> <li> Retrospective diabetes identification algorithm</li> <li> Sample patient letters and phone scripts</li> </ul> <p> If you want to learn even more about prediabetes and what you can do, the AMA provides a <a href="https://www.stepsforward.org/modules/prevent-type-2-diabetes" rel="nofollow" target="_blank">free module</a> in its STEPS Forward™ collection that is approved for <em>AMA PRA Category 1 Credit</em> ™. We also offer a more extensive <a href="https://cme.ama-assn.org/Activity/2741078/Detail.aspx" target="_blank">performance improvement continuing medical education activity</a> that is also approved by the American Board of Family Medicine for Maintenance of Certification for Family Physicians Part IV credit.</p> <p> <strong>Why we need to act now</strong></p> <p> Having practiced family medicine in the inner city for decades, I’m all too familiar with the devastating effects diabetes can have on patients and their families. No doubt you’ve seen these effects among your patients too.</p> <p> Without taking action now to address prediabetes, it’s estimated that the typical primary care physician could see up to a 50 percent increase in type 2 diabetes among his or her patients over the next five years. That’s a trend we can and must stop—and to do so, we must act now.</p> <p> Let’s address prediabetes today to make sure our patients have a healthier tomorrow.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3659d0cd-ca9e-4847-98ea-2f91c21e41c3 Why the patient-physician relationship is central for medicine http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_patient-physician-relationship-central-medicine Wed, 20 Jan 2016 20:36:00 GMT <p> “We desperately need physicians to feel happy in what they do,” said Abraham Verghese, MD, senior associate chair of the Department of Internal Medicine at the Stanford University School of Medicine and <em>New York Times</em> bestselling author. Dr. Verghese sat down earlier this month with AMA President Steven J. Stack, MD, to discuss the current state of medical education, the ritual of the physical exam, overtesting and what it means to be a physician who writes fiction.</p> <p> <strong>How future physicians are educated</strong></p> <p> Dr. Verghese is an internist but also specializes in infectious disease and pulmonary medicine. He is very involved in medical education at Stanford University School of Medicine, where he runs the student clerkship. He has written several books, one of which, <em>Cutting for Stone</em>, was on the <em>New York Times </em>bestseller list for well over two years.</p> <p> <strong>Dr. Stack:</strong> “Do you see changes over the course of your career in the way medical students are educated and how that impacts our incoming physicians?”</p> <p> <strong>Dr. Verghese:</strong> “There have been some striking changes. For one thing, the model that you probably trained under and certainly I trained under—an intense focus on the patient and the bedside and rounds going from bed to bed—I think it’s been sort of kidnapped in a sense by the workstation.”</p> <p> “One of the great disappointments students have when they come on the wards is … in the first two years they’re learning physical diagnosis, and they’re so excited to learn how to read the body as a text. And they arrive on the wards, and their moment of awakening, almost disillusionment, is to find that the currency on the wards does not revolve around the patient. It revolves much more around the computer. For many of them, it’s a moment of crisis. I think it actually leads many of them away from primary care, which is not a good trend.”</p> <p> <object align="right" data="http://www.youtube.com/v/oN58wTxE3j4" height="315" hspace="10" id="ltVideoYouTube" src="http://www.youtube.com/v/oN58wTxE3j4" type="application/x-shockwave-flash" vspace="10" width="560"><param name="movie" value="http://www.youtube.com/v/oN58wTxE3j4" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="315" hspace="10" quality="best" src="http://www.youtube.com/v/oN58wTxE3j4" type="application/x-shockwave-flash" vspace="10" width="560" wmode="transparent"></embed></object></p> <div> <p> Learn how the AMA is collaborating with med schools throughout the country to <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">accelerate change in medical education</a> by creating a system that trains physicians to meet the needs of today's patients and to anticipate future changes.</p> <p> <strong>The ritual of the physical exam</strong></p> <p> Dr. Stack pointed to the conflicting aspects of the current practice environment. Citing his own specialty of emergency medicine, he pointed to the fast-paced nature of interactions with patients and the need to focus on information. At the same time, it’s important to still try to “connect in a very human way with patients.”</p> <p> <strong>Dr. Stack:</strong> “As an emergency physician, … I use human touch as an important part of what I do. I would not pretend to be as thorough as an internist, but I certainly use communication and human touch to establish a rapport and build that trust, which I think is unique to the patient-physician bond and therapeutic relationship. How has the physical exam become so important to you?”</p> <p> <strong>Dr. Verghese:</strong> “When you examine a patient after listening to them, you’re inevitably participating in a very important ritual. First, it’s a very unequal relationship. You’re a physician with your diplomas on the wall, and a stranger is coming to you.”</p> <p> “Even though we might have the illusion that this is a simple business transaction—an exchange in fact (I think that many of the hospital administrators tend to view it as that)—it’s actually much more loaded and complex. You’re wearing a white, shamanistic outfit with special tools in your pocket. The patient is in a paper gown. They’re expecting something to happen.”</p> <p> “In society we’re conditioned for rituals all the time. There’s a ritual when you go to church or the synagogue or mosque. A ritual when you graduate, when you marry, when you baptize. [The physical exam] has all the trappings of ritual, and I think to that degree that we shortchange it. We shortchange the product of a ritual. Rituals are about transformation. The result of the ritual of the exam, I think, is the sealing of the patient-physician bond.”</p> <strong><object align="left" data="http://www.youtube.com/v/ClJZfdkUDrk" height="315" hspace="10" id="ltVideoYouTube" src="http://www.youtube.com/v/ClJZfdkUDrk" type="application/x-shockwave-flash" vspace="10" width="560"><param name="movie" value="http://www.youtube.com/v/ClJZfdkUDrk" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="315" hspace="10" quality="best" src="http://www.youtube.com/v/ClJZfdkUDrk" type="application/x-shockwave-flash" vspace="10" width="560" wmode="transparent"></embed></object></strong> <p> <strong>Patient and physician satisfaction</strong></p> <p> What’s the flip side of performing the ritual of the physical exam for physicians and patients?</p> <p> <strong>Dr. Verghese:</strong> “There’s also the very important thing of patient satisfaction. That is clearly affected by the absence of a physician’s touch. Another thing that’s very important is that physician satisfaction is clearly tied to being connected with the patient. For most of us, that’s why we came to medicine. We didn’t come to sit in front of a screen.”</p> <p> <strong>Dr. Stack:</strong> “I describe it simply as finding out what makes doctors happy and sad. I think patients should be reassured and physicians should feel good to know that, overwhelmingly, the leading finding [of a 2013 <a href="http://www.rand.org/pubs/research_reports/RR439.html" rel="nofollow">study</a> by the AMA and the RAND Corporation] was that physicians are most fulfilled professionally when they feel they did good work at the end of the day to help their patients lead healthier, happier lives and were supported in that work by the health system, rather than interfered with and obstructed in that work.”</p> <p> “I think it’s a modern-day, research-based affirmation of the Hippocratic Oath, at least one facet of it: Putting your patients’ needs ahead of your own.”</p> <p> “Though [many technologies] have promise to make care available to more people, [they] are real challenges to the human connection. With technology causing distance between a physician and a patient, how can we, as physicians, keep the balance?”</p> <p> <strong>Dr. Verghese:</strong> “Remember the times when we had to go hunt the paper chart all over the hospital? I’m not in any way looking to go back, but I think that when we try to codify the encounter into being some sort of factory line, we are actually making more errors.”</p> <p> “If we were to invest more time in listening to the patient, if we were to invest more time in training people to examine the patient well and make good sense of that information, I think the downstream effect would be that we would be ordering less tests, ordering fewer consults.”</p> <p> <strong>Interested in additional insights?</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-bestseller-discusses-consequences-of-tech-exam-room" target="_blank">what Dr. Verghese said to physician leaders</a> at the AMA State Legislative Strategy Conference earlier this month regarding technology, the future of medicine and the ritual of the physical examination.</li> <li> Learn more about this and other conversations around developing #AHealthierNation via <a href="https://twitter.com/search?q=%23AHealthierNation&src=typd" rel="nofollow" target="_blank">Twitter</a> and <a href="https://www.facebook.com/search/top/?q=%23AHealthierNation" rel="nofollow" target="_blank">Facebook</a>.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7f471e4e-7d19-4535-a06c-eb95388dabaa 6 key aspects residents need for well-being http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-key-aspects-residents-need-well-being Wed, 20 Jan 2016 20:27:00 GMT <p> What’s just as important to the wellness of physician trainees as a supportive work environment? According to a new expert-authored solution for preventing resident and fellow burnout, tools to develop personal well-being also should be an essential part of residency programs. Learn the six key aspects for resident and fellow well-being and some of the tools programs should provide to help their trainees thrive.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/6/42124a0b-b9a4-406a-86cf-34515c362386.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/6/42124a0b-b9a4-406a-86cf-34515c362386.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> <strong>A multifaceted concept</strong></p> <p> Wellness is more than the absence of physical ailments. For physicians in training who have a multitude of pressures and responsibilities bearing down on them, it’s important to be mindful of the various components that contribute to overall well-being.</p> <p> A new <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">online module</a> in the AMA’s STEPS Forward™ collection explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs. To foster true personal wellness, residents’ needs must be met in these key areas:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Nutrition.</strong> Despite hectic and often irregular schedules, residents need healthful food options and scheduled time to eat. Physician authors of the STEPS Forward module suggest that once residency programs have formed a wellness team, a focus point for the team should be ensuring that residents have nutritious food available while they are on the job.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Fitness.</strong> Staying physically active is an important key to supporting good health, but it can be tough to do with all the demands placed on residents’ time. The module recommends that training programs should make sure residents have free access to a gym that is located in or near the medical center to remove some of the barriers to staying fit.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Emotional health. </strong>Residency programs should support wellness tactics that residents can apply on an individual level, including identifying personal and professional conflicts, nurturing relationships, and practicing mindfulness-based stress-reduction techniques. The module advises that the wellness team should encourage trainees and empower them to seek and offer help as needed. Another suggestion is to develop a physician support group for trainees and faculty members.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Preventive care.</strong> As a medical professional, you know the importance of preventive care for keeping patients healthy. But do you take the time to make sure you’re getting the well care you need, such as keeping regular appointments with your primary care physician and dentist? The module recommends that program leadership commit to giving trainees an occasional weekday afternoon off for personal meetings or their own doctor appointments.</p> <p style="margin-left:40px;"> <strong>5.   </strong><strong>Financial health.</strong> As a resident, you most likely have a limited income, massive med school debt and maybe even a growing family to support. Making sure that you’re financially secure in your day-to-day activities and prepared for unexpected events is an important part of maintaining peace of mind and ensuring future wellness. The module suggests that one way residency programs can help trainees with financial health is to bring in a financial counselor for informal discussions with interested residents.</p> <p style="margin-left:40px;"> <strong>6.   </strong><strong>Mindset and behavior adaptability.</strong> Understanding <em>how</em> to thrive in your environment is essential. The module advises that residency programs help their trainees learn techniques to adapt their daily routine around factors that are outside of their control, such as their work schedules.</p> <p> <strong>Make wellness at your program a priority</strong></p> <p> If your training program doesn’t have a successful wellness program in place, the AMA STEPS Forward <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">module</a> offers five concrete steps to create a wellness culture for residents and fellows. It also provides wellness <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">assessment tools</a>, <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">case studies</a> of successful wellness programs for trainees and suggestions for wellness activities.</p> <p> <strong>Additional resources to help boost your personal well-being</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/want-eat-healthy-budget-5-student-friendly-tips" target="_blank">five tips for eating healthy on a budget</a>, offered by a medical trainee and registered dietician.</li> <li> Access a variety of <a href="http://www.ama-assn.org/ama/ama-wire/blog/Financial_Issues/1" target="_blank">expert financial advice</a> for physicians, from managing medical school debt to planning for retirement.</li> <li> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">ways residents have found to conquer burnout</a>.</li> <li> Discover <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">three key tips for physicians in medical marriages</a> to strengthen your connection with your partner as your career and relationship progress.</li> </ul> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1a25ae95-8974-476d-b549-53e554c5d5a9 CPT® Link: The next generation of procedural health coding http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cpt-next-generation-of-procedural-health-coding Wed, 20 Jan 2016 15:00:00 GMT <p> Supercharge your coding and reach more informed clinical, financial and operational decisions with <a href="http://msgraphicsandweb.com/clients/AMA-CPTLink-Microsite/cpt-link-contactus.html" target="_blank" rel="nofollow">CPT® Link</a>.</p> <p> Designed to take high-quality medical and administrative procedural health coding to a higher level, CPT® Link is a structured platform that provides three annual updates including a machine-readable list of CPT® interim changes. This software enables:</p> <ul> <li style="margin-left:0.25in;"> Coordination between disparate clinical and administrative health data</li> <li style="margin-left:0.25in;"> More accurate, transparent and efficient claims payments</li> <li style="margin-left:0.25in;"> Accurate claim processing, adjudication and payment</li> <li style="margin-left:0.25in;"> In-depth analytics with actionable insights</li> </ul> <p> To learn more, read the <a href="http://msgraphicsandweb.com/clients/AMA-CPTLink-Microsite/cpt-link-overview.pdf" target="_blank" rel="nofollow">CPT® Link overview</a> or <a href="http://msgraphicsandweb.com/clients/AMA-CPTLink-Microsite/cpt-link-contactus.html" target="_blank" rel="nofollow">request more information</a>. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f4f5eac3-c8c3-45a7-ad0f-58aea6506995 Ace one of the most missed USMLE questions (here’s the answer) http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ace-one-of-missed-usmle-questions-heres-answer Wed, 20 Jan 2016 00:00:00 GMT <p> As the new year gets underway and you’re looking ahead to the next milestone in your training, take a few minutes to sharpen your skills for the United States Medical Licensing Examination® (USMLE®) with this exclusive scoop on one of the most challenging USMLE test prep questions and expert strategies to help you ace it. Find out what this month’s toughest question is and receive an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to the fifth post in <em>AMA Wire’s</em>® series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Step 1 Qbank.” Each month, we’re revealing one of the top questions students miss, a helpful analysis of answers and a video featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_blank">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 23-year-old woman comes to the physician because she has never had a menstrual period. Physical examination shows absent pubic and axillary hair, small breasts and no palpable uterus. Karyotypic results show 46,XY. Surgical resection of gonadal structures is performed. Examination of tissue obtained shows seminiferous tubules with normal Leydig cells. A loss-of-function mutation of the androgen receptor (AR) gene is found. Which of the following sets of laboratory findings in serum was most likely in this patient prior to surgery?<object align="right" data="http://www.youtube.com/v/YwdCvh0_B2Q" height="350" hspace="5" id="ltVideoYouTube" src="http://www.youtube.com/v/YwdCvh0_B2Q" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="http://www.youtube.com/v/YwdCvh0_B2Q" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="5" quality="best" src="http://www.youtube.com/v/YwdCvh0_B2Q" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></p> <p style="margin-left:40px;"> A.  High testosterone; high LH</p> <p style="margin-left:40px;"> B.  High testosterone; low LH</p> <p style="margin-left:40px;"> C.  Low testosterone; high LH</p> <p style="margin-left:40px;"> D.  Low testosterone; low LH</p> <p style="margin-left:40px;"> E.  Normal testosterone; normal LH</p> <p> <strong>The correct answer is A.</strong></p> <p> <strong>Kaplan says, here’s why: </strong>DNA analysis shows that this patient is a genotypic male with an abnormality of the androgen receptor molecule; the patient has complete androgen insensitivity syndrome.</p> <p> The androgen receptor molecule normally combines with testosterone inside the cell. The complex then binds with chromatin, resulting in the synthesis of messenger RNA. Because the target tissues contain defective androgen receptor protein, they are unable to respond to testosterone. Androgen insensitivity during the fetal period means that male sexual development is impaired and female external genitalia are formed.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with future studying.</em></p> <p> <strong>Choice B:</strong> High testosterone and low luteinizing hormone (LH) would not be expected in androgen insensitivity syndrome. Cells of the pituitary and hypothalamus also contain the androgen receptor protein. Feedback suppression of LH secretion occurs when the molecular complex is present in the hypothalamus and pituitary.</p> <p> <strong>Choice C:</strong> Testosterone is low and LH is high in primary hypogonadism due to defective gonadal steroid synthesis. The reduced testosterone results in feedback elevation of LH secretion by the pituitary.</p> <p> <strong>Choice D:</strong> Low LH, resulting in depressed levels of testosterone secretion, is characteristic of a defect in hypothalamic or pituitary function (hypogonadotrophic hypogonadism).</p> <p> <strong>Choice E: </strong>Because the androgen receptor in hypothalamic and pituitary tissue is also defective, normal testosterone suppression of pituitary gonadotropins, such as LH, is absent. As a result, serum levels of gonadotropins are elevated, resulting in increased production of testosterone by Leydig cells.</p> <p> <strong>Tip to remember</strong></p> <p> Testosterone and LH levels can help distinguish between different causes of abnormal sexual development:</p> <ul> <li> High testosterone and high LH: defective androgen receptor (androgen insensitivity syndrome)</li> <li> High testosterone and low LH: testosterone-secreting tumor</li> <li> Low testosterone and high LH: primary hypogonadism</li> <li> Low testosterone and low LH: hypogonadotrophic hypogonadism </li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:85372c20-41b2-43a3-b4df-a3fd2a2a78a5 Why one health insurer is embracing telemedicine http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-health-insurer-embracing-telemedicine Tue, 19 Jan 2016 21:28:00 GMT <p> As health technology continues to advance, the evidence base for telemedicine is growing ever stronger. Although many physicians are already putting telemedicine to good use, one major health insurer recently explained why it is embracing telemedicine. Learn some of the compelling reasons more insurers may pay for this form of care delivery.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/651e4013-01a6-430d-8ee1-0462088260bc.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/651e4013-01a6-430d-8ee1-0462088260bc.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Physicians gladly accept new technology, “but only on one condition,” said John F. Jesser, vice president of provider engagement strategy at Anthem, “it needs to work. It needs to provide some value [to their practice].”</p> <p> At the 2016 AMA State Legislative Strategy Conference in Tucson earlier this month, Jesser spoke with physician leaders about why Anthem is embracing telemedicine as a technology that complements physical practice space and in-person interactions, rather than replacing them.</p> <ul> <li style="margin-left:0.25in;"> <strong>Accessibility for minor issues.</strong> Some patients live far from their primary care physician’s office and often have minor issues that may not require a physical exam. Physicians can do their existing patients and themselves “a big favor by seeing [patients] via telehealth, rather than having [them] spend two hours each way on the highway,” Jesser said.</li> <li style="margin-left:0.25in;"> <strong>Accommodating mobility issues.</strong> Elderly patients or patients with disabilities may have trouble driving, walking to the office or even finding transportation for an appointment. If these appointments are follow-ups and don’t require an in-person physical exam, “you [can avoid making] that patient come in,” he said. </li> <li style="margin-left:0.25in;"> <strong>Extended hours.</strong> Telemedicine also creates opportunities for after-hours care. “Right now we have doctors with 25-30 state licenses,” he said, “so that a handful of doctors can provide round-the-clock service for when those primary care doctors need to go to bed.”</li> <li style="margin-left:0.25in;"> <strong>Expanding practice without building.</strong> Physicians never want to turn away patients, but with limited practice space, this sometimes means asking a patient to wait three or more days for an appointment. “Rather than build [another] exam room in their practice,” Jesser said, “[physicians] could add … another physician and expand their practice without building more brick and mortar.”</li> </ul> <p> But what does all of this mean for the future of physician practices? And what will practices that participate in telemedicine look like?</p> <p> “We never want to underestimate the physical exam,” Jesser said. “It is critical. There will always be an office or a physical exam room. There will always be a hospital.”</p> <p> “Patients will look for practices in the same way they look for doctors today,” he said. “They may want a female doctor or someone who speaks Spanish, but they are beginning to add the question, ‘Can I access this doctor on my phone?’”</p> <p> <strong>Physicians must lead the way down the path to telemedicine</strong></p> <p> The implementation and regulation of telemedicine must be led by doctors, said Pat Basu, MD, chief medical officer of Doctor On Demand, who also spoke to physician leaders during the session. “We have an opportunity to be a part of the solution—if not <em>the</em> solution.”</p> <p> The physician voice is the most important in completing the development of telemedicine in a way that works with practices and not against them. It is important that physicians to continue in leadership roles as telemedicine further develops, or this rapidly evolving area of medicine could easily be driven by those who don’t fully understand the practical application of telemedicine in physician practices.</p> <p> Interest in telemedicine is high among physicians. Doctor on Demand has more than 10,000 physicians who already have signed up to participate, Dr. Basu reported. “If we move the needle forward and doctors are the ones doing it—that makes me thrilled.”</p> <p> Both Dr. Basu and Jesser agreed on the next steps for regulating telemedicine. Keeping telemedicine regulation and legislation simple will be important so that physicians are free to exercise their clinical judgement. And making sure that regulation and legislation treat online appointments similar to in-office visits will ensure proper payment for physicians and open this emerging technology in a more efficient way to both patients and physician practices.</p> <p> <strong>What is being done to move telemedicine forward—in the right way</strong></p> <p> Physicians are attentively following the progress of telemedicine and taking action to shape it in a way that benefits not only their practices but also, and more importantly, the patients they treat.</p> <ul> <li style="margin-left:0.25in;"> With laws in place enforcing coverage for telemedicine services in more than one-half of the country, explore the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-physicians-prepping-telemedicines-success" target="_blank">ways physicians are prepping for its success</a>. </li> <li style="margin-left:0.25in;"> Released in 2014, <a href="https://download.ama-assn.org/resources/doc/arc/x-ama/telemedicine-model-bill.pdf" target="_blank">AMA model state legislation</a> (log in) provides guidance on licensure, payment and practice issues.</li> <li style="margin-left:0.25in;"> At its 2014 Annual Meeting, the AMA released the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-telemedicine-bolster-care-delivery" target="_blank">principles of coverage and payment for telemedicine</a> to shape essential elements of telemedicine to ensure patients receive the best possible care.</li> <li style="margin-left:0.25in;"> It can be difficult to decipher the differences between telemedicine, telehealth and mHealth. Learn how the <a href="http://www.ama-assn.org/ama/ama-wire/post/definitions-of-digital-health-differ" target="_blank">definitions of digital health differ</a><em>.</em></li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:789dbadd-7738-44da-b01b-0f809871530d Specialties with the highest burnout rates http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_specialties-highest-burnout-rates Fri, 15 Jan 2016 20:29:00 GMT <p> Work-related burnout is a pervasive problem among physicians—and it’s worsening across all specialties, according to a recent national study. Learn how burnout has increased in just three years and which specialties reported the highest rates of burnout. Where does yours fall on the list?<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/10/07b317e6-3d65-4414-aa41-c648811caca8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/10/07b317e6-3d65-4414-aa41-c648811caca8.Full.jpg?1" style="width:358px;height:809px;margin:15px;float:right;" /></a></p> <p> <strong>The rise of burnout in medicine </strong></p> <p> Physician burnout experts at the AMA and the Mayo Clinic conducted a survey of 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014,” according to <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" rel="nofollow" target="_blank">the study</a>, which was recently published in <em>Mayo Clinic Proceedings. </em></p> <p> “In 2011, we conducted a national study measuring burnout and other dimensions of well-being in U.S. physicians as well as the general U.S. working population. At the time of that study, approximately 45 percent of U.S. physicians met criteria for burnout,” the study authors wrote.</p> <p> When a follow-up survey was conducted in 2014, 54.4 percent of physicians reported at least one sign of burnout. Physicians also reported lower rates of satisfaction with work-life balance in 2014 compared to a similar sample of physicians in 2011. All physicians in the study were assessed using questions on the Maslach Burnout Inventory.</p> <p> <strong>Which specialties have the highest burnout rates? </strong></p> <p> “Substantial variation in the rate of burnout was observed by specialty, with the highest rates observed among many specialties at the front line of access to care,” the study authors noted.</p> <p> Compared to 2011, burnout rates were higher for all specialties in 2014. In fact, nearly a dozen specialties experienced more than a 10 percent increase in burnout over those three years:</p> <ul> <li> Family medicine (51.3 percent of physicians reported burnout in 2011 versus 63.0 percent in 2014)</li> <li> General pediatrics (35.3 percent versus 46.3 percent)</li> <li> Urology (41.2 percent versus 63.6 percent)</li> <li> Orthopedic surgery (48.3 percent versus 59.6 percent)</li> <li> Dermatology (31.8 percent versus 56.5 percent)</li> <li> Physical medicine and rehabilitation (47.4 percent versus 63.3 percent)</li> <li> Pathology (37.6 percent versus 52.5 percent)</li> <li> Radiology (47.7 percent versus 61.4 percent)</li> <li> General surgery subspecialties (42.4 percent versus 52.7 percent).</li> </ul> <p> Authors of the study also observed “substantial variation” in satisfaction rates based on specialty. In 2014, physicians across all specialties reported lower satisfaction with work-life balance, except for physicians in general surgery and OB/GYN.</p> <p> “Burnout among physicians also varied by career stage, with the highest rate among midcareer physicians,” according to the study.</p> <p> While burnout rates varied among physicians based on their career stages and specialties, authors of the study noted that burnout still proved to be more prevalent among physicians than the general U.S. working population. This is “a finding that persisted after adjusting for age, sex, hours worked and level of education,” they wrote. </p> <p> Read the <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" rel="nofollow" target="_blank">full study</a> for more observations on burnout.</p> <p> <strong>Also, don’t miss these resources on burnout and physician wellness: </strong></p> <ul> <li style="margin-left:0.25in;"> Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">7 signs of burnout</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">how to prevent them</a> in your practice.</li> <li style="margin-left:0.25in;"> Review these <a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" target="_blank">burnout busters</a> to increase physician satisfaction.</li> <li style="margin-left:0.25in;"> Check out this <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">online module</a> to learn how to measure and respond to burnout in your practice and a <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">second module</a> to discover how to increase physician resiliency. These modules are offered as part of the <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">AMA’s STEPS Forward collection</a>.</li> <li style="margin-left:0.25in;"> Other STEPS Forward modules give ways to improve elements of your practice that can be risk factors for burnout, such as improving work flow through <a href="https://www.stepsforward.org/modules/team-documentation" rel="nofollow" target="_blank">team documentation</a>, <a href="https://www.stepsforward.org/modules/patient-discharge-and-rooming" rel="nofollow" target="_blank">expanded rooming and discharge protocols</a>, <a href="https://www.stepsforward.org/modules/pre-visit-planning" rel="nofollow" target="_blank">pre-visit planning</a>, and <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" rel="nofollow" target="_blank">synchronized prescription renewal</a>.</li> <li style="margin-left:0.25in;"> Consider attending the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_blank">International Conference on Physician Health™</a> Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will showcases research and perspectives into physicians’ health and offer practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.<br /> <br /> If you’re interested in presenting, abstract submissions are welcome through Feb. 1 for research and perspectives into physicians’ health as well as practical, evidence-based skills and strategies that focus on staying healthy.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="http://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2feb783c-5f03-4f79-9e43-0f885839d5a7 One med school’s innovative approach to diversity http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-med-schools-innovative-approach-diversity Fri, 15 Jan 2016 20:17:00 GMT <p> Educators often talk about the importance of promoting diversity in medical schools, but creating an actionable institutional plan to address diversity and inclusion efforts can be challenging. Read how one school has created a strategic diversity action plan that’s already spurring creative solutions and ideas. Plus, follow these five steps to begin creating a diversity action plan at your own school.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/13/daebf48d-dc59-4566-bd4f-78efd14fb572.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/13/daebf48d-dc59-4566-bd4f-78efd14fb572.Full.jpg?1" style="width:500px;height:361px;margin:15px;float:right;" /></a></p> <p> <strong>The core of OHSU’s diversity action plan </strong></p> <p> Faculty at Oregon Health & Science University (OHSU) view diversity as more than a part of medical school demographics—they consider it an investment. OHSU is a founding member of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_blank">Accelerating Change in Medical Education Consortium</a>.</p> <p> “We view diversity as an investment for our community and those that we serve,” said Leslie Garcia, the acting chief diversity officer and assistant vice provost at OHSU. She also serves as the director of the OHSU Center for Diversity and Inclusion, which leads the school’s diversity initiatives to create an environment of respect and inclusion among students and faculty.</p> <p> OHSU created and began implementing its official diversity action plan in 2010. Since then, the school has made significant strides in its diversity efforts, which have led to the creation of an official diversity advisory council, expanded student pipeline program opportunities, improvements to physical accessibility features on OHSU buildings, and new diversity guides and resources. From 2011 through 2014, the school also earned top marks in the <a href="http://www.ohsu.edu/xd/health/services/diversity-and-inclusion/strategic-plan/awards.cfm" rel="nofollow" target="_blank">Health Equity Index</a> of the Human Rights Campaign Foundation for providing equitable and inclusive care to LGBT patients.</p> <p> “Ultimately for us, [diversity] is about serving the community,” said Garcia during a recent presentation of the school’s diversity action plan during a webinar hosted by the Institute for Diversity in Health Management. “Having a diversity action plan allows us to be innovative, creative and productive related to our mission. We know that we need to respond to key demographics and workforce changes and certainly meet the needs of [patients] in regards to health disparities and being able to address healthier communities.”</p> <p> <strong>How med schools can create their own diversity action plans </strong></p> <p> Michael Tom, director of OHSU’s Office of Affirmative Action and Equal Opportunity and co-chair of the Diversity Advisory Council, joined Garcia in sharing some of the key lessons OHSU has learned about promoting and creating a strategic diversity plan. They recommended that medical schools that are looking to transition from discussing diversity to strategically addressing it should follow five principles.</p> <p style="margin-left:40px;"> <strong>1.  Align diversity with your medical school’s key mission.</strong></p> <p style="margin-left:40px;"> “Diversity should not operate by itself but should be integrated within your current mission [and] strategic plan,” Garcia said.  </p> <p style="margin-left:40px;"> For instance, OHSU has made diversity a key goal within its strategic plan. The school aims to transform “from an institution that values diversity to one that lives the values of inclusion and equity across all mission areas, every day, in all aspects of our operations,” according to the school’s <a href="http://www.ohsu.edu/xd/about/vision/center-for-diversity-inclusion/about/upload/FNL_CDI_Annual-Report-2014.pdf" rel="nofollow" target="_blank">2013-2014 Diversity and Inclusion Community Report</a>.</p> <p style="margin-left:40px;"> <strong>2.  Partner with leaders who value diversity and plan to actively address it. </strong><br /> “When OHSU President Joe Robertson, MD, came on board, he started an agenda talking about diversity,” Tom said. “It was very transparent and visible.” Tom noted that Dr. Robertson set the school’s <a href="http://www.ohsu.edu/xd/about/vision/vision2020.cfm" rel="nofollow" target="_blank">strategic plan</a> with the goal of making OHSU a community that is “diverse in people and ideas with a strategy that [transforms]  OHSU from an organization that values diversity to one that lives it.”</p> <p style="margin-left:40px;"> Under Dr. Robertson’s leadership, the school also created an executive diversity leadership committee..</p> <p style="margin-left:40px;"> <strong>3.  Plan strategically, and measure your results.</strong><br /> “Diversity action planning is a cycle that really has no end,” Garcia said. “You plan, you implement, you measure and revise.” For instance, OHSU conducted a “climate survey” in 2010 and 2014, asking various students and faculty at OHSU questions related to the school’s diversity and inclusion plan.</p> <p style="margin-left:40px;"> “[The climate survey] was key to constructing our plan,” Garcia said. “This allowed us to learn from the voices of our community and propose actions in our diversity action plan.”</p> <p style="margin-left:40px;"> <strong>4.  Invite multiple stakeholders to the table.</strong><br /> If you have affirmative action, legal, human resources, faculty and student affairs and other departments at your school, invite leaders within each area to participate in conversations about your school’s diversity action plan. Inviting different people from various departments will “provide perspective buy-in and individual accountability as you develop the values that will guide your strategic plan,” Garcia said.</p> <p style="margin-left:40px;"> <strong>5.  Make diversity a part of innovation.</strong><br /> Creating a diverse community of students, residents and faculty can spur innovation in medical education and foster new ideas for physician training. Dr. Robertson implements this principle in his leadership, guidance and plans for diversity at the school, Tom said.</p> <p style="margin-left:40px;"> “Being a diverse institution creates an intellectually vibrant climate, where a variety of ideas and perspectives work together to foster innovation,” Dr. Robertson wrote in the school’s <a href="http://www.ohsu.edu/xd/about/vision/center-for-diversity-inclusion/about/upload/FNL_CDI_Annual-Report-2014.pdf" rel="nofollow" target="_blank">2013-2014 Diversity and Inclusion Community Report.</a></p> <p> <strong>Want to explore more diversity solutions? Check out these med ed resources:</strong></p> <ul> <li> Read these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-boost-diversity-medical-community" target="_blank">5 ways to boost diversity</a> in the medical community.</li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">the 21 medical students</a> the AMA Foundation selected as future minority physician leaders last year. Read their unique perspectives on being a student of color in medical school and <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">how they plan to succeed while promoting diversity in medicine</a>.   </li> <li> See <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/med-schools-tackling-challenges-health-disparities" target="_blank">how these medical schools are tackling challenges</a> in health disparities and cultural competencies.</li> <li> Educate yourself and your peers on the <a href="http://www.ama-assn.org/ama/ama-wire/post/debunking-5-myths-diversity-medical-education" target="_blank">5 myths of diversity in med ed</a>.</li> <li> Watch <a href="https://www.youtube.com/watch?v=KG6GCc3Pu2s&list=PL7ZHBCvG4qsf4HalVXnQ-cdg48xlLgz3S" rel="nofollow" target="_blank">this Google hangout</a> to learn more ways schools and students are promoting diversity in medical education.</li> <li> Visit the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us.page?" target="_blank">Minority Affairs Section Web page</a>, which features the latest on AMA policies, news and events to promote diversity in medicine and public health. You can also <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us/minority-affairs-consortium-membership/mac-membership-registration.page" target="_blank">join the section</a> to get further involved.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a20f9350-8743-4591-a705-f426de2a8841 AMA-IMG leader receives distinguished alumni award http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-img-leader-receives-distinguished-alumni-award Fri, 15 Jan 2016 15:02:00 GMT <p> Rajam Ramamurthy, MD, a longtime member of the AMA International Medical Graduate (IMG) Section, recently was honored with the Distinguished Alumnus of Bangalore Medical College award during the college’s 65<sup>th</sup> anniversary celebration.</p> <p> Dr. Ramamurthy, professor emeritus of the Department of Pediatrics, Division of Neonatology, at the University of Texas Health Science Center in San Antonio, was appointed by the AMA-IMG Section to the Educational Commission for Foreign Medical Graduates Board and served for eight years. She is an advocated for excellence in global health education and speaks frequently on international medical graduates in the physician workforce.</p> <p> Dr. Ramamurthy graduated from Bangalore Medical College in 1965 and received her pediatric training and fellowship in neonatology from Cook County Hospital in Chicago. She joined the UT Health Science Center in 1977, was a tenured professor and held the Rita and William Head Distinguished Professor in Environmental and Developmental Pediatrics endowment until her retirement in 2014. She continues her research on long-term outcomes of premature babies and the genetics of prematurity.</p> <p> The Bangalore Medical College of Rajeev Gandhi University is listed among the top 10 medical colleges in India. Dr. Ramamurthy and a group of neonatologists from the United States have helped promote the development of neonatology as a sub-specialty in India since 1978. The annual educational activities by this group of physicians and participation in the Indian Academy of Pediatrics educational forum laid the foundation for the birth of neonatology as a post-graduate sub-specialty following training in pediatrics. Dr. Ramamurthy helped to launch the neonatal resuscitation program in India in the early 1990s.</p> <p> The awards ceremony participants included K.S. Ravindranath, MD, vice chancellor of Rajeev Gandhi University of Health Sciences; P.K. Devadass, MD, dean of Rajeev Gandhi University of Health Sciences; K.M. Srinivasa Gowda, MD, convener of the Diamond Jubilee; and T. Rajeswari, MD, president of the BMC Alumni Association participated. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3098ecfc-df61-46f3-8269-80f149cd53f7 Excellence in Medicine Awards nominations due Feb. 26 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_excellence-medicine-awards-nominations-due-feb-26 Fri, 15 Jan 2016 15:01:00 GMT <p> The AMA Foundation’s Excellence in Medicine Awards program, with support from Pfizer Inc., recognizes physicians who exemplify the highest values of volunteerism, leadership and dedication to underserved populations, and present inspirational physician stories to the medical community and public.</p> <p> The Dr. Nathan Davis International Award in Medicine, named after the founder of the AMA, recognizes physicians whose influence reaches the international patient population and changes the future of their medical care. By treating, educating and counseling patients beyond the U.S. border, this physician’s work is having a positive impact on health care in the global arena.</p> <p> Applications to nominate a physician for this prestigious award are now available for submission by Feb. 26 at 6 p.m. Eastern time. A $2,500 grant will be given to the institution or organization with which the recipient works. The recipient also will receive travel expenses and accommodations to attend the <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_blank">Excellence in Medicine Awards</a> ceremony held in conjunction with the AMA Annual Meeting in Chicago. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e7c5265e-41ad-438b-bb51-0fed4523f2d0 Submit AMA-IMG Section Governing Council nominations by Feb. 19 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_call-nominations-img-section-governing-council Fri, 15 Jan 2016 15:00:00 GMT <p> Members of the AMA International Medical Graduates (IMG) Section are invited to submit their nominations for consideration in the 2016 governing council election.</p> <p> The AMA-IMG Section Governing Council will have three regular vacancies plus a resident/fellow position available. If you have leadership experience, consider nominating yourself or a colleague.</p> <p> Each governing council position carries a three-year term. Governing council nominees must be AMA members and able to attend the AMA Annual Meeting in June, the AMA Interim Meeting in November and an additional meeting in the spring. Governing council members must also serve as chair of an AMA-IMG Section committee and have proficient computer knowledge.</p> <p> Submit your nomination form, biosketch and photo (JPEG format) <a href="mailto:img@ama-assn.org" rel="nofollow">via email</a> by Feb. 19. Visit the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates/about-us/img-governing-council/img-section-governing.page">election Web page</a> for more information. Questions can be <a href="mailto:img@ama-assn.org" rel="nofollow">emailed to the section</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e84890cb-306a-46c9-a0e3-8ae886969505 Get in-depth ICD-10 training and earn CME http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_depth-icd-10-training-earn-cme Fri, 15 Jan 2016 15:00:00 GMT <p> Now that the ICD-10 transition is complete, go beyond the basics with the ICD-10 Specialty Coding Summit 2016 June 6 at The Cosmopolitan in Las Vegas. This two-day event will help your practice stay attuned to the errors, misinterpretations and revenue risk points all around you.</p> <p> This year’s summit will cover the gamut of ICD-10 issues that threaten the success and financial stability of your practice in 2016 and into the future, including:</p> <ul> <li> <strong>Safe harbor expiration. </strong>Go beyond ICD-9 equivalency and become truly ICD-10 capable.</li> <li> <strong>Auditors on the loose. </strong>Learn how to keep your claims out of the crosshairs for denials.</li> <li> <strong>2017 ICD-10 code changes and guideline updates. </strong>Stay ahead to avoid productivity and revenue setbacks.</li> <li> <strong>Medical necessity policy gaps. </strong>Learn about the hidden denial traps no safe harbor can protect you from.</li> </ul> <p> An ICD-10 Documentation Workshop on Day 1 of the summit will help you tackle gaps and change processes for success.</p> <p> Day 2 of the conference will focus on specialty tracks, offering a deep dive into real-world coding examples, live skills practice with intermediate and advanced scenarios, and hours of interaction and Q&As with specialty experts. Focus your attention on one of five specialty-specific tracks:</p> <ul> <li> Cardiology</li> <li> Primary care/internal medicine</li> <li> ICD-10 PCS</li> <li> Orthopedics</li> <li> Pain management</li> </ul> <p> Participants can earn continuing education applicable to coders, documentation specialists, physicians and nurses. <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2700003&navAction=push" target="_blank">Learn</a> more about the full summit at the AMA Store <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2700003&navAction=push" target="_blank">and register</a> by March 25 to receive the early bird rate, a discount of $100.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:79b79d8d-1da3-4304-8f08-7d370c3a236b 3 tips for a successful medical marriage http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-tips-successful-medical-marriage Thu, 14 Jan 2016 17:25:00 GMT <p> Research shows that physicians commonly enter <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">medical marriages</a>, but ensuring your marriage is a success requires much more than shared professional interests. Similarly, marriages between physicians and non-physicians have common challenges that come with medical careers. Learn these key tips for physicians in medical marriages to strengthen your connection with your partner as your career and relationship progress.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/373a92e4-761f-4489-a907-03b5f94dcf20.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/373a92e4-761f-4489-a907-03b5f94dcf20.Full.png?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> In a <a href="http://www.bluetoad.com/publication/?i=275739&pre=1#{"issue_id":275739,"page":0}" target="_blank" rel="nofollow">recent issue</a> of the AMA Alliance publication <em>Physician Family</em>, physician resilience experts offered some of the key lessons that can strengthen medical marriages, particularly for female physicians.</p> <p> Here’s what they recommend to physicians and their partners:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Expect to make “soul-splitting” decisions, especially if you’re planning to have children. </strong><br /> Starting a family is a wonderful life-changing event, but one that requires meticulous planning, especially for female physicians who face the “bittersweet combination” of finding time to care for patients and their own children.<br /> <br /> In fact, “within 10 years of completing medical training, approximately 80 percent of female physicians are married, and 85 percent of those become mothers,” according to the article.<br /> <br /> If you see children in your future, know that female physicians often report having to make more “intense soul-splitting” decisions than their average female colleagues who don’t have children or male colleagues, according to the article’s authors, Wayne M. Sotile, PhD, Mary O. Sotile, Julia E. Sotile Orlando, and Rebecca Sotile Fallon. The Sotiles run the Center for Physician Resilience in Davidson, N.C., and have counseled more than 10,000 physicians on resilience techniques.<br /> <br /> As you plan for children, think carefully about how your family will align your long-term career or the time you may have to take off. For instance, “in a national survey of 1,248 physicians, women reported interrupting their careers for 8.5 months for child rearing; men reported interrupting their careers for less than one month,” according to the article.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Communicate openly about your career goals and how they will impact your spouse.</strong><br /> Research has shown that feeling that your spouse supports your career is imperative to happiness in any marriage. However, this need for open communication about career plans is even more crucial in medical marriages for which juggling the demands of medicine and family life can put a unique strain on the partners of physicians.<br /> <br /> “Just as has been the case for female spouses of male physicians traditionally, male spouses of contemporary female physicians often report feeling overwhelmed by the combined home and/or work responsibilities that fill their lives,” the Sotiles wrote. “This in and of itself is not a risk factor [for a marriage]. Harboring resentment and avoiding communication about this is.”<br /> <br /> To avoid building resentment, the Sotiles emphasize the importance of communication and speaking honestly about major life decisions.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Learn to compromise (hint: joint decisions are key).</strong><br /> This one may be tough to accept, but it’s important to understand: “As family life progresses, even the most supportive partner’s tolerance for the demands of medicine is likely to wane,” the Sotiles wrote. “This is most clearly seen when a woman physician is married to a non-physician.”<br /> <br /> However, they noted that this “can be avoided” when a physician takes time to hear their partner’s perspective.<br /> <br /> “Research has shown time and again that keys to success and resilience in medical families are communication, compromise and joint decision-making,” the Sotiles wrote. “Without these three factors, spouses of physicians run the risk of being made to feel less than or second to a career in medicine.”</p> <p> Check out the <a href="http://cdn.coverstand.com/32550/275739/5b5d2270155cb57f5ee8d2399a39bd872b9c8205.24.pdf" target="_blank" rel="nofollow">full issue</a> of <em>Physician Family</em> for additional insights.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" target="_blank" rel="nofollow"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e2c7e268-b8a3-4536-8c3e-2926b3b17d3f Physician bestseller discusses consequences of tech in the exam room http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-bestseller-discusses-consequences-of-tech-exam-room Wed, 13 Jan 2016 22:02:00 GMT <p> How can physicians maintain a balance between essential time with patients and all of the necessary clicks and patient data input required for modern practice? Abraham Verghese, MD, senior associate chair of the Department of Internal Medicine at the Stanford University School of Medicine and <em>New York Times</em> bestselling author, last week spoke to a group of physician leaders about the ritual of the physical exam and the need to reclaim time with patients while keeping pace in the 21st century.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/7/c39088c4-7e8a-496e-97ff-5768122fafb2.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/7/c39088c4-7e8a-496e-97ff-5768122fafb2.Large.png?1" style="margin:15px;float:right;" /></a></p> <p> <strong>The ritual: How technology is coming between physicians and their patients</strong></p> <p> The physical exam is a humanistic ritual that builds trust and creates the crucial bond between physician and patient—a bond that is at the core of quality health care, Dr. Verghese told physician leaders at the 2016 AMA State Legislative Strategy Conference in Tucson.</p> <p> But with rapidly advancing technology, overwhelming amounts of data and burdensome regulations crowding into the exam room, what are the consequences when the computer screen steals physicians’ time from standing at the bedside of the patient?</p> <p> As a practicing physician and teacher of medicine, Dr. Verghese has found his passion in making sure that not only his students but also the physicians he speaks with around the world remember that the ritual of the physical exam is the most important aspect of developing trust between patient and physician.</p> <p> “There is something profound in listening to a patient and examining them thoroughly,” Dr. Verghese said.</p> <p> “I hit on this method with patients while I was in Texas, where I would do the history entirely in one visit and not try to do anything more than hear their story. The average American physician interrupts the patient in 14 seconds,” Dr. Verghese explained as he described a particular patient visit in which he realized the ritualistic nature of the physical exam.</p> <p> With this particular patient, “I held my peace for the entire first visit, and we agree that the physical would be in the second visit,” he said. “When they came in for the next visit, the patient continued to tell me history, and I decided to just launch into the exam.”</p> <p> “I began my ritual as I always do with the hand, and a very interesting thing began to happen: This voluble patient began to quiet down,” he said. “I had an eerie sense that I had stumbled onto a primitive dance or ritual in which I had a role and the patient had a role. When I was done, the patient said to me with some awe, ‘I have not been examined like this before.’”</p> <p> “We began with a partnership toward wellness,” Dr. Verghese said, “and it was only because I had earned the right by virtue of the exam.”</p> <p> <strong>Patient time vs. computer time</strong></p> <p> Physicians in the audience were asked to consider the well-known painting, “The Doctor,” by Sir Luke Fildes, commissioned more than 120 years ago to capture the physician in that time. The painting depicts a physician sitting attentively at the bedside of a very sick child, where—as reported historically—he held vigil for two or three nights.</p> <p> “[The painting] speaks to the Samaritan function of the physician,” Dr. Verghese said. “But what would this painting look like in our time?” Would the physician be facing a computer instead of the patient?</p> <p> “The patient in the bed has become a mere icon for the patient in the computer,” he said, and physicians “are at the front lines wrestling with this.”</p> <p> “We have an opportunity that we haven’t had in a long time to move the pendulum back in a direction that speaks to humanism,” Dr. Verghese said. Students must learn how to perform a thorough exam and “remember that patients have both a front and a back … a lot of juicy things happen between the dorsal of the patient and the bedsheets,” he said. The only way to get to those details is through a thorough examination.</p> <p> And physicians want to reclaim the time for thorough patient exams. With more than one-half of physicians reporting that they are unhappy in their practices, Dr. Verghese said, physicians are fed up with systemic issues that are out of their control and are taking the lead in changing the system by speaking up.</p> <p> Dr. Verghese highlighted what he believes are the four major consequences of losing time with patients at the bedside:</p> <ul> <li> <strong>Patient dissatisfaction.</strong> “Patients aren’t happy with our [current] style of medicine, even though we have never been more potent in what we can do,” Dr. Verghese said. Reviving the culture of bedside medicine is a driving force behind physician efforts to remove burdensome regulations and technology that hinder interactions with patients.</li> <li> <strong>Physician wellness.</strong> “There is a systemic issue that’s making doctors unhappy and driving them out of medicine,” Dr. Verghese said. “I think that the No. 1 cause of that issue is what I call the ‘4,000-clicks-a-day problem’—it takes 16 clicks to give a patient just one aspirin and 32 clicks to give them two.” These kinds of requirements are actively robbing physicians of time they would much rather spend examining their patients.</li> </ul> <p style="margin-left:40px;"> “Even though they don’t want to,” he said, “[physicians] are forced to spend a lot of their time right here [at the computer].”</p> <ul> <li> <strong>Hidden medical errors.</strong> In a <a href="http://www.amjmed.com/article/S0002-9343(15)00549-5/abstract" rel="nofollow" target="_blank">study</a> published in the <em>American Journal of Medicine</em>, Dr. Verghese and his colleagues collected 208 physician stories and found that “the most common cause of [medical] error was simply a failure to perform the physical exam.”</li> <li> <strong>Loss of ritual.</strong> “We engage in rituals to signal the crossing of a threshold,” he said. “An individual comes to see a physician to tell them things they would never tell their spouse … and then disrobe and allow touch, which would be considered assault in any other type of situation.”</li> </ul> <p style="margin-left:40px;"> The physical examination is a sacred ritual that has been developed and perfected over centuries, and physicians need to keep this ritual protected from extinction. “If we don’t protect and teach this ritual, it will die,” Dr. Verghese said. “At its very nature, the experience of medicine, the experience of being a patient, is very much a human experience—patients require the best of our science, but they don’t stop requiring the Samaritan function.”</p> <p> “We need a better solution,” Dr. Verghese said. “The Stone Age did not end because we ran out of stones; we found something better,” he said. “Our present hyper-digital computerized age in medicine has to end because there are better ways that can take us back to the patient.”</p> <p> <strong>Solutions physicians already have undertaken</strong></p> <p> With such imbalance between patient care and the lack of smooth functioning technology, physicians are actively seeking solutions that better merge technology with patient care.</p> <ul> <li> The <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank">Break The Red Tape</a> campaign gathers physicians at the grassroots level in order to form a coalition against burdensome regulations that complicate quality reporting and steal time away from patients.</li> <li> Just this month, the AMA <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-silicon-valley-common" target="_blank">founded Health2047</a>, a new integrated innovation company that will conduct rapid exploration of transformational solutions to some of the biggest challenges facing the nation’s physicians and the patients they care for.</li> <li> Last year, the AMA partnered with MATTER, a health IT incubator in Chicago, to develop the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-finally-say-tech-development" target="_blank">AMA Interaction Studio at MATTER</a>, which provides a space to create unique learning experiences and simulations using cutting-edge exam room equipment in order to build greater technology that streamlines work flows, saves time and allows physicians to spend more time providing quality care to patients.</li> </ul> <p> <strong>Coming soon</strong></p> <p> AMA President Steven J. Stack, MD, sat down with Dr. Verghese for <a href="https://twitter.com/hashtag/ahealthiernation?src=hash" rel="nofollow" target="_blank">#AHealthierNation</a> interview to further discuss the ritual of the physical exam, what it means to both patients and physicians, and the challenges physicians face in the current health care environment. <em>AMA Wire</em>® will share the exclusive content.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:28dcc9fe-57da-4d37-afa9-30c5875cd70d CMS chief vows to replace meaningful use with better policy http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cms-chief-vows-replace-meaningful-use-better-policy Wed, 13 Jan 2016 21:16:00 GMT <p> Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt on Monday said that the agency is changing its culture to focus more on listening to physician needs and giving them the freedom they need to keep patients at the center of the practice of medicine.</p> <p> <strong>Regaining physicians’ trust</strong></p> <p> “The day-to-day work of CMS at this point in time is to start up new consumer- and provider-facing capabilities, and then scale them, nurture and mature them,” <a href="http://blog.cms.gov/2016/01/12/comments-of-cms-acting-administrator-andy-slavitt-at-the-j-p-morgan-annual-health-care-conference-jan-11-2016/" target="_blank" rel="nofollow">Slavitt said during a panel</a> at the 34th annual <a href="http://jpmorgan.metameetings.com/confbook/healthcare16/login.php" target="_blank" rel="nofollow">J.P. Morgan Healthcare Conference</a> in San Francisco. “It demands that we change our culture and execute with clarity, with discipline and with collaboration. Things we haven’t always been known for.”</p> <p> “We have to get the hearts and minds of the physicians back because these are the people that our beneficiaries and consumers count on every day,” he said. “And I think we lost them.”</p> <p> Referring to execution of the electronic health record (EHR) meaningful use program, Slavitt noted that the agency’s previous regulatory approach created difficulties. “When in doubt, I think, do less and figure it out. … I remind people all the time that good ideas piled on top of other good ideas become bad ideas pretty quickly because they sink under their own weight.”</p> <p> Instead, Slavitt said he views the agency’s role in setting policy and acting as a regulator as a two-way street. “Here our most important job is to listen and learn,” he said. “Policy is often a blunt instrument, and in the real world, it takes continual adjusting.”</p> <p> The recent ICD-10 transition is evidence of how this collaborative approach can work well. Listening to physician needs, <a href="http://www.ama-assn.org/ama/ama-wire/post/cms-icd-10-transition-less-disruptive-physicians" target="_blank">CMS adopted AMA recommendations</a> to make implementation of the new code set less disruptive for their practices.</p> <p> Slavitt now is turning his attention to a critical issue that has plagued the nation’s physicians for the past several years.</p> <p> <strong>The end of meaningful use and the start of something new</strong></p> <p> “The meaningful use program as it has existed will now be effectively over and replaced with something better,” Slavitt said.</p> <p> In its place will be the new Merit-Based Incentive Payment System (MIPS), called for in the Medicare Access and CHIP Reauthorization Act of 2015, which is intended to sunset the three existing reporting programs and streamline them into a single program.</p> <p> “The stakes are high for this program,” Slavitt said. “As any physician will tell you, physician burden and frustration levels are real. Programs designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”</p> <p> “At its core, we need to simplify,” he said. “That program needs to be streamlined and simple to use so physicians can focus where they need to—on their patients.”</p> <p> Importantly, Slavitt noted that they are taking an “outside-in” approach to designing this program. “Since late last year, we have been working side by side with physician organizations across many communities—including with great advocacy from the AMA—and have listened to the needs and concerns of many,” he said.</p> <p> In November, the AMA and 100 state and specialty medical associations submitted <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS, and provided <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue. The AMA also continues to drive home the message that the problems inherent in the meaningful use program must not be adopted into MIPS. To that end, the AMA last month submitted a <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work" target="_blank">detailed framework</a> for what needs to change.</p> <p> “Administrator Slavitt acknowledged the frustration of physicians attempting to comply with the meaningful use regulations and pledged to work collaboratively with physicians to replace the program with a more effective alternative,” said AMA CEO and Executive Vice President James L. Madara, MD. “His leadership is a model for how Washington should work. He listened to working physicians who said the meaningful use program made them choose between following byzantine technological requirements and spending more time with their patients. This is a win for patients, physicians and common sense.”</p> <p> Slavitt said several themes will be guiding implementation of the new system:</p> <ul> <li> <strong>Emphasis will be placed on outcomes.</strong> “The focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients,” Slavitt said.</li> <li> <strong>Health IT will be about physician needs.</strong> “Providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government,” he said. “Technology must be user-centered and support physicians, not distract them.”</li> <li> <strong>Vendors will need to unlock data.</strong> Slavitt said requirements will be put in place to “allow apps, analytic tools and connected technologies to get data in and out of an EHR securely.”</li> <li> <strong>Vendors will need to make health IT interoperable.</strong> “We are deadly serious about interoperability,” he said. “We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging patients in their care.”</li> </ul> <p> “The AMA will continue to work with CMS and the Administration on moving to a new framework for EHRs,” Dr. Madara said. “Physicians are at the front lines of these programs, and their insights should guide how the regulations are written and implemented.”</p> <p align="right"> <em>By AMA Wire editor</em> <a href="https://twitter.com/Amy_AMAWire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a4234b19-d04a-433d-a185-856917824ec1 Applying for residency: Fourth-year students’ essential checklist http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_applying-residency-fourth-year-students-essential-checklist Tue, 12 Jan 2016 23:45:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/11/c13abd02-192a-4e6f-ab11-fdb2f5e6633b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/11/c13abd02-192a-4e6f-ab11-fdb2f5e6633b.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> After three years of arduous studying, exams and clinical rotations, you’re finally in the home-stretch to completing your undergraduate medical training and transitioning to the next phase of your career in residency. As you apply to programs this year, keep these tasks top of mind to reduce stress and ensure you have an effective residency application process.</p> <p> <strong><input type="checkbox" />May-June: Obtain your token for the Electronic Residency Application Service (ERAS)</strong></p> <p> ERAS—a service that transmits students’ residency program applications and key information from their Designated Dean's Office to program directors—will become a very familiar part of your life as a fourth-year student. Take time early in your application process to ensure that you can <a href="https://students-residents.aamc.org/attending-medical-school/article/register-myeras-residency/" rel="nofollow" target="_blank">register at MyERAS</a>, the service’s application system for students. At this stage in your process:</p> <ul> <li> Be sure to request a token early in the process to avoid any delays in starting your application. Each medical school’s Designated Dean’s Office establishes their own procedures for distributing ERAS tokens, so be sure to contact your designated dean’s office for information on tokens. Your token will be a one-time access code used to register on MyERAS.</li> <li> Once you request a token, register for early any early match programs that interest you. </li> </ul> <p> <strong><input type="checkbox" />June-July: If you’re an osteopathic applicant, register for the AOA Intern/Resident Registration Program,</strong> which places students into osteopathic graduate medical education positions in the United States. Once you register, you can select and apply to American Osteopathic Association- (AOA) accredited residency programs through ERAS. Review these key resources before registering:</p> <ul> <li> The AOA <a href="https://www.natmatch.com/aoairp/" rel="nofollow" target="_blank">Intern/Resident Registration Program’s Web page,</a> which provides specific information about the Match for osteopathic students, submitting applications and rank results.</li> <li> Check out <a href="https://www.natmatch.com/aoairp/aboutdates.html" rel="nofollow" target="_blank">this detailed timeline</a> from AOA Intern/Resident Registration Program, featuring key dates for osteopathic students applying to residency. </li> </ul> <p> <strong><input type="checkbox" />July-August: Use these months to prepare supplemental application materials,</strong> such as finalizing letters of recommendation and providing each letter of recommendation author their letter request form. If you’re interested in military residency positions, you can also apply for them at this time.</p> <p> To learn more about letter of recommendations:</p> <ul> <li> Review <a href="https://www.aamc.org/download/377410/data/lor_process.pdf" rel="nofollow" target="_blank">this presentation</a> from the Association of American Medical Colleges (AAMC), which provides a helpful overview of the letter of recommendation process on ERAS, how to properly request a letter, and the unique roles medical schools and students play in this process. </li> </ul> <p> For advice on how to successfully complete your MyERAS profile and application:</p> <ul> <li> Review these <a href="http://www.ama-assn.org/ama/ama-wire/post/boost-residency-application-5-writing-tips" target="_blank">five key writing tips</a> to write an effective personal statement for your program application.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-answer-top-student-questions-away-rotations" target="_blank">advice from residents</a> on coordinating away rotations and how to use them to effectively boost your application for residency.</li> <li> Review the AAMC’s <a href="https://students-residents.aamc.org/attending-medical-school/how-apply-residency-positions/tools-residency-applicants/" rel="nofollow" target="_blank">tools for residency applicants</a>, which features guides and worksheets to help students successfully complete their MyERAS applications. </li> </ul> <p> <strong><input type="checkbox" />September: Select and apply to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).</strong> Also register for the National Residency Matching Program (NRMP) Match, which is the main matching service program directors use to rank and select residency program applicants. Students interested in the <a href="http://www.nrmp.org/match-process/couples-in-the-match/" rel="nofollow" target="_blank">couples match</a> and <a href="https://www.sfmatch.org/" rel="nofollow" target="_blank">San Francisco Matching Program</a> can apply for programs at this time. Flag these key resources to learn more about the Match and selecting programs for residency:</p> <ul> <li> It’s hard to select a good residency program if you don’t know how to find it. Conduct an effective search for residency programs by accessing <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page?" target="_blank">FREIDA Online®</a>—the Fellowship and Residency Electronic Interactive Database—which features listings for nearly 9,800 medical residency and fellowship programs. Students using FREIDA can find information about training programs, key application deadlines and specialty training statistics, which provide a helpful overview of residency programs based on trends across all programs in a specialty. Review <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_blank">these four search hacks</a>, FREIDA’s <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online/about-freida-online/frequently-asked-questions.page" target="_blank">FAQs</a> and <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page?" target="_blank">registration page</a> to make the most of searching for and selecting programs for residency.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-experience-match-couple" target="_blank">what it’s like to navigate the Match as a couple</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/navigate-match-couple" target="_blank">key tips</a> from students who’ve experienced the process.</li> <li> Check out <em>AMA Wire’s®</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/Match/1" target="_blank">Match resources</a>, featuring insights on the Match process and <a href="http://www.ama-assn.org/ama/ama-wire/post/matched-residency-program-now" target="_blank">what to do even after you match to your program.</a></li> <li> Review the NRMP’s <a href="http://www.nrmp.org/match-process/how-to-register-for-a-match-applicants/" rel="nofollow" target="_blank">information page</a> for important details about how to register for the Match.  </li> </ul> <p> <strong><input type="checkbox" />October-January:</strong> <strong>Schedule and travel to interviews.</strong> Following interviews, also be sure to send thank you letters. Now that you’ve selected and applied to programs, this will be an important time to carefully assess which residency programs best fit your preferences for training and lifestyle.</p> <p> If you participated in early match programs—such as those for the San Francisco Match, urology or ophthalmology—you will likely receive Match results in January. Students in the military Match will receive results in December.</p> <p> For students still ranking their residency programs, be sure to:</p> <ul> <li> Reference websites for deadlines to submit rank order lists and review <a href="https://www.aamc.org/cim/residency/thematch/rankorderlist/" rel="nofollow" target="_blank">these resources from the AAMC</a> for tips on how to strategically rank your residency programs.</li> <li> Keep <a href="http://www.ama-assn.org/ama/ama-wire/post/top-questions-ask-during-residency-program-interview" target="_blank">these top questions to ask</a> handy as you begin your residency program interviews. Asking the right questions can help you determine if a program is the right fit and whether how you’d like to rank them in the Match.</li> <li> Send thank-you notes following your interviews.</li> </ul> <p> <strong><input type="checkbox" />February: </strong><strong>AOA Intern/Resident Registration Program match results will be available.</strong> If you’re participating in the match for osteopathic applicants, you should receive your long-awaited results.</p> <p> <strong><input type="checkbox" />March: NRMP main residency Match results are announced. </strong>The much-anticipated Match Week will soon arrive—and you’ll likely learn your results during a special celebration at your medical school.</p> <p> <strong>Want additional guides for your undergraduate medical training?</strong> Check out these must-have checklists featuring key insights, resources and tasks for students to prioritize during their <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank">first, second</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank">third year</a> of medical school.</p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4dd89584-ff60-42d6-b9ec-6c4e2188764b In patient-centered care, where does family fit? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_patient-centered-care-family-fit Tue, 12 Jan 2016 22:52:00 GMT <p> The opinions of family members can affect a patient’s decisions about their medical care, but how can a physician respect the wishes of the patient while also including the patient’s family members who play a role in major life decisions, such as care planning?<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/3/455c9e6c-0f14-482a-93b8-27b4a1f05e82.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/3/455c9e6c-0f14-482a-93b8-27b4a1f05e82.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">January issue</a> of the <em>AMA Journal of Ethics</em> explores patient- and family-centered care as a movement toward participatory medicine that values the opinions of and relationships between patients and their family members.</p> <p> Articles featured in this issue include:</p> <ul> <li> <a href="http://journalofethics.ama-assn.org/2016/01/ecas2-1601.html" target="_blank">“What’s the role of autonomy in patient–and family–centered care when patients and family members don’t agree?”</a> When disagreements over approaches to care come between a patient and their family members, physicians might be able to facilitate a solution but must find the proper balance between respecting the decisions of the patient and the opposing opinions of that patient’s family. This article offers a case study to guide an investigation into the physician’s role when family members disagree with a patient’s wishes.</li> <li> <a href="http://journalofethics.ama-assn.org/2016/01/sect1-1601.html" target="_blank">“Evidence-based design: Structuring patient-and family-centered ICU care.”</a> When family members are allowed to witness lifesaving procedures they have less anxiety and greater confidence in the care provided to their loved one. But in the ICU, increased family presence can mean navigating interpersonal, social and cultural dynamics at the patient’s bedside. This article explores the ethical challenges of involving a patient’s family in ICU care.</li> <li> <a href="http://journalofethics.ama-assn.org/2016/01/stas1-1601.html" target="_blank">“Patient-and family-centered care: It’s not just for pediatrics anymore.”</a> Evidence has shown that family-centered care among patients of all ages can lead to compliance, improved communication and better care planning. This article explores the best strategy for successful patient- and family-centered care.</li> <li> <a href="http://journalofethics.ama-assn.org/2016/01/imhl1-1601.html" target="_blank">“We got your back: Patient advocacy through art.”</a> How can painting show the realities of patient experiences? One artist founded the Walking Gallery of Healthcare movement, in which patients and clinicians don business suit jackets with personalized health care story paintings on the backs.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-jan-2016.mp3" target="_blank">January podcast</a>, Kelly Parent, the patient-and family-centered care program specialist for quality and safety at the University of Michigan Health System, discusses what makes patient- and family-centered care an inclusive approach to health care delivery and how this approach is being implemented.</p> <p> <strong>Your chance to weigh in</strong></p> <p> Give your answer to <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">this month’s poll</a>: A child with acute myeloid leukemia needs a bone marrow transplant, but the only suitable match is the child’s younger sibling, who is afraid and not ready to assent to undergo surgery. What would you recommend to your patient and their family?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insight for medical students and physicians. <a href="https://www.rapidreview.com/AMA/CALogon.jsp" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2ac6188b-5ad5-4ac9-b782-2ea0c78dcc1b 3 things you should know about CME from the JAMA Network http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_three-things-should-cme-jama-network Tue, 12 Jan 2016 17:00:00 GMT <p> Most physicians are familiar with journal-based continuing medical education (CME) activities, and many used the JAMA Network journals for this purpose. Eleven of the JAMA Network journals have at least one article per issue that is certified for <em>AMA PRA Category 1 Credit</em>™. Here’s how the JAMA Network journals can help you fulfill your CME requirements:</p> <p> <strong>1. JAMA Network CME is organized to fulfill state-mandated CME requirements.</strong><br /> Some state licensing boards require physicians to participate in CME activities that include specific content requirements, such as pain management, end-of-life care, child abuse and appropriate prescribing. The JAMA network <a href="http://jamanetwork.com/cme.aspx" rel="nofollow" target="_blank">CME website</a> shows which CME activities will qualify for this content by identifying by state which journal-based articles will meet content specific CME requirements for license renewal.</p> <p> <strong>2. JAMA Network CME counts as type II maintenance of certification (MOC) for a number of boards.  </strong><br /> Physicians certified by one of the American Board of Medical Specialties member boards have to meet certain MOC requirements. Journal-based CME from the JAMA Network is approved to meet MOC requirements for Part II and Part II self-assessment from various boards, including:</p> <ul> <li> The American Board of Ophthalmology</li> <li> The American Board of Physical Medicine and Rehabilitation</li> <li> The American Board of Plastic Surgery</li> <li> The American Board of Psychiatry and Neurology</li> <li> The American Board of Surgery </li> </ul> <p> Some of the courses approved for MOC can be found in the <a href="https://www.mededportal.org/abmsmoc/continuingeducation/activity/1528" rel="nofollow" target="_blank">JAMA section of the MedEd PORTAL</a>, a collaboration of the Association of American Medical Colleges (AAMC) and the American Board of Medical Specialties. You must have an AAMC account and be signed in to access the material.</p> <p> We anticipate JAMA Network CME will count for American Board of Internal Medicine MOC in the near future.</p> <p> <strong>3. You do not have to be a member of the AMA to participate in JAMA Network CME.</strong> <br /> JAMA Network CME is free to AMA members and subscribers for the journal(s). Non-members and non-subscribers can purchase CME tokens that allow them to earn <em>AMA PRA Category 1 Credit</em>™ for their participation. To purchase tokens, visit the <a href="https://store.jamanetwork.com/productDetails.aspx?productCodeID=65" rel="nofollow" target="_blank">JAMA Network CME store</a>. Physicians need to enter their country, customer type and the number of tokens they wish to purchase to see the price. Quantity discounts are available.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2d704cbe-283c-40a9-9476-d9f74d94c9d9 Court case could increase liability exposure, redefine injury http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-case-could-increase-liability-exposure-redefine-injury Mon, 11 Jan 2016 23:19:00 GMT <p> A state supreme court is set to determine whether “loss of chance” for a better outcome should be recognized as a legal injury in medical liability lawsuits—which could leave physicians exposed to increased liability.</p> <p> <strong>The details of the case</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/cad1f371-a49c-4391-a54f-0cd269e81012.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/cad1f371-a49c-4391-a54f-0cd269e81012.Large.jpg?1" style="margin:15px;float:right;" /></a>At stake in <em>Smith v. Providence Health Services</em> is whether or not the Oregon Supreme Court should redefine what constitutes an injury legally to include the lost possibility of a better outcome, known in legal terms as the “loss of chance” doctrine. Existing law does not include loss of chance as grounds for medical liability. The case is an attempt to expand the definition of injury—one that would open the door for speculation.</p> <p> The patient in this case presented at a hospital emergency room, where the physicians failed to diagnose a stroke and discharged him. As it turned out, the patient did have a stroke and suffered significant permanent injuries.</p> <p> The missed opportunity for proper diagnosis led the patient to file a lawsuit, claiming a loss of chance for a better outcome. At the same time, even the patient admitted that he would probably have suffered the same injuries had he been properly diagnosed.</p> <p> <strong>Decision could put physicians at risk</strong></p> <p> If the “loss of chance” doctrine is recognized by the court, it could lead to significantly greater and uncontrollable liability exposure for physicians.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> filed an <a href="http://www.theoma.org/sites/default/files/documents/2015-12-10%20OMA%20AMA-Amicus%20Brief%20on%20the%20Merits.pdf" target="_blank" rel="nofollow">amicus brief</a>, arguing that recognizing the loss of chance doctrine in the same way as a more definitive injury could single out physicians for a “unique and consequential form of new professional … liability.”</p> <p> Changing “the established common law of causation for this one category,” the brief said, “is based solely on a policy argument that the courts should open their doors to such claims, so that [the patient] can be compensated for the effects of a stroke that the physician did not cause and for the ‘wondering’ that [the patient] has been left to do about what might have been.”</p> <p> If physicians are at increased risk of a medical liability suit for injuries they probably did not cause, it also could be a greater inducement to practice defensive medicine to avoid being singled out for such speculative claims. A decision to recognize loss of chance carries with it the possibility of aggravating the current medical liability climate, which already places a wedge between physicians and their patients and drains resources that could be used to advance patient care through medical research or expanded access to care.</p> <p> Learn about other cases in which the AMA Litigation Center has sought to defend physicians in medical liability cases on its <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center/case-summaries-topic/professional-liability.page" target="_blank">professional liability Web page</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:362c76a1-0734-4267-80fe-bd80b6410421 What physicians and Silicon Valley have in common http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-silicon-valley-common Mon, 11 Jan 2016 15:55:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/62a13e71-175e-4a19-8d2d-5ba39182e8bd.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/62a13e71-175e-4a19-8d2d-5ba39182e8bd.Large.jpg?1" style="float:left;margin:15px;" /></a><em>An </em><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" target="_blank"><em>AMA Viewpoints</em></a><em> post by AMA CEO and Executive Vice President James L. Madara, MD</em></p> <p> Would it surprise you if I said that the nation’s medical profession and those at the cutting-edge of technological innovation now have a common purpose? Up until now, you might have thought that such a question could only be answered with a punchline. We haven’t seen much overlap between these two leading communities—but there needs to be. And happily, now there is.</p> <p> <strong>Minding the gap</strong></p> <p> A lack of connection between tech developers and physicians has left significant gaps between the technology that is available and what is sorely needed. We don’t need to look far for examples—just think of what electronic health records are and what they <em>could</em> <em>be</em> if physicians and patients’ needs and work flows were at the heart of the designs.</p> <p> But the gaps are more than just the shortcomings of existing technology. We’ve also been missing out on a powerful opportunity.</p> <p> Harnessing the united strengths of these two groups of professionals could really change the landscape for the health of Americans and our system of care. Both physicians and tech developers are natural problem-solvers, and both look for opportunities to make people’s lives better. But it’s our unique skill sets and perspectives that can come together to create something truly remarkable.</p> <p> <strong>Building the bridge</strong></p> <p> We have long needed a bridge between physicians and Silicon Valley tech, and I’m pleased to say that this bridge is now in place. Today we founded <a href="http://health2047.com/" rel="nofollow" target="_blank">Health2047</a>, a new integrated innovation company that will conduct rapid exploration of transformational solutions to some of the biggest challenges facing the nation’s physicians and the patients they care for.</p> <p> Because improving the health of the nation is at the core of the AMA’s work, we’re committed to leading the way so that advancements in technology have useful applications in hospitals and clinics, contribute to better health outcomes, and improve central relationships between patients and physicians.</p> <p> Innovative technology solutions form a common thread among our three strategic priorities of <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">improving health outcomes</a>, <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">creating the medical school of the future</a> and <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">ensuring thriving physician practices</a>. The goal of Health2047 to advance and accelerate innovation at the system level should enhance U.S. health care in ways that will improve the lives of physicians and patients.</p> <p> <strong>Achieving real solutions</strong></p> <p> Just how will this partnership of communities take place? Health2047 will have an innovation studio in San Francisco and will ensure that the physician perspective is represented in all major innovation cycles as it develops new products, tools and resources that improve the practice of medicine and the delivery of care.</p> <p> That means that Health2047 will gather physician input at the outset of projects, incorporate physician testing and feedback during prototype development, and leverage physician channels to accelerate market adoption of transformative health care solutions.</p> <p> In addition, the tech talent at Health2047—which will encompass design, engineering and business development—will partner with AMA experts in a wide range of medical, health policy and pragmatic practice areas and with others in the entrepreneurial and technology world. Together, we’ll create prototypes that lead to commercial products and services that can help alter the future for health care and the medical profession.</p> <p> While this all may seem very conceptual right now, our goal is to achieve real solutions in the near future. And we intend that these solutions will be ones that make concrete improvements for physicians’ practices, their profession and their patients.</p> <p> So what do physicians and Silicon Valley have in common? We’re now working side by side on advancements that will improve the health of the nation.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ae2cc020-b618-43d5-a6e1-dd0a384ac8c2 What ails the medical profession--and ways to heal it http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ails-medical-profession-ways-heal Fri, 08 Jan 2016 16:00:00 GMT <p> <em>An </em><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" target="_blank"><em>AMA Viewpoints</em></a><em> post by AMA President Steven J. Stack, MD</em></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/32484937-fa2e-49c2-8280-56603dc20c34.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/32484937-fa2e-49c2-8280-56603dc20c34.Large.jpg?1" style="margin:15px;float:left;" /></a>It’s ironic and deeply distressing that the very people who have devoted their lives to keeping others healthy are most at risk of suffering from the work-induced syndrome of burnout. As more than one-half of the medical community suffers from burnout—a percentage on the rise—it’s time to turn toward healing our own profession. Several medical societies have begun to do just that.</p> <p> <strong>Prevalence</strong> <strong>and roots of the problem</strong></p> <p> A <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/fulltext" rel="nofollow" target="_blank">new study</a> in <em>Mayo Clinic Proceedings</em> found that 54.4 percent of physicians reported at least one symptom of burnout in 2014, up from 45.5 percent in 2011. In comparison, prevalence of burnout among the general working population was about 28.5 percent.</p> <p> And physician burnout seems to be directly tied to our environment. Authors of the study, who are AMA and Mayo Clinic experts on physician burnout, note that future physicians begin medical school with mental health profiles that are better than those of college graduates who pursue other fields. But those profiles are reversed within two years of beginning med school.</p> <p> Similarly, a <a href="http://www.rand.org/pubs/research_reports/RR439.html" rel="nofollow" target="_blank">study</a> the AMA released with the RAND Corporation in 2013 found that the major drivers of professional dissatisfaction among physicians were environmentally driven barriers to providing high-quality care, such as burdensome governmental regulations, insurers that refuse to cover medically necessary services and unsupportive practice leadership.</p> <p> <strong>What’s being done to address the problem</strong></p> <p> The findings of studies such as these beg the question, “What can be done to prevent physician burnout?”</p> <p> The AMA has made physicians’ wellness and ability to thrive a top priority. In fact, one of our three strategic focus areas is <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a>. As part of this initiative, we have created our <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of online modules, which offer proven solutions by physicians for physicians.</p> <p> Three modules are specifically focused on physician wellness: One gives <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">steps for preventing burnout</a>, another module outlines <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">solutions for enhancing joy in practice and mitigating stress</a>, and a third module focuses on <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">ways to promote the well-being of physicians in training</a>.</p> <p> Other modules provide ways to improve elements of your practice environment that can be risk factors for burnout, such as improving work flow through <a href="https://www.stepsforward.org/modules/team-documentation" rel="nofollow" target="_blank">team documentation</a>, <a href="https://www.stepsforward.org/modules/patient-discharge-and-rooming" rel="nofollow" target="_blank">expanded rooming and discharge protocols</a>, <a href="https://www.stepsforward.org/modules/pre-visit-planning" rel="nofollow" target="_blank">pre-visit planning</a>, and <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" rel="nofollow" target="_blank">synchronized prescription renewal</a>.</p> <p> We’re also hosting the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_blank">International Conference on Physician Health™</a> Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> If you’re interested in presenting, <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health/call-for-abstracts.page?" target="_blank">abstract submissions</a> are welcome through Feb. 1 for research and perspectives into physicians’ health as well as practical, evidence-based skills and strategies that focus on staying healthy.</p> <p> Other medical associations are offering practical ways to help physicians as well. My own specialty of emergency medicine is the hardest hit by burnout, and the American College of Emergency Physicians (ACEP) has created the 2016 Emergency Medicine Wellness Week™ to give all emergency physicians and their colleagues an opportunity to take the time to self-renew while staying dedicated to the highest quality patient care. </p> <p> This event will take place Jan. 24-30. You can visit the <a href="http://www.acep.org/EMWellnessWeek" rel="nofollow" target="_blank">wellness week website</a> to sign up for daily wellness tips, print a personal pledge card, find resources and videos about better wellness, and share your stories of personal improvement.</p> <p> At the local level, physicians may find additional programs or resources. In my hometown, the Lexington Medical Society in Kentucky began offering its <a href="http://members.kyma.org/scripts/4disapi.dll/4DCGI/cms/review.html?Action=CMS_Document&DocID=197&MenuKey=lms" rel="nofollow" target="_blank">Physician Wellness Program</a> this year. Designed as a safe harbor, the program gives members of the society up to six free, anonymous counselling sessions each calendar year so they can address normal life difficulties in a confidential and professional environment at a local psychiatry group. This program is modeled after a <a href="http://www.lcmedsociety.com/physician_wellness.html" rel="nofollow" target="_blank">highly successful program</a> of the Lane County Medical Society in Eugene, Oregon.</p> <p> <strong>Take steps to improve your well-being today</strong></p> <p> As we look to the year ahead, I encourage you to make your own health and well-being a top priority.</p> <p> First, be sure to learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/8-things-can-put-risk-of-burnout" target="_blank">eight things that can put you at risk of burnout</a>, regardless of your career stage.</p> <p> Next, familiarize yourself with the resources that can help you in your current situation. Whether you choose to use the STEPS Forward modules, participate in the ACEP wellness week, attend the International Conference on Physician Health, or take advantage of counseling or other wellness programs, be sure to make the most of the resources available to you.</p> <p> As service-oriented people, we physicians often put our own needs after those of others. But it’s important for us to be physically and mentally well both for ourselves and for the many people who rely on us—our families, our friends and our patients. Make this a New Year’s resolution you keep. Putting your well-being first is essential for keeping those you care about healthy.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f043cab9-fca5-4dc2-99d5-d26204cb6052 Your chance to shape medicine’s future http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_chance-shape-medicines-future Fri, 08 Jan 2016 16:00:00 GMT <p> Do you wish the nation’s lawmakers understood the real impact of the health policy decisions they make in Washington, D.C., on physicians and patients? Here’s your chance to make that happen. Participate in the 2016 <a href="http://www.ama-assn.org/ama/pub/advocacy/events/national-advocacy-conference.page" target="_blank">National Advocacy Conference</a>, to be held Feb. 22-24 in the nation’s capital. This event will empower you to be an advocate for patients, the medical profession and the future of health care.</p> <p> At the conference, you’ll hear from political insiders, industry experts and members of Congress about current efforts in health system reform refinement and implementation. Share your thoughts and participate in discussions to help guide the AMA’s efforts to improve the health of the nation.</p> <p> This year’s “President’s Lecture” speaker is Ken Adelman—a diplomat and political writer who served as the U.S. ambassador to the United Nations and advised President Ronald Reagan during the historic Iceland superpower summits with Soviet leader Mikhail Gorbachev. Adelman will share a first-hand look into the character and leadership of Reagan, including his personal account of the weekend that became the key turning point in the Cold War.</p> <p> Also speaking at the event is Chuck Todd, NBC News political director and host of <em>Meet the Press</em> and <em>MTP Daily</em>. Joe Scarborough, co-host of MSNBC’s <em>Morning Joe</em>, former U.S. congressman and <em>New York Times</em> best-selling author, will act as master of ceremonies at the Nathan Davis Awards.</p> <p> Among the activities in which attendees can participate are:</p> <ul> <li style="margin-left:18.75pt;"> A briefing on what’s happening on Capitol Hill</li> <li style="margin-left:18.75pt;"> Visits with members of Congress</li> <li style="margin-left:18.75pt;"> The <a href="http://www.ama-assn.org/ama/pub/about-ama/awards/nathan-davis-awards-outstanding-government-service.page?" target="_blank">Nathan Davis Awards</a> reception and dinner, during which physicians will honor elected officials and career government employees who have made significant accomplishments in advancing the well-being of the nation</li> </ul> <p> <a href="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=b732dd91-22f4-4747-9572-f3983e8b48ae" target="_blank">Register now</a> to be a part of this important event, which will be held at the Grand Hyatt Washington in Washington, D.C. Also, watch <em>AMA Wire</em>® for full coverage of the conference programming.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:57a15293-851a-4a45-af2a-097c942fff96 Minority health disparities focus of national summit http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_minority-health-disparities-focus-of-national-summit Fri, 08 Jan 2016 15:07:00 GMT <p> The Clinton Global Initiative recently hosted its fifth annual Health Matters Activation Summit to identify strategies for systemic health improvement and ways to implement those strategies. The summit opened with a town hall, <a href="http://livestream.com/clintonfoundationus/2016healthmatters" target="_blank" rel="nofollow">“Addressing health disparities through technology and innovation,”</a> moderated by former President Bill Clinton.  </p> <p> Topics covered during the town hall included financing innovative, scalable technological ventures in health; improving public health and access to care for Native Americans in rural communities; leveraging health innovation for disease prevention and management; and using holistic approaches to transform the nation’s culture of health and well-being.  </p> <p> Among the distinguished panel was Donald Warne, MD, the Association of American Indian Physicians representative on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section.page" target="_blank">AMA Minority Affairs Section</a> Governing Council. Others joining the panel included Vice Admiral Vivek H. Murthy, MD, U.S. surgeon general; Anya Pogharian, inventor and student at Marianopolis College; Nate Gross, MD, co-founder of Rock Health; and Kyu Rhee, MD, chief health officer of IBM Corporation.</p> <p> Key themes at the two-day summit included communities as centers of health innovation, the quest for longevity and healthy aging, health-tech innovation and addressing health disparities through entrepreneurship. The summit brought together leaders working in health care, technology, business, education, sports and government.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:970b8c32-5126-47fc-9587-737625407cbf Serve your fellow academic physicians--seek election to AMA-APS http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_serve-fellow-academic-physicians-seek-election-ama-aps Fri, 08 Jan 2016 15:01:00 GMT <p> Use your experience and talent in the service of the medical profession. AMA members can take advantage of the opportunity to serve on the 2016 AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools.page" target="_blank">Academic Physicians Section (APS)</a> Governing Council. The deadline for nominations in March 7.</p> <p> AMA members are invited to apply for the following open positions on the governing council to begin in June 2016:</p> <ul> <li> Chair-elect</li> <li> At-large member (three slots)</li> <li> Delegate</li> <li> Alternate delegate</li> </ul> <p> Visit the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools/leadership.page?" target="_blank">AMA-APS Web page</a> for position descriptions and term lengths. The section’s nominating subcommittee will review all applications and make recommendations to the AMA-APS Governing Council. If the proposed slate is approved by the governing council, it will be brought before the section for a vote at its annual meeting, June 10-11 in Chicago.</p> <p> To apply, email <a href="mailto:fred.lenhoff@ama-assn.org?subject=SMS%20nominations" rel="nofollow">Fred Lenhoff</a> of the AMA or call (312) 464-4635 to obtain the application form.</p> <p> AMA members also are invited to become more involved in medical education at the national level by seeking appointments to serve on boards and committees of key national medical education organizations. <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education/leadership.page?" target="_blank">Learn more now, and view current openings</a>. Email <a href="mailto:mary.oleary@ama-assn.org?subject=Nominations" rel="nofollow">Mary O'Leary</a> of the AMA or call (312) 464-4515 with questions.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0a441ce0-088c-4376-a683-e35e6b0e029b Nominations due Feb. 29 for AMA-SPS Governing Council http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nominations-due-feb-29-ama-sps-governing-council Fri, 08 Jan 2016 15:00:00 GMT <p> The AMA’s Senior Physicians Section (SPS) is seeking nominations for four seats on its governing council.</p> <p> The governing council is comprised of seven physicians over the age of 65, whether retired or still practicing medicine. The council is charged with directing the programs and activities of the section. Nominees must be active members of the AMA-SPS and interested in a leadership role representing senior physicians. </p> <p> The governing council meets twice a year prior to the AMA Annual Meeting and AMA Interim Meeting and for a strategy meeting in August. The AMA reimburses travel and meeting expenses. Nominations will be accepted for the following positions with terms commencing in June:</p> <ul> <li> Delegate: Two-year term (one position)</li> <li> Alternate delegate: Two-year term (one position)</li> <li> Officers at large: Two-year term (two positions)</li> </ul> <p> All nomination materials, including the current council roster are posted on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/senior-physicians-section/about-us/sps-governance/governing-council-nominations.page" target="_blank">nomination Web page</a>. To ensure consideration of your candidate(s), nominations must be received by Feb. 29.   </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9ced7f3f-281a-4bfe-b8ee-7e58f42163d0 3 traits of successful payment models http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-traits-of-successful-payment-models Fri, 08 Jan 2016 15:00:00 GMT <p> New payment models can help physicians overcome the barriers of current payment systems so they can provide high-quality patient care at lower costs while securing the sustainability of their practices. For physicians who are considering adopting an alternative payment model, the model you choose should have three essential characteristics to ensure your success.</p> <p> <strong>What should a payment model look like?</strong></p> <p> The goal of developing new payment models is to give physician practices the resources and flexibility they need to improve the aspects of costs and quality that they can control or influence. The fact that a new payment model is different from traditional fee-for-service payment does not automatically mean that it is better—but it can be.</p> <p> The AMA worked with Harold Miller at the Center for Healthcare Quality and Payment Reform, a member of the newly appointed Physician-Focused Payment Models Technical Advisory Committee to the federal government, to develop the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to physician-focused alternative payment models</a>.”</p> <p> The guide, in addition to describing seven physician-focused alternative payment models and <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">barriers in current payment systems</a>, highlights the three characteristics of a successful payment model:</p> <ul> <li> <strong>Flexibility in care delivery.</strong> The design of an alternative payment model should focus on giving physicians sufficient flexibility to deliver the services their individual patients need in the most effective way possible.<br /> <br /> For example, if a physician performs a specific service and the current payment system does not pay for that service, an important element of the alternative payment model that physician adopts would be for that model to enable payment for additional services, broaden the definition of the services that will be covered or both.</li> </ul> <ul> <li> <strong>Adequacy and predictability of payment.</strong> A crucial component to any practice is the ability to plan for the future. An alternative payment model must provide adequate and predictable resources to enable physicians to cover the costs of high-quality care.<br /> <br /> If physicians cannot predict how much they will be paid for their services, it becomes nearly impossible to make investments in equipment and recruit, train and retain the personnel needed to provide the best care for their patients.</li> </ul> <ul> <li> <strong>Accountability only for costs and quality that physicians can control.</strong> An alternative payment model should be designed to support better quality and lower spending for the specific services that physicians deliver or order. The model should not hold physicians accountable for aspects of spending and quality that they can’t control.</li> </ul> <p> <strong>How physicians are leading the way</strong></p> <p> Physicians are voicing their need for new models of payment that are patient-focused and physician-friendly. More than 100 state and specialty medical associations recently joined the AMA in sending a <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/macra-sign-on-letter-16nov2015.pdf" target="_blank">letter</a> (log in) to the Centers for Medicare & Medicaid Services (CMS) recommending <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), which includes the adoption of alternative payment models.</p> <p> The AMA has spent more than five years encouraging the development and implementation of better health care payment systems. This work has emphasized several goals:</p> <ul> <li> Give physicians more resources and flexibility to deliver care</li> <li> Improve financial viability in physician practices</li> <li> Minimize administrative burdens that weigh physicians down</li> <li> Enable physicians to control aspects of spending that they can influence</li> <li> Avoid transferring inappropriate financial risk to physicians</li> </ul> <p> Accelerating its efforts to support physician-designed alternative payment models, the AMA also compiled a step-by-step process to develop successful payment models for medical specialties. Visit the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Medicare alternative payment models Web page</a> to read more.</p> <p> Look for more insights about adopting new payment models from the “Guide to physician-focused alternative payment models” in the coming weeks as <em>AMA Wire®</em> shares the many different types of alternative payment models that will be available.</p> <p style="text-align:right;"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5533e0b6-f5b9-4ba1-9083-21ffeedb4c57 How one school is training students for rural medicine http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-school-training-students-rural-medicine Fri, 08 Jan 2016 00:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/d8d348f6-438a-426a-90ac-991e80f75456.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/d8d348f6-438a-426a-90ac-991e80f75456.Large.jpg?1" style="margin:15px;float:right;" /></a>To address the shortage of physicians practicing rural medicine, one regional medical school has developed a four-year curriculum that allows students to train in rural and underserved areas. Learn how the program creates a unique clinical “continuity experience” for students that’s prompted 90 percent of its graduates to enter residencies in specialties needed in the region.</p> <p> <strong>Serving the needs of the country’s most rural areas </strong></p> <p> “With 27 percent of the U.S. landmass and 3.3 percent of the population, Washington, Wyoming, Alaska, Montana and Idaho are among the most rural areas of the country,” according to <a href="http://journals.lww.com/academicmedicine/Fulltext/2016/01000/The_WWAMI_Targeted_Rural_Underserved_Track__TRUST_.26.aspx" rel="nofollow">a report</a> recently published in <em>Academic Medicine.</em> The report examines the University of Washington School of Medicine’s (UWSOM) rural health curriculum. As the only four-year MD-granting medical school in the five-state region, UWSOM is one of the new members of the AMA Accelerating Change in Medical Education Consortium and admits 240 students per year.</p> <p> To address the health care needs of these five rural states, UWSOM developed its Target Rural Underserved Track (TRUST) curriculum in 2008, which centers on “a required four-year clinical longitudinal continuity experience with students repeatedly returning to a single site located in a rural community or small city,” the report explains. “TRUST sites range in population from 1,000 to 30,000 people. This longitudinal placement in a single community differs significantly from other rural programs in the United States.”</p> <p> <strong>How TRUST creates a continuous rural health experience for students </strong></p> <p> Students in the TRUST program are selected through a targeted admissions process during their general admission to UWSOM, in which students can submit a secondary application explaining their interest in rural medicine. The admission committee interviews and selects TRUST applicants with special attention given to those who exhibit behaviors the medical literature has commonly associated with physicians who return to practice rural medicine.</p> <p> After a pilot year, TRUST officially launched in 2009. From 2009 to 2015, 776 medical students applied to TRUST, 467 were interviewed and 123 were accepted into the program.  </p> <p> Students in the program receive a “cohesive educational experience” in rural medicine, which includes repeated preclinical visits, clerkships, electives and mentorship from practicing physicians in rural health sites. “Students in the program are strategically linked to a single rural community over four years, known as their Trust Continuity Community,” according to the report.</p> <p> While working at their respective Trust Continuity Communities, students participate in courses designed to build their knowledge of caring for patients in rural and underserved areas while fostering continuous connections with their assigned rural health community. Some of these curricular elements include:</p> <ul> <li> <strong>The Underserved Pathway:</strong> This comprehensive longitudinal extracurricular program teaches students the fundamental principles of underserved medicine.</li> <li> <strong>The First Summer Experience:</strong> This one- to two-week clinical and community experience allows students to explore their assigned rural Trust Continuity Community prior to the start of classes.</li> <li> <strong>The Rural Underserved Opportunities Program:</strong> This “month-long rural underserved experience in a student’s Trust Continuity Community … incorporates clinical learning and principles of community medicine,” according to the report.</li> <li> <strong>The WWAMI Rural Integrated Training Experience:</strong> This “18- to 23-week rural longitudinal integrated clerkship experience at a student’s Trust Continuity Community … emphasizes the rural physician’s responsibilities and roles in diagnosing, treating and managing the majority of medical, surgical, obstetrical and psychosocial problems on a continuity basis,” the report notes.</li> </ul> <p> These various curricular elements create a sense of connectedness to rural communities for students while strengthening their clinical skills in primary care. As one student participant <a href="http://academicmedicineblog.org/keeping-me-focused-on-the-woods-in-spite-of-all-the-trees-the-role-of-relationships-in-the-wwami-targeted-rural-underserved-track-program/" rel="nofollow"><em>wrote on the Academic Medicine</em> blog</a>, “For me, the centerpiece of the TRUST curriculum is the longitudinal relationship we develop at our continuity sites with physician role models in rural communities.” He noted that medical education usually requires medical students to “knit together tidbits of career guidance gleaned from different physicians from three years of largely disconnected educational experiences,” while the TRUST program allows students to spend intensive time “living and working” alongside a single physician mentor who practices in rural medicine.</p> <p> <strong>The impact of TRUST on specialty, residency choice</strong></p> <p> While interest in the TRUST program and applicant numbers continue to grow each year, “it is too early in the TRUST experience to determine whether the program is producing more rural physicians to meet regional needs,” the report notes. However, preliminary measures “show significant entry into needed specialties.”</p> <p> Since launching the program, roughly 90 percent of graduates have entered residencies in needed specialties, and nearly one-half of graduates have remained in one of the program’s five rural states for their residency training.</p> <p> Professors at UWSOM plan to secure institutional funding for new TRUST curricular developments and partnerships with rural residency programs.</p> <p> “While specific outcomes remain undetermined, the program is enjoying growth and is becoming highly visible within the UWSOM and within the … region, showing the feasibility of a coordinated and comprehensive program,” the report states.</p> <p> <strong>Accelerating change in underserved areas </strong></p> <p> UWSOM’s rural health program is one of several innovative efforts in medical education training future physicians in underserved areas that is part of the AMA’s Accelerating Change in Medical Education Consortium. The consortium consists of 32 medical schools working together to create the medical school of the future and transform the training of future physicians.</p> <p> Other members addressing physician shortages in rural areas include the Brody School of Medicine at East Carolina University which recently launched new curricula with a special focus on training students in <a href="http://www.ama-assn.org/ama/ama-wire/post/med-school-curriculum-changes-aim-eliminate-health-care-disparities">rural and underserved populations</a>. The school has continued its mission to train underrepresented minorities while focusing on team-based care and population health.</p> <p> The University of California, Davis, School of Medicine, another consortium member, also has developed a program to train diverse, highly skilled physicians to meet the needs of underserved communities and populations. In partnership with Kaiser Permanente, the program follows <a href="http://www.ama-assn.org/ama/ama-wire/post/new-three-year-curriculum-producing-primary-care-physicians">a collaborative three-year curriculum</a>, which places a special emphasis on addressing workforce and diversity gaps in underserved populations.</p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:df374d10-a935-4c55-99bc-0a48221637da 3 things residents want to recover post-call http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-things-residents-want-recover-post-call Wed, 06 Jan 2016 22:49:00 GMT <p> Duty hour literature often focuses on residents’ need for sleep in recovering after lengthy shifts, but are there other methods of recovery that are also valuable to residents? A recent study on residents’ activities post-call identified two processes in addition to sleep for how residents want to recover. Learn what they are and see how you compare.</p> <p> <strong>Why residents need more than sleep to recover </strong></p> <p> Medical researchers conducted a <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Recovery_of_Sleep_or_Recovery_of_Self__A_Grounded.98675.aspx" rel="nofollow">study</a> of residents across six surgical and non-surgical specialties, examining their post-call activities immediately following a 24-hour overnight shift, what motivates them to prioritize certain activities post-call, and the personal impact these decisions have on residents’ recovery of sleep and self. The study took place from 2012 to 2014 at a Canadian medical school accredited by the Liaison Committee on Medical Education.</p> <p> Based on an analysis of interview transcripts, study authors found that residents juggle competing priorities and often use <a href="http://www.ama-assn.org/ama/ama-wire/post/sleep-not-sleep-residents-decisions-post-call">“trade-off orientations”</a>—in which they barter crucial sleep hours for personal time—to determine how to recover after overnight shifts. While sleep is always a precious commodity for residents, the study revealed that residents’ recovery processes also entail activities that are far more complex.</p> <p> “The duty hours literature tends to focus exclusively on the recovery of sleep, which can be at odds with the recovery of self,” wrote authors of the study, which was recently published in <em>Academic Medicine. </em>“Based on our findings, we propose a preliminary dual recovery model that includes both the recovery of sleep and the recovery of self.”</p> <p> <strong>Residents identify how they want to recover after shifts </strong></p> <p> To recharge after overnight shifts, residents in the study often participated in three key recovery processes:</p> <ul> <li> <strong>The recovery of self: “</strong>Participants in our study seemed highly motivated to spend their post-call day doing things other than sleeping or resting, which suggests that residents are working with a broader notion of recovery,” study authors wrote. “We have named this broader notion of recovery the recovery of self. Within this recovery framework, residents are intending to reconnect with their identities, roles and relationships that exist outside of the hospital.”<br /> <br /> To accomplish this, residents often used “psychological detachment,” a process in which “one deliberately mentally disengages from work to facilitate recovery from workplace demands,” according to the study.<br /> <br /> Establishing this psychological boundary is crucial to <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-survey-reveals-concerning-data-resident-wellness-1" target="_blank">resident wellness</a>. In fact, the study authors noted that <a href="http://www.apaexcellence.org/resources/research/detail/3997" target="_blank" rel="nofollow">previous research</a> has shown common associations between a failure to psychologically disconnect from work and emotional exhaustion, dissatisfaction and poor sleep quality.</li> </ul> <ul> <li> <strong>The recovery of study: </strong>Although studying “did not feature predominantly in residents’ accounts of how they spent their post-call time,” the authors noted, residents still expressed a desire to study despite lacking the time or energy for it.  “For those residents in our study who raised the issue of studying post-call, they often reasoned that their fatigue precluded them from engaging meaningfully in such a cognitively demanding task. Spending time with loved ones or tending to personal needs was feasible because it did not require the same cognitive resources,” according to the study.</li> </ul> <ul> <li> <strong>The recovery of sleep: </strong>While residents valued time for personal relationships and goals, resting post-call still emerged as a common way for residents to mitigate fatigue and recover from strenuous shifts.</li> </ul> <p> “Where other studies have assumed that residents may be unwilling or unable to ‘recover their lost sleep’ on post-call days, residents in our study agreed that post-call days were useful (and often necessary) to catch up on sleep,” study authors wrote. “However, there was great variability in how residents translated this into practice. Even when residents are motivated to reduce their fatigue, some of them believed they got a better night’s sleep if they restricted their daytime sleep to preserve their sleep-wake rhythm.”</p> <p> Read <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Recovery_of_Sleep_or_Recovery_of_Self__A_Grounded.98675.aspx" target="_blank" rel="nofollow">the full study</a> for additional observations.</p> <p> <strong>Also get additional resources on balancing wellness and residency:</strong></p> <ul> <li style="margin-left:51.75pt;"> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/sleep-not-sleep-residents-decisions-post-call" target="_blank">how residents use “trade-off” approaches</a> to determine how to spend time post-call.</li> <li style="margin-left:51.75pt;"> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/new-duty-hours-review-spotlights-resident-outcomes" target="_blank">how duty-hour restrictions</a> are impacting crucial resident outcomes, including patient safety.</li> <li style="margin-left:51.75pt;"> See how physicians rank <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">residency work-life balance based on specialties</a>.</li> <li style="margin-left:51.75pt;"> Educate yourself on the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">signs of burnout</a> and how to <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">increase satisfaction in training</a>.</li> <li style="margin-left:51.75pt;"> Check out <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">these tips from residents who have conquered burnout</a>.</li> </ul> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" target="_blank" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:08c757b0-e99b-4d9d-adec-b63b528c628b Who’s using new delivery and payment models http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_whos-using-new-delivery-payment-models-1 Wed, 06 Jan 2016 21:00:00 GMT <p> With little data available on the prevalence of new models of care delivery and payment, you may be wondering whether any of your peers actually are participating. Learn which practice types have adopted these new models and which are still contemplating the transition.</p> <p> A new <a href="http://www.ama-assn.org/resources/doc/health-policy/x-pub/practicepay-prp2015.pdf" target="_blank">AMA report</a> (log in) presents a national perspective on physician participation in medical homes and Medicare accountable care organizations (ACO), using data from the AMA’s 2014 Benchmark Survey. Based on information gathered from post-residency physicians who provided at least 20 hours of patient care per week, the report assessed the extent to which alternative payment models (APM) have taken hold across the country.</p> <p> Here are four key takeaways from the report:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Participation in medical homes and ACOs varies with practice type.</strong> In 2014, 23.7 percent of physicians were part of a medical home, while 28.6 percent were part of a Medicare ACO. Participation varied across practice type, specialty and practice ownership.<br /> <br /> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/8/36461ff7-2596-4d6d-b8d7-8a9898eddadb.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/8/36461ff7-2596-4d6d-b8d7-8a9898eddadb.Full.jpg?1" style="width:800px;height:359px;margin:15px;" /></a></p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Many physicians are unaware if they are part of a medical home or ACO.</strong> For both medical homes and ACOs, almost 25 percent of physicians did not know their practice’s participation status.<br /> <br /> Not surprisingly, different levels of uncertainty among physicians corresponded with practice type. Physicians in solo practice expressed less uncertainty than those in single specialty practices, while physicians in multi-specialty practices expressed higher levels of uncertainty. These differences relate to the characteristics of physicians in those practice types, such as age, tenure in the practice and whether physicians tend to be owners or employees.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Ownership structure plays a role in practices that are part of a medical home or ACO.</strong> Participation in a medical home was twice as likely among physicians in single specialty practices that were hospital-owned (31.4 percent), compared to practices that were physician owned (14.9 percent).<br /> <br /> In the same fashion, more participation in ACOs was found among physicians in single specialty, hospital-owned practices (36.0 percent) than among physicians in single specialty, physician owned practices (21.7 percent).</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Well over half of physicians are using APMs.</strong> In 2014, 59.0 percent of physicians worked in practices that received payment through at least one APM. Although participation in APMs is growing, very few physicians report that their practice has eliminated the fee-for-service payment structure.<br /> <br /> The report shows that fee-for-service revenue shares steadily decrease with the number of APMs in use. For example, physicians in practices with only one APM reported that 72.5 percent of practice revenue came from fee-for-service. In practices that received three or four APMs, fee-for-service accounted for less than half of practice revenue.</p> <p> <strong>Interested in adopting new payment models?</strong></p> <p> As new delivery and payment models become an increasingly critical part of today’s health care environment, the AMA worked with Harold Miller at the Center for Healthcare Quality and Payment Reform to develop the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to physician-focused APMs</a>” to help physicians make decisions about which models will best fit their patients and practices.</p> <p> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">two most common barriers</a> of current payment systems that often stand in the way of implementing changes and learn ways physicians are working to overcome these barriers.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1a51f60d-7457-4a09-aa6c-fcc1ad57b090 How to set your practice team up for successful change http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_set-practice-team-up-successful-change Tue, 05 Jan 2016 23:27:00 GMT <p> The new year makes us think about change, both personal and professional. If you already have decided what practice changes you plan to make in 2016, use these five steps to help you organize and motivate your practice team to see changes through to completion.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/7/9b0cab9f-0949-476f-8745-66f45bfe51e7.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/7/9b0cab9f-0949-476f-8745-66f45bfe51e7.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> <strong>Make sure practice changes take hold</strong></p> <p> Organization of your practice is crucial to enabling transformation and will help everyone on your team stay focused on the change initiative while still managing daily responsibilities with patients. A <a href="https://www.stepsforward.org/modules/practice-transformation" rel="nofollow" target="_blank">free online module</a> from the AMA’s <a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank">STEPS Forward</a>™ collection provides a framework for organizing your practice for this type of change implementation.</p> <p> An analysis of your practice should depend on these two basic questions:</p> <p style="margin-left:1.0in;"> A. Where are we now?</p> <p style="margin-left:1.0in;"> B. Where are we going?</p> <p> Use these questions as you follow the five steps to organize your practice for change:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Perform a practice assessment</strong>. First, investigate your practice’s finances, personnel management, productivity and morale, performance metrics, patient engagement, and any other areas of your practice. Learning exactly how your practice team operates in the present will help you design the future.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Develop and share a vision for your practice</strong>. Now that you’ve assessed all aspects of your practice, consider where you want to go by asking:</p> <ul> <li style="margin-left:40px;"> What are we trying to accomplish, and what are our goals for patient care and work flow?</li> <li style="margin-left:40px;"> What do we want to be known for?</li> <li style="margin-left:40px;"> What do we have to do to be successful as the payment system evolves?</li> </ul> <p style="margin-left:40px;"> Craft a shared vision of your practice with your team that defines where you are going—articulate this vision and discuss it often. You can even use signs, posters or tag lines to constantly remind your practice team that the entire practice is undergoing change together and moving toward providing more efficient and higher quality care for patients. Keeping this information “front of mind” will help your team stay motivated throughout the process.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Designate and train your change team</strong>. The change team should consist of three or four individuals who have the interest and aptitude to manage and monitor the change effort. Make sure these leaders have the time and resources available to do this while still meeting their patient care responsibilities.</p> <p style="margin-left:40px;"> It is difficult to send the entire team out for Lean or Six Sigma Black Belt training, but you can help train your practice team without expensive and time-consuming external training using the STEPS Forward <a href="https://www.stepsforward.org/modules/lean-health-care" rel="nofollow" target="_blank">starting Lean health care</a> and <a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank">change-management</a> modules.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Document your progress with a project management approach</strong>. Simplistic approaches to project management go a long way toward reaching your goals. A project manager can aid in resource allocation, foster accountability and help everyone on the team appreciate daily progress.</p> <p style="margin-left:40px;"> You do not need to invest in expensive project management software. Using a one-year wall calendar to document milestones, responsibilities and resources can help keep the initiative on track and ensure that no one’s time and effort are wasted.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Design systematic and sustainable changes</strong>. Changes to your practice will not take hold immediately—patience is critical. To be successful in the rapidly changing landscape of the medical world, your practice must develop a “measure … improve … measure” mindset.</p> <p style="margin-left:40px;"> Sustainable and successful change is a constant endeavor. Opt for long-term, systematic solutions over quick “band-aid” fixes.</p> <p> Following these five steps will help your practice team stay involved not only in the big picture of your change initiative but also in each short-term goal that is set. If you have not yet selected a change initiative to alleviate the needs of your practice, check out these <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-physicians-say-practice-changes-successful" target="_blank">three steps physicians have offered</a> to help your practice successfully choose the changes that will improve your efficiency and the quality of patient care.</p> <p> <a href="https://www.stepsforward.org/modules/practice-transformation" rel="nofollow" target="_blank">Check out the module</a> to dig deeper into how the organization of your practice can help your team work together to implement changes efficiently. This module offers continuing medical education credit.</p> <p> More than 25 modules are available in the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a> collection, and several more will be added in 2016, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b1adeb68-c2b9-4d51-b8fd-b4745d9e75db Why the physician voice is key to public health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-voice-key-public-health Tue, 05 Jan 2016 13:28:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/15/e5d2b643-17fa-4a54-9f47-af4a984e31f1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/15/e5d2b643-17fa-4a54-9f47-af4a984e31f1.Large.jpg?1" style="margin:15px;float:right;" /></a>Physicians bear the right to speak up for themselves and their patients. That’s a principle Mary Travis Bassett, MD, public health commissioner for the New York City Department of Mental Health and Hygiene, said guides her work and commitment to speaking out against health disparities—even if it means being bold in her convictions. Here’s why she says a physician’s voice is always one of the most valuable assets in public health and addressing health disparities.</p> <p> <strong>Learning to speak up: A lesson from the AIDS crisis in Zimbabwe</strong></p> <p> After completing her medical training, Dr. Bassett moved to Harare, Zimbabwe, where she served on the medical faculty at the University of Zimbabwe for 17 years and learned the value of advocating for patients.</p> <p> “When I moved to Harare in 1985, social justice was at the core of Zimbabwe’s national health policy,” Dr. Bassett said at a recent talk during TEDMED 2015. “The country’s government had emerged from a long war of independence and immediately proclaimed a socialist agenda in which health care services and primary education became essentially free for residents. A massive expansion of rural health centers placed roughly 80 percent of the population less than a two hour walk from health care facilities.” </p> <p> “It was truly a remarkable accomplishment,” Dr. Bassett said. “Working side by side with brilliant Zimbabwean scientists ...  I felt connected not only to an African independence movement but to a global progressive health movement. But there were daunting challenges. Zimbabwe reported its first AIDS case in 1985 .... I had taken care of a few patients with AIDS in the early 1980s when I did my medical training at Harlem Hospital, but we had no idea what lay in store for Africa.”</p> <p> She said when she first arrived on the continent, AIDS infection rates stood at two percent. “These would soar to 1 in every 4 adults by the time I left Harare 17 years later,” Dr. Bassett said. “By the mid-1990s, I told hundreds of people in the prime of life that they were HIV positive. I saw colleagues and friends die, my students [and] hospital patients die.”</p> <p> <strong>Responding to the AIDS crisis </strong></p> <p> Dr. Bassett said she and her colleagues set up HIV clinics, conducted research on HIV, gave condom demonstrations, hosted school and workplace intereventions, and counseled the partners of people infected with HIV on how to protect themselves. She said she worked exhaustively and did “everything she could” for each of her patients no matter how limited her resources. Still, she wishes she had done more.</p> <p> “At the time I believed I was doing my best,” Dr. Bassett said. “But I was not speaking up about structural change.” For instance, she said she didn’t voice her concerns about the early stance on AIDS that Zimbabwe’s government adopted or how it tried to deal with the epidemic. </p> <p> Dr. Bassett said she rationalized her silence because she felt that as a clinician and “guest in the country,” her role was to combat the AIDS crisis using strong technical and medical skills—not necessarily her voice as a patient advocate.</p> <p> “I felt I was doing my best ... but I realize now that there was more I could have done to rally for change and support,” she said.</p> <p> <strong>Taking the first step to improve public health </strong></p> <p> Today, Dr. Bassett keeps her lesson from Zimbabwe top of mind, especially as she encounters national statistics showing the deeply rooted connections between social determinants of health and grave outcomes for communities.</p> <p> “Inequities are embedded in the political and economic organization of our social world, often in ways that are invisible to those with privilege and power,” she said. “We do little for our patients if we fail to recognize these social injustices. Sounding the alarm is the first step toward doing public health right, and it’s how we may rally support to break through and create real change together …. These days I’m not staying quiet. I’m speaking up about a lot of things, even when it makes other people uncomfortable, even when it makes me uncomfortable.”</p> <p>  “As health professionals in our daily work, whether in the clinic or doing research, we are witness to great injustice: The homeless person who is unable to follow medical advice because he has more pressing priorities, the transgender youth who is contemplating suicide because our society is just so harsh, the single mother who’s been made to feel that she’s responsible for the poor health of her child,” Dr. Bassett said. “Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change. Rightfully or not, our societal position gives our voices great credibility, and we shouldn’t waste that.”</p> <p> “I regret not speaking up in Zimbabwe, and I promised myself as New York City’s health commissioner I will use every opportunity I have to sound the alarm and rally support for health equity. It’s time to rise up and collectively speak up about structural inequality,” she said. “We don’t have to have all the answers to call for change. We just need courage. The health of our patients—the health of us all depends on it.”</p> <p align="right"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:af908925-50a0-47a3-84c0-875183fc534d Top 9 issues that will affect physicians in 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-9-issues-will-affect-physicians-2016 Tue, 05 Jan 2016 00:00:00 GMT <p> What issues should you follow closely in the year ahead? Crucial developments will emerge in health care regulations, legislation and the health insurance market—and many of them will profoundly impact your practice and patients. Taking a look ahead, we’ve identified nine of the top issues you’ll want to watch in 2016.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/9/d2b400f0-b2d7-49ee-896f-a03476c61981.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/9/d2b400f0-b2d7-49ee-896f-a03476c61981.Large.jpg?1" style="border-width:0px;border-style:solid;margin:15px;float:right;" /></a></p> <p style="margin-left:0.25in;"> <strong>1.  </strong><strong>Medicare reform. </strong>The <a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" target="_blank">elimination of the sustainable growth rate</a> (SGR) formula with the passage of the Medicare Access and CHIP Reauthorization Act in 2015 was a giant leap forward for Medicare reform. The law paves the way for important payment reforms. The Merit-Based Incentive Payment System (MIPS) under development is intended to streamline the various reporting programs for physicians, and alternative payment models (APM) will support physicians in adopting new models of care.<br /> <br /> Shaping the MIPS so that it fixes the problems of the current system and is beneficial for both physicians and patients will be at the heart of Medicare reform efforts in the coming year. The AMA will continue its work, which includes a task force of physicians from various states and specialties who already drafted and delivered to the Centers for Medicare & Medicaid Services (CMS) <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS, which will streamline requirements for quality, electronic health records (EHR) and resource use.<br /> <br /> The AMA also will offer additional resources to help physicians successfully participate in the new system. One resource you can check out already is the recently released the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to physician-focused APMs</a>,” which outlines <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">barriers in current payment systems</a>, presents the three characteristics of successful payment models and details seven physician-focused APMs.</p> <p style="margin-left:0.25in;"> <strong>2.  </strong><strong>EHR meaningful use program.</strong> This burdensome regulatory program is scheduled to move forward next year, following the Centers for Medicare & Medicaid Services’ (CMS) release of the <a href="http://www.ama-assn.org/ama/ama-wire/post/new-meaningful-use-rules-issued-despite-calls-reassessment" target="_blank">meaningful use Stage 3 final rule</a> late in 2015. The medical community immediately called on policymakers to put physicians back in control of their practices and put patients before bureaucracy after the rule was released and will continue these efforts this year.<br /> <br /> The AMA’s grassroots campaign <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank">Break The Red Tape</a> is calling for physician-led and patient-focused medicine and pressing for a reset of Stage 3. Recommendations for the reset seek to alleviate meaningful use burdens and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work?utm_source=BulletinHealthCare&utm_medium=email&utm_term=121915&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_blank">revise the program</a> to improve flexibility, expand patient engagement and clear the way for increased health IT interoperability and innovation.</p> <p style="margin-left:0.25in;"> <strong>3.  </strong><strong>Insurance mergers.</strong> The nation’s largest <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_blank">health insurers have proposed mergers</a> that would reduce competition in the health insurance market. If approved, this consolidation would have a damaging impact on patients and physician practices by reducing health care access, quality and affordability.<br /> <br /> In a <a href="https://download.ama-assn.org/resources/doc/washington/proposed-health-insurance-mergers-letter-to-doj-11nov2015.pdf" target="_blank">letter</a> (log in) to the U.S. assistant attorney general, the AMA urged the Department of Justice to block the proposed mergers and will continue to advocate to Congress and state policy makers to prevent this detriment to health care. Physicians also adopted <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-reaffirm-commitment-stop-insurance-mergers" target="_blank">new policy</a> on the matter at the 2015 AMA Interim Meeting.</p> <p style="margin-left:0.25in;"> <strong>4.  </strong><strong>Provider networks and balance billing. </strong>Insurer networks are expected to continue narrowing, and out-of-pocket expenses for insured patients will continue to increase. In the face of these trends, the AMA will continue to work with states, the Department of Health and Human Services (HHS) and other groups to protect patients’ access to care and seek solutions to unanticipated out-of-network bills while preserving incentives for insurers to contract and physicians’ rights to fair payment.</p> <p style="margin-left:0.25in;"> <strong>5.  </strong><strong>Prescription drug abuse and addiction. </strong>A <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-explain-end-opioid-overdose-epidemic" target="_blank">four-fold increase in opioid deaths</a> in the last decade highlights the importance of the opioid overdose epidemic in the year ahead. The AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">Task Force to Reduce Opioid Abuse</a> will continue to provide national leadership to stem this public health crisis. Solutions that need to be adopted this year include use of <a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-overdose-one-hour-primer-rx-monitoring" target="_blank">prescription drug monitoring programs</a>, evidence-based prescribing, a reduction in the stigma associated with substance use disorder, enhanced access to treatment and <a href="http://www.ama-assn.org/ama/ama-wire/post/new-naloxone-product-could-save-thousands-of-lives" target="_blank">expanded access to naloxone</a>—the lifesaving medication that can reverse the effects of an opioid overdose.</p> <p style="margin-left:0.25in;"> <strong>6.  </strong><strong>Graduate medical education (GME) funding and student debt relief. </strong>Critical funding for <a href="http://www.ama-assn.org/ama/ama-wire/post/gme-numbers-heres" target="_blank">graduate medical education</a> (GME) is in danger of being cut. The AMA’s <a href="http://savegme.org/" rel="nofollow" target="_blank">Save GME</a> grassroots campaign will continue to urge Congress to maintain funding.  Grassroots activities also will focus on simplifying student loan application processes and improving repayment rules as part of the Higher Education Reauthorization Act.</p> <p style="margin-left:0.25in;"> <strong>7.  </strong><strong>Prescription drug costs. </strong>The cost of prescription drugs has soared in recent years, making it challenging for patients to afford their necessary medications. Pharmaceutical spending growth has shown no signs of abating. In November, <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-call-fairness-drug-prices-availability" target="_blank">physicians voted</a> at the 2015 AMA Interim Meeting to convene a task force and launch an advocacy campaign to drive solutions and make prescription drugs more affordable.<br /> <br /> The task force will develop principles to address pharmaceutical costs and support physicians and patients in local and national initiatives that will bring attention to rising prescription drug prices and help put forward solutions to make these drugs more affordable.</p> <p style="margin-left:0.25in;"> <strong>8.  </strong><strong>Health data security. </strong>Threats to health data security have been increasing over the past two years. A study found that 81 percent of health IT executives reported cyberattacks in that time span. Such endangerment of health data is expected to increase this year. With such private information so vulnerable to attack, appropriate protections for sharing and data storage must be a focal point for health IT. The AMA is working with the federal government to ensure better protections for health information.</p> <p style="margin-left:0.25in;"> <strong>9.  </strong><strong>Telemedicine. </strong>Already a <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-physicians-prepping-telemedicines-success" target="_blank">growing trend</a> in care delivery, telemedicine will see more widespread use in the upcoming year. The AMA intends to advance the <a href="http://www.ama-assn.org/ama/ama-wire/post/new-commission-streamline-medical-licensure" target="_blank">Interstate Medical Licensure Compact</a> of the Federation of State Medical Boards, which facilitates state licensure for telemedicine. The AMA also will advocate for the removal of arbitrary barriers to telemedicine coverage under Medicare and promote AMA model state telemedicine legislation.</p> <p> <em>AMA Wire</em>® will provide timely coverage of developments around these issues throughout the year ahead.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6cde6e88-ac54-43c8-b4c8-0db9029f66c5 Top questions to ask during your residency program interviews http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-questions-ask-during-residency-program-interview Mon, 04 Jan 2016 21:00:00 GMT <p> Beyond the opportunity to leave a great impression, residency program interviews give you the rare chance to assess whether a program is the right fit for you—but only if you ask the right questions. As you travel to various interviews, keep this list of questions handy to conduct an effective conversation with program directors and current residents.</p> <p> The Association of American Medical Colleges (AAMC) created <a href="https://www.aamc.org/download/77936/data/residencyquestions.pdf" rel="nofollow" target="_blank">a list</a> of key questions physicians in training recommend students ask to learn important information about residency programs. They suggest asking various people you meet during your interviews different questions to gain a holistic picture of the program you’re considering.</p> <p> <strong>Questions to ask program administrators: </strong><br /> <em>Ask program staff questions that will help you understand the educational, research and clinical opportunities you’ll receive in training. It’s also wise to talk to staff about employee benefits, faculty and resources the program offers residents. Broken down by topic, here are some key questions the AAMC suggests for an informative residency program interview.</em></p> <p> <strong>On education:</strong></p> <ul> <li> Is there an orientation program for incoming residents?</li> <li> What programs exist for resident education? Are there opportunities for lectures, journal clubs, grand rounds and board review courses</li> <li> What formal and informal learning opportunities can I expect? Is there an official didactic curriculum in this program? If so, how is it structured?</li> </ul> <p> <strong>On clinical duties:</strong></p> <ul> <li> What is the general call schedule? Are provisions made for back-up call or sick-call coverage?</li> <li> How much support do residents receive from other members of the care team?</li> <li> What type of supervision structure is in place for residents?</li> <li> Does the general volume of clinical work support a balance between service and education?</li> </ul> <p> <strong>On employment benefits:</strong></p> <ul> <li> What are the basic resident benefits?</li> <li> Are meals paid for when on call?</li> <li> Is there a reimbursement policy for educational supplies and books?</li> <li> What is your family leave policy?</li> <li> Are moonlighting opportunities available? If so, what are the rules for moonlighting?</li> </ul> <p> <strong>Questions to ask other residents:</strong><br /> <em>One of the most valuable sources of information on any program will be the residents in training. Speak with residents about key issues such as work-life balance, transitioning to residency and resident satisfaction to gain insight into the program’s culture. Ask residents these candid questions and carefully note how their responses align with your expectations for training.</em></p> <ul> <li> What are the strengths and weaknesses of the program?</li> <li>  Would you consider the same program if applying again?</li> <li> How accessible is the faculty?</li> <li> Do residents get along with one another?</li> <li> What activities are you involved in outside your program?</li> </ul> <p> Read <a href="https://www.aamc.org/download/77936/data/residencyquestions.pdf" rel="nofollow" target="_blank">the full list of questions</a> from AAMC, which covers other essential considerations, including residency performance and evaluations, research and teaching opportunities and requirements, and questions you should ask yourself following an interview.</p> <p> <strong>Want more tips for applying to residency? Check out these resources:</strong></p> <ul> <li>  Get <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-ace-video-interviews-residency" target="_blank">six key tips</a> to help you excel on video interviews for residency.</li> <li> Learn how to write a competitive CV using <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">these six strategic steps</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty).</li> <li> If you’re still in the early years of your training but are getting a head start preparing for residency, also be sure to consult <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank">this must-have checklist</a> of tasks to prioritize during your first and second years of training. Also, save this second checklist <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank">for success during your third year</a> of med school.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3cdd289f-de42-4aa9-a84d-df1bd3de440f 3 steps physicians say make practice changes successful http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-steps-physicians-say-practice-changes-successful Sun, 03 Jan 2016 20:00:00 GMT <p> The new year is here and brings with it many—often <em>too</em> many—resolutions for change. While change fatigue is common, when the desire for change comes from within your practice, the results can unify your team. If you’re planning to make changes in 2016, use these three tips from physicians to select the right change initiatives for your practice and keep your practice team on board throughout the process.<a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/4/2429554b-a5ce-444f-94f6-4b405fb784d3.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>How to decide on changes in your practice</strong></p> <p> Change is always difficult, and identifying the right opportunities for improvements in your practice often can be the most critical part of the transformation process. For instance, you may want to iron speed bumps out of your work flow, or you may want each member of your practice team to be enabled to perform at the top of their skill set.</p> <p> Change becomes much easier to lead and facilitate when the change initiative addresses issues that arise from the needs and experiences of your practice team. A <a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank">free online module</a> from the AMA’s <a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank">STEPS Forward</a>™ collection provides three steps developed by physicians for success as you get ready for change in your practice.</p> <p> Use this three-step framework to choose the best change initiatives to tackle important goals within your practice:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Determine whether the change will ease the work burden for those who deliver care.</strong> Generating commitment to change requires your practice team to be able to individually see “what’s in it for them.” A successful change should make it easier for front-line workers to do their work well.<br /> <br /> Involving all members of your team in the process—from determining which project to undertake to actual implementation—will ensure their involvement, buy-in and engagement throughout the process.<br /> <br /> When considering whether a specific change will be beneficial, ask these questions:</p> <ul> <li style="margin-left:40px;"> What aspects of the daily work frustrate the physicians and other members of your practice team?</li> <li style="margin-left:40px;"> What does your practice team do that seems counterproductive or unnecessary?</li> <li style="margin-left:40px;"> In what areas are the results of your care delivery disappointing?</li> </ul> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Confirm that the change will improve patient care.</strong> Most initiatives your team identifies will likely benefit patients. For example, eliminating duplication or repetition in a process will translate to more time spent with patients.<br /> <br /> Measurement is key to change implementation. First, measure the current state so your team can see improvement as it happens. Measurement will also give your team a goal to work toward. For example, if your team anticipates saving 20 minutes by implementing a certain process, they will remain motivated until they accomplish that goal.<br /> <br /> Even if the goal is exceeded, your team may continue working to see how much they can surpass the original goal. Seeing improvement is a positive energy builder.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Confirm that a revenue stream will support the change.</strong> Dedicating people, time and energy to embark on an improvement initiative must make financial sense. If benefits do not outweigh costs, your practice should not make the change.<br /> <br /> It is easier to commit to change when the costs of not making the change—maintaining inefficient operations or poor patient outcomes—are made clear. Work with your financial manager to see the potential benefits of implementing your change project. Several STEPS Forward modules offer calculators to determine cost and time savings. You can find these calculators in modules on <a href="https://www.stepsforward.org/modules/pre-visit-planning" rel="nofollow" target="_blank">pre-visit planning</a>, <a href="https://www.stepsforward.org/modules/pre-visit-laboratory-testing" rel="nofollow" target="_blank">pre-visit laboratory testing</a> and <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" rel="nofollow" target="_blank">synchronized prescription renewal</a>.</p> <p> <strong>How these three-steps are working for physicians</strong></p> <p> One practice, the Family Care Network in Bellingham, Wash., used this three-step framework several times over the past few years to select change efforts. One such effort utilized the concerns of the practice care team to implement a patient management system change that saw tremendous success in managing patients on anticoagulants, improving convenience for the patient and reducing phone calls to the practice. The Family Care Network then capitalized on the team’s increased motivation to improve further.</p> <p> After initial success with their first project, the practice team’s attitude toward practice improvement projects changed. They suggested new projects and were able to further improve patient care and advance teamwork.</p> <p> <a href="https://www.stepsforward.org/modules/implementing-change" rel="nofollow" target="_blank">Check out the module</a> to find a more in-depth look at what it takes to select the right change initiatives for your practice and to read the Family Care Network’s story. This module offers continuing medical education credit.</p> <p> More than 25 modules are available in the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a> collection, and several more will be added in 2016, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b04c64e0-4912-4143-b359-e81c40058abf 5 tips to minimize prior authorization delays http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-tips-minimize-prior-authorization-delays Sat, 02 Jan 2016 16:00:00 GMT <p> Is the prior authorization process disrupting your work flow and impeding your ability to provide quality care to patients? Use these five tips to relieve your prior authorization frustrations and better select a method that suits your practice.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/1a888726-0fad-474a-8a77-0c713e6a50b8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/1a888726-0fad-474a-8a77-0c713e6a50b8.Large.jpg?1" style="margin:15px;float:right;" /></a>Prior authorization steals time from physicians that would be better spent with patients and increases practice costs. The process can pose roadblocks to patient care, delaying much needed services or stalling the delivery of a patient’s treatment.</p> <p> Practice management experts shared these tips to better manage this burdensome process and reduce its effect on patient care during an AMA webinar last week:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Check prior authorization requirements before providing services or sending prescriptions to the pharmacy</strong>.<br /> Taking this step will help prevent delays to filling prescriptions, denials of claims and lost payments that can result from unmet prior authorization requirements.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Establish a protocol to consistently document data required for prior authorization in the medical record</strong>.<br /> Uniformly following a protocol can help you avoid delays in patient therapy, prevent potential follow-ups with patients for additional information and minimize time spent on authorization.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Select the prior authorization method that will be most efficient, given the particular situation and available options</strong>.<br /> A variety of prior authorization methods are available today, including standard electronic transactions, health plan portals, fax, telephone and secure email. A newly updated <a href="https://download.ama-assn.org/resources/doc/psa/x-pub/prior-authorization-toolkit.pdf" target="_blank">prior authorization toolkit from the AMA</a> (log in) details the advantages and disadvantages of each method to help you make educated decisions for your practice. By selecting the method that best fits your practice, you can reduce work flow disruptions.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Regularly follow up to ensure timely prior authorization approval</strong>.<br /> The prior authorization process is primarily manual. As a result, a request could be lost in one of the many steps. Track your requests, and follow up to prevent delays that can occur if information is lost or not received by payers.</p> <p style="margin-left:40px;"> <strong>5.   </strong><strong>When a prior authorization is inappropriately denied, submit an organized, concise and well-articulated appeal with supporting clinical information</strong>.<br /> You can increase your chances of success in overturning a prior authorization denial by making sure all clinical information is included with the appeal, including any data that may have been missing from the initial request.<br /> <br /> For prescription appeals, think about adopting electronic prior authorization technology to further streamline the process.</p> <p> Learn more about these recommendations by viewing the <a href="https://cc.readytalk.com/cc/playback/Playback.do?id=5s8rny" rel="nofollow" target="_blank">archived webinar</a> (log in), the AMA’s <a href="https://download.ama-assn.org/resources/doc/psa/x-pub/prior-authorization-tips.pdf" target="_blank">prior authorization tip guide</a> (log in) or the <a href="https://download.ama-assn.org/resources/doc/psa/x-pub/prior-authorization-toolkit.pdf" target="_blank">prior authorization toolkit</a> (log in) to find an in-depth look at the current situation and what is being done to change it.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:593ba914-3511-4b79-9810-027969e3c0cc New med school to prioritize diversity, disparities and cultural competence http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-med-school-prioritize-diversity-disparities-cultural-competence Sat, 02 Jan 2016 15:01:00 GMT <p class="p1"> Kaiser Permanente has announced that it will open its own medical school that will educate physicians to meet 21st-century demands of diverse consumers and communities. </p> <p class="p1"> “Shifts in the U.S. population have created more diverse communities, which require greater cultural competency and understanding,” a <a href="http://share.kaiserpermanente.org/article/kaiser-permanentes-innovative-approach-to-care-delivery-defines-its-new-national-school-of-medicine-opening-in-2019/" target="_blank" rel="nofollow"><span class="s1">news release</span></a> notes. “The Kaiser Permanente School of Medicine will teach advanced skills in decision-making, teamwork, the use of technology, evidenced-based medicine and communication tailored to specific populations.”  </p> <p class="p1"> The school will redesign physician education around strategic pillars that include providing high-quality care beyond traditional medical settings, acknowledging the central importance of collaboration and teamwork to inform treatment decisions, and addressing disparities in health.  </p> <p class="p1"> An <a href="http://www.latimes.com/business/la-fi-kaiser-diversity-20151218-story.html" target="_blank" rel="nofollow"><span class="s1"><i>L.A. Times</i> article</span></a> about the new school gave insight into its mission: “The company wants to recruit more minority students and teach doctors how to care for a diverse patient population, two goals medical schools throughout the country have been trying to achieve with mixed results. Many ethnic groups are under-represented in medical schools, leading to concerns that doctors might struggle to treat some minority groups, especially Latinos, who make up about 17 percent of the U.S. population but only about 9 percent of medical students, according to the Association of American Medical Colleges. By acknowledging that one of its new school's primary focuses will be on diversity, Kaiser executives are sending a key message, said James Prescott, the group's chief academic officer. ‘When a school starts, it's important to understand their mission, and when Kaiser says diversity and meeting needs of community are top goals, it's powerful,’ Prescott said.”</p> <p class="p1"> Currently, more than 600 new physicians complete their residency programs at Kaiser Permanente, and 18,000 doctors work for its affiliated medical groups. The health care system has 38 hospitals and a large network of clinics that serve more than 10 million patients in eight states and the District of Columbia. The school is scheduled to open in the fall of 2019 with 46 students in the first class. It will be located in Southern California, where physicians in training will be immersed in an environment of cultural and economic diversity. </p> <p class="p1"> “Opening a medical school and influencing physician education is based on our belief that the new models of care mean we must reimagine how physicians are trained,” said Bernard J. Tyson, chairman and CEO, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals. “Training a new generation of physicians to deliver on the promise of health and health care demonstrates our belief that our model of care is best for the current and future diverse populations in this country.”</p> <p class="p1"> The planning, design and implementation of the Kaiser Permanente School of Medicine will be led by a multidisciplinary team of physician, health plan and operational leaders. National Quality Forum CEO Christine K. Cassel, MD, will join the team responsible for designing an innovative new approach to training the physicians of tomorrow. Recruitment for the founding dean will begin in 2016. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:898d91bf-c46a-483f-9a45-7b8a1557a734 LGBT advisory committee seeks nominees http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_lgbt-advisory-committee-seeks-nominees Sat, 02 Jan 2016 15:00:00 GMT <p class="p1"> The AMA Board of Trustees is seeking diverse candidates for the following positions for its Advisory Committee on LGBT Issues:</p> <ul> <li class="p2"> Two at-large positions</li> <li class="p2"> One AMA Medical Student Section (MSS) representative (incumbent is eligible for re-appointment)</li> <li class="p2"> One Gay and Lesbian Medical Association (GLMA) representative (incumbent is not eligible for re-appointment)</li> </ul> <p class="p1"> The Advisory Committee on LGBT Issues meets twice a year and hosts monthly teleconferences in between face-to-face meetings. The committee’s role is to advise the AMA Board of Trustees on LGBT issues and host the LGBT and Allies Caucus and Reception along with other LGBT educational sessions. </p> <p class="p1"> Nominees should have expertise and interest in LGBT issues and should have held previous leadership or committee positions. Newly appointed committee members are expected to attend the next committee meeting in Chicago, June 9-11. The AMA-MSS and GLMA representative positions will be administered through those respective organizations. Interested AMA-MSS or GLMA candidates should contact the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/contact-us.page?" target="_blank"><span class="s1">AMA-MSS</span></a><span class="s2"> </span>by Jan. 15 and the <a href="http://www.glma.org/" target="_blank" rel="nofollow"><span class="s1">GLMA</span></a><span class="s2"> </span>directly by Feb. 1.</p> <p class="p1"> At-large position nominees must complete and sign an <a href="https://download.ama-assn.org/resources/doc/glbt/x-pub/2016-lgbt-nominations-form.docx" target="_blank"><span class="s1">AMA nomination form</span></a><span class="s2"> (log in) </span>along with their executive curricula vitae, not to exceed three pages. Nomination materials should be submitted to<span class="s2"> <a href="mailto:lgbt@ama-assn.org%22%20%5Ct%20%22_blank" rel="nofollow"><span class="s1">lgbt@ama-assn.org</span></a> </span>by Feb. 29. If you have any questions, please email <a href="mailto:JMori.Johnson@ama-assn.org" rel="nofollow"><span class="s1">J. Mori Johnson</span></a><span class="s2"> of the AMA, </span>or call her at (312) 464-5678.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a866a4e2-5c00-42c5-8ba5-eeda75ffec21 To sleep or not to sleep: How residents make decisions post-call http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_sleep-not-sleep-residents-decisions-post-call Tue, 29 Dec 2015 21:36:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/0/6fb5c168-6517-4f10-b0d1-9350fbf6a84a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/0/6fb5c168-6517-4f10-b0d1-9350fbf6a84a.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Residents are using “trade-off” approaches—in which they barter crucial sleep hours for personal time—to determine how to recover after overnight shifts, according to a <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Recovery_of_Sleep_or_Recovery_of_Self__A_Grounded.98675.aspx" rel="nofollow" target="_blank">recent study</a><u>.</u> Authors of the study identified two key behaviors among residents struggling to maintain work-life balance and decide the best way to spend their personal time.</p> <p> “Despite assumptions about how residents should be using their post-call, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities,” according to authors of the study, which was recently published in <em>Academic Medicine. </em>“This study sought to understand residents’ nonclinical post-call activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery.”</p> <p> The study took place from 2012 to 2014 at a Canadian medical school accredited by the Liaison Committee on Medical Education. The authors interviewed 24 residents across six surgical and non-surgical specialties about their post-call activities immediately following a 24-hour overnight shift, what motivates them to prioritize certain activities post-call and the personal impact these decisions have on residents’ recovery of sleep and self.</p> <p> Based on an analysis of interview transcripts, study authors found that residents grapple with competing priorities and typically use “two trade-off orientations—being oriented toward maintaining a normal life or toward mitigating fatigue—when making decisions about how to use their post-call days. These orientations were not static; residents reported shifting their predominant orientation according to the situation and accrued experience,” the study authors wrote.</p> <p> <strong>Trade-off one: What’s a “normal life” for residents?</strong></p> <p> Residents who focused on “maintaining a normal life” restricted sleep to a few hours or sacrificed rest altogether to pursue activities “that permitted them to maintain what residents characterized as ‘normal human things’ involving their personal lives and relationships outside of the hospital,” according to the article.</p> <p> Many residents said they wished to “break [the] cycle” of solely working and sleeping between rotations to explore activities that improved their connections with loved ones and personal lives.  While certain residents in the study said that forfeiting precious hours of sleep was challenging, some of the key activities they prioritized over sleep post-call included:</p> <ul> <li> <strong>Connecting with family and friends. </strong>Many residents cited a desire to connect with loved ones during personal hours due to concerns that unpredictable work schedules wouldn’t allow them to see close family and friends at a later time.</li> <li> <strong>Completing important life errands. </strong>Residents expressed a desire to “keep their life order,” which motivated them to replace sleep with completing pressing life tasks, such as going to the bank, a dentist appointment and getting their car repaired during normal business hours. “As one resident reasoned, if it [were] not for post-call days, these services would be fairly inaccessible to residents,” according to the study.</li> <li> <strong>Productivity. </strong>Despite acknowledging the need to sleep, some residents said that they still choose to use their time post-call to complete duties—such as working out and buying groceries—to increase their sense of personal fulfillment and productivity.</li> </ul> <p> <strong>Trade-off two: Sleeping the fatigue away</strong></p> <p> While life activities emerged as priorities for some residents, others pursued sleep post-call to mitigate fatigue and recover from overnight shifts. These “trade-offs” typically occurred “in situations where recharging experiences, such as choosing to ‘crawl right into bed and sleep for as long as possible’ or engage in passive activities, took priority over tasks that required more energy expenditure, such as studying, socializing or attending to normal life,” according to authors of the study.</p> <p> Some key trends study authors noted among these residents included:</p> <ul> <li> <strong>Substantial differences in sleep durations</strong>. “A few residents described wanting to sleep ‘for as long as possible’ while others deliberately restricted their daytime sleep with the intention of preserving their sleep-wake rhythm,” according to the study.</li> <li> <strong>A perceived need to justify why they’d like to sleep</strong>. “Anticipated criticism from colleagues further complicates residents’ trade-offs,” the study noted.</li> <li> <strong>Concerns about missing important opportunities</strong>. Many residents who prioritized their sleep still felt conflicted about “sacrificing valuable educational experiences by leaving the hospital and choosing to sleep or rest,” according to the study.</li> </ul> <p> Authors of the study noted that these trends—among residents in both “trade-off” groups—addresses “the evidence gap involving residents’ nonclinical post-call activities” but also underscores the importance of re-evaluating how duty-hour restrictions impact residents' recovery processes post-call.</p> <p> “These findings challenge the dominant viewpoint in the current-duty hours literature, which has maintained a singular focus on sleep as the only path to recovering from working long hours,” the study authors wrote. “Our study suggests that we must broaden the duty-hours discussion to include other recovery processes.”</p> <p> Read <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Recovery_of_Sleep_or_Recovery_of_Self__A_Grounded.98675.aspx" rel="nofollow" target="_blank">the full study</a><u> </u>for additional observations.</p> <p> <strong>Also get additional resources on balancing wellness and residency:</strong></p> <ul> <li style="margin-left:36.75pt;">  Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/new-duty-hours-review-spotlights-resident-outcomes" target="_blank">how duty-hour restrictions</a> are impacting crucial resident outcomes, including patient safety.</li> <li style="margin-left:36.75pt;"> See how physicians rank <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">residency work-life balance based on specialties</a>.</li> <li style="margin-left:36.75pt;"> Check out <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">these tips from residents who have conquered burnout</a>.</li> <li style="margin-left:36.75pt;"> Educate yourself on the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">signs of burnout</a> and how to <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">increase satisfaction in training</a>.</li> <li style="margin-left:36.75pt;"> Explore this new method one residency program devised to <a href="http://www.ama-assn.org/ama/ama-wire/post/tired-of-miserable-schedules-one-residency-programs-solution" target="_blank">get rid of miserable schedules.</a></li> <li style="margin-left:36.75pt;"> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/one-residency-program-improved-documentation-reduced-stress" target="_blank">this residency program intervention</a> that decreased stress by improving documentation timeliness.</li> <li style="margin-left:36.75pt;"> Check out Stanford University School of Medicine’s <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">successful wellness program</a>, and learn why taking time for fun (and the occasional sailing lesson) can improve resiliency in training.</li> </ul> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eda1e3bd-0d87-47b2-ae75-365a33a7fe1f Master one of the most missed USMLE questions http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_master-one-of-missed-usmle-questions Mon, 28 Dec 2015 18:00:00 GMT <p> With finals behind you, take a few minutes to sharpen your skills for the United States Medical Licensing Examination® (USMLE®) with this exclusive scoop on one of the most challenging USMLE test prep questions and expert strategies to help you ace it. Find out what this month’s toughest question is and receive an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to the fourth post in <em>AMA Wire’s</em>® series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Step 1 Qbank.” Each month, we’re revealing one of the top questions students miss, a helpful analysis of answers and a video featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_blank">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 21-year-old man with a history of schizophrenia is brought to the emergency department by his mother because of the acute onset of neck stiffness. He says his neck has been locked to the right for the last hour, and he has been unable to move it. Physical examination shows that he is anxious, diaphoretic and his pulse is 120/min. His upper body and neck are rigid, with his neck locked in flexion and rotated to the right. A review of his records shows that treatment with haloperidol was begun four days ago. He said that he took an additional dose three hours previously in order to control his auditory hallucinations. Which of the following best describes the physical findings in this patient?</p> <p style="margin-left:40px;"> A.  Akathisia<br /> B.  Dystonia<br /> C.  Neuroleptic malignant syndrome<br /> D.  Parkinsonism<br /> E.  Tardive dyskinesia</p> <p> <object data="http://www.youtube.com/v/nm0AIelkXhY" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/nm0AIelkXhY" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/nm0AIelkXhY" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p> <strong>The correct answer is B.</strong></p> <p> <strong>Kaplan says, here’s why: </strong>This patient is exhibiting an acute dystonic reaction, manifesting as torticollis. 90 percent of dystonic reactions occur within five days of starting a new antipsychotic medication. More specifically, symptoms may begin immediately or can be delayed hours to days. As many as one in three patients experience at least a mild dystonic reaction during this time. Dystonias are sustained muscle contractions, often causing twisting, repetitive movements or abnormal postures. Examples include torticollis (a twisting of the neck), oculogyric crisis (rotary eye movements or a deviated gaze) and opisthotonic crisis (spasm of entire body with back arching and flexion of the upper limbs and extension of the lower limbs). Patients are often frightened and can be in considerable pain.</p> <p> Dystonic reactions occur more frequently in males, children and young adults, especially if there is a history of acute dystonia, and with high-potency D2 receptor antagonists (e.g., haloperidol, fluphenazine). The first line of treatment is with benztropine (antimuscarinic agent), and the response can be rapid and dramatic. Benzodiazepines and antihistamines with anticholinergic activity (e.g., diphenhydramine, promethazine) can also be used. All of the other answer choices also can be consequences of neuroleptic therapy.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with future studying.</em></p> <p> <strong>Choice A: </strong>Akathisia is an extrapyramidal syndrome characterized by a feeling of restlessness, frequent repetitive stereotyped movements and an inability to sit still for more than a short period of time. It usually occurs during the first few months of drug use.</p> <p> <strong>Choice C: </strong>Neuroleptic malignant syndrome is a rare but potentially fatal syndrome that usually occurs within 10 days of starting neuroleptic therapy. Clinical manifestations include fever, encephalopathy, muscle rigidity, dystonia, diaphoresis, tachycardia and labile blood pressure. Treatment is with dantrolene or with dopamine agonists such as bromocriptine.</p> <p> <strong>Choice D: </strong>Parkinsonism, as the name implies, is similar to Parkinson’s disease. Mask-like facies, drooling, tremors, pill-rolling motion, cogwheel rigidity and shuffling gait all may be present. Parkinsonism can be produced by neuroleptic drugs, usually beginning about three weeks after the initiation of therapy.</p> <p> <strong>Choice E: </strong>Tardive dyskinesia is an often irreversible syndrome characterized by involuntary, choreoathetoid movements in patients treated with antipsychotic medications. The frequency of tardive dyskinesia increases with age and with the length of therapy. This disorder would be unlikely to occur within a few days of the initiation of drug therapy.</p> <p style="margin-left:4in;text-align:right;"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:37d92493-f48b-4619-b41e-8646f32d00e7 The simple way to boost health you may have overlooked http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_simple-way-boost-health-may-overlooked Mon, 28 Dec 2015 14:34:00 GMT <div> Happiness and small acts of gratitude are helping communities create innovative public health solutions, according to U.S. Surgeon General Vivek Murthy, MD. Here’s one simple yet profound way he says happiness benefits communal health. <br />  </div> <div> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/11/532f7e8e-55aa-4d5f-8ba8-e5f8a3685b0e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/11/532f7e8e-55aa-4d5f-8ba8-e5f8a3685b0e.Large.jpg?1" style="float:right;margin:15px;" /></a></div> <div> <strong>The science behind happiness and good health </strong></div> <div>  </div> <div> Dr. Murthy (pictured right) said he has traveled to various communities throughout the country and has witnessed the unexpected benefits happiness can have on public health. </div> <div>  </div> <div> “Happiness affects us on a biological level. Happy people have lower levels of cortisol, a key stress hormone,” he said during a presentation at TEDMED 2015. Happy people “have more favorable heart rates and blood pressure levels. They have strong immune systems … and lower levels of inflammatory markers like C-reactive protein that is linked to coronary heart disease. It turns out that even when you control for smoking, physical activity and other health behaviors, happy people live longer. There’s something about happiness that seems to be protective.”</div> <div>  </div> <div> He noted that this “happiness” isn’t predicated on the feelings people experience from “indulgence or hedonism,” but rather a sense of “long-term emotional well-being that comes from fulfillment, purpose, connectedness and love.” </div> <div>  </div> <div> <strong>Understanding the formation of happiness </strong></div> <div>  </div> <div> “Now you may ask yourself, ‘Does happiness really lead to better health? Isn’t it the other way around—doesn’t happiness result from good health and favorable circumstance?’” Dr. Murthy said, noting that people often think their happiness hinges upon contingencies, such as losing 15 more pounds, getting a better job or earning more money. </div> <div>  </div> <div> However, “the truth is that while circumstances can and do impact our short-term happiness, our long-term happiness is far more driven by how we process life events than by the events themselves,” he said. </div> <div>  </div> <div> Contrary to popular belief that happiness is innate, Dr. Murthy said research shows that people can actually “create happiness” using gratitude exercises, meditation and social connectedness. </div> <div>  </div> <div> <strong>A lesson on creating happiness: Visitacion Valley Middle School</strong><br />  </div> <div> “Perhaps one of the most powerful examples of cultivating happiness comes from Visitacion Valley Middle School in San Francisco,” Dr. Murthy said. “Some years ago, Visitacion was struggling.” </div> <div>  </div> <div> Dr. Murthy visited the school the day before giving his presentation at TEDMED 2015, which is where he learned that eight years ago, Visitacion school suffered from low test scores, high suspension rates and “so much violence that the school had to hire a full-time grief counselor.” </div> <div>  </div> <div> Teachers tried afterschool programs, peer counseling and sports programs to help mitigate students’ anger and improve attendance rates, but none of them proved effective. Then the school decided to “take a leap of faith” and try a non-traditional approach to reducing stress and improving mental health for students, Dr. Murthy said. </div> <div>  </div> <div> School staff “created two 15-minute ‘quiet time’ meditation sessions [for] each school day. They taught the teachers and students how to meditate. They taught the administrators how to meditate as well. And within a year, something incredible happened: Suspension rates dropped by 45 percent, teacher absenteeism dropped by 30 percent, and test scores and grade point averages rose markedly,” Dr. Murthy said. </div> <div>  </div> <div> Students also reported that they were less anxious, slept better and “their self-reported happiness scores went from one of the lowest scores in San Francisco to the highest in the district …. These are remarkable stories,” Dr. Murthy said. </div> <div>  </div> <div> Visitacion’s meditation model is now being replicated as a tool for happiness and improving student health in various schools across the country. </div> <div>  </div> <div> “What is so striking about these tools for increasing happiness—meditation, gratitude, social connection, exercise—is that they are so simple and accessible,” Dr. Murthy said. “We have become accustomed to thinking that complex problems require complex solutions, but that’s not always the case. Sometimes simple solutions can enable us to take on some of our most intractable problems. That’s what happiness can do when it comes to health. “ </div> <div style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9bae1feb-927c-40f3-8299-37c5a636cd64 Bill gives blanket approval for meaningful use exemptions http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_bill-gives-blanket-approval-meaningful-use-exemptions Mon, 21 Dec 2015 21:51:00 GMT <p> Legislation adopted by Congress Friday will allow any physician who applies for a hardship exemption from the 2015 electronic health record (EHR) meaningful use program to be exempted from the penalties that would have been levied in 2017. This blanket exemption will alleviate burdensome administrative issues for both physicians and the agency.</p> <p> <strong>Addressing the regulatory problem</strong></p> <p> The Patient Access and Medicare Protection Act (S. 2425) is intended to address the issues created by the delay of the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">Stage 2 modifications rule</a> issued in October. The modifications rule revised meaningful use requirements to make them more realistic but did little to help physicians because it was finalized so late in the year.</p> <p> Under the Stage 2 modifications, physicians could avoid a financial penalty if they attested to meeting the Stage 2 requirements for 90 consecutive days during 2015. But the modifications rule wasn’t published until Oct. 16, leaving fewer than the 90 minimum days left in the calendar year.</p> <p> CMS previously stated that it would grant hardship exemptions for 2015 if eligible physicians were unable to attest as a result of the lateness of the rule. But CMS was legally only permitted to grant such exemptions on a case-by-case basis. That meant that many physicians would have been required to apply for exemptions, and CMS would have had to act on each application individually.</p> <p> <strong>Alleviating this burden </strong></p> <p> The meaningful use provision in the new legislation, for which the AMA was instrumental in securing support, will grant CMS the authority to process requests for hardship exemptions to physicians through a streamlined process.</p> <p> Many members of Congress played key roles in advancing this provision of the legislation, including Rep. Tom Price, MD, R-Ga., and Sens. Orrin Hatch, R-Utah, and Ron Wyden D-Ore. Numerous members of the House and Senate leadership—both Republicans and Democrats—went to extraordinary lengths to ensure that this provision was considered prior to the end of the 2015 congressional session.</p> <p> Physicians will have until March 15 to apply for an exemption from the 2015 meaningful use program year.</p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7e1a1301-754a-4805-8da4-e6f2f5d7ad02 Residents share 4 tips for assessing specialty lifestyle http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residents-share-4-tips-assessing-specialty-lifestyle Mon, 21 Dec 2015 21:42:00 GMT <p> Evaluating the lifestyle of a medical specialty can help you determine whether it’s the best fit for you, but how do you decide what to practice when you’re interested in a specialty yet aren’t sure whether you like the lifestyle it supports? Check out these tips from residents on how to weigh your specialty options and work-life preferences as you advance in training.</p> <p> <em>AMA Wire</em><em>® </em>gathered key tips from a panel discussion in which recent residents offered advice in response to students’ questions. When you’re assessing the lifestyle of a specialty, panelists recommended that you:</p> <p style="margin-left:40px;"> <strong>1.     </strong><strong>Shadow an attending physician in your desired specialty and be honest with yourself about what you observe.</strong> Clinical rotations open valuable peepholes into the lives of physicians, so attentively monitor what you see during rotations. Ask questions about what’s expected of young physicians and duties that are integral to the field.<br /> <br /> For instance, one OB-GYN resident said students who intern at his program often sign up for a 20-30 hour “labor and delivery” night shift to gain a more holistic view of what it’s like to practice in that field. <br /> <br /> “In residency, you’ve got your 80-hour rule. You’ve got your time off. But when you go into practice, what you see those practicing attendings [doing] is what you’re going to do from then on, so if there are parts of that … you find completely unacceptable … because of the lifestyle, then that’s probably not the specialty for you,” he said.<br /> <br /> While he said the culture of a specialty can vary in different practice environments, the duties that are intrinsic for physicians in that field are the same across practice settings, so gauge what you think about the everyday work flow, lifestyle trends and perceived personalities of clinicians around you.</p> <p style="margin-left:40px;"> <strong>2.     </strong><strong>Don’t pick a specialty unless you understand—and accept—its associated lifestyle habits</strong>. Speak with residents and clinicians about the daily lives and schedules of physicians in that specialty. When you feel like you’ve acquired enough insight, assess your options and be sincere about what makes you feel uneasy. “Being an OB-GYN, if I were someone who [were] completely averse to being woken up during the middle of the night, this would not be the specialty for me,” one resident said.</p> <p style="margin-left:40px;"> <strong>3.     </strong><strong>Pay attention to work-life balance.</strong> One resident panelist advised students to consider how the specialty might pair with their social life or family obligations. Speak to residents in that specialty about their sense of wellness and work-life balance in that specialty to understand whether it aligns with your plans for family and other personal interests or responsibilities.<br /> <br /> To get started, learn more about how physicians have <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">ranked specialties according to their work-life balance</a> in residency.</p> <p style="margin-left:40px;"> <strong>4.     </strong><strong>Know what you value in your long-term goals—both in and outside of medicine</strong>. Choosing a specialty can be a very reflective process that requires introspection. Avoid <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">overlooking crucial aspects</a> in your decision-making, and give yourself time to be honest about what you really want in practice. “You have to eliminate ego [from] the equation and really have to look honestly and say, ‘Okay, what will my life be like in 10 years?’ And if you do that, I really think you’ll make the right decision,” another resident said.</p> <p> <strong>Want more advice on choosing your specialty?</strong></p> <ul> <li> Review the <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialty-choice-under-microscope-2015" target="_blank">highlights of the specialty choice topic</a> from 2015.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialties-vary-gender" target="_blank">how medical specialties vary by gender</a>.</li> <li> Read about your specialty options in AMA’s <em>Choosing a Medical Specialty</em> <a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (log in). This must-have resource is free for AMA members and highlights the major specialties and subspecialties, and offers Match data and career information statistics.</li> <li> Avoid overlooking <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">these 5 important factors</a> when choosing a specialty.</li> <li> Check out <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank"><em>AMA Wire’s®</em> “Shadow Me” Specialty Series</a>, which features advice directly from physicians in the field.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7e32f4e2-ef97-44f0-8552-4e966d62a9ad Top 5 topics for the medical community in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-5-topics-medical-community-2015 Sat, 19 Dec 2015 02:00:00 GMT <p> Despite being a particularly eventful year for medicine, 2015 saw clear themes emerge that the physician community kept coming back to. We’ve distilled the top five topics you should know and the most important highlights from the year for each one.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/8/2226e310-3f54-44fe-88a9-4ded2db73010.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/8/2226e310-3f54-44fe-88a9-4ded2db73010.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-tops-physician-issues-2015" target="_blank">No. 1: Physician burnout</a></strong></p> <p> Burnout topped physician issues this year, with the dreaded phenomenon becoming all too common as burdensome regulations and the mounting pressures of practice put many physicians in survival mode. Learn more about the scope of the problem, the tell-tale signs you should never ignore and solutions for physicians, residents and students.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialty-choice-under-microscope-2015" target="_blank"><strong>No. 2: Specialty choice</strong></a></p> <p> From selecting a specialty as a student and applying to sub-specialty fellowships as a resident to evaluating life within a specialty as a practicing physician, specialty choice has been top of mind this year. Find out what physicians are saying about their specialties, which fields are attracting the most fellowship applicants and key things students need to consider.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-physicians-found-put-patients-first-2015" target="_blank"><strong>No. 3: Putting patients first</strong></a></p> <p> The physician-patient relationship is a sacred bond, but how is it maintained amidst changes in the culture and practice environment? In the face of new challenges this year, physicians stated loud and clear that patients remain their top priority. Read about some of the ways physicians stood up for patients and advanced their medical care this year.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-thrive-outside-office" target="_blank"><strong>No. 4: Thriving outside the office</strong></a></p> <p> In medicine, leisure time barely exists, and physicians have to learn to juggle their personal lives with long hours in the office. How do busy physicians maintain a work-life balance? Learn what physicians had to say about their personal lives and gain some practical tips.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" target="_blank"><strong>No. 5: Dealing with electronic health records (EHR)</strong></a></p> <p> Burdensome regulations and technology have led physicians to spend considerable time struggling with their EHRs. Fortunately, policymakers and health IT developers are starting to take note. See how this issue evolved over the past year and where things stand moving into 2016.</p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:12f63a32-1abf-4cbb-b90f-e0882c625ea8 5 medical publishing pitfalls residents often overlook http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-medical-publishing-pitfalls-residents-overlook Fri, 18 Dec 2015 00:00:00 GMT <p> <img src="http://pluck.ama-assn.org/static/images/store/5/14/a5664829-a1db-470a-9efd-af0bb706643e.Large.jpg?1" style="float:right;margin:15px;" /></p> <p> If you’re hoping to get published in the coming year, take time to learn common mistakes residents make in the publishing process to ensure your plan is a success. Avoid these five missteps when writing or submitting research to journals. </p> <p> Susan Bates, MD (pictured right), gave expert insights to a group of residents at the 2015 AMA Interim Meeting in November. Dr. Bates has been published more than 250 times and owns multiple patents. She’s the senior clinical investigator and head of the Molecular Therapeutics Section in the Developmental Therapeutics Branch and Coronary Vector of Columbia University’s BA Cancer Initiative and has mentored multiple fellows.</p> <p> As an advisor, she urges young researchers to avoid some common mistakes in medical publishing:</p> <p style="margin-left:31.5pt;"> <strong>1.   </strong><strong>Not reading author instructions</strong>. Surprised? This one may seem shocking, but many people still forget to follow author guidelines—a major pet-peeve for journal editors. Instead of rushing to submit, “be sure to read the instructions for authors,” Dr. Bates said. “Sometimes you’ll prepare a paper, and it’ll be just perfect, but it’ll [have] three times too many figures and twice as many words” as the required author guidelines.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Targeting journals that don’t fit the scope of your paper or research.</strong> Your ability to target the right journal will often depend upon how well you assess your research. “Think about the journal’s scope and audience,” Dr. Bates said. “Try to [determine] whether your research is really high profile.” Ask whether your work represents a “big conceptual leap” or an incremental change, Dr. Bates said, noting that it’s perfectly acceptable for a paper to be “incremental” as long as it contributes meaningful research to your field.<br /> <br /> After assessing the content and quality of your paper, find a journal that you think will be receptive to your project. Avoid submitting to elite publications if your paper doesn’t fit the scope of research that particular journal typically publishes, Dr. Bates said.<br /> <br /> Targeting the wrong journal or submitting papers to high-profile publications that don’t align with your research topic can prompt unnecessary delays in the publishing process.<br /> <br /> “Your papers can end up rejected. You can [start] a new rotation. Your research sits on the back burner. The data gets overturned by other events, somebody else publishes it and pretty soon you’ve lost all that work,” she said. “So it’s very important to target the right journal and be sure that you don’t go too high.”</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Failing to carefully craft interesting titles or abstracts. </strong>“People do not pay enough attention to their titles,” Dr. Bates said. Avoid bland titles for papers you want to catch an editor’s eye. Instead, craft headings that are meaningful, clear and interesting.<br /> <br /> “I often write three or four titles and get other people to give me their thoughts about which title they like [more]” before finalizing a paper for publishing, Dr. Bates said.<br /> <br /> She also urges residents to fine-tune every word and figure in an abstract. “It’s really important that your abstract tell the story you want to tell. Don’t write an incomplete abstract or save it for the last minute.”<br /> <br /> Sometimes, Dr. Bates said, the abstract may be the first—or only—component of your paper reviewers see. To write an effective abstract, she recommends residents “spend time thinking about keywords” and how to integrate them in the abstract description.<br /> <br /> This is important when submitting to online research databases “because the abstract and keywords you use [determine] how people will find your paper, especially on PubMed,” Dr. Bates said.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Forgetting to examine previously published papers that relate to your project. </strong>Before diving into lab work, take time to carefully review published literature on your research topic to understand if certain aspects of your project are already dated. Think expansively about new questions you can answer with your data and how it aligns with the literature in your field.<br /> <br /> “It’s always so easy—particularly in this day and age with the way PubMed is—to miss key papers in the literature. But a friend of mine says, ‘A day in the library can save you a year in the lab,’” Dr. Bates said.  <br /> <br /> She also encourages residents to think about whether there are discrepancies between the literature and their own data and to be transparent about sharing this information.</p> <p style="margin-left:40px;"> <strong>5.   </strong><strong>Being shaken by rejection—overlooking the value of reconsideration letters</strong>. Because of the competition to publish, it’s very common to get rejected from publications, especially as editors continue to request more data before committing to publish papers in print, Dr. Bates said.<br /> <br /> She noted that even the “work horse” journals that have historically been accessible for publishing have become more selective. “You’re more likely now than in the past to get a rejection or at least get a ‘major revision’ [letter],” Dr. Bates said.<br /> <br /> Still, being rejected by one journal doesn’t mean your paper can’t find new life. This is especially true if a journal offers to reconsider your research provided you revise or update it. One of the common mistakes Dr. Bates said new researchers make is viewing reconsideration letters as official rejections from journals when, in fact, they’re actually opportunities.<br /> <br /> “I can’t tell you how many [residents] at your stage of the game have thought that a [reconsideration letter] was a rejection and have put their research down and never come back to it. It’s not a rejection. It’s great news” when a journal allows you to revise and resubmit your work for another chance at publishing, Dr. Bates said.<br /> <br /> If your paper was rejected without review, simply reformat and send it to another journal to see if they’d be interested in it, she advises.<br /> <br /> However, if your paper was rejected with notes for review, Dr. Bates suggests revising and resubmitting the paper provided you have time to actually enhance it. “If you choose to revise and resubmit the manuscript, one thing that’s really important is to try to address every reviewer comment. Even if they give you 20 comments, you don’t have to make 20 changes. But say why you didn’t make that change or try to make some small change …. Reviewers hate spending time [offering comments on papers], then having you resubmit and it didn’t change at all …. Whatever the reviewer wants, try to do it,” Dr. Bates said.</p> <p> <strong>Explore more on publishing:</strong></p> <ul> <li> Get more expert advice from Dr. Bates with these <a href="http://www.ama-assn.org/ama/ama-wire/post/published-using-5-writing-research-tips" target="_blank">must-have tips on writing and publishing.</a></li> <li> Learn how to publish your research like a pro with <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_blank">these five strategies</a>.</li> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals that accept research from physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_blank">these 9 expert tips</a> for getting published in a medical journal.</li> <li> Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_blank">how to handle it.</a><br />  </li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8fdb5701-c642-4ff3-b2b0-d0f52c35c16d Burnout tops physician issues in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_burnout-tops-physician-issues-2015 Thu, 17 Dec 2015 21:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/b2fcac26-e9d0-4df9-adcf-d009f9ca2b9c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/b2fcac26-e9d0-4df9-adcf-d009f9ca2b9c.Full.jpg?1" style="margin:5px 20px;" /></a></p> <p> As the year comes to a close, we wrap up our look at five top topics that struck a chord with the medical community in 2015. Coming in at No. 1 on the list is physician burnout, a phenomenon that has become all too common as burdensome regulations and the mounting pressures of practice have put many physicians in survival mode.</p> <p> <strong>The problem</strong></p> <p> A <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" target="_blank" rel="nofollow">new study</a> reveals that the prevalence of burnout among physicians has escalated in recent years, with 54.4 percent of physicians reporting at least one symptom of burnout.</p> <p> With those odds, it’s important to understand when burnout may be creeping up on you. At the beginning of the year, a physician burnout researcher identified the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">seven tell-tale signs</a> you should never ignore—and they include some factors that are so common they may surprise you.</p> <p> We also highlighted the <a href="http://www.ama-assn.org/ama/ama-wire/post/8-things-can-put-risk-of-burnout" target="_blank">eight things that can put physicians at risk of burnout</a>, most of which can happen at any point in physicians’ careers.</p> <p> As a matter of fact, burnout reaches beyond physicians who are established in practice. Survey results released this year by the Accreditation Council for Graduate Medical Education (ACMGE) also found similar <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-survey-reveals-concerning-data-resident-wellness-1" target="_blank">concerning trends in resident wellness</a>.</p> <p> <strong>Ways physicians are overcoming burnout</strong></p> <p> Thankfully, help is at hand for those who are struggling with burnout or trying to minimize their risk.</p> <p> The AMA’s <a href="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward™ collection</a> offers online modules with proven solutions, including <a href="http://www.ama-assn.org/ama/ama-wire/post/6-ways-improve-resiliency-demanding-practice-environment" target="_blank">six ways to improve resiliency</a> in a demanding practice environment and ways to prevent burnout. Other modules provide ways to help reduce risk factors for burnout, such as improving work flow through <a href="https://www.stepsforward.org/modules/team-documentation" target="_blank" rel="nofollow">team documentation</a>, <a href="https://www.stepsforward.org/modules/patient-discharge-and-rooming" target="_blank" rel="nofollow">expanded rooming and discharge protocols</a>, <a href="https://www.stepsforward.org/modules/pre-visit-planning" target="_blank" rel="nofollow">pre-visit planning</a>, and <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" target="_blank" rel="nofollow">synchronized prescription renewal</a>.</p> <p> <em>AMA Wire</em>® also shared tips from a physician burnout expert, who explained <a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" target="_blank">how physicians can boost satisfaction</a> in their personal lives and practices during a presentation at the 2015 AMA Annual Meeting in June.</p> <p> For residents, meanwhile, some training programs are figuring out ways to conquer burnout. Learn how one program was able to <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">achieve wellness and work-life balance</a> for its residents. And some <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre" target="_blank">creative approaches</a> are starting to take hold as well.</p> <p> On the medical student end, we also <a href="http://www.ama-assn.org/ama/ama-wire/post/student-sos-7-ways-avoid-distress-medical-school" target="_blank">spoke to a burnout expert</a> who explained the concept of “student distress” and how this can be avoided in medical school.</p> <p> <strong>Addressing burnout before it starts</strong></p> <p> Clearly, burnout has become a widespread problem for the medical profession. But it doesn’t have to be every physician’s fate. And there’s good news for the next generation of physicians as medical educators are making changes that should help prevent burnout before it becomes a problem.</p> <p> Through the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education initiative</a>, a consortium of medical schools is implementing bold changes that will prepare students to thrive in today’s evolving practice environment. Just last month, <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank">21 additional schools joined</a> the now 32-school consortium in innovative work aimed at transforming undergraduate medical education.</p> <p> The consortium will soon support training for an estimated 19,000 medical students, and the consortium will rapidly disseminate best practices to other medical schools across the country.</p> <p> <strong>What’s coming next?</strong></p> <p> In addition to the projects these medical schools will be tackling next year, organizations will be undertaking efforts to help beat burnout across the physician community, from first-year medical students to physicians who have been in practice for decades. Some of these efforts include:</p> <ul> <li style="margin-left:0.25in;"> The <a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-burnout-top-priority-physicians-training" target="_blank">AMA adopted policy last month</a> that is aimed at ensuring physicians in training have access to potentially life-saving mental health services.</li> <li style="margin-left:0.25in;"> The ACGME is <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-seeks-transform-residency-foster-wellness" target="_blank">working on solutions for resident wellness</a> that can be implemented in training programs across the board.</li> <li style="margin-left:0.25in;"> The <a href="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward™</a> collection, part of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative, will be releasing additional modules to help physicians with proven solutions for their lives and practices. Existing solutions include <a href="https://www.stepsforward.org/modules/physician-burnout" target="_blank" rel="nofollow">preventing physician burnout</a>, <a href="https://www.stepsforward.org/modules/physician-wellness" target="_blank" rel="nofollow">addressing resident and fellow burnout</a>, and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" target="_blank" rel="nofollow">improving physician resiliency</a>.</li> <li style="margin-left:0.25in;"> The <a href="http://www.ama-assn.org/ama/ama-wire/post/boost-joy-medicine-submit-ideas" target="_blank">International Conference on Physician Health™</a>, a collaborative meeting of the AMA, the Canadian Medical Association and the British Medical Association, will take place Sept. 18-20 in Boston. The conference will explore the theme “Increasing joy in medicine” and will focus on ways to promote wellness among the physician community.</li> </ul> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f360c71c-fd41-4163-adc9-5868b0ec0f58 7 tips for writing a winning med ed research proposal http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_7-tips-writing-winning-med-ed-research-proposal Wed, 16 Dec 2015 23:42:00 GMT <p> If you plan to apply for a medical education research grant, writing a strong proposal can help you rise above the competition. These expert recommendations will be useful as you pursue future funding opportunities.</p> <p> Writing a compelling grant proposal requires strategic thinking and research, especially if you want to increase your chances of attracting a particular funder, according to <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Needles_and_Haystacks___Finding_Funding_for.98646.aspx" rel="nofollow" target="_blank">a recent perspective article on medical education research</a> in <em>Academic Medicine</em>. As you write your funding proposal, some tips the authors recommend include:</p> <p> <strong>1. </strong><strong>Speaking to someone who already has received the grant you’re applying for or who works at the funding agency you’re interested in.</strong><br /> These conversations can help you investigate projects your funder has supported previously and understand whether your proposal fits their interests. Speaking with previous grant recipients also can offer valuable information about a particular funder’s application process and requirements.  <br /> <br /> If the funder has staff who can readily respond, call someone at the funding organization. For instance, “program officers at the [National Institutes of Health] are prime examples of people who will help by providing feedback on research ideas and how these ideas fit the goals of the institute,” the article authors wrote. “Some funders do this through letters of intent, but even then, a quick conversation with a representative of the funding agency can be invaluable in saving time and effort if the research idea does not fit the agency priorities and can help focus the study to make it a better fit.”</p> <p> <strong>2. </strong><strong>Asking for the appropriate amount of money in your proposal</strong>.<br /> “It is unwise to ask for more money than the agency can realistically provide—excessive budget requests are easy to reject,” the article stated. “Similarly, asking for funding for costs that are not permitted suggests that the researcher has not read the instructions or guidelines from the funder.”</p> <p> <strong>3. </strong><strong>Building a collaborative research team.</strong><br /> Writing a funding proposal alone can be daunting and time consuming. Instead of putting pressure solely on yourself, partner with colleagues who share your passion for the project you’re proposing.<br /> <br /> Planning a proposal with colleagues “makes it much more palatable and likely improves its quality. Collaborators can help watch for funding opportunities, provide complementary areas of expertise, supply access to a broader professional network, and offer encouragement when proposals get excoriated by reviewers,” the article authors wrote.</p> <p> <strong>4. </strong><strong>Proposing research that addresses a problem your funder will find interesting and relevant.</strong>  <br /> “This may be done by framing a larger research interest in terms of a specific problem,” the authors wrote. “For example, a larger interest in how practitioners become aware of and adopt new innovations may fit within the current spread of electronic medical records and how this technology might influence the dissemination of innovations.”</p> <p> Identifying “a practical problem” you’d like to address in your proposal can help funders understand how your research aligns with real-world solutions rather than elusive theories. “Most funders are more interested in solving a problem than in basic and theoretical study in education,” the authors wrote.</p> <p> However, this doesn’t mean that funders don’t value theory, the authors noted. It just shouldn’t be the crux of your proposal. “Theory development may not be feasible as the primary purpose of many grants, but it can and should be considered as one of the subsidiary aims of the project. Examples of using theory and targeting larger medical education research interests include exploring clinical reasoning with contemporary theory and biologic methods, sleep and decision making, and well-being,” according to the article.</p> <p> <strong>5. </strong><strong>Submitting a polished proposal.</strong> <br /> After writing and revising your proposal, carefully proofread it to ensure your work is error-free. “Unfortunately, too many applications for scarce funding have the obvious hallmarks of being assembled at the last moment. They contain misspellings, missing sections, conflicting information and editorial comments that were not removed,” the authors wrote. “Submitting an unpolished proposal is largely a waste of time for the investigator, reviewers and funders.”<br /> <br /> Because of the scarcity of medical education grants, submitting a high-quality proposal is crucial if you’d like to advance in the funding process. You don’t have to be a perfectionist, but your proposal should reflect your ability to conduct quality research. “This starts with a clearly stated research question, substantiated by a theoretical framework, and built on prior research and literature,” the authors wrote.</p> <p> <strong>6. </strong><strong>Keeping your ideas big. </strong><br /> When writing your proposal, “think big” and communicate the larger questions your research will investigate. “Although any study can be constrained by issues such as location, subjects or time, it is important to convince the funder that the study addresses a larger problem that will have implications for others and make a difference.” Even if you’re conducting a smaller study, “fundamental questions about education can still be addressed,” the authors wrote.</p> <p> <strong>7. </strong><strong>Checking with your peers</strong>.<br /> Do you solicit peer review before the peer review? That’s precisely what you’ll need to ensure you receive helpful feedback on your proposal before submitting it to reviewers. “It is almost always better to get feedback before submitting a proposal. This saves time, reduces the need for resubmission and improves the odds of getting accepted,” the article stated. “Even one critical review from a colleague can be enormously helpful in pointing out unfounded assumptions, jargon and confusing terms, lapses in logic and various other deficiencies.”</p> <p> This is the second post in a two-part series on applying for medical education research grants. Read the <a href="http://www.ama-assn.org/ama/ama-wire/post/7-strategies-funding-med-ed-research" target="_blank">first post</a> for ideas to help you find funding opportunities.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:18725508-c615-41ea-b249-57b7539ce93f Medical specialty choice under the microscope in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-specialty-choice-under-microscope-2015 Wed, 16 Dec 2015 22:46:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/cfa83c19-00e6-4629-8f01-f9d23412eb59.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/cfa83c19-00e6-4629-8f01-f9d23412eb59.Full.jpg?1" style="margin:5px 20px;width:805px;height:250px;" /></a></p> <p> We’re continuing a weeklong look at five top topics that struck a chord with the medical community in 2015. In the No. 2 slot is specialty choice. From selecting a specialty as a student and applying to sub-specialty fellowships as a resident to evaluating life within a specialty as a practicing physician, specialty choice has been top of mind this year.</p> <p> <strong>Physicians offer insights</strong></p> <p> Practicing physicians took time to reflect on life in their specialties this year as they took part in a new series to help medical students make informed choices for their careers. In its 2015 installation, <em>AMA Wire’s</em>® <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank">“Shadow Me” Specialty Series</a> profiled more than a dozen physicians who offered honest advice, observations and resources. Among the insights offered up were:</p> <ul> <li style="margin-left:0.25in;"> What the most challenging and rewarding aspects of caring for patients in their specialties are</li> <li style="margin-left:0.25in;"> How their lifestyles match or differ from what they envisioned in med school</li> <li style="margin-left:0.25in;"> What a typical week in practice looks like</li> </ul> <p> On a broader scale, a survey of more than 94,000 physicians looked at important aspects of their residency experience, including career guidance, schedule flexibility for pregnancy and other life events, program culture, and clinical diversity. <em>AMA Wire</em> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">provided a breakdown</a> of how the specialties were ranked.</p> <p> Students also received recommendations from a physician advisor for specific questions they should consider when choosing a specialty to help them find the right fit. Among the insights provided were the <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">five things students generally overlook</a> when they make their specialty choice.</p> <p> <strong>Specialty breakdowns</strong></p> <p> 2015 was a record-breaking year as 9,538 applicants participated in at least one fellowship match of the National Resident Matching Program Specialties Matching Service®. <em>AMA Wire</em> <a href="http://www.ama-assn.org/ama/ama-wire/post/top-specialties-fellowship-applicants-2015-match-glance" target="_blank">took a look</a> at which subspecialties drew the most applicants and which ones were the most fiercely competitive.</p> <p> The gender breakdown of residents in different medical specialty programs also revealed trends that may influence choice of specialty. An <em>AMA Wire</em> piece also <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialties-vary-gender" target="_blank">explored reasons</a> that physicians of different genders are attracted to certain specialties.</p> <p> <strong>What’s coming next?</strong></p> <p> Specialty choice remains an important topic for the medical community, and <em>AMA Wire</em> will continue to provide insights throughout the year ahead.</p> <p> Among these posts will be the continuation of the “Shadow Me” Specialty Series. If you’re a practicing physician who’s interested in sharing your experiences, <a href="mailto:mr.feedback@ama-assn.org?subject=Shadow%20Me%20Specialty%20Series%20profile" rel="nofollow">send us an email</a> to be considered for a potential profile in this series.</p> <p> Students also will have a special opportunity to speak directly with physicians about their practices during the annual AMA Specialty Showcase, which will be held in conjunction with the 2016 AMA Annual Meeting in Chicago. Participating physicians will share information that can help students learn more about their preferred specialties.</p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fe0b36d5-1153-4752-97d6-0e5b3d807aed Educators discuss plans to transform physician training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_educators-discuss-plans-transform-physician-training Wed, 16 Dec 2015 15:32:00 GMT <p> <em>A panel of medical education leaders recently selected <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training">21 new members</a> of the AMA’s Accelerating Change in Medical Education Consortium to transform the way future physicians will be trained. For this special Spotlight on Innovation column, AMA Wire® checked in with faculty at three new consortium schools to talk about why they joined the consortium and their exciting plans to reshape med ed. </em></p> <table border="1" cellpadding="1" cellspacing="1"> <tbody> <tr> <td> <p> <strong>Vineet Arora, MD</strong><br /> <em>Associate professor of medicine, assistant dean for scholarship and discovery and director of graduate medical education clinical learning environment innovation at the University of Chicago Pritzer School of Medicine </em></p> <p> <strong>Why the University of Chicago applied to join the AMA’s Accelerating Change in Medical Education Consortium: </strong>[Joining the consortium offered] an opportunity to catalyze change at our local institution by promoting health care delivery science, which we defined as “VISTA” (value, improvement, safety, team training and advocacy) as a main thread in our curriculum, on par with clinical medicine. It was also an exciting opportunity to be part of something bigger. I have been impressed with the innovation taking place in the consortium as well as the collaboration among consortium schools that are at the cutting edge of medical education reform.</p> <p> <strong>Now that we’re part of the consortium, we’re excited to explore: </strong>How to reverse the “deficit model” of medical students into one that is characterized by proactive advocacy for a better health care delivery system in the areas of value, improvement, safety and teamwork. In addition, we look forward to empowering medical students for their new roles through novel technology tools, such as mobile apps and enterprise micro-blogging.  </p> <p> I am eager to contribute tools to the consortium as well as evaluation tools that could be implemented more broadly. In addition, I look forward to collaborations with other schools around the VISTA areas.</p> <p> <strong>Real change in medical education starts with: </strong>Improving patient care.</p> </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/8a37c0ac-3881-432d-a5c7-d7b509fd006f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/8a37c0ac-3881-432d-a5c7-d7b509fd006f.Large.jpg?1" style="margin:15px;" /></a></td> </tr> </tbody> </table> <div>  </div> <table border="1" cellpadding="1" cellspacing="1"> <tbody> <tr> <td> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/f934526e-7949-4125-9095-70de4d9d7d22.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/f934526e-7949-4125-9095-70de4d9d7d22.Large.jpg?1" style="float:left;margin:15px;" /></a></p> <p> <strong>Suzanne Rose, MD</strong><br /> <em>Senior associate dean for education and professor of medicine at the University of Connecticut School of Medicine</em></p> <p> <strong>Why the University of Connecticut School of Medicine applied to join the AMA’s Accelerating Change in Medical Education Consortium: </strong>Our team was inspired to apply to join the consortium because we were excited about participating with other schools in closing the gap between how students are trained to be physicians and the future needs of the health care system, patients and our communities.<br /> <br /> We have been thinking a lot about these issues as we approach our curriculum reform implementation in August 2016 that will promote individualized and personalized education, incorporate more active learning with patient-centered learning and use technology to achieve these goals.</p> <p> <strong>Now that the University of Connecticut School of Medicine is part of the consortium, we’re excited to: </strong>Work with all of the schools in the consortium to share ideas and collaborate. In particular, we are thrilled to continue our work with Indiana University School of Medicine as we plan to embed a family of cases into their teaching EMR (tEMR) to support our team-based learning curriculum.</p> <p> We are also very excited to contribute to the large number of misidentified cases that have been compiled for use in our Vertically Integrated Teams Aligned in Learning and Scholarship Course (VITALS). This course—which includes students from years one through four, along with interprofessional students in teams—will explore issues in population health, health law, ethics, health policy, etc. Working with Indiana University will allow us to achieve our goal to incorporate a tEMR as a central component of our curriculum, which will prepare our students for medicine of the future.</p> <p> <strong>Real change in medical education starts with:</strong> Embracing the imperative to change; change can be difficult. However, with the transformation of health care systems, the explosion of scientific information, advances in adult learning, and the need to address the values and talents of the millennial generation, it is imperative. </p> <div>  </div> </td> <td>  </td> </tr> </tbody> </table> <p> <strong>Isaac Kirstein, DO</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/90fac860-10fe-4e17-ae21-0731e32e082c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/90fac860-10fe-4e17-ae21-0731e32e082c.Large.jpg?1" style="float:right;margin:15px;" /></a><br /> <em>Dean of the Ohio University Heritage College of Osteopathic Medicine, Cleveland</em></p> <p> <strong>Why the Ohio University Heritage College of Osteopathic Medicine, Cleveland, applied to join the AMA’s Accelerating Change in Medical Education Consortium: </strong>[Our institution] has been working with the Cleveland Clinic over the last two years to develop a new model for medical education. Our planning has been guided by the Blue Ribbon Commission for the Advancement of Osteopathic Medical Education.</p> <p> As part of the process, I compared and contrasted the findings of the commission with the work of the original 11 schools in the consortium. I wrote a paper published in the <em>Journal of the American Osteopathic Association </em>about the consortium’s work, and now it is a great honor to be part of this group.<br /> <br /> <strong>Now that Ohio University Heritage College of Osteopathic Medicine, Cleveland, is part of the consortium, we’re most excited to explore: </strong>How being a member of the consortium will allow us to be on the front lines of conversations about what curricular innovation looks like nationally.</p> <p> Our transformative care curriculum is a competency-based program that integrates primary care delivery and medical education in a six-year integrated model. Other schools in the consortium are tackling similar challenges with unique tactics, and we are excited to be able to interface and learn from our collective experiences.</p> <p> I couldn’t be more pleased to be joining this elite group of medical schools, each of us committed to real innovation in how we train physicians. This consortium will allow us to share and learn from others about some of the most exciting innovations taking place in medical education today.</p> <p> <strong>Real change in medical education starts with:</strong> A comprehensive understanding of the evolving needs of our patients and communities. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bd9e9aad-72de-4308-bac1-2189e3b6b82f Why I serve: A profile of AMA leaders in medical education http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_serve-profile-of-ama-leaders-medical-education-1 Wed, 16 Dec 2015 04:00:00 GMT <div> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/572511b9-0bb2-48a0-9d7a-4d910b30d119.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/572511b9-0bb2-48a0-9d7a-4d910b30d119.Large.jpg?1" style="float:right;margin:15px;" /></a></div> <div> <em>Physicians are spurring new changes in organized medicine as leaders at the AMA. Check out this month’s special profile of Donald Eckhoff, MD. Learn why Dr. Eckhoff pursued his AMA position and how it’s helping him improve medical education.</em></div> <div>  </div> <div> <strong>Name:</strong> Donald Eckhoff, MD</div> <div> <strong>Specialty: </strong>Orthopedic surgery</div> <div> <strong>Current position and title: </strong>Professor in the Departments of Orthopedic Surgery and Bioengineering at University of Colorado School of Medicine</div> <div> <strong>Current AMA role:</strong> Delegate for the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page?" target="_blank">AMA Academic Physicians Section </a></div> <div> <strong>AMA member since: </strong>The early 1980s, as a member of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/resident-fellow-section.page?" target="_blank">AMA Resident and Fellow Section</a></div> <div>  </div> <div> <strong>What compelled you to pursue a leadership role in the AMA?</strong></div> <div> My mentor in residency made a strong case for participating in organized medicine, encouraging me to join the Federation of Medicine at the local, state and national levels. The networking afforded by these organizations was very beneficial to building my private practice. </div> <div>  </div> <div> When I left private practice to return to academic medicine, the dean of the medical school promoted my involvement at the local, state and national levels as one way to advance the cause of academics. I now recognize the pivotal role the AMA has played in shaping the last century of medical education, beginning in 1904 with the formation of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page?" target="_blank">AMA Council on Medical Education</a>, which is charged with elevating and standardizing the requirements for medical education.</div> <div>  </div> <div> How has this role helped facilitate your professional development and your involvement in other medical organizations?</div> <div> The contacts and relationships acquired through the AMA create a network that crosses the artificial boundaries or “silos” that are inherent in specialty societies and geographic medical organizations. My academic and professional careers have benefited from this “connectivity” throughout the medical community. </div> <div>  </div> <div> <strong>How has your AMA leadership role helped you increase your involvement in other professional organizations?</strong></div> <div> Leadership in the AMA expands one’s horizon, forcing you to look beyond the local environment or the immediate workplace. With this wider perspective, becoming involved in other professional organizations follows naturally.</div> <div>  </div> <div> <strong>How has your leadership role helped you address some of the pressing issues for public health and the profession?</strong></div> <div> Working in the AMA helps one see the “big picture.” Although all politics are local, many of our most pressing public health and professional issues are more expansive. Activity in the AMA helps one appreciate the breadth of issues and opens up collaborative relationships to address them. </div> <div>  </div> <div> For instance, consider the pressing need for more residency positions nationally to accommodate the increased number of graduating medical students. This issue prompted members of the AMA Academic Physicians Section to introduce a recent resolution, which I ushered through the House of Delegates, directing the AMA to collaborate with the Association of American Medical Colleges to orchestrate a national solution.</div> <div>  </div> <div> <strong>How has your AMA leadership role helped you succeed in other aspects of your career as an academic physician?</strong></div> <div> I am actively involved in developing surgical simulators for medical training in my academic practice; meanwhile, I am collaborating with AMA colleagues to advance the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education i</a>nitiative. Therefore, my leadership role at the AMA in promoting the transition from “time-based” to “competency-based” training goes hand-in-hand with my academic career as professor of orthopedics and bioengineering in building training simulators for medical student and resident education.</div> <div>  </div> <div> <strong>What advice would you give to a medical student or physician in training to take advantage of the opportunities the AMA offers for professional development and potential leadership roles?</strong></div> <div> Leadership is an acquired skill that takes practice. If one aspires to become a leader in medicine, the AMA offers young physicians and aspiring leaders the opportunities to develop leadership skills through training forums, volunteering for committee service and taking on leadership roles. </div> <div>  </div> <div> <strong>What would you say to your colleagues in academic medicine about why you devote your time to your profession through your service in the AMA?</strong></div> <div> Volunteering as a leader in medicine by working in the AMA provides a broader perspective on my daily practice of medicine. A lot of physicians in the AMA share with me the same daily professional frustrations; by working together, we can take action toward cooperative problem solving and collective solutions. While the time and energy to spend on activities in the AMA may be hard to find, the reward is this broader perspective on our shared challenges as physicians. </div> <div>  </div> <div> <strong>Want to contribute to a future AMA leadership profile?</strong> If you know of an AMA member physician that we should profile, <a href="http://mailto:fred.lenhoff@ama-assn.org" rel="nofollow" target="_blank">email Fred Lenhoff of the AMA.</a></div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ed92c581-dec1-45ba-9fd4-82b185485ce2 Physicians share plan for how meaningful use should really work http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-share-plan-meaningful-use-should-really-work Tue, 15 Dec 2015 22:35:00 GMT <p> Physicians said enough is enough and submitted their own revisions to Stage 3 of the electronic health record (EHR) meaningful use program in a letter Tuesday, which would address real-world needs of physicians and patients. The letter outlines several detailed ways the program needs to change in light of the program’s impact on the design of EHRs, the movement toward new payment and delivery models, and the quality of patient care.</p> <p> <strong>Fix the present before planning the future</strong></p> <p> Earlier this year, Stage 3 of the meaningful use program was <a href="http://www.ama-assn.org/ama/ama-wire/post/new-meaningful-use-rules-issued-despite-calls-reassessment" target="_blank">finalized against the recommendations</a> of the physician community. In response, the AMA submitted a <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-stage-3-comment-letter-15dec2015.pdf" target="_blank">comment letter</a> (log in) Tuesday to the Centers for Medicare & Medicaid Services (CMS), outlining a framework for a more practical meaningful use program.</p> <p> The comment letter seeks to alleviate meaningful use burdens and revise the program to improve flexibility, expand patient engagement, and clear the way for increased health IT interoperability and innovation.</p> <p> The recommended changes would improve the program for both physicians and patients. They include:</p> <ul> <li style="margin-left:0.25in;"> Provide flexibility and eliminate the program’s pass-fail design</li> <li style="margin-left:0.25in;"> Expand measures to promote patient engagement and interoperability</li> <li style="margin-left:0.25in;"> Remove requirements that are beyond physicians’ control</li> <li style="margin-left:0.25in;"> Reorient measures away from process-based tasks to highlight goals that are useful to patients and physicians</li> <li style="margin-left:0.25in;"> Focus certification on new technology functions rather than placing requirements on physicians that may not be feasible yet</li> <li style="margin-left:0.25in;"> Support the reuse of data to reduce the physicians’ documentation burden</li> </ul> <p> The letter points out that new payment systems, such as the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APM) established in the <a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" target="_blank"> Medicare Access and CHIP Reauthorization Act</a> (MACRA), will not work under the current pass-fail design, in which physicians are penalized for failure to meet just one of many requirements and are held accountable for measures not in their control. Increasing flexibility should ensure more successful participation and ease the implementation of new payment models in the future, the letter states.</p> <p> <strong>Interactions with patients (beyond data) should count</strong></p> <p> It’s no surprise that patient engagement is a major focus of the recommended revisions as well. The outline calls for broadening patient engagement measures to include the “numerous innovative ways that patients and physicians can communicate and connect with one another.”</p> <p> “Instead of having multiple measures that overlap,” the letter states, “we urge CMS to adopt a single expanded measure that would include activities beyond viewing, downloading and transmitting data.”</p> <p> A revision of Stage 3 could include measures focused on reviewing clinical notes; accessing information about labs, tests and prescriptions; viewing cost information; and scheduling appointments and paying for services electronically. The measure should not dictate which type of technology must be used, the letter urges. “We believe such criteria stifle new approaches and will become quickly outdated.”</p> <p> <strong>Enhancing quality reporting and data entry</strong></p> <p> The recommended revisions focus on what EHR technology should accomplish, rather than on data entry requirements.</p> <p> The requirements for computerized provider order entry and clinical decision support, which currently are focused on counting data entry, can add ongoing challenges to practice work flow. Although CMS tried to mitigate some of these problems in Stage 3 requirements, the measures still need greater flexibility to remove these work flow challenges and ensure relevance to all physicians.</p> <p> The AMA proposed the following revised measure:</p> <ul> <li> Physician-designated staff should be allowed to electronically enter medication, lab and radiology orders. These orders should be processed electronically without intervention.</li> <li> Physicians should have a choice in selecting at least one clinical decision support tool and the information that is taken into account. Clinical decision support should not only be tied to quality measures and should not be required for the entire EHR reporting period.</li> </ul> <p> “Changing the focus away from data entry and toward actual processing of the order will help ameliorate [some] concerns and improve productivity,” the letter states. However, this will require advancements in interoperability. As a solution, the letter urges the Office of the National Coordinator for Health IT (ONC) to establish a more focused approach for testing the interoperability of health IT at the point of development to promote <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_blank">better user-centered design</a>.</p> <p> Also flagged for revision are the qualified clinical data registry measures. The framework recommends that physicians, particularly specialists, who participate in a qualified clinical data registry should be deemed as successfully meeting the meaningful use quality requirements.</p> <p> Additionally, because CMS has not updated the electronic clinical quality measures list in years and does not plan to do so again until 2017, the AMA recommends scaling down the number of quality measures required to report until there are enough electronic clinical quality measures that work for all physician specialties.</p> <p> <strong>For additional reading:</strong> Learn about some of the provisions in the recently <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">released Stage 3 rule</a> or find out how EHRs and meaningful use <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" target="_blank">tied up physicians’ time in 2015</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4ff61854-57ca-4c2b-94c9-3c5c7a50b481 Why embracing failure may spark your next research breakthrough http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_embracing-failure-may-spark-next-research-breakthrough Tue, 15 Dec 2015 20:50:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/0/c40c35e7-f87f-4360-a036-2b2fc0e0dda8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/0/c40c35e7-f87f-4360-a036-2b2fc0e0dda8.Large.jpg?1" style="margin:15px;float:right;" /></a>Crushing a scientist’s soul only requires seven words: “I don’t find your research very innovative,” said Roberta Ness, MD (pictured right), during a presentation at TEDMED 2015. Dr. Ness recently shared ways physicians can push past conceptual barriers and naysayers in medical research to create scientific innovations. Here’s why she says embracing failure is key to catalyzing breakthrough science.</p> <p> <strong>Balancing creativity and caution</strong><br /> Dr. Ness is the vice president of innovation at the University of Texas Health Science Center at Houston and has authored many books on scientific novelty, including <em>Innovation Generation</em>, <em>Genius Unmasked</em> and <em>The Creativity Crisis</em>.</p> <p> After multiple years of studying science innovation, Dr. Ness said she’s convinced that true breakthroughs in medicine start with physicians’ willingness to remain creative and not let “caution” stifle their passion for exploration.</p> <p> This is especially true in fields like academic medicine, she said, where physicians who historically challenged popular theories were often rejected.</p> <p> For instance, biologist Élie Metchnikoff, now considered one of the most transformative researchers in medicine, was an “academic pariah” of his day, Dr. Ness said. He had proven his theory of immunity, but it was never even accepted in his lifetime.</p> <p> She recalled how Metchnikoff didn’t allow cautionary responses from peers or institutional rejection to prevent him from exploring new clinical theories. Metchnikoff remained imaginative even when others said he was failing. </p> <p> <strong>A valuable lesson on accepting failure</strong><br /> It’s this unapologetic commitment to “shattering assumptions” and independent thinking that Dr. Ness urges physicians to adopt if they wish to chart new solutions in modern medicine. She said this advice is particularly salient for young physicians who are brimming with new ideas.</p> <p> “I’m no Élie Metchnikoff, but when I first started residency training at Bellevue Hospital, I figured I was pretty courageous,” she said, noting that Bellevue provides health care for some of New York City’s most destitute patients. “I specifically chose to train there to test my clinical metal on [the hospital’s] toughest cases, knowing I could cure the sick and save the world.”</p> <p> Dr. Ness said this bold notion stayed top of mind throughout her training until she met Mya, a 14-year-old prostitute who was admitted to the hospital after injecting herself with tissue-eating bacteria while using heroin. </p> <p> To treat Mya, Dr. Ness consistently gave her antibiotics and advised the young patient to “turn her life around” to improve her health. Then one day, despite having established a relationship with her, Dr. Ness learned that Mya had left the hospital without properly completing her treatment.</p> <p> “I had failed to save Mya because I thought my medical toolbox made me all powerful,” Dr. Ness said. In retrospect, she admits Mya needed more than a knowledgeable physician to change her life.</p> <p> “After seven years of preparing for clinical practice, I turned away from medicine and took up public health. My medical school classmates could not believe I was giving up … being a physician. Truth be told, I didn’t do it because I was courageous. I did it because I was too prideful to accept failure,” Dr. Ness admitted.</p> <p> <strong>How physicians can thrive despite failure, barriers in medical research</strong><br /> After entering the public health field, Dr. Ness has learned that failure is an intrinsic—and often required—part of innovation.</p> <p> “Fortunately, there are some institutions where failure is the expected cost of creative boldness,” she said. As an example, she explained that financial support from institutions such as Howard Hughes Medical Institute (HHMI) have allowed scientists to create <a href="https://www.janelia.org/" rel="nofollow" target="_blank">Janelia Research Campus</a>, “a 700-acre research haven.” </p> <p> Dr. Ness credits the progressive culture of the Janelia Research Campus to HHMI’s unique philosophy, which supports “people—not projects.”</p> <p> “Meaning, they don’t expect their brilliant draft picks to get five-year grants or to garner lucrative patents. Imagine instead, they follow [physicians] long-term and support them through success and failure all the way up until their breakthroughs,” she said.</p> <p> Dr. Ness said HHMI’s willingness to support bold scientific research—even if it doesn’t always yield its expected results—already has allowed Janelia Research Campus to produce a Nobel Laureate after its first 10 years of operating.</p> <p> <strong>What physicians must do to spark medical breakthroughs</strong><br /> While she’s excited large organizations are supporting and allocating certain grants to bold “high-risk” research, Dr. Ness said physicians can’t wait for institutions to validate their ideas.</p> <p> “We can’t cede change to bureaucrats or foundations. If we want to bring innovation inside the citadel, [we] … must support creative failure. We must allow challenges to our own authority,” she said.  </p> <p> She urges medical researchers to share information and train future physicians to foster collaborations with their peers as they explore clinical research.</p> <p> “Science is about society—not ourselves and not our careers,” she said. “That means working on the most impactful solutions, even when our work is only a cog in another scientist’s wheel …. It means shifting our ideas about education. Innovative thinking can be taught. It’s not simply innate. The work that I do allows anyone to generate more and better ideas.”</p> <p> <strong>Interested in more TEDMED?</strong><br /> AMA members have <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank">complimentary on-demand access</a> to the stage program for TEDMED 2015, which brought together the global community dedicated to shaping a healthier world, Nov. 18-20.</p> <p> Thought leaders and change agents shared compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p> AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks on demand through Dec. 20.</p> <p align="right"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6ccde04b-5fed-48a1-a9c3-54be4718f971 Ways physicians found to put patients first in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ways-physicians-found-put-patients-first-2015 Tue, 15 Dec 2015 20:42:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/dda1aa37-be6e-4b8c-b655-a07a86320e2d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/dda1aa37-be6e-4b8c-b655-a07a86320e2d.Full.jpg?1" style="margin:5px 20px;width:805px;height:250px;" /></a></p> <p> As the end of the year approaches, we continue our look at five top topics that struck a chord with the medical community in 2015. The physician-patient relationship is a sacred bond, but how is it maintained amidst changes in the culture and practice environment? Despite new challenges this year, physicians stated loud and clear that patients remain their top priority. Learn some of the ways physicians stood up for patients and advanced their medical care this year.</p> <p> <strong>Bond unbroken: Patients matter most</strong></p> <p> At the 2015 AMA Interim Meeting in November, AMA President Steven J. Stack, MD, reflected on how physicians have had their time stolen from them and explained <a href="http://www.ama-assn.org/ama/ama-wire/post/moments-matter-physicians-must-back-ama-president" target="_blank">how physicians are taking that time back</a>. The patient-physician relationship is crucial to effective treatment, and “providing excellent care to patients is not negotiable,” he said.</p> <p> In addition to the highly regulated practice environment, several court cases threatened the patient-physician relationship in 2015. <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">The Litigation Center of the AMA and State Medical Societies</a> kept vigilant watch over proceedings and advocated on behalf of physicians across the nation, filing amicus briefs in the following cases:</p> <ul> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-puts-patient-privacy-peril" target="_blank">Patients’ right to privacy</a> was circumvented when the California Medical Board began collecting prescription information without a warrant.</li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-threatens-physician-patient-confidentiality" target="_blank">Physician-patient confidentiality was threatened</a> in a state supreme court case that potentially could raise new obstacles to communication and trust.</li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-rules-physicians-can-stand-up-their-patients" target="_blank">Physicians were enabled to stand up for their mental health patients</a> in court, thanks to a recent U.S. appeals court ruling.</li> </ul> <p> The May issue of the <em>AMA Journal of Ethics</em>, meanwhile, investigated physician-patient relationships by taking a close look at situations when a physician’s efforts to help a patient may <a href="http://www.ama-assn.org/ama/ama-wire/post/helping-patient-violate-professional-boundaries" target="_blank">cross professional boundaries</a>.</p> <p> <strong>A focus on major public health concerns</strong></p> <p> Physicians also took steps to address some of the nation’s biggest health concerns, and the AMA offered key resources to help drive important clinical improvements.</p> <p> In the wake of the nation’s opioid overdose epidemic, the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">convened the Task Force to Reduce Prescription Opioid Abuse</a>. The task force has offered <a href="http://www.ama-assn.org/ama/ama-wire/post/now-comes-hard-part-turning-national-attention-action" target="_blank">steps physicians can take</a> to help their patients and resources to help them in these efforts. A panel of physician experts on the subject also <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-explain-end-opioid-overdose-epidemic" target="_blank">gave insight</a> into the epidemic and what must be done to address it.</p> <p> On the other end of the spectrum, physicians often encounter problems with keeping patients healthy when patients have a hard time sticking to their medication regimen. A module in the STEPS Forward collection, part of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative, offered ways to improve medication adherence and explained the <a href="http://www.ama-assn.org/ama/ama-wire/post/8-reasons-patients-dont-their-medications" target="_blank">8 reasons patients don’t take their medications</a>.</p> <p> To combat another public health epidemic, the AMA took steps to help physicians prevent type 2 diabetes—a condition so prevalent that <a href="http://www.ama-assn.org/ama/ama-wire/post/diabetes-prediabetes-affect-1-2-adults-but-theres-hope" target="_blank">one in two American adults has either diabetes or prediabetes</a>. As part of its <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page?" target="_blank">Improving Health Outcomes</a> initiative, the AMA partnered with the Centers for Disease Control and Prevention (CDC) to take action with <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" target="_blank">Prevent Diabetes STAT: Screen, Test, Act – Today™</a>. This program helps physicians tap into diabetes prevention and treatment options in their communities or online.</p> <p> The Improving Health Outcomes initiative also took aim at the nation’s No. 1 cause of death—heart disease. Physicians are now equipped with more tools to help patients get high blood pressure under control to prevent the onset of heart disease, including:</p> <ul> <li style="margin-left:0.25in;"> An infographic that details <a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank">seven simple tips to get accurate blood pressure readings</a>.</li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank">Three questions to ask patients</a> when measuring blood pressure to achieve more accurate readings.</li> <li style="margin-left:0.25in;"> The <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-heart-disease.page" target="_blank">M.A.P. (Measure/Act/Partner)</a> to improve blood pressure control.</li> </ul> <p> The much-anticipated results of the SPRINT trial showed that certain high-risk patients may benefit from a <a href="http://www.ama-assn.org/ama/ama-wire/post/120-mm-hg-new-bp-target-headlines-arent-telling" target="_blank">lower blood pressure target</a>.</p> <p> In addition, as people age 65 and older are becoming a larger percentage of the population, fall-related injuries are a rising public health concern. On National Falls Prevention Awareness Day, the AMA offered <a href="http://www.ama-assn.org/ama/ama-wire/post/3-simple-ways-prevent-falls-among-older-patients" target="_blank">three ways to help</a> this specific patient population avoid falls and have a better quality of life.</p> <p> <strong>What’s coming next?</strong></p> <p> Physicians can expect to see more of these efforts and resources to enhance the patient-physician relationship and promote public health throughout the year ahead.</p> <ul> <li style="margin-left:0.25in;"> The AMA Litigation Center will continue to stand up against challenges to the patient-physician relationship in court.</li> <li style="margin-left:0.25in;"> On the public health front, the Task Force to Reduce Prescription Opioid Abuse will offer resources and guidance to help physicians combat the opioid epidemic.</li> <li style="margin-left:0.25in;"> The AMA’s Improving Health Outcomes initiative also will advance national efforts to prevent type 2 diabetes and heart disease to help patients live longer, healthier lives.</li> <li style="margin-left:0.25in;"> STEPS Forward will publish additional modules in the new year. Existing offerings include more than 25 modules that cover such practical topics as <a href="https://www.stepsforward.org/modules/hypertension-blood-pressure-control" target="_blank" rel="nofollow">improving blood pressure control</a>, <a href="https://www.stepsforward.org/modules/prevent-type-2-diabetes" target="_blank" rel="nofollow">preventing type 2 diabetes in at-risk patients</a>, promoting <a href="https://www.stepsforward.org/modules/medication-adherence" target="_blank" rel="nofollow">medication adherence</a> and providing preventive care through <a href="https://www.stepsforward.org/modules/panel-management" target="_blank" rel="nofollow">panel management</a>.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0ee8e92b-a050-47de-910e-44f4c218b8ba 7 clinical rotation tips from experienced physicians http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_7-clinical-rotation-tips-experienced-physicians Mon, 14 Dec 2015 22:11:00 GMT <p> Imagine your first day of clinical rotations. After hours of studying, you’ll finally transition from learning in classrooms to exploring the floors of real care environments. What should you focus on to ensure your success in patient care? Follow these tips from experienced physicians as you begin clinical rotations and start planning for your specialty.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/19a63b75-d9c8-4f39-922f-8bc2202b6169.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/19a63b75-d9c8-4f39-922f-8bc2202b6169.Large.jpg?1" style="height:192px;width:365px;margin:15px;float:right;" /></a></p> <p> Nearly 150 students attended a clinical skills workshop hosted last month at the 2015 AMA Interim Meeting. Students in the workshop received hands-on training in airway management, blood pressure checks, ultrasound administration, casting and suturing (photos at right and below show students gettings hands-on experience).  </p> <p> <em>AMA Wire</em>® checked in with physicians who facilitated the workshop to discuss key insights students can use during their early days of clinical rotations. As you begin working with patients, be sure to: </p> <p> <strong>1. </strong><strong>Practice skills you’ll use across clinical settings. </strong><br /> For instance, during the workshop, students participated in a mini-training session with Jessica Millsap, MD, a musculoskeletal imaging diagnostic radiology fellow at the University of Alabama School of Medicine, who taught them how to operate ultrasound equipment.<br /> <br /> “Ultrasound is ubiquitous … now,” she said. “It’s used in the emergency room, ICUs, on the floors … and perhaps the most prolific use is to put in central lines, so it’s important people know what they’re looking at, and when things look [abnormal], they know what to do and who to talk to.”<br /> <br /> Dr. Millsap also encouraged students to take advantage of future clinical skills workshops and opportunities to master the technical aspects of ultrasound.</p> <p> <strong>2. </strong><strong>Check in with your fourth-year peers. </strong><br /> Medicine is a field with complex technologies and health systems that are rapidly changing. That’s why Michael Rakotz, MD, a <a href="http://www.ama-assn.org/ama/ama-wire/post/patients-heart-health-changes-qa-dr-rakotz">primary care physician</a> and director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, recommends students ask senior classmates questions about their experiences working with clinicians.</p> <p> “I always tell students to find somebody who is a fourth year when you’re going to be a third year because that’s invaluable,” he said. “These students would have been through exactly what future students will experience and will know what clinical rotations will be like in their school or hospital environment. They can always give the most precise advice on what to expect.”</p> <p> Talking with your peers can keep you informed about important new health technologies, clinical skills, work hour requirements and procedures students should practice in training, Dr. Rakotz said.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/0/fed6a1f5-0209-415c-b08e-f8673005eb53.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/0/fed6a1f5-0209-415c-b08e-f8673005eb53.Large.jpg?1" style="float:left;margin:15px;height:192px;width:365px;" /></a></p> <p> <br /> <strong>3. T</strong><strong>ry to speak with an attending who works fulltime in that specialty before applying for residency. </strong></p> <p> Clinical rotations can give you the rare opportunity to interact with attending physicians, ask questions and observe how they care for patients in a real care setting. This can be especially helpful for students who already know they’d like to pursue a very specific specialty.</p> <p> “If you want to be something specific—like a cardiologist, nephrologist or surgeon—it’s great to talk to older students on those rotations, but also find an attending who has actually [practiced that specialty] in real life for years,” Dr. Rakotz said.</p> <p> For instance, the life of a general surgeon teaching students on rotation or in an academic setting may differ greatly from that of a general surgeon who is actually practicing the specialty full time, Dr. Rakotz said. While immersed in a clinical setting, try to gain insights from a physician who practices in your field full time to make sure you understand the everyday expectations and culture of that specialty.  </p> <p> <strong>4. </strong><strong>Don’t forget to have fun—enjoy discovering medicine.</strong><br /> From acing the United States Medical Licensing Exam to prepping for shelf exams, as a medical student, it’s natural to often have a goal or deadline in mind. But try not to let these responsibilities eclipse the excitement of donning your white coat or experiencing clinical rotations for the first time.<br /> <br /> “I still remember what seems like every second on my first clinical rotations,” Dr. Rakotz said. “I remember how much fun they all were and how great it was to get out of the classroom because I did not enjoy sitting in a classroom eight hours a day. But I loved every second of learning how to practice medicine from real doctors in a real hospital with real patients. I loved every second of it, and I know most students to do too. It’s really where you learn how to become a doctor.”</p> <p> <strong>5. </strong><strong>Choose your rotations wisely.</strong> <br /> Clinical rotations give students the experience they need to make informed decisions about what to practice, so “choose your medical school rotations wisely … get broad exposure to specialties, and look at them first hand,” said Chris Dangles, MD, an orthopedic surgeon at Gibson City Area Hospital in Gibson City, Ill.<br /> <br /> “I have a wife who knew she wanted to be a plastic surgeon from the time she was five years old and fortunately she was able to do that. Myself, as an orthopedic surgeon, I didn’t pick the specialty until my last year of medical school,” he said, noting that he gave himself the time he needed in training to gain exposure to orthopedic surgery before choosing the specialty.<br /> <br /> Dr. Dangles also encourages students to “come to the AMA meeting and ask questions of the specialists at workshops like this” to get more exposure to clinical skills and learn more about different specialties.</p> <p> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-orthopedic-surgeon-shadowing-dr-dangles">more about Dr. Dangle’s experiences in orthopedic surgery</a> as part of <a href="http://www.ama-assn.org/ama/ama-wire/post/need-choosing-specialty-dont-miss-this-series"><em>AMA Wire’s</em> “Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties. </p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/12/ec882bdc-13da-4cf2-acb0-e3dc5acf9180.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/12/ec882bdc-13da-4cf2-acb0-e3dc5acf9180.Large.jpg?1" style="float:right;margin:15px;height:192px;width:365px;" /></a></p> <p> <strong>6.  </strong><strong>Hone your ability to listen (it’s one of most critical clinical skills you’ll need).   </strong><br /> “I tell my students all the time, ‘Just listen to your patients, and they’re going to tell you what’s wrong,’” Dr. Dangles said.  </p> <p> If you’d like to start practicing now, check out <a href="http://www.ama-assn.org/ama/ama-wire/post/6-simple-ways-master-patient-communication">this expert advice and acronym</a> to help students master patient communication.  </p> <p> <strong>7.  </strong><strong>Think about coordination of care during rotations. </strong> <br /> “[Students] have to think about how their rotations fit into an integrated care unit, [focusing on] the coordination of care,” said Howard B. Fleishon, MD, of the Department of Radiology and Imaging Sciences at Emory University. “I think that’s really important in today’s medical paradigms that we’re going to see. There’s going to be much more demand … not only for individual care within the medical homes but also integrated care, where everybody is working together with the patient at the focus of the care.”<br /> <br /> Dr. Fleishon recommends students focus on clinical rotations across a variety of specialties and strengthen their abilities to effectively practice team-based care. For instance, he said that as students progress in training and practice, they need to know how to comfortably refer to and work with radiologists on care teams.</p> <p> “You need to concentrate on how everyone can work together and where you fit into the continuum of health care,” he said. </p> <p> <strong>For more student-friendly tips:</strong></p> <ul> <li style="margin-left:18.75pt;"> Review and print <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank">this must-have checklist</a> of tasks to prioritize during your first and second years of training. This will help you begin preparing a strong application for residency.</li> <li style="margin-left:18.75pt;">  Print your second checklist <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank">for success during your third year</a> of med school.</li> <li style="margin-left:18.75pt;"> Master these <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_blank">4 tricks to a successful residency program search</a>.</li> <li style="margin-left:18.75pt;">   Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty).</li> <li style="margin-left:18.75pt;"> Learn how to ace video interviews for residency <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-ace-video-interviews-residency">with these 6 helpful tips.</a></li> <li style="margin-left:18.75pt;">  Follow these 6 steps for building a <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">competitive CV</a>.</li> <li style="margin-left:18.75pt;"> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get published</a>, and review <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list of the top journals</a> seeking to publish work from physicians in training.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:68cbbf46-f5b3-4781-8517-13a25f9fb174 How physicians thrive outside the office http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-thrive-outside-office Mon, 14 Dec 2015 21:58:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/8/40f41d2c-190a-4a58-982c-c46f733ae882.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/8/40f41d2c-190a-4a58-982c-c46f733ae882.Full.jpg?1" style="width:805px;height:250px;margin:5px 20px;" /></a></p> <p> As we continue our look at the top five topics of 2015, we take a step outside of the exam room to see what physicians do in their personal lives. In medicine, leisure time barely exists, and physicians have to learn to juggle their personal lives with long hours in the office. How do busy physicians maintain a work-life balance? Learn what physicians had to say about their personal lives and gain some practical tips.</p> <p> <strong>How physicians balance work, free time and relationships</strong></p> <p> Even in the throes of a long work schedule, physicians seem to find ways to enjoy the free time they do have.</p> <p> The <a href="https://www.amainsure.com/work-life-profiles-of-todays-us-physician.html" target="_blank" rel="nofollow">2014 Work/Life Profiles of Today’s Physician</a>, released by AMA Insurance, examined several aspects of physicians’ work and personal lives. Findings showed that <a href="http://www.ama-assn.org/ama/ama-wire/post/many-hours-average-physician-workweek" target="_blank">most physicians clock in 40-60 hours per week</a>, while 20 percent of physicians work a whopping 61-80 hours per week.</p> <p> When <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-spend-their-time-outside-exam-room" target="_blank">physicians find time</a> for themselves, the profiles showed, most enjoy running or jogging, cycling or walking to stay healthy. Many physicians describe themselves as avid readers and also enjoy time outdoors fishing, golfing, skiing or playing tennis.</p> <p> On the family side, the <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">profiles revealed</a> that almost 40 percent of physicians are likely to find a partner who is also a physician or health care professional. Emergency medicine physician Steve Sherick, MD, said that marrying someone who understands the challenges unique to doctors can create a strong bond, which is one of the psychological and emotional benefits of a medical marriage.</p> <p> To help physicians maintain solid relationships, the <a href="http://www.amaalliance.org/site/" target="_blank" rel="nofollow">AMA Alliance</a> magazine <em>Physician Family</em> offered physicians <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">three tips for maintaining happiness in a medical marriage.</a> For family members and significant others,  the magazine also provided <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tips-communicating-medical-student" target="_blank">four ways to communicate with a medical student</a>.</p> <p> <strong>Planning for financial health</strong></p> <p> Though physicians have to spend a lot of time making sure their practices are financially sound, maintaining healthy personal finances is important.</p> <p> <em>AMA Wire®</em> investigated several ways for physicians to keep track of their personal finances and prepare for the future. One of the pieces physicians found most helpful was how to <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_blank">partner with a physician-friendly financial advisor</a> who understands physicians’ unique needs. We also spoke with a student loan expert, who offered <a href="http://www.ama-assn.org/ama/ama-wire/post/top-tips-developing-med-school-loan-repayment-strategy" target="_blank">tips for developing a med school loan repayment strategy</a>.</p> <p> In support of their colleagues, experienced physicians chimed in this year to share their <a href="http://www.ama-assn.org/ama/ama-wire/post/top-personal-finance-tips-experienced-physicians" target="_blank">top personal finance tips</a>, citing ways physicians can plan ahead, educate themselves on their finances and prepare for the unexpected. In addition, a <a href="https://www.amainsure.com/2015-introduction-to-women-physicians-financial-preparedness-report.html?utm_source=AMA&utm_medium=AMA&utm_campaign=Women" target="_blank" rel="nofollow">new study</a> of the financial preparedness of women physicians from <a href="https://www.amainsure.com/index.html" target="_blank" rel="nofollow">AMA Insurance</a> revealed the <a href="http://www.ama-assn.org/ama/ama-wire/post/6-traits-of-financially-prepared-physician" target="_blank">six traits of financially prepared physicians</a> who are prepared for almost anything.</p> <p> Equally important in the realm of financial stability is getting a head start as a physician in training. <em>Physician Family</em> offered <a href="http://www.ama-assn.org/ama/ama-wire/post/5-financial-goals-residents" target="_blank">five financial goals for residents and fellows</a> to incorporate in their busy lifestyle and prepare for the future.</p> <p> <strong>What’s coming next?</strong></p> <p> Watch <em>AMA Wire</em> in the year ahead for more practical information and insights for thriving outside the office.</p> <p> Look for more on physicians’ personal lives next year from <a href="http://www.physicianfamilymedia.org/" target="_blank" rel="nofollow"><em>Physician Family</em></a> magazine, a publication designed for and created by medical families.</p> <p> The AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative continues to develop pragmatic solutions to support physicians in their personal and professional lives. Among those solutions are <a href="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward™</a> modules for helping to <a href="https://www.stepsforward.org/modules/physician-burnout" target="_blank" rel="nofollow">prevent physician burnout</a>, <a href="https://www.stepsforward.org/modules/physician-wellness" target="_blank" rel="nofollow">address resident and fellow burnout</a>, and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" target="_blank" rel="nofollow">improve physician resiliency</a>. Additional modules will be added next year.</p> <p> The <a href="http://www.ama-assn.org/ama/ama-wire/post/boost-joy-medicine-submit-ideas" target="_blank">International Conference on Physician Health<sup>TM</sup></a> provides a forum to share ways to promote wellness among the physician community. The upcoming conference, taking place Sept. 18-20 in Boston, will explore the theme “Increasing joy in medicine.” <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health/call-for-abstracts.page" target="_blank">Read more</a> about the guidelines to submit an abstract, the categories for presentations and the acceptable presentation formats. Submissions are welcome through Feb. 1.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6eb9cbfb-c434-4b03-b5f4-8aa6282bbfb2 CMS posts physician performance data despite serious issues http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cms-posts-physician-performance-data-despite-serious-issues Fri, 11 Dec 2015 22:26:00 GMT <p> The Centers for Medicare & Medicaid Services (CMS) has released new performance scores on its Physician Compare website, despite miscalculations of quality data that resulted in the exclusion of many physicians. The move gives an unreliable picture that could mislead patients who use the tool to make choices about the health care they receive.</p> <p> <strong>Patients misinformed</strong></p> <p> In recent months, the AMA became increasingly aware of miscalculations with the Physician Quality Reporting System (PQRS) scores. Despite these problems, CMS moved ahead with posting information only for about 40,000 physicians, while thousands more were excluded as a result of data submission and CMS miscalculations that produced inaccurate performance assessments.</p> <p> In a Dec. 1 <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/pqrs-vm-letter-to-cms-01dec2015.pdf" target="_blank">letter</a> (log in) to CMS, the AMA had called on the agency to abandon plans to publish quality performance data this year. “[G]iven the widespread issues with 2014 PQRS calculations and feedback reports, the AMA believes it is extremely premature for CMS to expand Physician Compare to individual measures on profile pages,” the letter stated.</p> <p> “The data inaccuracies and difficulties with CMS' processes grew over the last couple of months and, while CMS has acknowledged these problems, it has failed to address the underlying issues,” AMA President Steven J. Stack, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-12-10-cms-problematic-information-patients.page" target="_blank">statement</a> Thursday. “The AMA is a strong supporter of transparency, but today's action goes in the opposite direction—offering the public information that will lead consumers to draw faulty inferences about the quality of care that an individual physician or group provides.”</p> <p> <strong>CMS problems may lead to physician penalties</strong></p> <p> As an additional consequence of these data inaccuracies, many physicians are facing penalties in 2016. Poorly executed communications from CMS also mean that many physicians are unaware that they are in danger of penalties or that there is a fast-approaching deadline to <a href="https://www.qualitynet.org/portal/server.pt/community/pqri_home/212" target="_blank" rel="nofollow">file an appeal</a>.</p> <p> Physicians only have until <a href="http://www.ama-assn.org/ama/ama-wire/post/file-dec-16-avoid-medicare-pay-cut-of-2-4-percent" target="_blank">Dec. 16 to avoid Medicare payment penalties of 2-4 percent</a>. The AMA continues to press the agency to protect physicians from payment penalties that stem from these data issues.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d5a9affa-3d8a-4e8a-87cc-96177f8c6d20 How EHRs tied up physician time in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehrs-tied-up-physician-time-2015 Fri, 11 Dec 2015 22:22:00 GMT <p> <img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/9/cfb71787-fbdc-4079-998f-d72ca59a29aa.Full.jpg?1" style="color:rgb(0, 0, 238);margin:15px;width:805px;height:250px;" /></p> <p> As the year draws to a close, we’re taking a look at five of the topics that struck a special chord with the medical community throughout 2015. </p> <p> Burdensome regulations and technology have led physicians to spend considerable time struggling with their electronic health records (EHR). Fortunately, policymakers and health IT developers are starting to take note.</p> <p> <strong>Problems with EHR systems</strong></p> <div> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/8-things-physicians-saying-their-ehrs" target="_blank">Physicians shared key insights</a> about their EHRs in a survey by AmericanEHR Partners released this summer. The survey showed that physicians think the investments in EHRs are failing to offer substantial returns. Impractical technology has meant that too much time is spent on clerical work, stealing time that would otherwise be spent with patients.</p> <p> In the fall, the AMA and MedStar Health released an <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_blank">EHR User-Centered Design Evaluation Framework</a> that compared the design and testing processes for 20 of the most common EHR products. Out of the 20 products examined, only three met the basic capabilities. The framework shines light on the low-bar of the certification process and calls for improvements.</p> <p> Problems with EHRs are so prevalent that a 2013 <a href="http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf" rel="nofollow" target="_blank">study</a> by the AMA and the RAND Corporation found that EHRs are one of the top sources of physician dissatisfaction.</p> <p> <strong>The meaningful use mess</strong></p> <p> Meanwhile, the federal meaningful use program has become an even greater cause for concern as rulemaking moved forward despite alarms raised by the medical community.</p> <p> In a letter to the National Coordinator of Health IT (ONC) in the spring, the AMA highlighted the most important <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-talking-one-another-understanding" target="_blank">factors to achieving true interoperability</a> between EHRs based on the ONC’s <a href="https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf" rel="nofollow" target="_blank">Interoperability Roadmap</a>. The letter emphasized that penalizing physicians for not using certified EHRs will not help achieve a more robust health IT system because the lack of interoperability is out of their control.</p> <p> In October, the Centers for Medicare & Medicaid Services (CMS) modified Stage 2 of the meaningful use program and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">finalized requirements for Stage 3</a>, ignoring physician outcries to hold off on Stage 3 until the program is reassessed.</p> <p> Though there were some immediate improvements to Stage 2—a shortened reporting period for 2015 and a reduced overall number of measures physicians must report on, among others—they were finalized too late in the year.</p> <p> At the same time, <a href="http://www.ama-assn.org/ama/ama-wire/post/new-meaningful-use-rules-issued-despite-calls-reassessment" target="_blank">new regulations</a> for Stage 3 will make requirements even less achievable than they were in Stage 2. Considering only about 12 percent of physicians and other eligible professionals attested to Stage 2 of meaningful use in 2014, that’s saying a lot.</p> <p> Following release of the Stage 3 final rule, the AMA and 110 other medical associations <a href="http://www.ama-assn.org/ama/ama-wire/post/ehr-meaningful-use-doomed-unless-congress-steps" target="_blank">sent letters</a> to members of the U.S. <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-senate-02nov2015.pdf" target="_blank">Senate</a> (log in) and <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-house-02nov2015.pdf" target="_blank">House</a> of Representatives (log in), calling for intervention. The letters point out that CMS “has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”</p> <p> <strong>Physicians are speaking up, and people are listening</strong></p> <p> To curtail the ever-increasing burdens that EHRs and meaningful use have continued to press upon physicians and their patients, the AMA launched <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a>, a grassroots campaign that spearheads physician efforts to change the burdensome federal program.</p> <p> Kicking off the campaign in July was the first-ever <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank">town hall meeting on EHRs</a> and meaningful use, which was held in Atlanta. Physicians shared stories of the detrimental effects these programs have had on their practices.</p> <p> Two months later, a <a href="http://www.ama-assn.org/ama/ama-wire/post/regulations-sidelining-patients-physicians-talk-ehrs" target="_blank">second EHR town hall</a> was held in Boston, this time focusing on the impact of EHRs on physician practices affects patient care.</p> <p> As physicians, “we embrace technology … at a blistering pace,” AMA President Steven J. Stack, MD, said at the town hall. When these technologies are not coordinated properly or have unrealistic requirements for practice that monopolize physicians’ time, quality of care for patients can suffer.</p> <p> These efforts haven’t fallen on deaf ears. Members of Congress followed physicians’ lead and also called for a delay in finalizing the meaningful use Stage 3 regulations in the fall. In the House, Reps. Renee Ellmers, R-N.C., Tom Price, MD, R-Ga., and David Scott, D-Ga., led a bipartisan letter that was signed by 113 other members of the House.</p> <p> On the Senate side, Sen. John Thune, R-S.D., chairman of the Senate Committee on Commerce, Science and Transportation, and Sen. Lamar Alexander, R-Tenn., chairman of the Senate Committee on Health, Education, Labor and Pensions, sent a similar letter to federal regulators the same day.</p> <p> Rep. Ellmers also <a href="http://www.ama-assn.org/ama/ama-wire/post/congress-moves-delay-stage-3-of-meaningful-use" target="_blank">introduced a bill</a> that would provide more flexibility in the meaningful use program and ensure EHR systems address interoperability challenges in addition to pausing Stage 3 rulemaking.</p> <p> On the vendor side, health IT developers will be working with physicians in the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-finally-say-tech-development" target="_blank">AMA Interaction Studio at MATTER</a>. This new collaboration space places physicians in the same room with health IT developers to make sure physician input is a critical component in the initial stages of design.</p> <p> <strong>What’s coming next?</strong></p> <p> The year may be coming to an end, but efforts to address EHR issues are far from slowing down.</p> <p> The Break the Red Tape campaign will continue to urge Congress to intervene in the meaningful use disaster in the months ahead. At the same time, the AMA will continue to work with vendors and others to drive EHR improvements that can advance the delivery of high-quality, affordable care, based on the <a href="http://www.ama-assn.org/ama/ama-wire/post/8-top-challenges-solutions-making-ehrs-usable" target="_blank">eight guiding solutions</a> developed in 2014.</p> <p> Expect to hear more about the AMA Physician Innovation Network, which aspires to connect and match physicians and health tech companies based on their interests and needs. The program is in beta development, but interested physicians can <a href="https://innovationmatch.ama-assn.org/members/home" target="_blank">sign up today</a>.</p> <p> Two <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a> modules are available from the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative to help physicians <a href="https://www.stepsforward.org/modules/ehr-software-vendor-selection" rel="nofollow" target="_blank">select and purchase EHR products</a> and <a href="https://www.stepsforward.org/modules/ehr-implementation" rel="nofollow" target="_blank">implement those EHR products</a> in their practice. </p> <p> Physicians also will continue to guide the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-helping-rethink-ehrs" target="_blank">Substitutable Medical Applications and Reusable Technology</a> (SMART) Platforms project, an initiative to guide the development of EHRs and promote physician involvement, seeks to reimagine health IT as a smartphone-like platform that can run plug-and-play apps.</p> <p> This method could accelerate innovation to accommodate differences in work flow, drive down health tech costs and create a more competitive marketplace, which is the ultimate goal of every effort—to remove burdens and give physicians the tools to provide the highest-quality patient care.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0033144a-6b4b-4de7-872f-d42415112528 7 strategies for funding med ed research http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_7-strategies-funding-med-ed-research Fri, 11 Dec 2015 01:00:00 GMT <p> Studies <a href="http://jama.jamanetwork.com/article.aspx?articleid=201474" rel="nofollow" target="_blank">show</a> that medical education research suffers from a serious paucity of funding<em>.</em> As fewer institutions allocate dollars specifically for medical education projects, how can academic physicians ensure their innovative ideas find the financial support they deserve? Here are seven key strategies and resources to help.  </p> <p> Before writing a research proposal, physicians can take certain measures to make their search for funding more successful, according to <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Needles_and_Haystacks___Finding_Funding_for.98646.aspx" rel="nofollow" target="_blank">a recent perspective article on medical education research</a> in <em>Academic Medicine</em>. Some preliminary research steps the authors recommend include:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Looking in the right “haystack” for research funding.</strong> Authors of the perspective liken the search for medical education funding to looking for a needle in a very messy haystack. Although daunting, finding the right funding “needle” requires researchers to “first identify a haystack that may contain such needles,” the authors recommend.<br /> <br /> “The diversity of medical education research topics means that there are many sources for potential funding, although few are directed specifically at medical education research,” the authors wrote. Instead of searching for grants that are specific to med ed, researchers should explore funding opportunities within a variety of organizations, ranging from large public grant agencies like the National Institutes of Health (NIH) to small private foundations.<br /> <br /> Occasionally, funding outliers will emerge, according to the article. For instance, the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education</a> initiative in 2013 offered $11 million in competitive grants to help 11 medical schools transform future physician training, the authors wrote. This initiative <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank">has now expanded</a> to offer 21 additional schools $1.5 million in grants to fund related medical education projects.<br /> <br /> However, “such large amounts of money for medical education research are rare,” the authors noted. “Much more common are small grant programs that may be available through professional associations and societies or through the medical school or university.”</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Researching the type of projects your potential funder supports.</strong> Certain agencies, “such as the NIH and the Agency for Healthcare Research and Quality, have very broad and comprehensive research portfolios” and larger budgets, the authors wrote. In addition, private foundations “tend to focus their resources on specifics problems or issues and may accept proposals throughout the year.”<br /> <br /> Other funders may specifically focus on international health issues, local community health or research that supports a specific type of learner, such as residents or physicians in practice. Take time to determine how your research aligns with project themes that your funder typically supports, the article suggests.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Searching online databases for opportunities.</strong> “A growing number of online databases and clearinghouses can facilitate the search among these disparate organizations,” the authors wrote. They also advise exploring institutions that often offer “a health sciences library and informationists” who can help researchers find online databases that contain funding opportunities and learn best practices for effectively using these databases.<br /> <br /> “Many databases allow saved searches and weekly email alerts based on these searches to facilitate monitoring of new funding opportunities. However, many of these excellent resources require subscription fees and are accessible only to members of institutions that pay for subscriptions,” the authors noted.</p> <p style="margin-left:40px;"> Four databases they encourage educators to search for funding opportunities include: </p> <ul> <li style="margin-left:40px;"> <a href="http://www.grants.gov/" rel="nofollow" target="_blank">Grants.gov</a> "provides a centralized location for federal funding opportunities. [It] contains information on over 1,000 grant <div> programs. This resource centralizes funding announcements that are difficult to find in individual agencies."</div> </li> <li style="margin-left:40px;"> <div> <a href="http://pivot.cos.com/" rel="nofollow" target="_blank">Pivot (formerly known as Community of Science)</a> requires an institutional or individual subscription, but it also "provides access to funding opportunities globally. It is not limited to educational research."</div> </li> <li style="margin-left:40px;"> <div> <a href="http://infoedglobal.com/" rel="nofollow" target="_blank">SPIN (Sponsored Programs Information Network)</a> "targets institutions of higher education and currently contains information from more than 2,500 different sponsors."</div> </li> <li style="margin-left:40px;"> <div> <a href="https://fdo.foundationcenter.org/" rel="nofollow" target="_blank">Foundation Directory Online</a> "provides a comprehensive database for finding foundation support. [It] includes records for 100,000 grantmakers and over 500,000 grants." </div> </li> </ul> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Crafting an adaptable proposal. </strong>Authors of the perspective said physicians can use two logical strategies to search for medical education funding: “One is to develop a clearly stated research program around a specific idea and search for a funder who will support that research. The converse strategy is to first search for a funder who is willing to invest in a general area of interest and then develop a research program that addresses the funder’s goals and priorities,” they wrote.<br /> <br /> To propose an adaptable project, the article suggests academic physicians pursue a combination of the two strategies by crafting a proposal that reflects both the “researcher’s specific interests” and “the funders’ priorities.” This will help researchers secure funding that can advance their project “while also providing useful and valued research results to the funder,” according to the article.<br /> <br /> When using this “middle strategy” for your research proposal, the authors advise physicians “maintain a broad perspective” of their research “domain” and not become overly attached to a specific method of studying it. Instead, focus on how to “translate the goals of the funder” into questions that also fit your individual research topic and interests.</p> <p style="margin-left:40px;"> <strong>5.   </strong><strong>Bundling medical education research with other related research proposals. </strong>Because medical education encompasses diverse topics, it may be easier and more beneficial for physicians to integrate their med ed research ideas into larger projects that will help them secure funding.<br /> <br /> “Even when a grant proposal is for a biomedical or clinical study, it may be feasible to include medical education research as a component or ancillary study,” the article authors wrote. “For example, a large NIH center (P) grant in diabetes or Alzheimer’s disease may provide opportunities for the study of educational questions related to patient empowerment, provider decision making or team training.”</p> <p style="margin-left:40px;"> <strong>6.   </strong><strong>Developing strong research skills. </strong>It’s great to have an interesting project idea but creative concepts alone are not enough to secure competitive research funding. Innovative research “requires sophistication in research design, methodologies, data gathering quality and analytic procedures,” according to the article.<br /> <br /> Physicians looking to secure scarce med ed dollars can strengthen their research skills through “local institutional workshops or courses” and “programs such as the Association of American Medical Colleges Medical Education Research Certificate program, or, optimally, through master’s and PhD degree programs in health professions education,” the article authors suggest.</p> <p style="margin-left:40px;"> <strong>7.   </strong><strong>Staying prepared for new funding opportunities.</strong> Keep additional research ideas—or even an extra proposal that covers a topic outside your main project—on file in case you learn of last-minute funding opportunities you’d like to pursue on deadline.<br /> <br /> “Opportunities for funding appear from surprising directions and at unpredictable times and provide only the briefest of lead time for a proposal,” the article authors wrote. “Starting a research proposal from nothing is seldom feasible in such situations, so it is necessary for medical education researchers to be ready to take advantage of these serendipitous opportunities.”</p> <p> <strong>Want more tips on funding med ed research?</strong> Stay tuned for a related <em>AMA Wire</em>® post, which will discuss key strategies to help physicians draft an effective research proposal that will help generate funding and institutional support for ideas.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e8b3330f-c6cd-40fc-991d-35e8632fea22 Access to transgender medical care spotlighted http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_access-transgender-medical-care-spotlighted Thu, 10 Dec 2015 15:02:00 GMT <p> A recent <a href="http://www.nytimes.com/2015/12/09/opinion/no-reason-to-exclude-transgender-medical-care.html?_r=0" target="_blank" rel="nofollow"><em>New York Times</em> editorial</a> has highlighted the importance of improving access to transgender medical care.</p> <p> The piece states that “the American Medical Association, the largest group of doctors in the country, published a landmark resolution in 2008 that said barriers to transition-related care needed to be eliminated, citing ‘an established body of medical research that demonstrates the effectiveness and medical necessity’ of transition-related care. Every other prominent medical association in the country has echoed that assessment. But a corresponding shift in public policy has begun to take root only over the past couple of years.”</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page" target="_blank">Advisory Committee</a> on Lesbian, Gay, Bisexual and Transgender (LGBT) Issues was established by the AMA Board of Trustees in 2005 to provide advice and counsel to the board and AMA staff, when appropriate, on policy matters that bear directly on LGBT physicians, students and patients. </p> <p> The committee focuses on matters including, but not limited to, sexual orientation and gender identity/expression and is developing strategies, programs and policies to better serve AMA members, potential members and patients. To support the efforts of the AMA and its advisory committee, <a href="https://commerce.ama-assn.org/membership/" target="_blank">join the AMA or renew your membership</a> today. To subscribe to the bi-monthly AMA-LGBT list serve, <a href="mailto:lgbt@ama-assn.org" rel="nofollow">email the committee</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5100ed55-f26d-4e5f-b893-27a38b5efa0c Former AMA IMG Section chair highlights issue of waiting for residency http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_former-ama-img-section-chair-highlights-issue-of-waiting-residency Thu, 10 Dec 2015 15:00:00 GMT <p> Nyapati Rao, MD, a former chair of the AMA International Medical Graduates (IMG) Section Governing Council, recently authored an article published in <em>JAMA</em>.</p> <p> This compelling piece looks at how IMGs have been migrating to the United States for many years with the goal of obtaining residency positions. <a href="http://jama.jamanetwork.com/article.aspx?articleID=2471577&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=MASTER%3AJAMALatestIssueTOCNotification11%2F24%2F2015" target="_blank" rel="nofollow">Read the article</a>, titled “A Hobson’s Choice.”</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5ce3d3b5-4425-4c83-981b-112cd075353e 5 ways to optimize space in your practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-ways-optimize-space-practice Wed, 09 Dec 2015 22:44:00 GMT <p> Did you know the physical design of your practice can influence the relationships you have with your patients? Where you choose to place furnishings and how you decorate may create inefficiencies and drive down patient satisfaction. Learn how to positively influence those who pass through your practice with five quick and cost-effective design techniques that can smooth your work flow, increase patient safety and enhance patient and team interactions.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/2/af5b8015-bd1f-4b50-a248-3681c34e344f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/2/af5b8015-bd1f-4b50-a248-3681c34e344f.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> As a physician, you work with patients to treat current conditions and prevent future illnesses. Preventive treatment can start from the moment patients enter your practice—what do they see and experience? How do patients move through the space throughout their visit, and how do they feel as they navigate their visit? How does your staff navigate that same space?</p> <p> Addressing these questions with simple design solutions may lower patient anxiety and enhance team culture. A <a href="https://www.stepsforward.org/modules/space-design" rel="nofollow" target="_blank">free online module</a> in the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward collection</a> shows you how.</p> <p> Use these five steps to optimize your practice’s space:</p> <p> <strong>1. Develop team work stations that enhance interactions.</strong> Well-designed work stations and pods can improve efficiency and strengthen team culture.<br /> <br /> <strong>Here’s how:</strong></p> <ul> <li> Place exam rooms close to the team’s work area to minimize the space that must be traveled between tasks and improve exam room visibility.<br />  </li> <li> Create opportunities for your team to naturally interact to cultivate a more collegial atmosphere. Glass partitions allow teammates to see each other while conserving privacy and minimizing noise.</li> </ul> <p> <strong>2. Place furnishing to encourage patient engagement.</strong> The arrangement, shapes and types of desks, examination tables and chairs can work together to encourage productive interactions and eye contact.<br /> <br /> <strong>Here’s how:</strong></p> <ul> <li> If a patient can sit in a chair to speak with the physician instead of spending the entire visit on the examination table, they are more likely to feel positively about the visit.<br />  </li> <li> Mount computers on the wall on a swivel arm or use laptops so your team is free to shift their position to face the patient.</li> </ul> <p> <strong>3. Add positive distractions to alleviate patient anxiety.</strong> Patients take in your clinic’s surroundings to gather clues about the quality of care they will receive. This may influence their confidence in the practice and their overall experience.</p> <p> <strong>Here’s how:</strong></p> <ul> <li> Sitting in a waiting room can be stressful. Patients may feel anxious or dissatisfied based on their waiting room experience. Positive distractions, such as window views of natural settings, divert attention away from stressors and create a positive mood.<br />  </li> <li> Television can exacerbate the stress of waiting. Calming artwork depicting landscapes with high visual depth, healthy foliage, warm weather or positive relationships between people are best for lowering anxiety.</li> </ul> <p> <strong>4. Reconfigure rooms to feel spacious and welcoming.</strong> There is no need to tear down walls or build new rooms to make a space seem more spacious. Simple rearranging can make a small room feel more open and comfortable.</p> <p> <strong>Here’s how:</strong></p> <ul> <li> Brighten up a consultation space with additional lighting or soften harsh overhead lighting. Place examination tables at an angle to free up wall space for more chairs.<br />  </li> <li> Using light, warm-colored paint on the walls can add to the positive effect of the artwork you chose in Step Three.</li> </ul> <p> <strong>5. Connect with patients while incorporating technology.</strong> Typing or examining a patient’s electronic health record can take away from patient interaction and frustrate physicians and patients.</p> <p> <strong>Here’s how:</strong></p> <ul> <li> Increase your eye contact share a computer screen with your patients to positively influence their engagement and adherence to treatment. Semi-circular desks and large monitors can help you maintain face to face contact and also involve patients in their own information.<br />  </li> <li> Try implementing a <a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_blank">team documentation process</a>, in which a nurse, medical assistant or documentation specialist helps with record keeping to allow the physician to provide more undivided attention to patients.</li> </ul> <p> <strong>What physicians are saying about changing their practice space</strong></p> <p> “We were inconveniencing our patients and creating unnecessary work for ourselves,” said Morris Gagliardi, MD, associate medical director of Gouverneur Health in New York.<br /> <br /> “Focusing on better wayfinding for patients and grouping like services together in the clinic revealed incredible opportunities for us to better deliver a more efficient, patient-centered experience,” he said.</p> <p> North Carolina family physician Michael Toedt, MD, has found that adjacent team rooms with partially open space between teams work best. He decided not to have any private offices in their new facility.</p> <p> “As a physician, I am not running around to find the team members I need to coordinate care,” Dr. Toedt said. “I don’t have to worry about the patient not following up with a behavioral health specialist or dietician because we provide the warm hand-off in real-time.”</p> <p> <a href="https://www.stepsforward.org/modules/space-design" rel="nofollow" target="_blank">Check out the module</a> to read examples of how physicians re-designed their spaces to gain productivity and completely overhaul the patient experience. This module offers continuing medical education credit.</p> <p> More than 25 modules are available in the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a> collection and several more will be added in 2016, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7d8f5249-2d1b-433e-a629-8d56016d7bbd Top 10 stories from 2015 every resident should read http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-10-stories-2015-resident-should-read Wed, 09 Dec 2015 22:37:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/15/92facf3f-3587-49b7-bfa2-69c0aeecff4c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/15/92facf3f-3587-49b7-bfa2-69c0aeecff4c.Full.jpg?1" style="width:805px;height:250px;margin:5px 20px;" /></a></p> <p> The past year proved lively for residents as they broke records for the highest number of fellowship applicants, charted creative burnout solutions and discovered new ways to thrive in the profession. Look back at some of the top resident moments and headlines of 2015. </p> <p style="margin-left:40px;"> <strong>1. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank"><strong>Physicians rank residency work-life balance by specialty</strong></a><br /> Physician network Doximity and <em>U.S. News & World Report</em> asked physicians to rate residency programs based on work hours and schedule flexibility. This resulted in more than 90,000 physician comments, which were used to create a peer-ranked list of the best—and worst—specialties for work-life balance. Wonder where your field ranks on the list? Don’t miss this must-read post.</p> <p style="margin-left:40px;"> <strong>2. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/top-personal-finance-tips-experienced-physicians" target="_blank"><strong>Top personal finance tips from experienced physicians</strong></a><br /> Physicians s over age 60 shared life lessons, wisdom and personal advice on finance they wished they had learned as residents. Now, you can learn from their advice.</p> <p style="margin-left:40px;"> <strong>3. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank"><strong>Why doctors marry doctors: Exploring medical marriages</strong></a><br /> Nearly 40 percent of physicians are likely to marry another physician or health care professional, according to a special report AMA Insurance released earlier this year. Find out why a fellow health care professional may be the best person to meet under the mistletoe this month.</p> <p style="margin-left:40px;"> <strong>4. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialties-vary-gender" target="_blank"><strong>How medical specialties vary by gender</strong></a><br /> While many factors influence what specialty medical students and residents choose, data released from the Association of American Medical Colleges revealed that gender may also impact where future physicians practice. <em>AMA Wire</em>® examined the data to note which specialties attract the highest percentages of male and female physicians.</p> <p style="margin-left:40px;"> <strong>5. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/many-hours-average-physician-workweek" target="_blank"><strong>How many hours are in the average physician workweek?</strong></a><br /> Everyone knows that physicians generally work long hours. But just how many hours are in the typical physician workweek? A special report from AMA Insurance documented the average number of hours physicians work each week and found that age has a surprising impact on the amount of time spent at work.</p> <p style="margin-left:40px;"> <strong>6. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank"><strong>Ways residents have found to conquer burnout</strong></a><br /> Don’t let fatigue, cynicism or depression weigh you down as you progress through training. Get a dose of wellness advice from your peers in this special <em>AMA Wire</em> feature<em>.  </em></p> <p style="margin-left:40px;"> <strong>7. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/top-specialties-fellowship-applicants-2015-match-glance" target="_blank"><strong>Top specialties for fellowship applicants: 2015 match at a glance</strong></a><br /> The 2015 appointment year marked the largest in the history of the National Resident Matching Program (NRMP) Specialties Matching Service®, featuring 3,674 programs within 56 subspecialties, according to national data from the NRMP. <em>AMA Wire</em> took a closer look at the data and determined which specialties attracted the most fellowship applicants. The piece also offers a helpful graphic for internal medicine residents.</p> <p style="margin-left:40px;"> <strong>8. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/10-must-read-articles-want-medical-educator" target="_blank"><strong>10 must-read articles if you want to be a medical educator</strong></a><br /> <em>Journal of Graduate Medical Education</em> editor-in-chief Gail M. Sullivan, MD, rounded up her favorite articles to boost physicians’ medical education abilities and prepare them to tackle versatile subjects in academic medicine. If you’re planning a career in med ed, then this must-read list is for you.</p> <p style="margin-left:40px;"> <strong>9. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank"><strong>Where to publish: Top journals for physicians in training</strong></a><br /> Targeting the appropriate journal for your research submission is half the battle to successfully publishing. If you’d like to see your clinical study or exciting pilot project in print, this is one resource from 2015 you don’t want to miss. <em>AMA Wire</em> highlighted the top journals that accept research from physicians in training, with a special list of publications that are especially ripe for resident submissions.</p> <p style="margin-left:40px;"> <strong>10. </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" target="_blank"><strong>Burnout busters: How to boost satisfaction in personal life, practice</strong></a><br /> Burnout expert Lotte Dyrbye, MD, shared her informative “two-bucket” approach for helping physicians avoid burnout in their personal lives and practice. Here’s why she said real wellness solutions will always require a collaborative approach.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" target="_blank" rel="nofollow"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7cea6f10-b028-4861-b7f7-ed53a23f2fb3 Top 10 newsmakers for physicians in 2015 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-10-newsmakers-physicians-2015 Tue, 08 Dec 2015 22:40:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/1/196b495e-2b35-4dc3-8144-44a6f8e1e6ef.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/1/196b495e-2b35-4dc3-8144-44a6f8e1e6ef.Full.jpg?1" style="width:805px;height:250px;margin:5px 20px;" /></a></p> <p> This year was an eventful one for the physician community, seeing the end of an era for Medicare, the launch of one of the most complex practice changes in recent decades and the continued advancement of patient care. Take a look at some of the biggest news in medicine from 2015.</p> <p style="margin-left:40px;"> <strong>1.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" target="_blank"><strong>Medicare payment formula bites the dust</strong></a><br /> That’s right. Thanks to the <a href="http://www.ama-assn.org/ama/ama-wire/post/overcame-sgr-hurdle" target="_blank">steadfast efforts of physicians</a>, the sustainable growth rate (SGR) formula was repealed in April. The failed budgetary gimmick had plagued physicians and threatened patients’ access to care since 1997. Under the <a href="http://www.ama-assn.org/ama/ama-wire/blog/SGR_Repeal_Series/1" target="_blank">Medicare Access and CHIP Reauthorization Act</a>, the SGR formula was eliminated, and a number of <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-health-care-will-look-different-post-sgr-era" target="_blank">significant Medicare changes</a> were adopted to help reform the program for physicians and patients alike.</p> <p style="margin-left:40px;"> <strong>2.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank"><strong>How to beat burnout: 7 signs physicians should know</strong></a><br /> With the pressures of practice putting an ever-increasing number of physicians in survival mode, it’s more important than ever to understand the signs of physician burnout. An expert explained the signals to look for and why they can be preludes to burnout.</p> <p style="margin-left:40px;"> <strong>3.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/cms-icd-10-transition-less-disruptive-physicians" target="_blank"><strong>CMS makes ICD-10 transition less disruptive for physicians</strong></a><br /> The long-anticipated ICD-10 code set was fully implemented Oct. 1. And while the transition entailed a heavy investment of time and resources for physicians, the AMA secured provisions from the Centers for Medicare & Medicaid Services (CMS) so physicians could continue to provide high-quality patient care without risking their livelihood.</p> <p style="margin-left:40px;"> <strong>4.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank"><strong>The one graphic you need for accurate blood pressure reading</strong></a><br /> Blood pressure measurement is a routine task in most practices, but it’s easy to get skewed results if clinicians and patients aren’t on the same page about how to take accurate blood pressure measurements. Physicians, care teams and patients started using this popular infographic as a simple way to help get the most accurate results.</p> <p style="margin-left:40px;"> <strong>5.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank"><strong>Three questions to ask patients when measuring blood pressure</strong></a><br /> As the nation observed American Heart Month in February, physicians made sure their practices’ work flows included three important questions to better measure and control patients’ blood pressure and help improve their overall health.</p> <p style="margin-left:40px;"> <strong>6.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/top-personal-finance-tips-experienced-physicians" target="_blank"><strong>Top personal finance tips from experienced physicians</strong></a><br /> About one-half of physicians think they are behind where they should be in retirement savings. But with smart planning, it is possible to be secure in your personal finances. Physicians over the age of 60 offered six lessons to help younger physicians avoid mistakes.</p> <p style="margin-left:40px;"> <strong>7.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank"><strong>Why doctors marry doctors: Exploring medical marriages</strong></a><br /> Nearly 40 percent of physicians are likely to marry another physician or health care professional. This story took a look at some of the benefits of medical marriages as well as challenges to consider.</p> <p style="margin-left:40px;"> <strong>8.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/many-hours-average-physician-workweek" target="_blank"><strong>How many hours are in the average physician workweek?</strong></a><br /> Everyone knows that physicians generally work long hours. But just how many hours are in the typical physician workweek? Find out how your workweek compares to your peers.</p> <p style="margin-left:40px;"> <strong>9.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-threatens-physician-patient-confidentiality" target="_blank"><strong>Court case threatens physician-patient confidentiality</strong></a><br /> Among other <a href="http://www.ama-assn.org/ama/ama-wire/blog/Litigation_News/1" target="_blank">important cases</a> in the nation’s courts this year is a case before the Washington Supreme Court that would threaten the integrity of the patient-physician relationship, potentially raising new obstacles to communication and trust. The Litigation Center of the AMA and State Medical Societies joined in an amicus brief calling for continued protection of the patient-physician relationship.</p> <p style="margin-left:40px;"> <strong>10. </strong> <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank"><strong>21 more schools tapped to transform physician training</strong></a><br /> In November, a panel of medical education leaders selected 21 new members of the Accelerating Change in Medical Education Consortium to transform the way future physicians will be trained. Find out which schools were selected and what these transformations will look like in the next few years.</p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e51f871e-6448-4c79-a006-69d0eda06985 How improv is helping patients with Alzheimer’s disease http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_improv-helping-patients-alzheimers-disease Tue, 08 Dec 2015 22:14:00 GMT <p> Two actors are approaching Alzheimer’s disease with a creative way to break through. Find out how the rules of improvisational theatre can actually help forge stronger connections with people who have dementia.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/52f9689e-97cc-4c8d-9293-ef7d6d0b5d46.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/52f9689e-97cc-4c8d-9293-ef7d6d0b5d46.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <div> <p> <strong>What Alzheimer’s disease and improvisational theatre have in common</strong></p> <p> “I love performing, but I’m lousy at memorization, so I took up improv30 years ago,” Karen Stobbe told physicians during a special performance with her husband, Mondy Carter, at TEDMED2015 last month. “My dad, Manfred, passed away from Alzheimer’s disease in October of 2000, and my mom, Virginia, has been living with Alzheimer’s for the past 13 years. I realized in caregiving for both of my parents that the guidelines for improv and the guidelines for being with a person with Alzheimer’s are parallel.”</p> <p> “And we say ‘guidelines’ because really there are no rules for either. Also, you can’t rehearse either one,” Carter said. However, he noted that unlike Alzheimer’s, improv does offer games and exercises that help people practice certain guidelines for performing. People can rehearse these guidelines until they are familiar enough to use on stage or during interactions with people who have Alzheimer’s.</p> <p> Channeling inspiration from theatre and her own experiences with Alzheimer’s disease, Stobbe created a training guide and workshop for dementia caregivers based on the rules of improvisation. Carter, who is a trained actor and improviser, also writes creative stage plays and hosts workshops on Alzheimer’s with Stobbe.</p> <p> In order to reach people with Alzheimer’s, some of the rules of improvisation Stobbe and Carter encourage workshop participants to use include:</p> <p style="margin-left:.75in;"> <strong>1.   </strong><strong>Accepting the reality given to you. </strong>Instead of following a prescribed script or trying to predict every moment, improv actors are encouraged to fluidly accept and act upon the ideas, plots twists and characters their fellow actors propose on stage. This allows them to avoid rationalizing and free themselves to create lively, imaginative moments.</p> <p style="margin-left:.75in;"> Communicating with people who have dementia requires a similar break from reality. “Sometimes it’s incredibly hard to jump into the world of a person with Alzheimer’s,” Stobbe said. “Accepting their reality means letting go of ours …. Stepping into their world provides a launching pad that is positive instead of negative. It provides a connection that you can talk about—[you can] have a conversation.”</p> <p style="margin-left:.75in;"> <strong>2.   </strong><strong>Listening fully and allowing others to unpredictably define themselves as the scene progresses.</strong> “Going with the flow is really the crux of improv,” Carter said. “[Be] spontaneous …. You never know what the next moment might hold.”</p> <p style="margin-left:.75in;"> “That’s exactly the same for being with a person who has Alzheimer’s. Be spontaneous and accepting of whatever comes your way,” Stobbe said.</p> <p style="margin-left:.75in;"> <strong>3.   </strong><strong>Making an extra effort to say “yes and” during scenes. </strong>“Now, it’s crucial to commit to practicing saying ‘yes and’ and not ‘yes but’” when performing, Stobbe said. She noted that denying or saying “no” while acting can swiftly put an end to otherwise creative and enjoyable scenes.</p> <p style="margin-left:.75in;"> Instead, she encourages workshop participants to say “yes and” during scenes with their acting partners as a way of validating someone else’s ideas. This logic also applies to interactions with Alzheimer’s patients, she said.</p> <p style="margin-left:.75in;"> “‘Yes and’ provides agreement. It provides validation—even empathy. Persons with Alzheimer’s receive ‘no’s’ all the time,” Stobbe said, noting that dementia patients regularly encounter “no’s” when people tell them they remembered something or completed a basic task—like buttoning their shirt—incorrectly.</p> <p style="margin-left:.75in;"> That’s why “for a person living with Alzheimer’s, hearing the word ‘yes’ can feel really good,” Carter said.</p> <p style="margin-left:.75in;"> Stobbe and Carter said practicing the rules of improv with people who have dementia can offer practical support for patients and families.</p> <p style="margin-left:.75in;"> “This approach is not a solution to every issue that comes about with Alzheimer’s disease, yet we know that it can help those who are struggling day to day to find more connections … have a better quality of life,” Stobbe said.  <br />  </p> <p> <strong>Interested in more TEDMED?</strong></p> <p> AMA members have <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank">complimentary virtual access</a> to the stage program for TEDMED 2015, which brought together the global community dedicated to shaping a healthier world, Nov. 18-20.</p> <p> Thought leaders and change agents shared compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p> AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks on demand through Dec. 20.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:42dd2353-f9c0-4ca0-958b-db94465166ef Top 12 stories from 2015 every med student should read http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_top-12-stories-2015-med-student-should-read Mon, 07 Dec 2015 22:24:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/7/7e98c4b8-bf92-4bb8-9744-73e85c008fde.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/7/7e98c4b8-bf92-4bb8-9744-73e85c008fde.Full.jpg?1" style="margin:15px;" /></a></p> <p> Medical students have been incredibly busy in 2015, and <em>AMA Wire</em>® has the headlines to prove it. Look back at some of the top student news this year, covering topics from why some medical students aren’t matching to expert strategies for acing the United States Medical Licensing Examination (USMLE®).</p> <p style="margin-left:40px;"> <strong>1.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank"><strong>5 things students overlook when choosing a specialty.</strong></a> Deciding on a specialty is one of the most crucial decisions a medical student will ever make, but how do you know what to practice before you even practice it? One med ed expert shared his top advice on how students can make an informed decision about their specialty and avoid common mistakes in the process.</p> <p style="margin-left:40px;"> <strong>2.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank"><strong>Here’s how many residency programs med students really apply to.</strong></a> A national survey asked more than 1,000 fourth-year students to list the total number of residency programs they applied to in different specialties, and the results were very telling. </p> <p style="margin-left:40px;"> <strong>3.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/arent-medical-students-matching-happens-next" target="_blank"><strong>Why medical students aren't matching—and what happens next?</strong></a> More than 250 of this year’s graduating seniors from U.S. allopathic schools did not match to a residency position, which sparked concern in the med ed community. Experts at the 2015 AMA Annual Meeting discussed where these unmatched students are going and strategies to ensure they’ll find future careers for medical graduates.</p> <p style="margin-left:40px;"> <strong>4.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/top-specialties-fellowship-applicants-2015-match-glance" target="_blank"><strong>Top specialties for fellowship applicants: 2015 match at a glance.</strong></a> The 2015 appointment year marked the largest in the history of the National Resident Matching Program (NRMP) Specialties Matching Service®, featuring 3,674 programs within 56 subspecialties, according to national data from the NRMP. <em>AMA Wire</em> took a closer look at the data and determined which specialties attracted the most fellowship applicants.</p> <p style="margin-left:40px;"> <strong>5.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_blank"><strong>4 tricks to a successful residency program search.</strong></a> Finding the right residency program may feel as if it requires its own special form of training—but not to worry. FREIDA Online®—the Fellowship and Residency Electronic Interactive Database—can help. Conduct an effective search for residency this New Year with these must-have FREIDA hacks.</p> <p style="margin-left:40px;"> <strong>6.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/studying-usmle-step-1-early-start-strategy" target="_blank"><strong>Studying for the USMLE Step 1: An early start strategy.</strong></a> An expert from Kaplan Medical shared tips for how students can build their best study plan and beat last-minute test anxiety.</p> <p style="margin-left:40px;"> <strong>7.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank"><strong>21 more schools tapped to transform physician training.</strong></a> A panel of medical education leaders selected 21 new members of the Accelerating Change in Medical Education Consortium to transform the way future physicians will be trained. The consortium announced which schools were selected and their exciting plans.</p> <p style="margin-left:40px;"> <strong>8.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/student-sos-7-ways-avoid-distress-medical-school" target="_blank"><strong>Student SOS: 6 ways to avoid “distress” in medical school.</strong></a> Burnout can blaze through all phases of a physicians’ career, beginning with medical school. That’s why burnout expert Lotte Dyrbye, MD, urged students to learn the key signs of “student distress” to boost their well-being and productivity. </p> <p style="margin-left:40px;"> <strong>9.    </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank"><strong>Here’s your must-have checklist for med school success</strong></a><strong>. </strong>Planning to reassess your goals and priorities for 2016? If so, plan ahead with this easy-to-navigate list of the top tasks students should prioritize in their first and second years of training. The list features resources on studying, building your CV and choosing a specialty.</p> <p style="margin-left:40px;"> <strong>10.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank"><strong>Your checklist for success in your third year of med school.</strong></a> The third year of training can be an exciting yet uncertain time for students, especially as clinical rotations begin. <em>AMA Wire </em>rounded up a must-have check list of the top tasks and resources to help you prioritize important deadlines and successfully apply for residency.</p> <p style="margin-left:40px;"> <strong>11.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank"><strong>Where to publish: Top journals for physicians in training.</strong></a> If you’re planning to publish, this is one resource from 2015 you don’t want to miss. <em>AMA Wire</em> highlighted the top journals accepting research from physicians in training, with a special list of publications that are especially ripe for student submissions.</p> <p style="margin-left:40px;"> <strong>12.   </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/want-eat-healthy-budget-5-student-friendly-tips" target="_blank"><strong>Want to eat healthy on a budget? 5 student-friendly tips.</strong></a> Medical students often want to eat healthy, but busy schedules and limited budgets can conflict with this goal. That’s why <em>AMA Wire</em> checked in with a registered nutritionist who understands your perspective. Here’s what she said students need to plan cost-effective meals and live a healthy lifestyle. </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4792fa94-f91b-4b59-9d6c-c600a1d79372 Overcoming barriers to new models of care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_overcoming-barriers-new-models-of-care Mon, 07 Dec 2015 21:21:00 GMT <p> Physicians are looking to new models of care delivery and payment as a proven means of keeping patients healthier and reducing health care costs. Recent legislation opens the door for new models, and provides funding to physicians who adopt them. But two key barriers still need to be broken down.</p> <p> Changing the way care is delivered and paid for could better enable physicians and their care teams to help keep patients from developing preventable health problems, avoid unnecessary tests and better manage health conditions to prevent hospitalizations, complications or infections.</p> <p> The recently adopted Medicare Access and CHIP Reauthorization Act (MACRA)—the legislation that repealed Medicare’s sustainable growth rate (SGR) formula—creates opportunities to advance implementation of alternative payment models. Physicians who reach threshold levels of participation in qualified models from 2019-2024 will receive 5 percent bonus payments each year.</p> <p> <strong>What’s standing in the way</strong></p> <p> The AMA worked with Harold Miller at the Center for Healthcare Quality and Payment Reform, a member of the newly appointed Physician-Focused Payment Models Technical Advisory Committee to the federal government, to develop the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to Physician-Focused Alternative Payment Models</a>.”</p> <p> The guide, in addition to describing seven physician-focused alternative payment models, first highlights two common barriers in current payment systems that often stand in the way of implementing necessary changes.</p> <p> <strong>1. Limited payment for high-value services.</strong> Medicare and most commercial health plans do not pay physicians for many services that would benefit patients and help reduce avoidable spending.<br /> <br /> A number of time-consuming activities that keep patients healthy and costs in check generally aren’t paid for or are paid insufficiently. For example:</p> <ul> <li style="margin-left:40px;"> Responding to a patient’s phone call about a symptom or problem.</li> <li style="margin-left:40px;"> Communications between primary care physicians and specialists to coordinate care, or the time spent by a physician serving as the leader of a multi-physician care team.</li> <li style="margin-left:40px;"> Communications between community physicians and emergency physicians, and short-term treatment and discharge planning in emergency departments.</li> <li style="margin-left:40px;"> Spending time in a shared decision-making process with patients and family members when there are multiple treatment options.</li> <li style="margin-left:40px;"> Hiring nurses and other staff to provide education and self-management support to patients and family members.</li> <li style="margin-left:40px;"> Providing palliative care for patients in conjunction with treatment.</li> </ul> <p> <strong>2. Financial penalties for delivering a different mix of services.</strong> Under fee-for-service payment, physician practices can lose revenue if physicians perform fewer procedures or lower-cost procedures that benefit patients. Meanwhile, the costs of running the practices often do not decrease in proportion to the changes in income, which can cause operating losses.<br /> <br /> For many patient conditions, most of the savings payers would experience from new models do not come from the payments that are made to the physician practice, so savings still can be achieved without financially penalizing the physician practice. The most severe impact under fee-for-service is that, when their patients stay healthy and do not need health care services, physicians may not be paid at all.</p> <p> <strong>How physicians are working to overcome these barriers</strong></p> <p> Physicians aren’t just waiting on the sidelines. More than 100 state and specialty medical associations joined the AMA in sending a <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/macra-sign-on-letter-16nov2015.pdf" target="_blank">letter</a> (log in) to the Centers for Medicare & Medicaid Services (CMS) recommending <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients?utm_source=BulletinHealthCare&utm_medium=email&utm_term=112815&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_blank">10 principles</a> to guide MACRA implementation of alternative payment models.</p> <p> The repeal of the SGR formula created new opportunities for improved payment systems. The AMA has spent more than five years encouraging the development and implementation of better health care payment systems.</p> <p> This work has emphasized several goals:</p> <ul> <li style="margin-left:40px;"> Give physicians more resources and flexibility to deliver care</li> <li style="margin-left:40px;"> Improve financial viability in physician practices</li> <li style="margin-left:40px;"> Minimize administrative burdens that weigh physicians down</li> <li style="margin-left:40px;"> Enable physicians to control aspects of spending that they can influence</li> <li style="margin-left:40px;"> Avoid transferring inappropriate financial risk to physicians</li> </ul> <p> Accelerating its efforts to support physician-designed alternative payment models, the AMA also compiled a step-by-step process to develop successful payment models for medical specialties. Visit the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Medicare alternative payment models Web page</a> to read more.</p> <p> Look for more insights about adopting new payment models from the “Guide to Physician-Focused Alternative Payment Models” in the coming weeks as <em>AMA Wire</em> shares the characteristics of successful payment models and the many different types that will be available.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7bce2741-7a5a-4356-a5f1-e84e2dd533a6 Experts explain how to end opioid overdose epidemic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_experts-explain-end-opioid-overdose-epidemic Fri, 04 Dec 2015 19:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/5/7c0482ea-c85f-45a1-958e-4448a0ad8ec8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/5/7c0482ea-c85f-45a1-958e-4448a0ad8ec8.Large.jpg?1" style="margin:15px;float:right;" /></a>The nation has seen a four-fold increase in opioid deaths in the last decade, according to the Centers for Disease Control and Prevention (CDC)—and physicians stand on the front lines of this national health crisis. During the <a href="http://www.ama-assn.org/sub/meeting/index.html">2015 AMA Interim Meeting</a>, physician experts recently discussed actions you can take now to help combat the opioid epidemic and improve patient care.</p> <p> <strong>Rethinking prescribing practices, effectively using PDMPs</strong><br /> CDC Director Thomas Frieden, MD, was among a panel of experts who offered actionable solutions to help curb the nation’s high rate of opioid overdoses. He noted that the rise in opioid-related deaths and abuse directly correlates with an increase in the prescribing of opioids.</p> <p> Unless physicians adopt improved practices for prescribing for pain, he said the nation will continue to struggle with addiction. That’s why he recommends that every physician should view prescribing an opiate as a “momentous decision,” in which they should carefully assess whether the opioid is an essential form of treatment.</p> <p> One way physicians can better assess whether to prescribe an opioid is to effectively use prescription drug monitoring programs (PDMPs), said Sharon Meieran, MD, a lead physician from the Emergency Department for Emergency Psychiatric Services at Kaiser Sunnyside Medical Center in Oregon.</p> <p> “Different specialties have their unique challenges, but we all share the common goal of wanting to take care of our patients and wanting to keep them safe, so we very much need the information that can be provided by the PDMP—and really at this point only the PDMP,” Dr. Meieran said.</p> <p> She said using Oregon’s PDMP has effectively helped her monitor trends in opioid prescriptions and find important patient information—or spot any potential red flags in a patients’ history—before prescribing an opioid.</p> <p> Dr. Meieran encouraged physicians to <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?">register</a> for their state prescription drug monitoring programs and use them to help inform the risk-benefit analysis when considering to prescribe opioids for patients.</p> <p> <strong>Reducing stigma to improve patient care</strong><br /> In addition to carefully monitoring opioid prescriptions, American Academy of Pain Medicine President-Elect Daniel Carr, MD, also stressed the importance of reducing stigma and bias against patients who may genuinely require opioid medications or other treatment for chronic pain.</p> <p> Dr. Carr was the founding editor of <em>Pain: Clinical Updates</em> and noted that the journal already has received “84 citations on stigma alone in the last few years,” which underscores that stigma—often the result of wrongfully judging patients or harboring bias against them—is a deeply entrenched problem in health care that needs to be addressed.</p> <p> “There is a huge [amount of] literature on stigma and pain,” he said, referencing a recent article that discussed stigma among sufferers of lower back pain. “Stigma is consistently experienced by such patients and propagated by health care professionals … the ramifications of stigma and discrimination are enduring, potentially disabling and interfere with care-seeking or rehabilitation participation and success.”</p> <p> Dr. Carr reminded physicians that chronic pain is a public health issue He also encouraged physicians to educate themselves about stigma in pain medicine and unconscious bias to help advance patient care.</p> <p> Richard Soper, MD, chief medical officer and director of addiction medicine at the Center for Behavioral Wellness in Nashville, Tenn., agreed with Dr. Carr that reducing stigma is key to improving care, especially among patients struggling with substance abuse and mental illness.</p> <p> “The antidote for the toxic presence of stigma is proper medical treatment,” he said, noting that physicians must alter how they discuss addiction, mental health and treatment.</p> <p> “We need some shifting in conversation and the verbiage amongst ourselves and the general public,” he said.</p> <p> <strong>How physicians can advance opioid education and prescribing practices</strong><br /> Patrice A. Harris, MD (pictured above), chair-elect of the AMA Board of Trustees, who chairs the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page">Task Force to Reduce Prescription Opioid Abuse</a> encouraged physicians also to study the best practices for prescribing opioids, managing pain and treating substance use disorder.</p> <p> The task force <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?">web page</a> offers a collection of the best educational resources from more than 70 organizations, including state medical associations and medical specialty societies.</p> <p> “Challenge yourself and your colleagues to ensure they have the latest information about safe, effective prescribing,” Dr. Harris said.</p> <p> She also urged physicians to adopt prescribing and co-prescribing the opioid overdose reversal drug naloxone to patients who are at risk. Dr. Harris noted, “It’s up to us to be the leaders our nation and our patients need to bring an end to this public health crisis.”</p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b4ada238-8345-440c-ad1e-3804978b4abf The ethical demands of 21st-century clinical research http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethical-demands-of-21st-century-clinical-research Fri, 04 Dec 2015 18:51:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/10/7ed06650-69c9-4fda-8a84-96dc7fc7843b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/10/7ed06650-69c9-4fda-8a84-96dc7fc7843b.Large.jpg?1" style="margin:5px 10px;float:right;" /></a></p> <p> What should the ethics of clinical research look like as biomedical science advances? Debate is already underway about physicians’ responsibilities to current and future patients.</p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">December issue</a> of the <em>AMA Journal of Ethics</em> explores the roles of physicians and patients in improving the art and science of medicine in the 21st century.</p> <p> The issue features:</p> <ul> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/12/fred1-1512.html" target="_blank"><strong>“Revisiting the ethics of research on human subjects.”</strong></a> In the 20th century, human subject research protections were developed in response to human rights abuses. This article explores how physicians can work together to advance these protections in the 21st century.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/12/stas1-1512.html" target="_blank"><strong>“Expanded access to new drugs: What physicians and the public need to know about FDA and corporate processes.”</strong></a> Existing treatments don’t cure some patients’ illnesses. When this happens, physicians can help patients get access to investigational drugs through the expanded access process. This article investigates what changes to this process mean for patient care.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/12/pfor2-1512.html" target="_blank"><strong>“Patient-physician relationships and research on medical practice: Do OHRP guidelines help?”</strong></a> Boundaries between clinical research and practice are often blurred, but their convergence can be necessary for improving patient care. This article explores whether and when government regulations can help physicians study their own practices and impact health outcomes.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/12/ecas3-1512.html" target="_blank"><strong>“Enrolling research participants in clinical settings: Conflicts of interest, consistency, therapeutic misconception, and informed consent.”</strong></a> Using a case example, this article investigates ethical predicaments physicians face when enrolling patients in clinical trials.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-dec-2015.mp3" target="_blank">December podcast</a>, Robert Levine, co-author of the landmark Belmont Report, discusses changes in clinical research guidelines, conflicts of interest among institutional review board members and the top ethical challenges facing clinical researchers today.</p> <p> <strong>Your chance to weigh in</strong></p> <p> <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">Give your answer</a> to this month’s poll: A child’s parents ask you for advice on whether to enroll their five-year-old in a phase 3 clinical trial. What do you tell them?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insight for medical students and physicians. Submit your work for publication at <a href="https://www.rapidreview.com/AMA/CALogon.jsp" rel="nofollow" target="_blank">Rapid Review</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:307e3771-cade-47ce-b045-d72813bd7207 Key advice for students who are ready to turn med ed on its head http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_key-advice-students-ready-turn-med-ed-its-head Thu, 03 Dec 2015 22:34:00 GMT <p> <img src="http://pluck.ama-assn.org/static/images/store/3/9/236ec363-7abe-4dac-99c6-2f8e76ed0b1f.Large.jpg?1" style="float:right;margin:15px;" />If you were to design the med school of the future, what would it look like? A <a href="http://www.innovatewithama.com/" rel="nofollow">special challenge</a> with cash prizes gives medical students a chance through Dec. 11 to share their bold project ideas to transform physician training. <em>AMA Wire</em> checked in with Susan Skochelak, MD (pictured right), AMA group vice president of medical education. Here’s what she says students should know about this exciting opportunity.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Why did the AMA decide to launch this student challenge?</strong><br /> <strong>Dr. Skochelak:</strong> Medical students have an important and unique perspective on how medical education works and how it doesn’t. We want medical students to have the opportunity to propose how they would transform medical school to turn out even better physicians.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Why do you think this challenge is important?</strong><br /> <strong>Dr. Skochelak:</strong> This challenge is open to teams led by a medical student, but other team members may be students of any discipline. This challenge will give a voice to medical student ideas about what medical school should be like as well as draw inspiration from other fields such as engineering, computer science or the humanities.</p> <p> <strong><em>AMA Wire:</em></strong><strong> What do you hope the challenge will accomplish?</strong><br /> <strong>Dr. Skochelak:</strong> We hope this challenge will lead medical students and those studying other disciplines to work together in new ways to solve the problems facing the U.S. medical education system and even the health care system as a whole.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Is there a certain kind of project or idea you’re looking for?</strong><br /> <strong>Dr. Skochelak:</strong> Surprise me. We don’t want to limit the ideas students can submit. As long as the submission touches on key themes in the challenge guidelines, the sky’s the limit.</p> <p> <strong><em>AMA Wire: </em></strong><strong>How will students benefit from participating?</strong><br /> <strong>Dr. Skochelak:</strong> The most obvious benefit is the $5,000 prize for the first place team. There is also a $3,000 prize for second place and $1,000 for third place. The other benefit includes the opportunity to get your idea in front of medical education leaders. The first place team will be invited to present at the <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page">Accelerating Change in Medical Education Consortium</a> meeting in Hershey, Pa., March 6-8. We are also looking for other opportunities to disseminate the best ideas.</p> <p style="text-align:right;"> <em style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;text-align:-webkit-right;">By AMA staff writer</em><span style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;text-align:-webkit-right;"> </span><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;text-align:-webkit-right;" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:68430a9b-5bcd-47a7-9795-06627377774c What patients really want--and why it’s important for their health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_patients-really-want-its-important-their-health Thu, 03 Dec 2015 18:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/13/891b56ec-9ab7-454c-8d3f-1b094c62ea4e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/13/891b56ec-9ab7-454c-8d3f-1b094c62ea4e.Large.jpg?1" style="margin:15px;float:right;" /></a>Getting patients to make healthy lifestyle choices ranks high on every physician’s professional wish list. But realistically accomplishing this goal, especially in a fast-paced health care setting, requires care teams to zero in on what really matters to patients.</p> <p> Thomas Lee, MD (pictured right), explained at TEDMED 2015 that the best place for physicians to start is building a shared sense of trust and empathy with their patients. Here’s why Dr. Lee says a clear understanding of “patient suffering” can help improve care delivery and unlock the key to successful relationships.</p> <p> <strong>Meeting patient needs in a complex health system</strong><br /> As the chief medical officer for Press Ganey, a health company that consults more than 20,000 health care organizations on strategies to improve patient care, Dr. Lee understands the strenuous juggling act physicians must perform to manage high patient demands, deliver quality care and meet expectations for patient satisfaction in fast-paced health settings.</p> <p> Increased pressures in practice can lead to missed opportunities for coordinating care, shaky handoffs or forgotten follow up with patients about questions they asked. These missteps attest to “the superficial chaos that’s arrived in health care as a result of advancements in medicine,” Dr. Lee said.</p> <p> This same chaos often infiltrates daily interactions between physicians, patients and care teams, and erodes patients’ trust in the health care system, Dr. Lee said. </p> <p> To counter this trend, he urges physicians to instill confidence in their patients by focusing on ways to reduce their suffering. In ideal clinical situations, Dr. Lee said his research has shown that patients often simply want four things: “Good clinicians, communication, teamwork and empathy.”</p> <p> <strong>Empathy helps spur patient action</strong></p> <p> When exploring new ways to foster patient participation and improve quality care, Dr. Lee urges physicians to shift how they think about patient suffering. This will help physicians build stronger patient relationships, which also can encourage patients to more actively partner with their physicians when making decisions to improve their health.</p> <p> “There’s avoidable suffering, and there’s unavoidable suffering,” Dr. Lee said. “Unavoidable suffering is driven by the patient’s disease and treatment. It includes the pain, side effects and fear of where the disease is going to go.”</p> <p> But then, there’s “avoidable suffering, which has nothing to do with the patient’s treatment and everything to do with how we work together,” Dr. Lee said, stressing the importance of coordinating care and reducing patient confusion caused by poor communication.</p> <p> “We have to put patients in the middle and organize around meeting their needs and reducing suffering. To do that, we need technical excellence and empathy. We have to be great at both,” Dr. Lee said. “You can’t have truly excellent care without empathy.”</p> <p> <strong>Interested in more TEDMED?</strong><br /> AMA members have <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank">complimentary virtual access</a> to the stage program for TEDMED 2015, which brought together the global community dedicated to shaping a healthier world, Nov. 18-20.</p> <p> Thought leaders and change agents shared compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p> AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks on demand through Dec. 20.</p> <p>  </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0e7b7600-7c1f-4546-bf73-f6f793746f86 Court decides: Is patient safety information protected? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-decides-patient-safety-information-protected Wed, 02 Dec 2015 22:49:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/3/1a185981-97a7-4fda-8358-7b91060e2be2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/3/1a185981-97a7-4fda-8358-7b91060e2be2.Large.jpg?1" style="margin:15px;float:right;" /></a>A Florida district court of appeal considered whether patient safety information is protected from disclosure under a federal act in a medical liability case against a hospital and its physicians.</p> <p> <strong>What was at stake</strong></p> <p> In <em>Southern Baptist Hospital of Florida, Inc. v. Charles</em>, a trial court had ordered the hospital to produce medical documents that were being used for patient safety and quality improvement efforts.</p> <p> The Patient Safety and Quality Improvement Act of 2005 (PSQIA) offers physicians and hospitals a way to share medical information used for quality improvement through a patient safety organization (PSO). Under the PSQIA, the confidentiality of data within these systems is protected if that data is not requested by a state administrative agency.</p> <p> Patient safety systems were created to allow hospitals and practices nationwide to share information about safety issues and incidents in order to improve quality and patient safety. Historically, physicians were hesitant to document such issues and incidents out of fear that this information could be used against them in a medical liability case.</p> <p> As the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> noted in an amicus brief filed in support of the hospital’s appeal of the trial court’s ruling, the purpose of the PSQIA and PSOs is to “improve patient care and reduce risk through collective action.”</p> <p> “The trial court’s decision threaten[ed] to undo … progress and undermine the valuable work that has been done by PSOs,” the brief said. “Patients, who are the ultimate beneficiaries of the PSQIA, will suffer.”</p> <p> <strong>The outcome</strong></p> <p> A few weeks ago, a Florida district court of appeal overturned the trial court’s decision and upheld the protection of medical information being used for patient safety efforts. It held that the PSQIA preempted a provision in the Florida constitution, which might otherwise have require the recovery of the information.</p> <p> As a result, hospitals and medical practices will be able to continue confidentially sharing patient safety information without fear of disclosure in medical liability litigation. This is a significant victory for quality improvement.</p> <p> Knowledge must be shared, and physicians are using it to learn from the past to build a better—and safer—future. With protections on patient safety information upheld, the sharing can continue, and future incidents may be prevented.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b62f9e41-a142-48c6-9cf1-95b2125d50c1 Wikipedia meets medical research? Rise of the online journal club http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_wikipedia-meets-medical-research-rise-of-online-journal-club Wed, 02 Dec 2015 18:00:00 GMT <p> Wikipedia-style journal clubs are building collaborative channels for physicians to stay current on the latest research in their fields. Imagine enjoying the lively conversation, informative clinical studies and evidence-based research of an innovative medical conference but without the costly registration or travel fees. Sound like your kind of scene? Here are five key benefits to look for if you’re planning to join an online journal club.</p> <p> The <em>Journal of Graduate Medical Education (JGME) </em><a href="http://www.jgme.org/toc/jgme/7/3" rel="nofollow" target="_blank">recently published</a> a series of articles discussing the benefits of online journal clubs, which have empowered physicians to use innovative social media and blogging tools in productive research settings online.</p> <p> If you’re searching for a digital journal club, make sure it meets these key criteria and offers the following member benefits:</p> <p> <strong>1.  </strong><strong>An accessible platform that supports multiple viewpoints and a robust exchange of credible information. </strong>Most contemporary journal club conferences offer information that will improve physicians’ biostatistics knowledge and critical appraisal skills, according to three research fellows who recently authored <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00488.1" rel="nofollow" target="_blank">a <em>JGME</em> article</a> about their experience starting Wiki Journal Club, an online community for peer-reviewed clinical and specialty-based research. “Yet journal clubs are limited by their real-time-only nature, relatively low attendance and propensity to over represent the viewpoints of a handful of vocal participants, who tend to overpower even the most diplomatic of mediators,” they wrote.</p> <p> Helpful journal clubs will avoid allowing a few members to dominate research discussions and instead foster an open exchange of ideas. They may also use conversational tools such as Twitter and blog posts for physicians to share articles and discussion topics, article authors noted.</p> <p> <strong>2. </strong><strong>Open membership for qualified participants across multiple clinical and academic settings.  </strong>In January, <em>JGME</em> and staff at the Academic Life in Emergency Medicine blog (ALieM) facilitated an open-access online journal club to discuss a <em>JGME</em> article about a multisite survey examining medical students’ expectations for resident teachers. The journal club housed online discussions and comments about the survey on a blog post, which garnered 1,324 page views from 372 cities in 42 countries during the single week the online journal club operated, according to <a href="http://www.jgme.org/doi/abs/10.4300/JGME-D-15-00071.1" rel="nofollow" target="_blank">an article</a> on the <em>JGME</em>-ALieM project.</p> <p> Project facilitators said that participation in the club received from physicians around the world proves that effective online journal clubs can operate beyond the confines of traditional medial conferences and build global communities for physicians.</p> <p> <strong>3. </strong><strong>An effective way to collect and share peer-reviewed research using crowd sourcing. </strong>Unlike medical conferences, sharing research in an online journal club doesn’t require PowerPoint presentations or an available hotel conference room. Instead, physicians can request and discover resourceful clinical studies using social media and blogging tools.<br /> <br /> For instance, the <a href="http://wikijournalclub.org/wiki/Main_Page" rel="nofollow" target="_blank">Wiki Journal Club</a> uses a blog and Twitter to allow physicians to submit various clinical studies across different specialties. From there, the club’s editors select the studies they will share based on general consensus and whether the research under review offers valuable information, such as practice-changing studies in internal medicine and studies requested by other journal club participants.</p> <p> <strong>4. </strong><strong>An evolving library of online resources and clinical studies.</strong><br /> In addition to offering studies and research articles based on requests from club members, the Wiki Journal Club also catalogs and archives clinical studies based on topic and specialty. Over time, as members continue to share links, add information to research pages and discuss additional Wiki Journal Club entries, the club is building a searchable body of online research that can help any resident or fellow stay informed in their field. “At the center of WJC is a bibliography of landmark studies organized by disease, specialty and publication date,” the club facilitators <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00488.1" rel="nofollow" target="_blank">wrote</a>.</p> <p> <strong>5. </strong><strong>Greater access to evidence-based research that may improve clinical outcomes.  </strong>Editors at <em>JGME</em> said that online journal clubs offer a fun cost-effective way for physicians to review and discuss helpful clinical research. But beyond information sharing, they noted that online research-based clubs also can increase physicians’ access to valuable research that may improve clinical outcomes and efficiencies in practice.<br /> <br /> “Our objective is to shorten the knowledge-to-practice time for research that has strong evidence and to reduce premature uptake of research that contradicts the collective experience of medical educators and researchers,” <em>JGME</em> editors <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00229.1" rel="nofollow" target="_blank">wrote</a>. “Our goal is not to replace the benefits of expert review and editorial insights but to amplify these resources with the wisdom of diverse communities of practice.”</p> <p> For more information about online journal clubs, check out <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00070.1" rel="nofollow" target="_blank">this special cheat sheet</a> from the <em>JGME</em>, which explains how to start a journal club and the key components of an effective online research community.</p> <p> <strong>Explore more on research and publishing:</strong></p> <ul> <li> Get published using these <a href="http://www.ama-assn.org/ama/ama-wire/post/published-using-5-writing-research-tips" target="_blank">5 writing and research tips</a>.</li> <li> Learn how to publish your research like a pro with <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_blank">these five strategies</a>.</li> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals that accept research from physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_blank">these 9 expert tips</a> for getting published in a medical journal.<br /> Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_blank">how to handle it.</a></li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow"><em>Lyndra Vassar</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:937d3054-c2f5-4002-82c8-40e444add525 File by Dec. 16 to avoid Medicare pay cut of 2-4 percent http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_file-dec-16-avoid-medicare-pay-cut-of-2-4-percent Wed, 02 Dec 2015 11:00:00 GMT <p> Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.</p> <p> Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.</p> <p> Estimates place the number of those who will see a payment cut at no less than one-quarter of Medicare participating physicians—and that figure includes many practices that have successfully participated in quality reporting programs in the past. Payment cuts for 2016 are based on data from the 2014 reporting period.</p> <p> <strong>How to avoid the penalty</strong></p> <p> <a href="https://www.qualitynet.org/portal/server.pt/community/pqri_home/212" rel="nofollow" target="_blank">File an informal review request</a> with CMS before midnight Eastern time Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request. Practices will be contacted by email within 90 days of filing.</p> <p> Additional information about the process is available in CMS’ <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014PQRSIR2016PayAdjMadeSimple.pdf" rel="nofollow" target="_blank">informal review fact sheet</a>. And questions regarding the informal review process can be directed to the QualityNet Help Desk at (866) 288-8912 or <a href="mailto:Qnetsupport@hcqis.org" rel="nofollow">Qnetsupport@hcqis.org</a>, Monday-Friday from 8 a.m. to 8 p.m. Eastern time.</p> <p> <em>Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.</em></p> <p> <strong>Think it shouldn’t be this way? </strong></p> <p> We agree. That’s why the AMA is pressing CMS to rectify the impossible situation in which it has placed physicians.</p> <p> “Automatic, across-the-board protections are desperately needed,” the AMA stated in a <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/pqrs-vm-letter-to-cms-01dec2015.pdf" target="_blank">letter</a> (log in) sent Tuesday to CMS Acting Administrator Andrew Slavitt. The letter calls on the agency to not impose 2016 PQRS penalties or negative value-based payment modifier adjustments on physicians who attempted to comply with PQRS requirements during the 2014 reporting period.</p> <p style="text-align:right;"> <em>By AMA Wire editor <a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:10970834-dbd5-458f-ae9a-0d3ec6764776 3 things to consider when selecting an EHR http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-things-consider-selecting-ehr Wed, 02 Dec 2015 00:00:00 GMT <p class="p1"> Electronic health records (EHR) are commonplace in physician practices now, but physicians know they haven’t always made it easier to practice medicine or provide high-quality care. A <a href="https://www.stepsforward.org/modules/ehr-software-vendor-selection" rel="nofollow" target="_blank"><span class="s1">free online module</span></a> in the AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" rel="nofollow" target="_blank"><span class="s1">STEPS Forward</span></a> collection can help you prioritize the needs of your patients and your practice to make the best EHR choice. There is no “one-size-fits-all” approach to EHR adoption, but there are things you can consider before you make your selection.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/d9a2987c-3c47-4a13-a0d0-2996334ed4fb.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/d9a2987c-3c47-4a13-a0d0-2996334ed4fb.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p class="p1"> Assess the needs of your practice to determine the most important and relevant characteristics you need in an EHR system. Consider:</p> <p class="li1" style="margin-left:40px;"> <b>1.  Health IT your practice already uses</b><br /> Interoperability is still a major concern for physicians using EHRs, but you generally can find one with basic interoperability. If you’re already using a variety of health IT for managing patient information and medical care, such as e-prescribing software or a practice management system, choose an EHR that can integrate with your existing systems.</p> <p class="li1" style="margin-left:40px;"> <b>2.  Health IT providers and products other health care partners in your network are using</b><br /> You might wish to give consideration to systems used by other groups you often interact with to help ensure you choose a system that can integrate, or at least communicate, with these other systems. Without this capability, some paper-based processes will remain unchanged even with an EHR. For example, instead of transmitting lab tests and referrals electronically, you’ll still have to send them via fax.</p> <p class="li1" style="margin-left:40px;"> <b>3.  Systems used by local hospitals and health care systems that may partner with you in the future</b><br /> Other local health care groups may prefer a certain type of EHR and may be willing to subsidize or assist with adoption. Partnering with these groups may help you negotiate a lower-cost option.</p> <p class="p1"> Many more details on this process can be found in the module, including downloadable resources to help you in your decision. The module also includes information about how to get support for implementing EHR changes in your practice, and it offers continuing medical education credit. More than 25 modules are expected to be available in the AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" rel="nofollow" target="_blank"><span class="s1">STEPS Forward</span></a> collection by the end of the year.</p> <p class="p1"> <b>Additional insights into making the most of your EHR</b></p> <p class="p1"> Several other STEPS Forward modules can help you maximize the benefits of using an EHR in your practice. These include:</p> <ul class="ul1"> <li class="li1"> <span class="s2"><a href="https://www.stepsforward.org/modules/ehr-implementation" rel="nofollow" target="_blank"><span class="s3">Implementing an EHR</span></a></span> in your practice</li> <li class="li1"> <span class="s2"><a href="https://www.stepsforward.org/modules/team-documentation" rel="nofollow" target="_blank"><span class="s3">Using team documentation</span></a></span> to free up time for patient care</li> <li class="li1"> <span class="s2"><a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" rel="nofollow" target="_blank"><span class="s3">Synchronizing prescription renewals</span></a></span> to streamline this time-consuming task</li> </ul> <p class="p2" style="text-align:right;"> <i>By AMA staff writer Lauren Rees</i></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e8a438fd-9e06-4d75-9741-1e07fc2f23dc Court decides whether insurers can be sued for underpaid claims http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-decides-whether-insurers-can-sued-underpaid-claims Mon, 30 Nov 2015 22:16:00 GMT <p> The ruling of a U.S. court of appeal last month weighed whether physicians who are assigned insurance policy benefits have the right to bring lawsuits against insurers that fail to pay correctly for medically necessary services provided to covered patients.</p> <p> The decision was a victory for physicians and patients. The appeals court concluded that an assignment of the right to payment is sufficient to confer standing to sue under the Employee Retirement Income Security Act of 1974 (ERISA). In so doing, it resolves several conflicting lower court rulings.</p> <p> <strong>The trial court decision: Easy assignment to ERISA claims denied</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/8/a3369dbc-599b-43af-9870-6ab48ed3d6c4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/8/a3369dbc-599b-43af-9870-6ab48ed3d6c4.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The North Jersey Brain and Spine Center (NJBSC) operated on three patients who were insured under employee benefit plans administered by Aetna. NJBSC obtained assignments “to all payments for medical services rendered” from each of these patients. All three surgeries were medically necessary and authorized by Aetna, yet the insurer denied or underpaid each of the claims. NJBSC appealed to Aetna without success and so filed a suit under ERISA.</p> <p> A district court agreed with Aetna that the current assignments were insufficient. More specific language was required for patients to assign their full policy benefits to physicians, which would allow physicians to assert ERISA benefit claims.</p> <p> The trial court’s ruling essentially meant that standard assignments of benefits weren’t sufficient to give physicians grounds to file a lawsuit. Instead, physicians would be limited to whatever the insurance company happened to pay, even if that payment was less than the amount required under the patient’s insurance policy.</p> <p> <strong>Reversal of the decision: Rights to claims under ERISA upheld</strong></p> <p> On appeal, the U.S. court of appeals reversed the lower court decision. The appeals court concluded that “we are guided by Congress’s intent that ERISA ‘protect … participants in employee benefit plans,’ and our conviction that the assignment of ERISA claims to providers ‘serves the interests of patients by increasing their access to care.’”</p> <p> Physicians willingly provide medical care without demanding up-front payments because they are confident that, if necessary, they can pursue remedies under ERISA for denied or underpaid insurance benefits.</p> <p> Decades of legal precedent have allowed physicians to enforce their assignments of benefits by bringing ERISA claims in court. Physicians’ ability to deal directly with insurance companies when there is an issue with how a claim has been paid not only saves the patient who may be ill from dealing with overwhelming administrative processes but also prevents financial constraints from interfering in the patient-physician relationship.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> filed an amicus brief in support of NJBSC claiming, “patient assignments vary widely in their particular wording, reflecting physicians’ expectation that, so long as the assignment transfers the patient’s right to insurance benefit payments, it concomitantly transfers standing to enforce that right through ERISA litigation.”</p> <p> “Patients can obtain medical care without being required to pay up front and await payment of their insurance benefits in the future,” the brief said. This “financial hardship … would cause many patients with health insurance to be unable to afford lifesaving treatments.”</p> <p> <strong>Other ERISA cases, past and present</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/supreme-court-weigh-insurer-payment-transparency" target="_blank">A case before the Supreme Court of the United States</a> will determine whether a technicality will stand in the way of reform efforts and keep the insurance payment process cloaked in mystery.</li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-rules-physicians-can-stand-up-their-patients" target="_blank">A U.S. appeals court ruling</a> gave legal power to patients who face unfair scrutiny or rejection of their mental health claims and enabled their physicians to stand up for this vulnerable population in court.</li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ruling-could-give-insurers-leeway-terminate-physicians" target="_blank">A federal court decided</a> it was permissible for a large health insurer to terminate two physicians from its network following a dispute over the necessity of medical services they provided.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e181fb52-0838-4391-bf22-fb8bde2ec8d0 Make waves in the political world: AMPAC shows you how http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_waves-political-world-ampac-shows Wed, 25 Nov 2015 19:24:00 GMT <p> Physicians, residents and students who have political aspirations or want to actively influence health care policy can learn how with help from AMPAC, the AMA’s bipartisan political action committee. Whether it’s running for public office or campaigning for a candidate who supports issues that are important to medicine, AMPAC offers programs to help physicians and doctors in training enter the political world.</p> <p> <strong>A curriculum for a successful candidacy</strong></p> <p> Making the leap from the exam room to the campaign trail is not an easy task. For AMA members, their spouses, medical students and residents, and state medical association staff considering a run for public office, the <a href="http://www.ampaconline.org/political-education/ampac-candidate-workshop/ampac-hold-2015-candidate-workshop/" target="_blank" rel="nofollow">AMPAC Candidate Workshop</a>, taking place Feb. 19-21 in Arlington, Va., can provide training in the skills required for a successful campaign, such as campaign strategizing, media advertising, public speaking and fundraising.</p> <p> At the workshop, bipartisan political veterans will give expert advice on politics and what it takes to mount a competitive and ultimately successful campaign. Attendees also will learn the importance of a disciplined campaign plan and message, how to become a better public speaker and how to handle campaign crises, among other skills.</p> <p> In the 2014 elections, 25 graduates of the program were elected to public office. Graduate Bill Cassidy, MD, of Louisiana, was elected to the U.S. Senate and is one of five physician AMPAC alumni in the U.S. Congress.</p> <p> “The knowledge gained is of great benefit, especially when the campaign season comes around,” said Steve Magie, MD, who attended the Candidate Workshop in 2009. “I still refer back to the written materials.”</p> <p> After an unsuccessful campaign in 2010, Dr. Magie went on to win elections in 2012 and 2014 for the 72nd District seat in the Arkansas General Assembly. “Campaigns are really a foreign creature to how we are trained as physicians,” he said. “Just being a great doc doesn’t translate to success on the campaign trail. There really is a method to the madness, and educating ourselves with regard to all the nuances of a campaign is vital.”</p> <p> <strong>The campaign trail starts here</strong></p> <p> For AMA members, their spouses, medical students and residents, and state medical association staff who want to become more involved in campaigning for their candidates, the <a href="http://www.ampaconline.org/political-education/ampac-campaign-school/" target="_blank" rel="nofollow">AMPAC Campaign School</a>, taking place Apr. 13-17, also in Arlington, Va., offers hands-on training.</p> <p> A simulated congressional campaign is the center of this five-day training ground, during which attendees are broken into campaign staff teams and use what they learned during the day to complete nightly exercises in strategy, vote targeting, social media, advertising and public speaking.</p> <p> Excluding travel, AMPAC covers all expenses for applicants who are accepted to one of these programs—an excellent value for AMA membership.</p> <p> <a href="http://www.ampaconline.org/political-education/apply/" target="_blank" rel="nofollow">Apply today</a> to participate in one of these education programs so you can influence an upcoming election for the better. If you’re not an AMA member, now is the time to <a href="https://commerce.ama-assn.org/membership/" target="_blank">join</a>.</p> <p> <strong>Special application deadlines for medical students:</strong> Student admission to these educational programs is limited, so applicants are selected based on a 500-word essay about why they would like to attend and what they hope to gain from participating. The deadline for medical student applications for the Candidate Workshop is Dec. 10, and the application deadline for the Campaign School is Jan. 29.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:14149f09-c1e9-4e29-8b69-d0b5605de661 This month’s most missed USMLE question--and the right answer http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_this-months-missed-usmle-question-right Wed, 25 Nov 2015 19:18:00 GMT <p> As you prepare for the United States Medical Licensing Exam<em><sup>® </sup></em>(USMLE<em><sup>®</sup></em>), do you know which questions to look out for? We’re giving you an exclusive scoop on the most challenging USMLE test prep questions and expert strategies to help you beat them. Find out what this month’s toughest question is and receive an expert video explanation of the answer from <a href="http://www.ama-assn.org/ama/priv/membership/membership-benefits/member-value-program/mvp-kaplan.page" target="_blank">Kaplan Medical</a>.</p> <p> Welcome to the third post in <em>AMA Wire’s<sup>® </sup></em>series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions.” Each month, we’re revealing one of the top questions students miss, a helpful analysis of answers and a video featuring tips on how to advance your test-taking strategies.</p> <p> This month’s question explores pathology and cardiovascular topics.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 72-year-old obese woman collapses and is brought to the emergency department. She flew from California to New York three days earlier. She has smoked a pack of cigarettes daily for 50 years. During physical examination, she is unable to respond to questions or follow instructions. Three days later, she becomes hypotensive and dies. Autopsy shows multiple loosely adherent clots within the distal branching arteries of the left middle cerebral artery and in the vertebrobasilar system. Which of the following pathologic conditions would most likely account for the neurologic findings in this patient?</p> <p style="margin-left:80px;"> <strong>A.</strong> Atherosclerosis of penetrating cerebral arteries<br /> <strong>B. </strong>Endocarditis of the tricuspid valve<br /> <strong>C. </strong>Patent foramen ovale<br /> <strong>D.</strong> Pulmonary thromboembolism<br /> <strong>E. </strong>Trousseau syndrome</p> <p> <object align="middle" data="http://www.youtube.com/v/kHaF4np-ki8" height="350" hspace="10" id="ltVideoYouTube" src="http://www.youtube.com/v/kHaF4np-ki8" type="application/x-shockwave-flash" vspace="10" width="450"><param name="movie" value="http://www.youtube.com/v/kHaF4np-ki8" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="10" quality="best" src="http://www.youtube.com/v/kHaF4np-ki8" type="application/x-shockwave-flash" vspace="10" width="450" wmode="transparent"></embed></object></p> <p> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why:</strong> Persistence of a patent foramen ovale is found in a significant proportion of healthy subjects. A widely patent foramen ovale may allow emboli originating from the veins in the legs to bypass the pulmonary circulation and reach the systemic arteries, thereby producing infarcts (paradoxical embolism) in the brain and in other organs. Interatrial or interventricular defects can have the same effect.<br /> <br /> None of the other answer choices would explain the development of embolic infarcts in the cerebral parenchyma. Thrombus formation is associated with Virchow’s triad of hypercoagulability, stasis and endothelial damage. This patient has all of the underlying risk factors, with her obesity, smoking and immobilization during the plane trip.</p> <p> <strong>Note:</strong> Another cause of paradoxical embolism in an adult is a small atrial septal defect.</p> <p> <strong>Why you shouldn’t choose the other answers</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with future studying.</em></p> <p> <strong>Choice A:</strong> Atherosclerotic changes are frequently found in the circle of Willis and its major branches, but not in the small caliber penetrating arteries of the brain.</p> <p> <strong>Choice B:</strong> Endocarditis of the tricuspid valve which is common in IV drug abusers, may give rise to emboli resulting from fragmentation of valvular vegetations. Emboli from the tricuspid valve, however, would enter the pulmonary circulation, possibly leading to infarcts of the lungs.</p> <p> <strong>Choice D:</strong> Pulmonary thromboembolism frequently occurs as a result of deep venous thrombosis, especially after immobilization (as in this patient during her plane trip), bed rest, obstetric delivery and surgery. Thromboemboli that become lodged in the pulmonary arteries, however, cannot pass through the pulmonary capillary filter and cause systemic embolization.</p> <p> <strong>Choice E:</strong> Trousseau syndrome, also known as migratory thrombophlebitis, occurs in association with disseminated cancers, especially mucinous adenocarcinomas. This condition is probably caused by release of procoagulant factors by the tumor, and it manifests with recurrent episodes of thrombosis affecting veins (but not arteries) in both limbs and visceral organs.</p> <p> <strong>Want more help with USMLE test prep questions?</strong> Check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-missed-usmle-question-right-answer" target="_blank">first</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/sharpen-usmle-skills-this-top-missed-test-prep-question" target="_blank">second</a> posts in <em>AMA Wire’s</em> Tutor Talk series. Also, review <a href="http://www.ama-assn.org/ama/ama-wire/post/definitive-usmle-step-1-study-guide-here" target="_blank">this definitive USMLE Step 1 guide</a>, which features expert tips on test-taking strategies and preparation. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:222ef245-148d-4be9-9c79-707809a3e7c8 Court case puts patient privacy in peril http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-case-puts-patient-privacy-peril Tue, 24 Nov 2015 17:49:00 GMT <p> What happens to physician-patient confidentiality when any government agency can obtain a patient’s prescription records without a warrant? A case before a state supreme court threatens to keep these indiscriminant lines of investigation wide open.</p> <p> <em>Lewis v. Superior Court of Los Angeles County</em>, a case before the Supreme Court of the State of California, calls into question whether or not the California Medical Board infringed upon patients’ constitutional right to privacy when it obtained prescription data without a showing of good cause. The board did so through the California Department of Justice (DOJ) database, which allows broad and indiscriminate disclosures to state, local and federal agencies—including law enforcement—and fails to adequately protect patient privacy.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/13/3533a489-d826-4354-9d55-58b191037cbf.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/13/3533a489-d826-4354-9d55-58b191037cbf.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Ignoring privacy laws</strong></p> <p> In this case, the Medical Board acquired three years of prescribing history of all of a single physician’s patients. In doing this, the Medical Board circumvented patients’ right of privacy guaranteed by the California constitution. This right protects sensitive medical information from disclosure without probable cause or judicial review.</p> <p> Yet the court of appeals concluded that government agencies did not violate patient privacy and that no further limitations should be established when it comes to data mining patient prescription records.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> filed an amicus brief in the interest of “ensuring that prescription drug monitoring (PDMP) databases … are governed by strong confidentiality safeguards” and “the disclosure of patient data … to third-party government agencies [is] subject to clear and consistent regulations and procedures.”</p> <p> “There is good reason why federal and state laws treat prescription information with the same level of protection as any other health information,” the brief states. “The DOJ has not offered an acceptable justification for ignoring the governing laws.”</p> <p> <strong>Why patient information needs protection</strong></p> <p> California’s PDMP, the Controlled Substance Utilization Review and Evaluation System (CURES), is maintained and administered by the Office of the Attorney General in the California DOJ. It has become routine practice for Medical Board investigators to obtain years of prescription records from CURES to identify individual patients every time the Medical Board receives any type of complaint against a physician, even if that complaint does not concern prescribing practices. The AMA Litigation Center brief emphasized that PDMPs were designed to make tracking more fluid for physician work flows so they can ensure the best patient care; the databases are not intended for agency investigation.</p> <p> The medical board acquired the prescribing records of the physician because of a single complaint from a single patient that the physician had seen only once. More importantly, the investigation had nothing to do with the physician’s prescribing practices.</p> <p> The brief points out that medical records should be protected because they can reveal potentially embarrassing and stigmatizing information about a patient. If patients do not feel that the information they share with their physician is protected, they may not share it at all, which could result in a misdiagnosis or the wrong course of treatment. In the worst case scenario, the patient may not seek medical care in the first place.</p> <p> “While patient privacy will suffer, the ability of health care providers to provide effective and safe care also will be hampered due to serious damage to the relationship between providers and their patients,” the amicus brief said of the effect the decision would have on the physician-patient relationship.</p> <p> A license to write prescriptions comes with tremendous responsibility. After assessing the needs of a patient, physicians also must closely monitor the use of prescriptions to ensure effective and safe use of controlled substances, the brief notes. This process profoundly depends on physician-patient confidentiality, candor and trust. A decision in <em>Lewis v. Superior Court </em>could potentially undermine this relationship.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:de8ff28a-799a-403b-b64b-f4ddaf35e9f8 The difficult science you might not know--but should http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_difficult-science-might-not-but-should Tue, 24 Nov 2015 02:14:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/12/ed210673-5f4a-4ede-9c51-66e634a69197.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/12/ed210673-5f4a-4ede-9c51-66e634a69197.Large.jpg?1" style="margin:15px;float:left;" /></a><em>An </em><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" target="_blank"><em>AMA Viewpoints</em></a><em> post by AMA Board of Trustees Chair </em><a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members/stephen-permut.page" target="_blank"><em>Stephen R. Permut, MD</em></a></p> <p> As a future physician, you’ll be pulled in many directions. Your medical skills will be tested, you’ll need to think on your feet, and you’ll need to make decisions that will affect your patients’ well-being and health outcomes. But how will you know whether you’re making the right decisions?</p> <p> To be a successful physician in practice, you’ll need to not only master clinical skills but also embrace a challenging science that only recently began making its way into physician training.</p> <p> <strong>The imperative to deliver high-value care</strong></p> <p> Physician training—as well as the practice of medicine—traditionally has focused on putting the best interest of the patient foremost by doing everything possible for each individual patient. But more recently, the medical profession has come to recognize that doing everything medically possible isn’t always in the patient’s best interest.</p> <p> At the same time, physicians have an ethical obligation to be prudent stewards of health care resources. That means that future physicians must learn how to deliver high-value care that achieves good patient outcomes at a reasonable cost—and simultaneously upholds the primacy of the patient-physician relationship.</p> <p> Think this sounds nuanced and challenging? That’s because it is.</p> <p> Even physicians like myself, who have been practicing and teaching for decades, can feel like we’re being pulled in so many directions that making the optimal decision for every scenario can be very difficult. First, we must evaluate the particular needs of the patient sitting right in front of us. We also must consider whether our decision would change if we were to apply it to the whole population of people who present with that medical problem.</p> <p> Then there are the institutional and financial considerations. Will the patient’s insurance company cover the tests or treatments? What about the clinical setting? If the patient is in the hospital, some immediate expenses can save money in the long term, while ordering similar tests or procedures in an outpatient setting might have just the opposite result.</p> <p> On top of that is the fear of medical liability that leads to what is known as “defensive medicine,” in which physicians order more than they might think is medically necessary to cover all their bases.</p> <p> But with <a href="http://jama.jamanetwork.com/article.aspx?articleid=1148376" rel="nofollow" target="_blank">estimates</a> in the hundreds of billions of dollars when it comes to annual expenditures on unneeded or unwanted health care in the United States, physician stewardship is more important now than ever.</p> <p> <strong>Learning how to be a prudent physician steward</strong></p> <p> Some medical schools and residency programs are building into their curricula programs that equip physicians in training to rise to the challenge of providing high-value care.</p> <p> For instance, one of the main themes in the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_blank">Accelerating Change in Medical Education Consortium</a>, which now consists of 32 medical schools around the country, is adding a new “third science” to the core of physician training. “<a href="http://www.ama-assn.org/ama/ama-wire/post/new-third-science-bedrock-transforming-med-ed" target="_blank">Health care delivery science</a>,” or “health systems science,” consists of a number of practical elements that prepare students for the modern health care environment. These include health policy and economics, population and public health, and value-based care, among other very timely topics.</p> <p> Schools in the consortium are working together to rapidly disseminate best practices from their curriculum innovations to medical schools around the country. So if you find yourself in a position to participate in similar training at your institution, take full advantage of it. Learning how to navigate these issues from experienced physicians is invaluable.</p> <p> Additionally, one excellent way that every physician in training can further explore what it means to deliver high-value care is through the <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">November 2015 issue</a> of the <em>AMA Journal of Ethics</em>. Created with students and residents in mind, the journal offers perspectives that get to the heart of the matter.</p> <p> In particular, these pieces are fantastic resources for physicians in training:</p> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2015/11/medu1-1511.html" target="_blank">Teaching high-value care</a>” describes several programs that are not only teaching medical students how to be physician stewards but are empowering students to be change agents in this area.</li> <li> “<a href="http://journalofethics.ama-assn.org/2015/11/ecas3-1511.html" target="_blank">Cost-consciousness in teaching hospitals</a>” takes a look at some of the elements of clinical training that may need to change to better prepare trainees for delivering high-value care.</li> <li> “<a href="http://journalofethics.ama-assn.org/2015/11/mnar1-1511.html" target="_blank">Countering medicine’s culture of more</a>” explains how one physician turned his experience as a resident on its head as he trains future physicians to understand clinical overuse and patient harm.</li> <li> The <a href="http://journalofethics.ama-assn.org/2015/11/coet1-1511.html" target="_blank"><em>AMA Code of Medical Ethics’</em> opinion on physician stewardship</a>, a fairly recent addition to the oldest of professional ethical codes, details how physicians should fulfill their obligation as prudent stewards of health care resources and outlines the greater system changes that are needed to foster high-value care.</li> </ul> <p> Physician stewardship isn’t a theoretical concept. It’s an essential part of the practice of medicine in the 21st century. Take every opportunity to make sure you’re prepared to deliver the high-value care that will lead to the best health outcomes for our patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:490d203b-3613-4445-b48f-5dcade495080 10 principles to improve care for Medicare patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_10-principles-improve-care-medicare-patients Fri, 20 Nov 2015 20:40:00 GMT <p> As the Centers for Medicare & Medicaid Services (CMS) prepares to implement new delivery and payment models and a streamlined incentive program, physicians took the lead in outlining principles that should govern these Medicare reforms.</p> <p> More than 100 state and specialty medical associations joined the AMA in signing a <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-sign-on-letter-16nov2015.pdf" target="_blank">letter</a> (log in) sent Monday to the Centers for Medicare & Medicaid Services (CMS) that recommends 10 principles to guide the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare reform law that repealed the sustainable growth rate formula.</p> <p> In particular, the recommendations deal with alternative payment models (APM) and the Merit-Based Incentive Payment System (MIPS), which are intended to promote improvements in the delivery of care for Medicare patients. They are:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Support delivery system improvements. </strong>Constraints and limitations of current payment systems that obstruct physician-identified improvements in care must be eliminated.<br /> <br /> Requirements for new models should be flexible enough to support different organizational arrangements and patient population needs so innovation can flourish.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Avoid administrative and cost burdens for patients. </strong>Patients should not be unduly burdened with hidden costs, administrative requirements or other obstacles that discourage them from seeking care or fulfilling their treatment plans.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Reduce administrative burdens for physicians. </strong>Administrative burdens must be limited and reporting tasks streamlined so the delivery of patient-centered care can be the principal focus in all clinical settings.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Improve current quality and reporting systems. </strong>Medicare’s existing reporting and quality measurement programs cannot simply be combined to create the new MIPS. These currently separate programs must be carefully assessed, revised, aligned and streamlined into a coherent and flexible system that is truly relevant to high-value care.<br /> <br /> The regulatory framework of the meaningful use program for electronic health records must be revised to eliminate obstacles to technological innovation, enable interoperability, and improve usability to meet the needs of patient care and reduce the burden of excessive data collection requirements.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Recognize patient diversity. </strong>Risk adjustment—for factors related to health status, stage of disease, genetic factors, local demographics and socioeconomic status—must be reflected in performance assessments to accommodate variations in patient needs and costs of care and to assure broad access to high-value care.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Provide choice of payment models. </strong>Physicians in all specialties, practice settings and geographic areas should have the opportunity to choose from the payment models available, based on what best accommodates their practice and the needs of their patients.</p> <p style="margin-left:40px;"> <strong>7.  </strong><strong>Be equitable. </strong>No specialty or payment model should confront disproportionate requirements in order to succeed, nor should any specialty experience hardship because insufficient resources have been devoted to developing quality measures or other delivery model components that are relevant to their patients.</p> <p style="margin-left:40px;"> <strong>8.  </strong><strong>Be relevant and actionable. </strong>Physicians should be held accountable only for those aspects of cost and quality that they can reasonably influence or control, and patient attribution methods must reflect these concerns.<br /> <br /> Timelines and deadlines must be realistic, significant policy changes should be phased in, and feedback on individual performance and benchmarks must be accurate, timely and actionable.</p> <p style="margin-left:40px;"> <strong>9.  </strong><strong>Provide stability and resources. </strong>Payment systems must provide adequate and predictable resources, and ensure that physicians have access to new tools they will need to redesign their practices to support the delivery of high-value care to all patients.</p> <p style="margin-left:40px;"> <strong>10. </strong><strong>Be transparent. </strong>Methodologies and performance assessment systems should be valid, scientifically tested and transparent so physicians have access to timely, accurate and actionable data for managing patient care.<br /> <br /> Medicare must provide claims and other performance data to physicians on the patient population covered by the delivery and payment model used in their practice.</p> <p> The letter also noted that these principles are just the start. An ongoing dialogue with the physician community “will promote smooth and successful implementation of MIPS and APMs,” and help physicians make the transition to new care and delivery models while assuring access to high-quality care for all patients, the letter said.</p> <p> The AMA also submitted <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) to CMS this week, responding to questions in a request for information on MACRA implementation.</p> <p> <strong>Learn more about MACRA and new payment models</strong></p> <ul> <li style="margin-left:0.25in;"> Interested in learning more about MACRA? An <a href="http://www.ama-assn.org/ama/ama-wire/blog/SGR_Repeal_Series/1" target="_blank"><em>AMA Wire</em>® series</a> takes a look at the law’s main elements, including its <a href="http://www.ama-assn.org/ama/ama-wire/post/sgr-repeal-law-supports-new-payment-models" target="_blank">support for new payment models</a>.</li> <li style="margin-left:0.25in;"> As part of its <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative, the AMA offers <a href="http://www.ama-assn.org/ama/ama-wire/post/5-contracting-keys-success-alternative-payment-model" target="_blank">two resources</a> to help physicians with contracting under an alternative payment model.</li> <li style="margin-left:0.25in;"> The AMA and the RAND Corporation recently <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-views-new-payment-models-5-things" target="_blank">conducted case studies</a> of 34 physician practices in six diverse geographic markets to determine the effects that alternative health care payment models had on physicians and practices.</li> <li style="margin-left:0.25in;"> AMA President Steven J. Stack, MD, has detailed the <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-unearthed-root-of-new-payment-model-challenges" target="_blank">root of new payment model challenges</a>. He writes about how physicians need better data and tools and ways the AMA is ensuring they are on the ground floor of the development of these tools.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:def475a8-02c8-4a79-ac2d-6610aacb618f Why positive emotions may be the next big predictor of health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_positive-emotions-may-next-big-predictor-of-health Fri, 20 Nov 2015 20:35:00 GMT <p> What if joy or amusement could improve your health—would you smile more today? That’s precisely the question psychology researcher, Jennifer Stellar, PhD, has explored in her work. The University of Toronto postdoctoral fellow recently presented her research at <a href="http://www.tedmed.com/" rel="nofollow" target="_blank">TEDMED 2015</a>. Learn about her evidence-based approach to exploring human emotions and why our feelings may have a greater impact on our well-being than we expect.</p> <p> <strong>Measuring positive emotions and health</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/15/3b4eeed1-4ff1-4f18-9f86-7edcb56ef86c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/15/3b4eeed1-4ff1-4f18-9f86-7edcb56ef86c.Large.jpg?1" style="margin:15px;float:right;" /></a>To determine whether emotions impact health, Stellar launched two studies in which she measured students’ levels of proinflammatory cytokines, which if chronically elevated for long periods of time, can have harmful health effects contributing to diabetes, cardiovascular disease and depression.</p> <p> In her research, Steller specifically measured students’ levels of Interluken-6 (IL-6), a common proinflammatory cytokine, based on the emotions they exhibited.</p> <p> Stellar noted that she and her research staff had an important hypothesis to test. “Our idea was that people who experience more positive emotions will have lower levels of IL-6 circulating in their body,” she said. “Why did we think this? Certain negative emotions have been associated with increases in IL-6, so we thought perhaps positive emotions would have an opposite effect leading to lower levels of this damaging biomarker.”</p> <p> Stellar had students come to a lab where she measured how many positive emotions they experienced in the previous month, then collected a saliva sample to measure each student’s level of IL-6. “It turns out, our hypothesis was correct. Positive emotions predicted lower levels of proinflammatory cytokines in our student population.”</p> <p> <strong>How Stellar challenged her own research, explored new emotions</strong></p> <p> This was a great discovery, but Stellar still felt compelled to approach her hypothesis differently. Not only did she want to confirm that human emotions impact IL-6 levels but she also wanted to know which specific emotions were key drivers to higher IL-6 levels, so she launched an additional survey that measured the frequency and intensity in which students experienced a core set of emotions.</p> <p> The survey measured seven key emotions: amusement, awe, contentment, compassion, pride, love and joy. Stellar found that four specific emotions—joy, pride, contentment and awe—predicted lower levels of IL-6.</p> <p> Interestingly, awe had the strongest negative relationship to IL-6, even when researchers controlled for the other six positive emotions, personality measures and a third method of measuring emotions.</p> <p> <strong>An awe-inspiring discovery </strong></p> <p> Awe is such a powerful emotion because it signifies wonder and amazement in the world, and you don’t have to travel abroad or pursue a daring adventure to find it. “In fact, participants report feeling awe about twice a week on average, making it a more common emotion than we might expect,” she said, noting that everyday experiences— glancing up at the stars or watching athletes achieve a seemingly impossible physical feat—can inspire awe. </p> <p> While researchers don’t entirely know why awe topped the list of emotions as a positive predictor of health, Stellar said she’s certain that her own studies have changed her way of thinking about awe in the world.</p> <p> “I used to see a walk in nature or a trip to the museum as a luxury I could barely afford in my busy life. Now I see it as essential to my mental and physician health.”</p> <p> She said her studies also remind her that as a field, psychology is transforming, and her colleagues are shifting how they think about positive emotions. “We now recognize that they’re not simply the absence of negative emotions but that they’re colorful and varied in their own right …. We still have a lot to learn about the emotion of awe, but it’s fascinating to think that in seeking out the beauty, mystery and vastness our world has to offer, we might actually find the key to our physical health.”</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> <span style="font-weight:700;">Interested in more TEDMED?</span><br /> AMA members have <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__mailview.bulletinhealthcare.com_mailview.aspx-3Fm-3D2015111901ama-26r-3D6405498-2Dacfa-26l-3D011-2D308-26t-3Dc&d=CwMDaQ&c=iqeSLYkBTKTEV8nJYtdW_A&r=NZ90covYUpIOy5-Y4A0txvOxUAyfa3shpb5hDlkl8rY&m=AY5Ua2L5iU6eOq79gkaT3I6wRiFf1RNt69SCy3qaWeA&s=jsY9cSxY2lV9BQ1OpjH13QzLRXkY13fcXvrHxvG6VHk&e=" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;" target="_blank">complimentary virtual access</a> to the stage program for TEDMED 2015, which brings together the global community dedicated to shaping a healthier world.</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> Thought leaders and change agents will share compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> Visit the <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;" target="_blank">AMA website</a> to learn more. AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks live during the event Nov. 18-20 and on demand through Dec. 20.</p> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b9f38cca-3b89-4d56-b7b4-824d22d52ec4 How creative thinking spurred a global public health solution http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_creative-thinking-spurred-global-public-health-solution Fri, 20 Nov 2015 19:00:00 GMT <p> When the Bill and Melinda Gates Foundation asked maverick engineer Peter Janicki to clean up sewage wastelands in developing countries, he swore the problem was impossible to solve. Then something happened—he traveled abroad and discovered new ways to conceptualize sanitation, which led to a groundbreaking invention that turns tons of sewage into clean, drinkable water. Janicki recently discussed at <a href="http://www.tedmed.com/" rel="nofollow" target="_blank">TEDMED 2015</a> why the way we think is always the most important aspect of problem-solving.</p> <p> <strong>Expanding the scope of the problem </strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/19354d2d-fad0-4d37-b2a1-917a1929622d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/19354d2d-fad0-4d37-b2a1-917a1929622d.Large.jpg?1" style="margin:15px;float:right;" /></a>After accepting the sanitation assignment, Janicki travelled throughout Africa and India to learn about the scope of various countries’ sanitation problems and possible ways he could help. During that time, he encountered large tracts of land buried in trash and children swimming in streams contaminated by sewage that seemed to ebb into another tragic yet daily part of life in poverty.</p> <p> Janicki soon understood the problem at hand: There was too much uncontained trash to prevent the sewage from polluting fresh water. And even if he could somehow clean up the sewage, it would be a costly and nearly impossible endeavor for underfunded countries to accomplish, Janicki said. Stunned by the miles of garbage and wastelands in each country, he was prepared to return to the United States without a real solution. But during one of his site visits, he became very sick.</p> <p> Janicki accidentally had drunk a small drop of polluted water. “I began vomiting violently,” he said. He had to be hospitalized, which is where he learned that nearly one-half of the people in the hospital he visited were there because they had drunk polluted water as well.</p> <p> “I thought, ‘How awful it must be for so many people to die like this,’” Janicki said. “My resolve to solve this problem became personal, and that’s when I realized that the problem was not too big. It was actually defined in a way that’s too small,” he said.</p> <p> Janicki noted that the original problem that he was tasked to solve—keeping sewage out the water—was far too narrow for such a complex problem as sanitation in developing countries. </p> <p> “I was looking through a straw. I could not figure out how to execute my vision,” Janicki said. “But then, I let the problem expand. All the constraints I was putting upon myself, I removed them. I let the problem get as big as it needed to get so that there wasn’t just a solution. There became multiple solutions that started to work—and that’s when it all came together.”</p> <p> Janicki said he realized that in order to improve sanitation abroad he had to “make sewage valuable,” which would incentivize people to not dump trash into the environment. He said he realized he needed to adapt a multi-pronged approach to solving the problem, which was much bigger than processing sewage in a traditional way.</p> <p> <strong>Rethinking the solution: How Janicki made sewage valuable </strong></p> <p> “In the United States we have a sanitation solution that works. We use flush toilets, pipe fresh water and septic systems that are connected to massively expensive waste treatment plants. None of this is profitable, and we don’t care,” Janicki said. “We simply tax our society, and force it to happen, which is no problem in a rich country. The mistake is that we repetitively force this solution in developing countries—and it almost never works.”</p> <p> Janicki visited dozens of waste water treatment plants in developing countries and found that none of them were operating because they couldn’t afford the recurring electrical costs. He said he knew he had to approach the problem differently.</p> <p> “If I was going to make sewage valuable, I had to dig down and see what was inside it. And what you find is that sewage is mostly [made of] water, and water is definitely valuable. [Once the water is separated from the sewage] what’s left by and large, is mostly biomass, which makes great fuel—and energy is also valuable,” Janicki said.</p> <p> <strong>Creating the solution: Meet the Omniprocessor </strong></p> <p> This discovery prompted him to create the Omniprocessor, a heavy-duty piece of equipment that’s roughly the size of two school buses. The equipment consumes sewage and produces “super-clean drinking water, electricity and ash that’s used in concrete,” Janicki said. Using a “sledgehammer approach,” the machine boils sewage to separate water from biomass, which in turn is burned to create energy to continue powering the Omniprocessor.</p> <p> Janicki built the machine, tested it and proved its effectiveness in the United States. The Omniprocessor now is being piloted in West Africa, where Janicki hopes to make it a sustainable solution that fits the region’s environment, politics and economic resources.</p> <p> While Janicki acknowledges that there are still several details about the Omniprocessor to sort out, he said he confidently believes  “we are on the verge of a major revolution in sanitation.” After a video of Bill Gates drinking water from the Omniprocessor went viral, Janicki said the machine instantly garnered global support.</p> <p> “If you take one thing away from my talk, I hope it’s this: If you’re faced with a critical problem that seems impossible, sometimes it helps to step back and rethink how the problem is framed, “ Janicki said. “You may be working on a problem that is framed in such a way that there is no solution even if you’re really smart  …. We have to allow ourselves to think bigger and then have the resolve to never give up. When we put these two things together, we can make big dreams into a big impact.”</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> <span style="font-weight:700;">Interested in more TEDMED?</span><br /> AMA members have <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__mailview.bulletinhealthcare.com_mailview.aspx-3Fm-3D2015111901ama-26r-3D6405498-2Dacfa-26l-3D011-2D308-26t-3Dc&d=CwMDaQ&c=iqeSLYkBTKTEV8nJYtdW_A&r=NZ90covYUpIOy5-Y4A0txvOxUAyfa3shpb5hDlkl8rY&m=AY5Ua2L5iU6eOq79gkaT3I6wRiFf1RNt69SCy3qaWeA&s=jsY9cSxY2lV9BQ1OpjH13QzLRXkY13fcXvrHxvG6VHk&e=" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;" target="_blank">complimentary virtual access</a> to the stage program for TEDMED 2015, which brings together the global community dedicated to shaping a healthier world.</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> Thought leaders and change agents will share compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p style="font-size:13px;margin-bottom:15px;margin-top:0px;overflow:hidden;word-wrap:break-word;color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;"> Visit the <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;" target="_blank">AMA website</a> to learn more. AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks live during the event Nov. 18-20 and on demand through Dec. 20.</p> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:490127d8-4a5a-401a-85b5-0d77a658e354 New naloxone product could save thousands of lives http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-naloxone-product-could-save-thousands-of-lives Thu, 19 Nov 2015 22:38:00 GMT <p> The Food and Drug Administration (FDA) has approved a nasal spray version of naloxone—the life-saving medication that can reverse the effects of an opioid overdose by restoring breathing and preventing death. The approval marks another gain in the effort to curb the opioid overdose epidemic.</p> <p> Narcan® nasal spray, the <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM473505" target="_blank" rel="nofollow">newly approved version of naloxone</a>, requires no additional assembly and delivers a consistent, measured dose when used correctly. The spray is delivered to an overdose victim through one nostril and can be repeated if necessary. Anyone, including those without medical training, can effectively administer Narcan® nasal spray.</p> <p> “The AMA applauds the FDA for approving the nasal spray version of naloxone,” Patrice A. Harris, chair-elect of the AMA, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-19-fda-approves-new-naloxone-product.page" target="_blank">press release</a>. The FDA’s “swift action will widely increase accessibility to this medication that will help prevent more opioid-related overdoses and save more lives.”</p> <p> When a person overdoses on opioids, their breathing may become shallow or even stop. If someone administers naloxone quickly and safely, overdose effects can be countered often in less than two minutes.</p> <p> “While naloxone will not solve the underlying problems of the opioid epidemic,” said Stephen Ostroff, MD, acting commissioner of the FDA, “we are speeding to review new formulations that will ultimately save lives that might otherwise be lost to drug addiction and overdose.”</p> <p> <strong>How physicians are combatting the opioid overdose epidemic</strong></p> <p> Earlier this year, the AMA convened the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page?utm_source=Press_Release&utm_medium=media&utm_term=072715&utm_content=public_health&utm_campaign=marketing_campaign" target="_blank">Task Force to Reduce Opioid Abuse</a> to identify best practices to curb opioid abuse and implement those practices across the country. The <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-can-stop-opioid-overdose-epidemic" target="_blank">Task Force has focused</a> not only on increasing access to naloxone but also on increasing the number of physicians who are registered for and use of <a href="http://www.ama-assn.org/ama/ama-wire/post/opioid-use-disorders-increase-physicians-offer-solutions" target="_blank">prescription drug monitoring programs</a> (PDMP), enhancing physician education, reducing the stigma of opioid disorders and improving access to comprehensive pain management.</p> <p> “With <a href="http://www.cdc.gov/drugoverdose/" target="_blank" rel="nofollow">44 people dying each day</a> from opioid-related overdose,” Dr. Harris said, “we are committed to expanding our efforts aimed at addressing prescription drug abuse and diversion and putting an end to this serious public health epidemic.”</p> <p> Recently, the AMA adopted new policy at its <a href="http://www.ama-assn.org/sub/meeting/" target="_blank">2015 Interim Meeting</a> to encourage manufacturers or other qualified sponsors to pursue the FDA’s application process for approving access to over-the-counter naloxone.</p> <p> Following the formation of the task force, Dr. Harris detailed <a href="http://www.ama-assn.org/ama/ama-wire/post/now-comes-hard-part-turning-national-attention-action" target="_blank">4 ways physicians can take action</a> in an <em>AMA Wire® </em>Viewpoints post. “This drug [naloxone] has saved tens of thousands of lives in communities across the country,” she wrote. “Now it’s time for us physicians to help increase the number of lives saved by co-prescribing naloxone when it is clinically indicated.”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:28ace91d-9035-4b86-a5b8-1e95405ab25d Music and medicine: How one cardiologist found peace in song http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_music-medicine-one-cardiologist-found-peace-song Thu, 19 Nov 2015 15:57:00 GMT <p> <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/12/39ba48c2-9226-49ef-9c93-f0680f1447f0.Large.jpg?1" style="margin:15px;float:right;" /></a>Being a physician requires a level of altruism unlike that in any other profession. Burying emotions under a facade of heroism—for the sake of treating patients—often becomes a standard in practice, and Suzie Brown, MD, knew such emotional suppression was draining her wellness. So she began writing songs—and they’ve made a difference. The cardiologist-songwriter recently performed at <a href="http://www.tedmed.com/" rel="nofollow">TEDMED2015</a>. Here’s how she says music restored her self-awareness and strengthened her relationships with patients.</p> <p> <strong>The “stoic” life of the physician </strong></p> <p> “Just this past Saturday night, I was up the entire night taking care of a patient who had become very sick in the intensive care unit,” Dr. Brown said. “It didn’t matter that I’m eight months pregnant or that I had just worked six 12-hour days in a row and had to be back at work the next day. Or that I had been up the six previous nights with our one-and-a-half-year-old daughter who is currently teething—none of that really mattered. What mattered was that this patient needed my care and attention, and my priority was to give it to her.”</p> <p> Although well-intentioned, Dr. Brown said this kind of “stoicism” prevailed throughout her cardiology training and caused her to continually put patients before her own needs, which became difficult to maintain.</p> <p> “By the time I finished my training as a cardiologist, I felt emotionally exhausted,” she said. “I began to seek out music as a place where I could show my vulnerability, a place where I could be honest about what I was really feeling. I found that making music made me feel more balanced and more at peace than I ever had before.”</p> <p> <strong>Finding joy in music and medicine<object align="right" data="http://www.youtube.com/v/-nm9ZylxNdI" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/-nm9ZylxNdI" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/-nm9ZylxNdI" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/-nm9ZylxNdI" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></strong></p> <p> Seven years later, what began as catharsis has become a way of life for Dr. Brown. She works part-time as a heart failure and cardiac transplant specialist at Vanderbilt University Medical Center and writes and performs songs with her husband Scott.</p> <p> “Showing my vulnerability through music has made me a better doctor,” Dr. Brown said, noting that music has improved her self-awareness and ability to create sincere emotional connections with patients.</p> <p> The emotions she once suppressed in practice—the same ones that often lead so many talented physicians to depression, cynicism and burnout—have now touched the hearts of thousands in her 2011 debut album <em>Heartstrings</em>, which has been featured at Starbucks, the Gap and Anthropologie. Her second album, <em>Almost There, </em>was funded entirely by her fans.</p> <p> Watch Dr. Brown’s official music video for her single, “Almost There” (right), and enjoy more of her music on<a href="http://www.suziebrownsongs.com/" rel="nofollow"> her artist page</a>. </p> <p> <strong>Also</strong><strong> explore these must-have wellness resources:</strong></p> <ul> <li>  See <a href="http://www.ama-assn.org/ama/ama-wire/post/6-ways-improve-resiliency-demanding-practice-environment">6 ways to improve resiliency in a demanding practice environment</a>.</li> <li>  Discover how to beat burnout with the<a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should"> 7 signs physicians should know</a>.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre">how residents are beating burnout</a> with help from the theatre.</li> <li> Find out how physicians rank <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">residency work-life balance based on specialties</a>.</li> <li> Check out <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">these tips from residents who have conquered burnout</a>.</li> <li> Educate yourself on the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">signs of burnout</a> and how to <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">increase satisfaction in training</a>.</li> <li> Read about Stanford University School of Medicine’s <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">successful wellness program</a>, and learn why taking time for fun (and the occasional sailing lesson) can improve resiliency in training.</li> <li> Plan to attend the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page">International Conference on Physician Health</a>™, which will explore the theme of “Increasing Joy in Medicine” Sept. 18-20 in Boston.</li> </ul> <p> <strong>Interested in more TEDMED?</strong><br /> AMA members have <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__mailview.bulletinhealthcare.com_mailview.aspx-3Fm-3D2015111901ama-26r-3D6405498-2Dacfa-26l-3D011-2D308-26t-3Dc&d=CwMDaQ&c=iqeSLYkBTKTEV8nJYtdW_A&r=NZ90covYUpIOy5-Y4A0txvOxUAyfa3shpb5hDlkl8rY&m=AY5Ua2L5iU6eOq79gkaT3I6wRiFf1RNt69SCy3qaWeA&s=jsY9cSxY2lV9BQ1OpjH13QzLRXkY13fcXvrHxvG6VHk&e=" rel="nofollow">complimentary virtual access</a> to the stage program for TEDMED 2015, which brings together the global community dedicated to shaping a healthier world.</p> <p> Thought leaders and change agents will share compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation.</p> <p> Visit the <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank">AMA website</a> to learn more. AMA members were sent an email with special instructions to gain exclusive access via the AMA’s custom online channel. Members can view TEDMED 2015 talks live during the event Nov. 18-20 and on demand through Dec. 20.</p> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e0bc0507-e642-4ffe-a26a-cd271ab2a09a AMA urges elimination of nuclear weapons http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-urges-elimination-of-nuclear-weapons Wed, 18 Nov 2015 18:00:00 GMT <div> Citing some of the medical and environmental consequences of nuclear war—no matter how “limited”—the AMA urged the U.S. Department of State to eliminate nuclear weapons and work to reduce nuclear arms in a letter sent earlier this month.</div> <div>  </div> <div> The letter comes just weeks after the World Medical Association updated its <a href="http://www.wma.net/en/30publications/10policies/n7/index.html" rel="nofollow" target="_blank">statement on nuclear weapons</a> during its General Assembly meeting in Moscow. The AMA is a founding member of the World Medical Association. </div> <div>  </div> <div> Among other actions, the statement condemns the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons. It also notes the devastating effect of using nuclear weapons, even beyond the immense human suffering and substantial death tolls among victims. </div> <div>  </div> <div> Catastrophic effects of even a so-called “limited” nuclear war would be felt in the earth’s ecosystem. That includes a subsequent decrease in the world’s food supply, which would put a significant portion of the world’s population at risk of famine.</div> <div>  </div> <div> Addressed to Secretary of State John F. Kerry, the letter notes the imperative for physicians to speak out on this issue. “As physicians, we have a clear duty and responsibility to preserve and safeguard the health of our patients and consecrate ourselves to the service of humanity,” it states. “Therefore, the AMA supports good faith efforts to eliminate nuclear weapons and urges the Administration to continue the process of bilateral and verifiable nuclear arms reduction.”</div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:288c7840-3e74-4af8-9030-3032f9189b5d From Rx prices to EHRs: Top stories from the 2015 AMA Interim Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_rx-prices-ehrs-top-stories-2015-ama-interim-meeting Wed, 18 Nov 2015 17:00:00 GMT <p> <a href="http://youtu.be/s4rCAx3EBXE" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/4/a2371143-f841-4fe2-94f4-57759b21a173.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <span style="font-size:12px;"><span style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;line-height:18.3273px;">The 2015 AMA Interim Meeting took place this week. Read these highlights from the meeting, and see <em>AMA Wire's</em></span></span><em style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;line-height:18.3273px;">®</em><span style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;line-height:18.3273px;"> </span><span style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;line-height:18.3273px;"><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Meeting/1" target="_blank">full coverage</a> of the event to learn more.</span></p> <p> <strong>1. </strong> <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/moments-matter-physicians-must-back-ama-president" target="_blank">Moments matter—and physicians must take them back: AMA president</a></strong><br /> AMA President Steven J. Stack, MD, spoke from the heart as he discussed the current state of health care in our country. When more and more moments are stolen from physicians, it is the patient who suffers most—and this cannot stand.</p> <p> <strong>2.  </strong><strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-call-fairness-drug-prices-availability" target="_blank">Physicians call for fairness in drug prices, availability</a></strong><br /> In response to increasing drug costs impacting patient access to needed medications, physicians called for a ban on advertising directly to patients, voted to convene a task force and agreed to launch an advocacy campaign to drive solutions and help make prescription drugs more affordable.</p> <p> <strong>3. </strong> <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/cdc-panel-shares-solutions-combat-antibiotic-resistance" target="_blank">CDC panel shares solutions to combat antibiotic resistance</a></strong><br /> An estimated 2 million U.S. illnesses and 23,000 deaths each year are caused by antibiotic-resistant infections. Three experts from the Centers for Disease Control and Prevention (CDC) spoke about this global health crisis and multifaceted solutions to address it. </p> <p> <a href="http://youtu.be/yy0RDpedi68" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/25a70b79-1856-4766-925e-0c1721fa56c4.Large.jpg?1" style="margin:15px;float:right;" /></a><strong>4. </strong> <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/standing-together-physicians-welcome-lead-change-ama-ceo" target="_blank">Standing together, physicians welcome and lead change: AMA CEO</a></strong><br /> “The American health care system evolves at a pace that would not have seemed possible not too long ago,” AMA Executive Vice President and CEO James L. Madara, MD, said. That’s why focusing on producing thriving practices that provide quality patient care is the most important aspect of health care today.</p> <p> <strong>5.</strong>  <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/report-points-toward-path-alternative-gme-funding" target="_blank">Report points toward path for alternative GME funding</a></strong><br /> A new report takes a look at alternative funding sources for residency programs and offers steps that could be taken to expand existing graduate medical education (GME) programs and create new programs.</p> <p> <strong>6.</strong>  <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-burnout-top-priority-physicians-training" target="_blank">Stopping burnout a top priority for physicians in training</a></strong><br /> As burnout and suicide continue to plague the medical profession at much higher rates than the general population, the physician community took action. New policy is aimed at ensuring physicians in training have access to potentially life-saving mental health services.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/7/00ad9f03-5269-4911-a76d-c6a3898b0a60.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/7/00ad9f03-5269-4911-a76d-c6a3898b0a60.Large.png?1" style="margin:15px;float:right;" /></a><strong>7.  </strong><strong><a href="http://www.ama-assn.org/ama/ama-wire/post/new-program-helps-develop-skill-set-physician-needs" target="_blank">New program helps develop the skill set every physician needs</a></strong><br /> Physicians have a strong history of leadership within the community, and the new Leadership Skills Series provides practical training for practicing physicians. Get involved and improve your ability to lead.</p> <p> <strong>8.  </strong><strong><a href="http://www.ama-assn.org/ama/ama-wire/post/attend-ehrs-can-attend-patients-physicians-say" target="_blank">Attend to EHRs so we can attend to patients, physicians say</a></strong><br /> The burden of meaningful use regulations and the associated problems with electronic health record (EHR) technology has plagued physicians for far too long. Physicians took action with the goal of removing these hindrances to physicians’ ability to provide quality care to patients.</p> <p> <strong>9.</strong>   <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-reaffirm-commitment-stop-insurance-mergers" target="_blank">Physicians reaffirm commitment to stop insurance mergers</a></strong><br /> In the face of mergers between major national health insurers, the medical profession will continue to stand against health insurance market consolidation that enhances health insurer market power, a trend that decreases health care access, quality and affordability.</p> <p> <strong>10.</strong>  <strong><a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-modern-medical-practice-needs" target="_blank">Five things modern medical practices need to thrive</a></strong><br /> There’s no golden rule for achieving the perfect care setting, but physicians can take certain measures to ensure their practices are prepared for evolving technology, increased patient demands and shifting payment models.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/12/a5f40775-0e9b-491b-ac41-5f78f6713aae.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/12/a5f40775-0e9b-491b-ac41-5f78f6713aae.Full.jpg?1" style="margin:15px 90px;width:700px;height:278px;float:left;" /></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:87cf7cce-bab8-46c4-931f-d11845dc2447 Attend to EHRs so we can attend to patients, physicians say http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_attend-ehrs-can-attend-patients-physicians-say Tue, 17 Nov 2015 21:08:00 GMT <p> The burden of meaningful use regulations and the associated problems with electronic health record (EHR) technology has plagued physicians for far too long. At the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a>, physicians took action with the goal of removing these hindrances to physicians’ ability to provide quality care to patients.</p> <p> <strong>EHR interoperability is crucial to certification process</strong></p> <p> Policy was adopted concerning shortcomings in EHR interoperability. The meaningful use program offers powerful financial incentives and disincentives for physicians but does not do so for EHR vendors. Meanwhile, most EHR systems fail to satisfy physician users.</p> <p> Additionally, some hospitals are requiring physicians to use specific brands of EHRs when those physicians already have invested in other EHR products. The fact that a lot of these different products do not work together has put many physicians in a financial bind. Should they purchase two EHR products? Three? Being able to share patient information and data seamlessly should be possible across EHR products.</p> <p> Physicians called for the Office of the National Coordinator for Health IT (ONC) to prioritize EHR interoperability, data portability and health IT data exchange testing.</p> <p> The AMA will work with EHR vendors to promote transparency of actual costs of EHR implementation, and CMS and ONC to identify barriers and solutions to data blocking so that physicians and hospitals have more options for purchasing, donating, subsidizing or migrating to new EHRs.</p> <p> New policy also asks that the AMA:</p> <ul> <li> Submit a report to the Department of Health and Human Services (HHS), the ONC and CMS concerning shortcomings in EHR interoperability, placing special emphasis on requiring vendors to provide systems that comply with interoperability standards as a basic requirement for certification.</li> </ul> <ul> <li> Insist that hospitals and health systems be prevented from requiring specific brands of EHRs for affiliated but independent physicians.</li> </ul> <ul> <li> Advocate that sponsoring institutions providing EHRs to physician practices provide data access to physicians if they withdraw support of EHR sponsorship.</li> </ul> <p> <strong>Information should be shared, not blocked</strong></p> <p> In the wake of the administration’s decision to move ahead with implementation of Stage 3 of the meaningful use program despite widespread failure of Stage 2, the AMA has taken action with urgency.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/ehr-meaningful-use-doomed-unless-congress-steps" target="_blank">In letters</a> sent earlier this month to both the <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-house-02nov2015.pdf" target="_blank">U.S. House of Representatives</a> (log in) and the <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-senate-02nov2015.pdf" target="_blank">Senate</a> (log in), the AMA and 110 other medical societies noted that what has emerged from the administration is a “morass of regulation” for a program that has “failed to focus on interoperability and has instead created new barriers to easily exchange data and information across care settings.”</p> <p> Specific to meaningful use, physicians reaffirmed AMA policies that seek revisions to quality standards and meaningful use requirements to make them more streamlined, usable and less burdensome, and the development of a one-portal, one username and password system to align all processes.</p> <p> AMA Immediate-Past Chair Barbara L. McAneny, MD, noted in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-ama-adopts-policies-improve-health.page" target="_blank">news release</a> that “action will be needed to refocus the goals of the meaningful use program on promoting better coordinated and high-quality patient care.”</p> <p> Physicians also adopted policy to call on Congress to “introduce legislation to eliminate unjustified information blocking  and excessive costs which prevent data exchange.”</p> <p> The policy insists that any clinician who has previously attested for meaningful use not be penalized if EHR technology is decertified as a result of stricter certification requirements.</p> <p> The policy also strongly reiterates the need to continue efforts to prevent expansion of meaningful use and other programs until EHR interoperability is accomplished.</p> <p> <strong>Until the job is done</strong></p> <p> Advocating on behalf of physicians and patients to relieve EHR woes continues to be a priority for the AMA. At two recent AMA town hall meetings on EHRs—the first in <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank">Atlanta</a> and second in <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank">Boston</a>—physicians convened to share publicly how burdensome EHRs and the regulations surrounding them have become.</p> <p> Recently, the AMA and MedStar Health’s Center for Human Factors in Healthcare developed an <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_blank">EHR User-Centered Design Evaluation Framework</a> and found that the top 20 EHR products didn’t measure up to user-centered recommendations.</p> <p> The AMA’s grassroots campaign, <a href="http://www.breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a>, provides a place for physicians to share their EHR stories with Congress and submit comments to CMS during the meaningful use Stage 3 comment period, which ends Dec. 15.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ee4a9999-b4bf-476b-8a48-e20bc3f9445c 5 things every modern medical practice needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-things-modern-medical-practice-needs Tue, 17 Nov 2015 21:03:00 GMT <p> Medical practices are complex, and there’s no golden rule for achieving the perfect care setting. But physicians can take certain measures to ensure their practices are prepared for evolving technology, increased patient demands and shifting payment models, Bruce Bagley, MD, told a group of physicians at the <a href="file:///I:/Communications%20Documents/2015%20Interim%20Meeting/News%20coverage/Final/2015%20AMA%20Interim%20Meeting" rel="nofollow" target="_blank">2015 AMA Interim Meeting</a>. Here are five things every practice will need to thrive.</p> <p> Dr. Bagley said practices that wish to survive rapid changes in health care and cultivate successful transformation will take these actions:</p> <p style="margin-left:40px;"> <strong>1.  Develop and adapt organizational models that can grow with your practice.</strong> Physicians shouldn’t burden themselves trying to predict every future change that will occur in health care and then designing a fool-proof practice that somehow reflects these unpredictable changes, Dr. Bagley said. Instead, he said physicians should “develop an agile organization” around themselves, “so that as things changes—and they’re going to constantly change—[the practice] can adapt to it.”<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/e335ed62-f3bc-476f-a4be-11549b7401a2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/e335ed62-f3bc-476f-a4be-11549b7401a2.Large.jpg?1" style="margin:15px;float:right;" /></a><br /> <br /> To create a nimble practice, Dr. Bagley advises that physicians view a <a href="https://www.stepsforward.org/modules/practice-transformation" rel="nofollow" target="_blank">special organizational development module</a> the AMA created as part of its <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward website</a>. The site currently offers a total of 27 interactive educational modules developed by physicians to help address common practice challenges. The modules also offer continuing medical education credit.<br /> <br /> Dr. Bagley said the module shows physicians how to navigate transitions and adapt to infrastructural change.</p> <p style="margin-left:40px;"> <strong>2.  Build a real care team—not another “hero model.”</strong> If medicine were a sport, it’d be one that revolves strictly around the team—not the star player, Dr. Bagley said. He noted that physician practices have to move away from “hero models” that rely solely on one physician and instead build teams that partner with others around defined goals and efforts.<br /> <br /> He advises practices to integrate work flows for physicians and the rest of the care team, so they are not treating patients in isolation or solely relying one person’s decisions. A STEPS Forward module can help physicians <a href="https://www.stepsforward.org/modules/create-healthy-team-culture" rel="nofollow" target="_blank">create a strong team culture</a> in their practices.</p> <p style="margin-left:40px;"> <strong>3.  Focus on population health. </strong>Practices that wish to reduce costs and not sink under high patient demands must take special measures to promote population health data, Dr. Bagley said. Doing so often entails “identifying the top 5 percent of your patient panel that’s costing you the most money” and designing special interventions that fit these patients’ needs.<br /> <br /> He said patient registries can help physicians identify these at-risk patients and develop evidence-based treatments. A STEPS Forward module on <a href="https://www.stepsforward.org/modules/panel-management" rel="nofollow" target="_blank">panel management</a> can help.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Build physician leaders.</strong> “In the future, if we really want change to work, it’s going to have to be physician led,” Dr. Bagley said. But this doesn’t mean that every health system or practice has to have a physician CEO. Instead, “there has to be enough clinical input and physician leadership at all levels of the organization, so it remains a clinical enterprise and not just a financial one,” he said. A new <a href="http://www.ama-assn.org/ama/ama-wire/post/new-program-helps-develop-skill-set-physician-needs" target="_blank">leadership program</a> from the AMA and the American Association for Physician Leadership® will be available next year to help physicians further develop these skills.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Foster physician satisfaction by measuring—and addressing—barriers to patient care. </strong>A <a href="http://www.rand.org/pubs/research_reports/RR439.html" rel="nofollow" target="_blank">study</a> released in 2013 by the AMA and RAND Corporation has found that being able to provide high-quality care to patients is the primary reason for job satisfaction among physicians, while obstacles—such as unusable electronic health records and administrative burdens—to doing so are a key source of stress in the profession.<br /> <br /> To avoid burnout and staff turnover, Dr. Bagley advises physicians to develop a systematic way to measure the prevalence of these obstacles in practice and create special initiatives that address them. STEPS Forward modules on <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">improving physician resiliency</a> offer the steps practices need to succeed in these endeavors.</p> <p align="right" style="margin-left:.5in;"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:14eb4926-4c86-4cd7-bb28-d6d247be5ac1 Military paramedics are already equipped http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_military-paramedics-already-equipped Tue, 17 Nov 2015 20:55:00 GMT <p> New policy adopted Tuesday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a> calls for support of federal, bipartisan legislation that would expedite and streamline paramedic training for returning veterans who already have received emergency medical training while in the military.</p> <p> Introduced by U.S. Sens. Amy Klobuchar, D-Minn., and Mike Enzi, R-Wyo., the <a href="https://www.congress.gov/bill/114th-congress/senate-bill/218" target="_blank" rel="nofollow">Veterans to Paramedics Transition Act of 2015</a> would authorize federal grants for universities, colleges, technical schools and state emergency medical services agencies to develop curricula that would help experienced veterans more quickly become eligible for paramedic certification. </p> <p> “The men and women who serve in our nation’s military as medics and corpsmen receive excellent training that should translate into work as paramedics as soon as possible upon their return to the civilian workforce,” said AMA Board Member David O. Barbe, MD.</p> <p> “Requiring these skilled service men and women to go through redundant, entry-level training is costly, timely and undervalues the relevant experience they’ve already received,” Dr. Barbe added.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f82ae928-8cce-46f4-9c50-0aceafc1730d Physicians call for fairness in drug prices, availability http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-call-fairness-drug-prices-availability Tue, 17 Nov 2015 17:51:00 GMT <p class="p1"> In response to increasing drug costs impacting patient access to needed medications, physicians voted Monday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank"><span class="s1">2015 Interim Meeting</span></a> to convene a task force and launch an advocacy campaign to drive solutions and help make prescription drugs more affordable. Physicians also are calling for greater competition in the pharmaceutical industry and transparency in prescription drug prices and costs<span class="s2">.</span></p> <p class="p1"> “Prescription drug spending was estimated to have increased by 12.6 percent in 2014, the highest rate of growth in the sector since 2002,” a report by the AMA Council on Medical Service said. “The pricing of prescription drugs impacts state Medicaid budgets, Medicare spending, insurance premiums and prescription drug tiers and, most importantly, patient access to these medications.”</p> <p class="p1"> <b>Solutions to promote affordability</b></p> <p class="p1"> The new policy calls for the AMA to generate an advocacy campaign to engage physicians and patients in local and national advocacy initiatives to bring attention to the rising price of prescription drugs and put forth solutions to make them more affordable for all patients.</p> <p class="p1"> “Physicians strive to provide the best possible care to their patients, but the boom in drug costs can impact the ability of physicians to place their patients on the best drug regimen,” AMA President Steven J. Stack, MD, said in a news release. “Patient care can be compromised and delayed when drug regimens are unaffordable and subject to coverage limitations by the patient’s health plan. In the worst-case scenario, patients entirely forego necessary treatments involving drugs due to their high cost.”</p> <p class="p1"> Once convened, the newly-created AMA task force will develop principles to guide AMA advocacy and grassroots efforts aimed at pharmaceutical costs and improving patient access and adherence to medically necessary prescription drug regimens. The new policy adopted today will be considered by the task force, along with existing AMA policy on the issue, as potential principles for advocacy efforts. </p> <p class="p1"> Actions called for in the new policy include:</p> <ul class="ul1"> <li class="li1"> Support legislation to shorten the exclusivity period for biologics.</li> </ul> <ul class="ul1"> <li class="li1"> Encourage actions by federal regulators to limit anticompetitive behavior by pharmaceutical companies attempting to reduce competition from generic manufacturers through manipulation of patent protections and abuse of regulatory exclusivity incentives. </li> </ul> <ul class="ul1"> <li class="li1"> Encourage prescription drug price and cost transparency among pharmaceutical companies, pharmacy benefit managers and health insurance companies, which will help patients, physicians and other stakeholders understand how drug manufacturers set prices, and the prescription drug tiering and cost-sharing requirements of health plans.</li> </ul> <ul class="ul1"> <li class="li1"> Monitor pharmaceutical company mergers and acquisitions in the pharmaceutical industry.</li> </ul> <ul class="ul1"> <li class="li1"> Support a balance between incentives for innovation and efforts to reduce regulatory and statutory barriers to competition as the patent system is evaluated and potentially reformed<span class="s2">.</span></li> </ul> <p class="p1"> Prices on generic and brand-name prescription drugs experienced a 4.7 percent spike in 2015, according to the Altarum Institute Center for Sustainable Health Spending. Last month, the Kaiser Family Foundation released a <a href="http://kff.org/health-costs/press-release/prescription-drug-costs-remain-atop-the-publics-national-health-care-agenda-well-ahead-of-affordable-care-act-revisions-and-repeal/" target="_blank" rel="nofollow"><span class="s1">report</span></a> saying that the high cost of prescription drugs remains a top health care priority for the public<span class="s2">.</span></p> <p class="p1"> <b>Targeting expensive drug ads</b></p> <p class="p1"> <span class="s4">Physicians also c</span>ited concerns that a growing proliferation of ads is driving demand for expensive treatments, despite the clinical effectiveness of more affordable alternatives. New policy calls for a ban on advertising directly to patients.</p> <p class="p1"> <span class="s4">“Today’s vote in support of an advertising ban reflects concerns among physicians </span>about the negative impact of commercially driven promotions and the role that marketing costs play in fueling escalating drug prices,” AMA Board Chair-Elect Patrice A. Harris, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-ban-consumer-prescription-drug-advertising.page" target="_blank"><span class="s1">news release</span></a>. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.” </p> <p class="p1"> The United States and New Zealand are the only two countries in the world that allow direct-to-consumer advertising of prescription drugs. Advertising dollars spent by drug makers have increased by 30 percent in the last two years—reaching a staggering $4.5 billion, according to the market research firm Kantar Media.</p> <p class="p5" style="text-align:right;"> <i>By AMA staff writer </i><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><span class="s1"><i>Troy Parks</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:68fb3e27-becb-4dc0-bd5e-b3a33d5d1ae4 Physicians reaffirm commitment to stop insurance mergers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-reaffirm-commitment-stop-insurance-mergers Tue, 17 Nov 2015 17:39:00 GMT <p class="p1"> In the face of mergers between major national health insurers, physicians Tuesday during the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a> said the medical profession will continue to stand against health insurance market consolidation that enhances health insurer market power, a trend that decreases health care access, quality and affordability. </p> <p class="p1"> Adopting new AMA policy, physicians  emphasized the need for active opposition of consolidation in the health insurance industry that may result in anticompetitive markets.</p> <p class="p1"> “The AMA strongly opposes these mergers as they would erode competition, causing patients and employers to pay higher premiums and forcing physicians to accept  terms that will degrade  their ability to provide patients with high-quality health care,” AMA Immediate-Past Chair Barbara A. McAneny, MD, said in a news release. “We urge the federal government to stop these mergers and protect consumers and physicians from the harm that would result from a lack of choice in health insurance plans.”</p> <p class="p1"> <b>How physicians already have taken a stand</b></p> <p class="p1"> Even before adopting the new policy, physicians have been far from silent on this issue. For years the AMA has issued a comprehensive annual study on competition in health insurance markets in the United States. The latest edition was <a href="http://www.ama-assn.org/ama/ama-wire/post/states-health-insurers-squeezing-out-competition" target="_blank"><span class="s1">released in early September</span></a> and included special analyses of the proposed mergers between <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" target="_blank"><span class="s1">Anthem and Cigna</span></a> (log in) and between <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/competition-aetna-humana-merger-full.pdf" target="_blank"><span class="s1">Aetna and Humana</span></a> (log in). </p> <p class="p1"> The analyses concluded that the mergers would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states. The mergers also would raise significant competitive concerns in additional areas. All told, nearly one-half of all states could see diminished competition in local health insurance markets.</p> <p class="p1"> The study and analyses were created to help researchers, lawmakers, policymakers and regulators identify markets where mergers and acquisitions among health insurers may harm patients, physicians and employers.</p> <p class="p1"> Also in September, members of the AMA Board of Trustees testified in two different congressional hearings:</p> <ul class="ul1"> <li class="li1"> On Sept. 10, Dr. Barbara L. McAneny delivered <a href="http://judiciary.house.gov/_cache/files/f4b44a1e-8d63-4aa1-90ac-e2764fb8fd3b/mcaneny-testimony.pdf" rel="nofollow" target="_blank"><span class="s1">testimony</span></a> during a hearing on the <a href="http://judiciary.house.gov/index.cfm/hearings?ID=417B9E62-CB8D-4FC7-905D-40F39B91E5E7" rel="nofollow" target="_blank"><span class="s1">state of competition in the health care marketplace</span></a>. Dr. McAneny told members of Congress, “Providing patients with more choices for health care services and coverage stimulates innovation and incentivizes improved care, lower costs and expanded access.”<br />  </li> <li class="li1"> On. Sept. 29, AMA President-Elect Andrew W. Gurman, MD, <a href="http://judiciary.house.gov/_cache/files/ffc68590-e407-49e7-be59-d988850ebfa8/gurman-testimony.pdf" rel="nofollow" target="_blank"><span class="s1">testified</span></a> at a hearing on <a href="http://judiciary.house.gov/index.cfm/hearings?ID=020363B9-F9EF-4623-8E67-28A0B260675A" rel="nofollow" target="_blank"><span class="s1">examining the proposed health insurance mergers and the consequent impact on competition</span></a>. Dr. Gurman urged federal and state regulators “to closely scrutinize the proposed health insurer mergers and utilize enforcement tools to protect consumers and preserve competition.”</li> </ul> <p class="p1"> Last week, the AMA <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_blank"><span class="s1">sent a letter</span></a> to the U.S. Assistant Attorney General, calling on the U.S. Department of Justice to “block the proposed mergers.” The letter emphasizes that “fostering competition, not consolidation, benefits American consumers through lower prices, better quality and greater choice.”</p> <p class="p1"> <b>Continued action</b></p> <p class="p1"> Building on its work with the National Association of Attorneys General, the AMA will present to a majority of state attorneys general later this month. The testimony will highlight findings from the AMA’s competition study and emphasize the importance of blocking mergers, such as those between the four major national insurers that are in the works.</p> <p class="p1"> The AMA also is offering its continued assistance to state medical associations around the country as they assess how to position themselves regarding the proposed mergers and the actions of their state regulatory agencies.</p> <p class="p2" style="text-align:right;"> <i>By AMA Wire editor </i><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><span class="s1"><i>Amy Farouk</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f9a0f3c1-494b-4988-b61e-1b660eb50f5e CDC panel shares solutions to combat antibiotic resistance http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cdc-panel-shares-solutions-combat-antibiotic-resistance Tue, 17 Nov 2015 17:35:00 GMT <p class="p1"> The Centers for Disease Control and Prevention (CDC) estimates that <a href="http://www.cdc.gov/drugresistance/" rel="nofollow" target="_blank"><span class="s1">2 million U.S. illnesses and 23,000 deaths</span></a> each year are caused by antibiotic-resistant infections, and these result in an <a href="http://www.niaid.nih.gov/topics/antimicrobialresistance/understanding/Pages/quickFacts.aspx" rel="nofollow" target="_blank"><span class="s1">estimated $20 billion</span></a> in excess health care costs. Three CDC experts spoke to physicians at the <a href="http://www.ama-assn.org/sub/meeting/" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a><span class="s1"> </span>about this global health crisis and multifaceted solutions to address it. </p> <p class="p1"> <b>Education and communication can curb antibiotic overuse in outpatient settings</b><br /> A major factor in the growing problem of antibiotic-resistant infections is overuse of antibiotics.</p> <p class="p1"> Trained as a pediatric-emergency medicine physician, Katherine Fleming-Dutra, MD, said she understands the importance of curbing antibiotic overuse in the outpatient setting. She’s now a medical epidemiologist for the National Center for Immunizations and Respiratory Diseases at the CDC. </p> <p class="p1"> In 2011, “providers prescribed 842 antibiotic courses per 1,000 population in outpatient settings,” Dr. Fleming-Dutra said, noting that researchers estimate that roughly 80 percent of antibiotic use in the United States occurs in outpatient facilities. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/1/486f83a7-d70a-479e-91f0-ba0c0c42826d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/1/486f83a7-d70a-479e-91f0-ba0c0c42826d.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p class="p1"> “To put that into context, that’s more than four antibiotic courses for every five people in the U.S., which totals to more than 263 million antibiotic courses per year.” </p> <p class="p1"> Dr. Fleming-Dutra said physicians commonly cite concerns about patient dissatisfaction as a major reason they overprescribe antibiotics. Yet she noted that research shows “patients are actually still satisfied if they don’t get antibiotics, even if they want [them], but they are dissatisfied if their communications expectations aren’t met.”</p> <p class="p1"> This is why she recommends communications training for physicians around antibiotic use, so they can understand patient expectations, comfortably explain to patients why their particular health condition does not require antibiotics and offer an alternative treatment. </p> <p class="p1"> She also suggests that physicians partner with initiatives such as the CDC’s <a href="http://www.cdc.gov/getsmart/" rel="nofollow" target="_blank"><span class="s1">Get Smart campaign</span></a>, which focuses on educating health care providers and the general public—often in community and outpatient settings—about proper antibiotic use. </p> <p class="p1"> The Get Smart About Antibiotics Week is currently underway, Nov. 16-22. <a href="http://www.cdc.gov/getsmart/week/index.html" rel="nofollow" target="_blank"><span class="s1">Learn more</span></a> about how you can get involved.</p> <p class="p1"> <b>Fighting back with antibiotic stewardship programs in inpatient settings</b></p> <p class="p1"> Arjun Srinivasan, MD, associate director for Health Care-Associated Infection Prevention Programs at the CDC, agrees that interventions offering physicians educational resources and a robust infrastructure for monitoring antibiotic use can reduce the spread of antibiotic-resistant bacteria—particularly in the inpatient setting, such as hospital and nursing homes. </p> <p class="p1"> “Stewardship programs in many studies have demonstrated [the ability to] improve antibiotic use, reduce antibiotic resistance, decrease complications of antibiotic use—especially clostridium difficile and improve patient outcomes,” Dr. Srinivasan said. </p> <p class="p1"> Plus, these programs “can do all of that while saving money,” he said. “I would argue that it’s one of the few interventions in health care that achieves so many benefits while saving money at the same time.” </p> <p class="p1"> Dr. Srinivasan said the CDC has already called on all acute care hospitals to implement antibiotic stewardship programs, and 39 percent of hospitals in the United States have launched an antibiotic stewardship program. </p> <p class="p1"> “And although larger hospitals are more likely to have these programs, there are lots of good examples of very small, rural and critical access hospitals [that] have found ways to start and run these antibiotic stewardship programs,” he said. “There are a lot of models out there; we simply need to figure out how to [disseminate those] models in other places.” </p> <p class="p1"> He said successful antibiotic stewardship programs require a multifaceted approach, which includes support from hospital leaders, physicians and pharmacists who are willing to help educate care teams about appropriate antibiotic use and prescribing. These programs also must implement effective tools that will track and measure antibiotic use, Dr. Srinivasan, so clinicians can extract data that will help them determine whether their interventions are effective. </p> <p class="p1"> <b>New diagnostic tools are key to beating antibiotic-resistant bacteria</b></p> <p class="p1"> While special stewardship programs and interventions can help curb antibiotic use across care settings, Jean Patel, PhD, acting director for the Office of Antibiotic Resistance at the CDC, said there are some new diagnostic developments underway that may allow physicians to better detect antibiotic-resistant bacteria and stop it before it spreads. </p> <p class="p1"> She said the CDC recommends that physicians curb the spread of antibiotic bacteria by identifying patients who have asymptomatic colonization and prevent them from transmitting infections caused by antibiotic-resistant bacteria to other patients. </p> <p class="p1"> For instance, “to get a CRE outbreak under control, you need to identify those patients and implement appropriate infection control precautions,” Patel said. “But to identify those patients, you need the right diagnostics.” </p> <p class="p1"> Currently, no tests have been approved by the Food and Drug Administration to help physicians identify patients who have asymptomatic colonization of CRE, but Patel said researchers are developing a diagnostic tool that they hope to make available next year. </p> <p class="p1"> But this is only the beginning, she added, noting that “we need more than just one. We need a variety of tests that can be implemented in hospitals to help with prevention efforts.” </p> <p class="p1"> <b>AMA continues efforts to combat antibiotic resistance</b></p> <p class="p1"> Also at the 2015 AMA Interim Meeting, a report by the AMA Council on Science and Public Health was adopted. It provides an in-depth update on the state of antibiotic resistance, from the ongoing overuse of antibiotics to the number of new drugs in the pipeline. </p> <p class="p1"> “A coordinated, multi-sector and multi-pronged approach is required to address the issue,” the report states. It outlines several essential steps that must be taken to help neutralize this major public health threat:</p> <ul class="ul1"> <li class="li1"> Adoption of antibiotic stewardship programs in both the human and animal health sectors</li> <li class="li1"> Education of patients regarding the appropriate use of antibiotics</li> <li class="li1"> Incentives to encourage manufacturers to develop new antibiotics and infectious disease diagnostics</li> <li class="li1"> Adequate funding for systematic surveillance of antibiotic use and resistance so there is a robust evidence base for understanding the problem and developing strategies for preventing the spread of human infections for which no effective treatment is available</li> </ul> <p class="p3" style="text-align:right;"> <i>By AMA staff writer </i><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><span class="s1"><i>Lyndra Vassar</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f16383d6-263b-4243-910b-0706879fbf8a Report points toward path for alternative GME funding http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_report-points-toward-path-alternative-gme-funding Tue, 17 Nov 2015 13:42:00 GMT <p class="p1"> As physicians continue efforts to ensure a sufficient number of medical trainees are able to enter the physician workforce to stave off a predicted physician shortage, a new report takes a look at alternative funding sources for residency programs and offers steps that could be taken to expand existing graduate medical education (GME) programs and create new programs.</p> <p class="p1"> The report, written by the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page" target="_blank"><span class="s1">Council on Medical Education</span></a> and adopted Monday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a>, notes that “given the scrutiny Medicare funding of GME has received of late, there may now be a greater prospect of developing a new payment system that could fund and shape a more appropriate physician workforce.”</p> <p class="p1"> <b>Initial</b> <b>steps for GME expansion</b></p> <p class="p1"> The report examines several existing programs that have relied on private or other alternative funding for bolstering residency programs, highlighting a program in North Carolina as a successful example that could provide insight for other programs, health care systems and communities that are looking to expand their training opportunities.</p> <p class="p1"> The report suggests these steps for programs that are trying to expand their number of residency slots:</p> <ul> <li class="p3"> <b>Research state funding possibilities.</b> Programs should look into how their state’s Medicaid funds are allocated, whether they support GME and how the allocation for GME is determined. In addition, states that have their own health insurance exchanges may have an option to use a tax on the exchange to help pay for local GME programs.</li> <li class="p3"> <b>Turn to philanthropic organizations.</b> Programs should perform an exhaustive search of the philanthropic organizations and insurance company foundations in their state that support economic development or health care. Programs should reach out to these groups to discuss possible program expansion rather than waiting for them to issue requests for proposals.</li> <li class="p3"> <b>Consider partnering with employers.</b> Local large employers may wish to supporting physician training if they understand that a pipeline of physicians is in their own interest.</li> <li class="p3"> <b>Work with local hospitals.</b> Large hospitals or health care systems may recognize their dependency on an adequate pipeline of physicians and wish to ensure it continues in their area.</li> </ul> <p class="p1"> For localities that are trying to develop a new residency program, the report recommends two first steps:</p> <ul> <li class="p3"> <b>Conduct a feasibility study.</b> Such a study would need to demonstrate the need for GME, the capacity of the region to sustain high-quality residency training programs and the financial commitment required.</li> <li class="p3"> <b>Create a business plan.</b> This document would need to include details about the governance structure of a new program, the number of residents to be trained, a staffing plan and an economic impact statement.</li> </ul> <p class="p1"> <b>Looking ahead</b></p> <p class="p1"> Policy adopted along with the report includes a number of actions that could help advance funding for GME:</p> <ul> <li class="p3"> The AMA will explore various models of all-payer funding for GME.</li> <li class="p3"> Organizations with successful existing models should publicize and share their strategies, outcomes and costs.</li> <li class="p3"> The AMA will encourage insurance payers and foundations to enter into partnerships with state and local agencies, academic medical centers and community hospitals to expand GME.</li> </ul> <p class="p1"> <b>Efforts already underway</b></p> <p class="p1"> “The AMA is committed to expanding funding for GME to ensure that there are enough residency slots to train physicians in regions where health care services are needed most,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-secure-adequate-funding-gme.page" target="_blank"><span class="s1">news release</span></a>. “We will continue to urge all health care payers—from local, state and federal government and private sources—to work together to adequately fund GME programs, and will continue to advocate for ways to address physician shortages and increase patient access to health care.” </p> <p class="p1"> The AMA has long advocated for and adopted numerous <a href="http://www.ama-assn.org/ama/ama-wire/post/4-key-changes-needed-modern-gme-system" target="_blank"><span class="s1">policies</span></a> that support the modernization of GME, including increased funding for medical residency slots, development of innovative practice models and residency positions that reflect societal needs. </p> <p class="p1"> Most recently, the AMA urged support of two federal bills. The Creating Access to Residency Education (CARE) Act would expand funding for GME and improve access to health care for patients in underserved areas. The recently introduced Resident Physician Shortage Reduction Act of 2015 would also help increase the number of residency slots and address physician shortages. </p> <p class="p1"> Additionally, through its <a href="http://savegme.org/" rel="nofollow" target="_blank"><span class="s1">SaveGME</span></a> campaign, the AMA continues to strongly urge Congress to protect federal funding.</p> <p class="p1"> The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education.page%22%20%5Ct%20%22_blank" target="_blank"><span class="s1">Accelerating Change in Medical Education</span></a> initiative also is addressing some of these issues through supporting medical school projects that accelerate student progress through medical school, allowing them to enter residency sooner and contribute more rapidly to expanding the physician workforce.</p> <p class="p4" style="text-align:right;"> <i>By AMA Wire editor </i><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><span class="s1"><i>Amy Farouk</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:17f9ccf3-e4da-405d-896f-7323bc2a4cc6 Stopping burnout a top priority for physicians in training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_stopping-burnout-top-priority-physicians-training Tue, 17 Nov 2015 02:00:00 GMT <div> <p> <span style="font-size:11px;">As burnout and suicide continue to plague the medical profession at much higher rates than the general population, the physician community took action Monday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a>. New policy is aimed at ensuring physicians in training have access to potentially life-saving mental health services.</span></p> <p> <span style="font-size:11px;"><strong>A weighty problem</strong></span></p> <p> <span style="font-size:11px;">Each year roughly 300-400 U.S. physicians die by suicide, according to the <a href="https://www.afsp.org/preventing-suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide" rel="nofollow" target="_blank">American Foundation for Suicide Prevention</a>. A frequently cited suicide rate in male physicians is 40 percent higher than in the general male population and 130 percent higher among female physicians than in the general female population.</span></p> <p> <span style="font-size:11px;">Despite high rates of suicidal thoughts and mental health problems among residents, very few actually seek mental health services, according to a <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=2467822" rel="nofollow" target="_blank">recent study</a> in <em>JAMA Psychiatry</em>. One of the main reasons residents cited for not seeking help was a concern about confidentiality.</span></p> <p> <span style="font-size:11px;">“Medical training can exacerbate risk factors for mental illness, such as sleep deprivation and relocation to a new environment with little support,” AMA Student Board Member Dina Marie Pitta said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-16-i15-new-policies-day-one.page" target="_blank">news release</a>. “That is why it is so important that we help increase access to mental health care services for any student or resident physician who is experiencing depression or suicidal thoughts and find ways to continue to reduce the barriers that may stand in the way of getting the care they need.”</span></p> <p> <span style="font-size:11px;"><strong>Overcoming barriers</strong></span></p> <p> <span style="font-size:11px;">To help address concerns about privacy that often keep physicians in training from getting the care they need, the AMA adopted new policy that promotes confidential, accessible and affordable mental health services for medical students, residents and fellows.</span></p> <p> <span style="font-size:11px;"><strong>Solutions already underway</strong></span></p> <p> <span style="font-size:11px;">The AMA offers several online modules through its <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward website</a> to help physicians in practice and physicians in training recognize and address burnout, including:</span></p> <ul> <li> <span style="font-size:11px;"><a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">Preventing resident and fellow burnout</a></span></li> <li> <span style="font-size:11px;"><a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">Preventing physician burnout</a></span></li> <li> <span style="font-size:11px;"><a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">Improving physician resiliency</a></span></li> </ul> <p> <span style="font-size:11px;">The <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_blank">International Conference on Physician Health</a> (a collaborative meeting of the AMA, the Canadian Medical Association and the British Medical Association) will take place Sept. 18-20 in Boston. Hosted by the AMA, the upcoming conference will explore the theme “Increasing Joy in Medicine.” The conference will feature research and perspectives into physicians’ health as well as practical, evidence-based skills and strategies that focus on staying healthy. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health/call-for-abstracts.page" target="_blank">Abstracts are being accepted</a> through Feb. 1.</span></p> <p> <span style="font-size:11px;">The Accreditation Council for Graduate Medical Education (ACGME) also is focusing on ways to improve resident well-being including a special working conference this month. <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-seeks-transform-residency-foster-wellness" target="_blank">Read more</a> in an <em>AMA</em> <em>Wire</em>® interview with Timothy Brigham, PhD, senior vice president of the department of education and chief of staff at the ACGME.</span></p> <p> <span style="font-size:11px;"><strong>Related reading on physician wellness:</strong></span></p> <ul> <li> <span style="font-size:11px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">Ways residents have found to conquer burnout</a></span></li> <li> <span style="font-size:11px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">How to beat burnout: 7 signs physicians should know</a></span></li> <li> <span style="font-size:11px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre" target="_blank">How residents are beating burnout with help from the theatre</a></span></li> <li> <span style="font-size:11px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">How one program achieved resident wellness, work-life balance</a></span></li> <li> <span style="font-size:11px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/student-sos-7-ways-avoid-distress-medical-school" target="_blank">Student SOS: 6 ways to avoid “distress” in medical school</a></span></li> </ul> <p align="right"> <span style="font-size:11px;"><em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></span></p> </div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1dc3c5e3-4c4b-4826-b419-d207ebd95f21 New program helps develop the skill set every physician needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-program-helps-develop-skill-set-physician-needs Mon, 16 Nov 2015 22:07:00 GMT <p class="p1"> Physicians have a strong history of leadership within the community, from the days of house calls to standing as a guiding light in the storm of an epidemic to safely bringing new life into the world. When health concerns arise, the public turns to their doctors for answers. The new Leadership Skills Series provides practical training for practicing physicians. Get involved and improve your ability to lead.</p> <p> <img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/10/577e30e8-1c0d-4b8a-8a96-1f461da123de.Full.png?1" style="margin:5px 10px;float:right;" /></p> <p class="p1"> The AMA has partnered with the American Association for Physician Leadership® (AAPL) to develop the Leadership Skills Series to assist physicians in both rethinking and transforming their traditional roles, an announcement made Monday during the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a>. The series is designed to help physicians prepare for leadership opportunities from which they can shape the health care system to produce better outcomes for both themselves and their patients.</p> <p class="p1"> “Every physician is a leader,” said Michael Tutty, PhD, AMA group vice president for <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/enhancing-professional-satisfaction-and-practice-sustainability.page%22%20%5Ct%20%22_blank" target="_blank"><span class="s2">professional satisfaction and practice sustainability</span></a>. “Physicians are leading care teams, changes in their practice, committees on quality improvement and other transformational activities every day.” </p> <p class="p2"> Leaders are not just those individuals in the C-suite, Tutty explained. Leaders are creating positive changes on a daily basis in the health care system in big and small ways toward the goal of achieving the Triple Aim.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/0/33c77f25-0b2c-4565-b0fb-715f3bf464ef.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/0/33c77f25-0b2c-4565-b0fb-715f3bf464ef.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p class="p1"> <b>Why is physician leadership important?</b></p> <p class="p1"> There are tremendous changes going on in health care. Those changes should be focused on what is best for patients, and physicians are in an excellent position to represent what is needed to create a stronger health care system. </p> <div> <p class="p1"> “We need physician leadership driving the changes in the health care, whether that be at the practice level, hospital, health system, association or community,” Tutty said. </p> <p class="p1"> Providing both online and in-person training events, the series features live events, a series of online courses and a leadership assessment. Physicians can benefit from the training no matter where they are in their career or in which type of setting they practice. </p> <p class="p3"> Legendary Michigan football coach Bo Schembechler once suggested that leadership can be learned. “If you want to become a great leader,” he said, “you need to prepare yourself to become a great leader, and the best way to do that is to study great leaders.” </p> <p class="p1"> The Leadership Skills Series is an opportunity to study the ways that great leaders have been able to motivate those around them to elevate themselves and become a lasting example. </p> <p class="p1"> The series covers more than 14 topics, focusing on three pillars and their components:</p> <p class="li1"> <b>1.<span class="Apple-tab-span"> </span>Personal development:</b> Helping physicians equip themselves with new skills to become effective leaders. This pillar includes:</p> <ul> <li class="p5"> Personal assessment tools</li> <li class="p5"> Well-being and resiliency</li> <li class="p5"> Effective teamwork</li> <li class="p5"> Communication skills</li> </ul> <p class="li1"> <b>2.<span class="Apple-tab-span"> </span>Professional development:</b> Helping physicians navigate and interact with their peers using contemporary approaches. This pillar includes:</p> <ul> <li class="p5"> Physician engagement</li> <li class="p5"> Quality and safety</li> <li class="p5"> Leading change and managing influence</li> <li class="p5"> Financial decision-making</li> </ul> <p class="li1"> <b>3.<span class="Apple-tab-span"> </span>Health system knowledge:</b> Helping physicians learn to engage with the health industry as a whole. This pillar includes:</p> <ul> <li class="p5"> Population health</li> <li class="p5"> Payment models</li> <li class="p5"> Health IT</li> <li class="p5"> Strategy development</li> </ul> <p class="p1"> Two live, three-day events will be held next year: The first will take place at the Omni San Diego Hotel, March 6-8. The second will take place at the Loews Hotel in Chicago, Sept. 25-27. Online courses will be available in March 2016.</p> <p class="p1"> Visit the <a href="http://leadershipseries.org/" target="_blank" rel="nofollow">Leadership Series website</a> to register.</p> <p class="p1"> The Leadership Skills Series is yet another piece of the multi-pronged approach of the AMA’s Professional Satisfaction and Practice Sustainability initiative. Other efforts in the initiative include <span class="s3">the AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" rel="nofollow" target="_blank"><span class="s4">STEPS Forward</span></a> website, a collection of more than 25 modules to help physicians revitalize their practices and improve patient care. The <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_blank"><span class="s5">International Conference on Physician Health</span></a></span>, to be held Sept. 18-20 in Boston, will explore <a href="http://www.ama-assn.org/ama/ama-wire/post/boost-joy-medicine-submit-ideas" target="_blank"><span class="s6">how to boost joy in medicine</span></a><span class="s6">. <a href="http://www.ama-assn.org/ama/ama-wire/post/boost-joy-medicine-submit-ideas"><span class="s1">Learn more</span></a></span><span class="s7"> </span><span class="s6">about the conference and how to submit your ideas.</span></p> <p class="p6" style="text-align:right;"> <i>By AMA staff writer </i><span class="s1"><i><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></i></span></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:00a0b33a-27c1-4e5b-a68b-813cf08c5b05 Looking for employment? 6 principles to consider http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_looking-employment-6-principles-consider Mon, 16 Nov 2015 14:15:00 GMT <p> A new report looking at physician employment by hospitals and health systems offers six new principles for physicians to consider when evaluating employment opportunities. The principles were recommended in light of changes in the health care environment and recent studies of what drives physician satisfaction in practice. </p> <p> The report also reaffirmed longstanding AMA policy that supports the freedom of physicians to choose their method of earning a living.</p> <p> Created by the AMA Council on Medical Service, the report notes that there has been a shift toward hospital employment. The AMA’s 2014 Physician Benchmark Survey found that 26 percent of physicians worked in practices that were at least partially owned by a hospital, and another 7 percent were directly employed by hospitals.</p> <p> In a more general look at physician employment across practice settings, the survey found that just over 50 percent of physicians were owners of their practices, while 43 percent were practice employees, and 6 percent were practice contractors. </p> <p> The report also cites a <a href="http://www.rand.org/pubs/research_reports/RR439.html" rel="nofollow" target="_blank">2013 study</a> by the AMA and RAND on physicians’ professional satisfaction. The study found that doctors in physician-owned practices were more satisfied than physicians in other ownership models, such as hospitals and corporate environments. But work controls and opportunities to participate in strategic decisions were found to mediate the effect of practice ownership on overall professional satisfaction.</p> <p> Building on such findings, the six principles in the report were adopted as AMA policy Monday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a>. The policy advises physicians who seek employment as their mode of practice to strive for an arrangement that offers these characteristics:</p> <ul> <li style="margin-left:31.9pt;"> Physician clinical autonomy is preserved.</li> <li style="margin-left:31.9pt;"> Physicians are included and actively involved in integrated leadership opportunities.</li> <li style="margin-left:31.9pt;"> Physicians are encouraged and guaranteed the ability to organize under a formal self-governance and management structure. </li> <li style="margin-left:31.9pt;"> Physicians are encouraged and expected to work with others to deliver effective, efficient and appropriate care.</li> <li style="margin-left:31.9pt;"> A mechanism is provided for the open transparent sharing of clinical and business information by all parties to improve care.</li> <li style="margin-left:31.9pt;"> A clinical information system infrastructure exists that allows capture and reporting of key clinical quality and efficiency performance data for all participants and accountability across the system to those measures. </li> </ul> <p> The report noted a lack of empirical data and published research on the long-term effects of physician employment and encouraged continued research on how integrated health care delivery models that employ physicians effect patients and the medical profession.</p> <p> <strong>Resources to aid physicians in employment arrangements</strong></p> <p> Employed physicians and those considering employment also have a <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/organized-medical-staff-section/physician-employment.page" target="_blank">variety of resources</a> from the AMA at their disposal. They include:</p> <ul> <li style="margin-left:28.5pt;"> The Annotated Model Physician-Hospital Employment Agreement</li> <li style="margin-left:28.5pt;"> The Annotated Model Physician Group-Practice Employment Agreement</li> <li style="margin-left:28.5pt;"> The AMA Principles for Physician Employment, which address some of the more complex issues related to employer-employee relationships</li> <li style="margin-left:28.5pt;"> The AMA and American Hospital Association’s <a href="https://download.ama-assn.org/resources/doc/about-ama/x-pub/ama-aha-integrated-leadership-principles.pdf" target="_blank">Integrated Leadership for Hospitals and Health Systems: Principles for Success</a> (log in)</li> <li style="margin-left:28.5pt;"> A <a href="http://www.ama-assn.org/ama/ama-wire/post/new-program-helps-develop-skill-set-physician-needs" target="_blank">new leadership development program</a> will be offered next year by the AMA and the  American Association for Physician Leadership</li> </ul> <p align="right"> <em>By AMA Wire editor </em><em><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c03dca53-a948-4257-8671-6d2ff4b5fad0 How Mayo Clinic puts patients at the center of innovation http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_mayo-clinic-puts-patients-center-of-innovation Mon, 16 Nov 2015 00:50:00 GMT <div> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/11/97531b00-1b99-4058-8b69-4c0855603504.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/11/97531b00-1b99-4058-8b69-4c0855603504.Large.jpg?1" style="float:right;margin:15px;" /></a>Entrepreneurs and health IT companies have poured billions of dollars into health innovations, but true innovation requires more than big money and ideas—it takes action and scalable implementation. This is a lesson the Mayo Clinic Center for Innovation (CFI) has mastered. Find out how physicians are creating new solutions to optimize patient care in their communities and homes.</p> <p> “We’re often asked [to explain] our mission at the Center for Innovation, and it’s simply this: To transform the delivery and experiences of health and health care,” CFI Medical Director Douglas Wood, MD (pictured right), said during a special session at the at the <a href="http://www.ama-assn.org/ama/ama-wire/post/future-physicians-honored-top-research-ama-symposium">2015 AMA Interim Meeting</a>. “But this statement is purposeful because it starts with the concept of health.”</p> <p> Dr. Wood said the CFI defines innovation as “discovering and implementing new ways to deliver better health.”</p> <p> He notes that “there’s an important word in this definition, and that’s ‘implementing.’ Simply thinking about things you could do—ideating or brainstorming—is not innovation. Innovation has to be active and result in solutions that will make the lives of people better.”</p> <p> <strong>From idea to solution: How physicians at CFI design innovations </strong></p> <p> Designers and physicians at the center conduct observational research with patients, care staff and consultants to identify problems in patients’ lives and conceptualize solutions.</p> <object align="right" data="http://www.youtube.com/v/Hjf3F6R-a54" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/Hjf3F6R-a54" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/Hjf3F6R-a54" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/Hjf3F6R-a54" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object> <p> Using information from their research, Dr. Wood said CFI designers synthesize their observations into design concepts, which they use to create low-fidelity models and prototypes for scalable solutions physicians can implement in health care settings. </p> <p> “The center has already conducted 10,000 hours of direct research for roughly 270 projects and 600 experiments in the last five years,” Dr. Wood said.</p> <p> To help reduce care costs, Dr. Wood said the CFI has launched several special initiatives to “shift our care locations away from hospitals and clinics and to community care that is home-based.”</p> <p> These initiatives do not isolate patients from physicians. Instead, they allow physicians to offer high-quality care and support for patients based on their individual needs. Some of these initiatives include:</p> <ul> <li>  <strong>Wellness navigators</strong>—Social determinants of health can have a serious impact on patients’ medical conditions. That’s why CFI employs “wellness navigators,” who work with patients to help them secure crucial non-clinical resources such as refrigeration, heating and air-conditioning, and even jobs, Dr. Wood said.<br />  </li> <li> <strong>The Well-Living Laboratory</strong>—“People spend more than 90 percent of their time outside a physicians’ office or hospital … so the determinants of health are going to largely happen at home,” Dr. Wood said. The Well-Living Laboratory allows physicians at CFI to monitor patients within their office or living environment “to understand how things like lighting, air quality, noise and living structures” impact their health. The lab simulates realistic living and working environments, such as homes, offices, schools, communities and hotels in order to test, monitor and identify the efficacy of wellness-based interventions.<br />  </li> <li>  <strong>Patient mobile apps</strong>—To enhance patients’ care experience, CFI has designed a unique and user-friendly app that allows patients to access important care information, such as customized health itineraries that list activities for patients to complete within and outside of the clinic, patient education resources and appointment times.</li> </ul> <p style="margin-left:.5in;"> You can learn more about innovations at the Mayo Clinic by viewing the <a href="http://www.mayo.edu/center-for-innovation/projects" rel="nofollow">CFI’s full list of projects</a>.</p> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f1757326-24db-485f-a8d2-7baa3db9aa34 Get published using these 5 writing and research tips http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_published-using-5-writing-research-tips Mon, 16 Nov 2015 00:36:00 GMT <p> Publishing papers is more challenging than in previous years—especially as journal editors grapple with high-volume submissions and competitive “impact factor” quotas in medical publishing. But knowing how to carefully think about your research, even before you write it, can help you pen an effective paper that has a greater chance of seeing print. Gear up for a productive writing process with these five tips from a medical publishing maven who understands your perspective.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/a5664829-a1db-470a-9efd-af0bb706643e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/a5664829-a1db-470a-9efd-af0bb706643e.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Susan Bates, MD (pictured right), has been published more than 250 times and owns multiple patents. Dr. Bates is the senior clinical investigator and head of the Molecular Therapeutics Section in the Developmental Therapeutics Branch and Coronary Vector of Columbia University’s BA Cancer Initiative and has mentored multiple fellows.</p> <p> While she acknowledges that “it’s getting harder and harder to publish papers these days,” Dr. Bates emphasizes that publishing is essential for the sake of advancing society and medicine. </p> <p> “One must write something and get it into print,” she told residents and fellows at a special session during the <a href="http://www.ama-assn.org/ama/ama-wire/post/future-physicians-honored-top-research-ama-symposium">2015 AMA Interim Meeting</a>. “We have an ethical imperative to publish. We have to share data whether it’s negative or positive, and move the field forward.”</p> <p> To write a successful paper, she advises physicians in training to understand what makes a “good” paper and how to tackle large research projects. Dr. Bates recommends five steps every medical researcher should follow:</p> <p> <strong>1.  </strong><strong>Start the paper when you start the project.</strong> While it may be tempting to preoccupy your time with lab work, Dr. Bates suggests that you actually write your paper as you conduct research—not at the end of a project. This will help you identify informational gaps and data you may need to further explore to complete your paper for publishing.</p> <p> “You need to be thinking about the paper from the get-go,” Dr. Bates said. “It’s not cheap science to think about the paper. It’s a way of executing what you do …. You need to have an idea about the point of your paper and the story you’re going to tell.”</p> <p> <strong>2. </strong><strong>Think carefully about shared authorship. </strong>“In this day and age, so many experiments are required to make a paper work that you’ll end up much better off if you collaborate,” Dr. Bates said.</p> <p> However, should you decide to collaborate with other authors, Dr. Bates recommends setting firm authorship guidelines and clearly articulating who will be lead author based on how much this person actually contributes to the project. You also should be judicious in terms of how many people you collaborate with for a given project.</p> <p> “More and more journals don’t want people to have honorific authorships,” Dr. Bates said, noting that some journals even limit the number of authors on a paper.</p> <p> “You’re not supposed to give your buddies authorship simply because you want to help each other. If you’re doing a clinical trial, you may find that if you didn’t enroll enough patients, you don’t even get authorship,” Dr. Bates said.</p> <p> When sharing authorship, she also advises residents and fellows to take credit for their work by properly noting authorship on their CVs. If more than one author equally contributes to the project, Dr. Bates said, it’s perfectly acceptable for both authors to list themselves as the “lead author” on their CVs.</p> <p> <strong>3. </strong><strong>Take a close look at your data.</strong> “Your manuscript is going to get evaluated based on how strong your data are. Work on your data until it’s strong enough to draw a conclusion and then write about that conclusion,” Dr. Bates said. “That’s part of why you keep writing, outlining and making figures as you go along and thinking, ‘Is this result what I need? Is this enough?’”</p> <p> If your paper discusses a clinical trial, “then of course you have to wait until the trial is over,” she said. “But for many projects, the data can be gathered as you go along.”</p> <p> <strong>4.  </strong><strong>Know what your paper is—and isn’t—in the scope of your respective field.</strong> Ask yourself this honest question: Is my research a big conceptual advancement, or is it incremental?</p> <p> “Much of science is incremental, and scientists get in trouble when they try to make huge, conceptual advancements,” Dr. Bates said. “Every paper can’t be like that. The vast majority of papers are actually incremental.”</p> <p> <strong>5. </strong><strong>Think like a reviewer.</strong> Carefully examine your project as if you are your own unapologetic reviewer. Be prepared to address the limitations of your study and data, especially if you’re conducting clinical trials. “We always say in our data meetings, ‘If your data can’t convince your friends, how is it going to convince your reviewer or your enemies and critics?” Dr. Bates said.</p> <p> This is why she urges researchers to consider whether their paper actually adds valuable information to their respective field or specialty—not simply their CV. </p> <p> “While it’s perfectly reasonable to be incremental, you do need to add to the field and think expansively and ask, ‘What questions can I answer with the data and model I have for this project?’”</p> <p> <strong>Explore more on publishing:</strong></p> <ul> <li>  Learn how to publish your research like a pro with <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research">these five strategies</a>.</li> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals that accept research from physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_blank">these 9 expert tips</a> for getting published in a medical journal.</li> <li>  Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_blank">how to handle it.</a></li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:193dfcdd-2187-467a-9b65-c4546b1e3311 What to expect of the new single GME accreditation system http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_expect-of-new-single-gme-accreditation-system Sun, 15 Nov 2015 18:11:00 GMT <p> The development of a single accreditation system for graduate medical education (GME) is well underway, and physician leaders expect its full implementation in July 2020. Learn how the unified system should benefit the medical community.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/4/f95f0f92-d75c-4578-94d4-f5f3c105e96c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/4/f95f0f92-d75c-4578-94d4-f5f3c105e96c.Large.jpg?1" style="margin:15px;float:right;" /></a><strong>Better alignment in GME</strong></p> <p> For the last two years, leaders of the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) have made institutional changes—such as electing new members from the AOA and American Association of Colleges of Osteopathic Medicine to join the ACGME’s board of directors—that will allow all GME programs to successfully align under one new accreditation system within the ACGME.</p> <p> The system will allow graduates of osteopathic and allopathic medical schools to complete their residency and fellowship education in ACGME-accredited programs. Under the new system, all physicians in training will be able to demonstrate their achievements by meeting a common set of milestones and competencies.</p> <p> AOA Trustee and President-Elect Boyd R. Buser, DO (pictured right), recently spoke to educators about the new accreditation system at the <a href="http://www.ama-assn.org/sub/meeting/">2015 AMA Interim Meeting</a>. Joining him for the panel discussion was co-presenter John R. Potts lll, MD, senior vice president of surgical accreditation for the Accreditation Council for Graduate Medical Education. Both speakers described how the single accreditation system will increase efficiencies, cost savings and transparency in GME.</p> <p> “Over the years, we’ve had a number of GME programs that are dually accredited—they were accredited by the ACGME and AOA—and those programs had to answer to two different accrediting bodies and pay two different sets of accrediting fees,” Dr. Buser said. “This is an unnecessary duplication and cost.”</p> <p> In addition to saving resources, switching to a single accreditation system could help advance efforts to expand residency programs. Under the new system, board members and educators would be able to join efforts in advocating for more residency spots.</p> <p> “Having a single accreditation system allows us to speak with one voice,” Dr. Buser said. “It will enhance accountability, public trust” and alleviate unnecessary burdens on program directors and other GME stakeholders.</p> <p> <strong>Dispelling misconceptions: What the single system won’t do</strong></p> <p> Dr. Buser emphasized that it’s important to understand that this new system specifically addresses GME accreditation alone—and not other associated factors.</p> <p> “What we’re doing here is bringing together the accreditation of GME—and that was all that our discussions revolved around,” Dr. Buser said. “This has never been about joining the undergraduate medial education accreditation [or] merging board certifications.”</p> <p> That means that osteopathic and allopathic medical schools will retain their distinctions. Similarly, processes for continuing medical education programs and licensure examinations will remain unchanged.</p> <p> To learn more about the goals, benefits and opportunities, and timeline of the single GME accreditation system, view the <a href="http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Documents/single-gme-accreditation-system-presentation.pdf" rel="nofollow">AOA’s online presentation</a> and <a href="http://www.acgme.org/acgmeweb/Portals/0/PDFs/FAQ/Osteopathic%20Recognition%20FAQs.pdf" rel="nofollow">FAQs</a>.</p> <p align="right" style="margin-left:0.5in;"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a0c5a15a-379b-4de1-8243-b17097589242 AMA Academic Physicians Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-academic-physicians-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:10:00 GMT <p> AMA policy review, educational sessions and networking opportunities with academic physician colleagues were part of the 2015 Interim Meeting of the Academic Physicians Section (AMA-APS) in Atlanta.</p> <p> Meeting participants—comprising deans and faculty from a wide range of medical schools, graduate medical education programs, and academic health systems nationwide—voiced their opinions and reached decisions on recommendations for several reports and resolutions to be acted upon by delegates at the Interim Meeting of the AMA House of Delegates (HOD).</p> <p> Issues covered included graduate medical education funding, access to mental health care services for medical students and resident/fellow physicians, education for future physicians in business and economics, and maintenance of certification. The AMA-APS reviewed 18 business items (reports and resolutions) to go before the AMA HOD.</p> <p> APS members also voted in favor of a report from the AMA Council on Constitution and Bylaws that would update the section’s bylaws. This bylaws update would codify the section’s name change from “Section on Medical Schools” to “Academic Physicians Section” and clarify the pathways to membership in the AMA-APS.</p> <p> <strong>Updates on key nationwide medical education activities</strong></p> <p> After welcome and introductions from Alma Littles, MD, the APS chair for 2015-2016 and senior associate dean for medical education and academic affairs at Florida State University College of Medicine, a number of speakers covered key issues affecting academic physicians.</p> <p> One of the meeting’s highlights was the welcome address from Valerie Montgomery Rice, MD, president and dean of Morehouse School of Medicine, the host medical school for the APS meeting. Morehouse is also one of the <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank">21 new members</a> of the AMA’s Accelerating Change in Medical Education consortium. Dr. Rice spoke of the critical work of her institution to ensure access to care for at-risk urban and rural populations in Georgia and increase the diversity of the nation’s physician workforce.</p> <p> Susan Skochelak, MD, group vice president of medical education at the AMA, provided an update on the work of the AMA’s Accelerating Change in Medical Education consortium to advance and disseminate innovations to all U.S. medical schools. She highlighted the new Turn Med Ed on its Head Innovation Challenge for teams of medical students. Dr. Skochelak was also recognized for her recent election to the National Academy of Medicine. <a href="http://www.ama-assn.org/ama/ama-wire/post/two-ama-leaders-elected-national-academy-of-medicine-out" target="_blank">Read more</a> at <em>AMA Wire</em>.</p> <p> Also presenting were representatives of the AMA’s two other strategic focus areas: Omar Hasan, MD, vice president of Improving Health Outcomes, and Michael Tutty, PhD, group vice president of Professional Satisfaction and Practice Sustainability. Both speakers called for academic physician involvement in these key AMA initiatives.</p> <p> Other highlights included a review of the APS role in developing and reviewing AMA policy, a legislative update from the AMA’s Washington, DC, office, an AMA academic physician membership update, a review of the work of the AMA Council on Medical Education, and the activities of the AMA Foundation presented by president William E. Kobler, MD, who also serves as a member of the AMA Board of Trustees.</p> <p> <strong>Educational sessions on graduate medical education accreditation, impact of mergers</strong></p> <p> The education component of the meeting focused on two topics of interest to academic physicians. The first session covered the single accreditation system for graduate medical education and featured Boyd Buser, president-elect of the American Osteopathic Association, and John R. Potts III, MD, senior vice president of surgical accreditation at the Accreditation Council for Graduate Medical Education. Both speakers highlighted the increased efficiencies, cost savings, and transparency of the new system, along with enhanced accountability and public trust. They also provided a timeline for full implementation of the move to a single accreditation system, with an anticipated completion date of 2020.</p> <p> The second session looked at the educational implications of hospital/health system and insurer mergers, and featured Henry Allen, senior attorney at the AMA, and John Roberts, MD, chair elect of the AMA-APS and vice dean for graduate medical education and continuing medical education at the University of Louisville School of Medicine. Mr. Allen profiled the AMA’s ongoing advocacy efforts to oppose anticompetitive mergers of health insurers, while Dr. Roberts provided a perspective on the educational impacts of a recent health system merger at his own institution.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:77179528-d8a8-493e-8cd4-4d9303a658af AMA International Medical Graduates Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-international-medical-graduates-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:09:00 GMT <p> On Friday, the International Medical Graduates Section (IMGS) began its 18th year of interim meetings with the 13th annual AMA Research Symposium in collaboration with the Medical Student and Resident and Fellows Sections. The research symposium included several computerized enhancements for judging abstracts and offered live networking and educational opportunities for all participants.</p> <p> Winners selected among the ECFMG certified physicians awaiting residency included: Rupesh Natarajan, MD, Podium for the Clinical Medicine category and Remi Okwechime, MD, Poster for he Improving Health Outcomes category.</p> <p> The IMGS Congress reception and business meeting featured two speakers. Lisa A. Robin, chief advocacy officer from the Federation of State Medical Boards, provided an update on the Interstate Licensure Compact. While Subhash Chandra, MD, led the congress participants in a meditation exercise for the well-being of meeting participants. IMGS was successful in reviewing the items considered for this House of Delegates meeting and was a positive forum for discussing IMG policy initiatives and organizational reports.</p> <p> On Sunday, the IMG Section held its Busharat Ahmad, MD, Leadership Development Program, which featured two speakers: Gerald Griffin, MD, retired Brig. General from California and Mark Abramson, California Center for TMJ and Dental Sleep Medicine, who spoke about “Effective Physician Leadership Essentials.”</p> <p> The IMG Section meetings culminated with its joint IMGS and Minority Affairs Section Caucus held on Monday. For more information visit the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates.page" target="_blank">section Webpage</a> or email your inquiries to <a href="mailto:img@ama-assn.org" rel="nofollow">img@ama-assn.org</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3c202e6f-d387-414a-b7b3-d64f4b70cda6 AMA Integrated Physicians Practice Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-integrated-physicians-practice-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:08:00 GMT <p> The AMA Integrated Physicians Practice Section held its interim meeting on Friday, chaired by Thomas Eppes, Jr., MD, Central Virginia Family Physicians. The meeting consisted of a two-part education program focusing on the changing health care business and compensation model.</p> <p> Part I featured Bruce Hamory, MD, Oliver Wyman; Susan Turney, MD, Marshfield Clinic; and Nayarana Murali, MD, Marshfield Clinic. Part II was presented in cooperation with the American Medical Group Association (AMGA) and featured Tom Dobosenski, AMGA; Rick Bone, MD, Advocate Health Care; and Lisa Blake, MD, Compass IPA.</p> <p> The IPPS aspires to create a setting for peer-to-peer learning and networking in a variety of breakout sessions and a networking luncheon. Participants engaged in a policy discussion related to items in the House of Delegates handbook.</p> <p> The IPPS seated a new House Delegate Susan Pike, MD, Baylor/Scott & White; and alternate House Delegate Michael Glenn, MD, Virginia Mason Medical Center.</p> <p> For the first time, the IPPS featured a program on for members of the House titled, “How to integrate and remain independent.”</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5de8aef1-5e28-4633-a3f7-94a332f497a1 AMA LGBT Advisory Committee: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-lgbt-advisory-committee-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:07:00 GMT <p> The AMA Advisory Committee on LGBT Issues conducted a member open forum during its committee meeting on Thursday.</p> <p> Many topics were discussed including, creation of special interest groups, medical school LGBT curriculum, mentoring and specific advice for LGBT medical students' regarding the Match. The following evening, the advisory committee hosted an engaging and lively LGBT & allies caucus and reception. All attendees were captivated by longtime AMA member and Physician General of Pennsylvania, Rachel Levine, MD.</p> <p> Dr. Levine detailed her historic ascent as the first state physician general, who happens to be a transgender woman. She shared her unique perspective as a transgender patient, physician and educator. Caucus attendees took advantage of this very unique educational opportunity by asking Dr. Levine several questions about how to best care for transgender adolescents and adults.</p> <p> The Caucus determined that each of them have an important role to advocate for the equal treatment and consideration of transgender individuals in our health care system.</p> <p> On Saturday, an educational session titled, “#LoveWins,” was held to inform medical students of appropriate ways to interview and care for LGBT patients. Featured panelists included:</p> <ul> <li> Nicholas Scanlon, advisory committee member and MSS representative</li> <li> Carl J. Streed Jr., MD, advisory committee RFS representative</li> <li> Shilpen Patel, MD, American society for radiation oncology delegate</li> </ul> <p> On Monday, the advisory committee hosted a CME educational session, “How to make your practice more LGBT-friendly,” for the AMA House of Delegates featuring Jason Schneider, MD, Emory University; Kimberly Acquaviva, PhD, George Washington University; and Brigid Scarbrough, of the Health Initiative. Attendees engaged with the panelists on issues related to providing a safe LGBT-affirming environment with signage and forms showing appropriate sexual orientation and gender identity.</p> <p> To learn more about the Advisory Committee on LGBT issues and to access the presentations and list of resources visit the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page" target="_blank">section Webpage</a> or send an email to <a href="mailto:lgbt@ama-assn.org" rel="nofollow">lgbt@ama-assn.org</a> to subscribe to bimonthly updates or to ask the Advisory Committee any questions.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f4482792-a538-40fb-8dab-3847c2e1e0e5 AMA Minority Affairs Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-minority-affairs-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:06:00 GMT <p> On Friday, a group of 50 physician and medical student volunteers from the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section.page?" target="_blank">Minority Affairs Section</a> (AMA-MAS) and the Medical Student Section conducted concurrent programming at two local elementary schools in Georgia.</p> <p> Combining efforts from the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/doctors-back-school.page" target="_blank">MAS Doctors Back to School™</a> program and the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes initiative</a>, the volunteers engaged 900 students at Conley Hills Elementary School and Hamilton E. Holmes Elementary School, which are primarily composed of Latino and African American youth.</p> <p> During the two-hour visits, physicians rotated between classrooms to encourage children to consider careers in medicine, while medical students engaged the children at themed, interactive stations such as healthy eating, asthma and yoga.</p> <p> At the AMA-MAS business meeting and reception, keynote speaker, <a href="http://www.drsoram.com/kim/" target="_blank" rel="nofollow">Kim A. Williams, MD, FACC</a>, shared the latest statistics regarding cardiovascular disease in the U.S. as well as treatment and prevention recommendations. Dr. Williams is the first African American president of the American College of Cardiology. He is affiliated with Rush University Medical Center in Chicago where he is the James B. Herrick professor and division chief of cardiology. </p> <p> Members reviewed reports and resolutions under consideration by the House of Delegates, which impact minority physicians and patients. They also paid tribute to two pioneer physicians of color: Dr. James McCune Smith, the first African American to earn a medical degree who died 150 years ago; and Dr. Beny Primm, international expert on HIV and substance abuse, and father of physician executive and medical educator, Annelle Primm, MD, MPH, who died in October.</p> <p> On Monday, the AMA-MAS hosted an education program, “The new science of unconscious bias: Implications for physicians and patients.” Presented by diversity and cultural competency expert <a href="http://www.criticalmeasures.net/about-us/leadership/david-b-hunt/" target="_blank" rel="nofollow">David Hunt, JD</a>, this evocative session explored how personal and systemic bias impacts clinicians’ objective evaluation and treatment of others based upon factors such as race, gender, religion, culture and language.</p> <p> Presentation slides of both AMA-MAS presenters, as well as the full meeting agenda book, can be found on the AMA-MAS <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/meetings.page?" target="_blank">meeting web-page</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f2d59cf0-64c1-4338-bfa7-e42e463b9994 AMA Medical Students Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-medical-students-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:04:00 GMT <p> At this year’s National Medical Student Meeting over the weekend in Atlanta, 750 medical students were in attendance from every year of medical school and many institutions across the country.</p> <p> The AMA Medical Students Section (MSS) programs included advising on how to get published and succeed in a research career, an introduction to the fundamentals of advocating for Graduate Medical Education funding and empowering medical students to engage in conversations about end-of-life care. In addition, the MSS welcomed Keynote Speaker, Tao Le, MD, to provide advice on USMLE Step 1.</p> <p> At the 13th annual AMA Research Symposium on Friday, nearly 400 medical students, residents and fellows, and international medical graduates presented posters on their research. Winners were announced Friday evening and the following medical students were recognized:</p> <p> <strong>Overall Winners</strong></p> <ul> <li> Poster: Maxine Warren, Emory University School of Medicine</li> <li> Podium: Kishor Jayakumar, University of Pennsylvania School of Medicine</li> </ul> <p> <strong>Category Winners</strong></p> <ul> <li> Biochemistry: Michael Lause, Ohio State University College of Medicine</li> <li> Clinical outcomes: Kathleen Wiest, University of Chicago Pritzker School of Medicine</li> <li> Immunology: Eun Beattie, SUNY School of Medicine, Buffalo</li> <li> Improving Health Outcomes: Taylor Wallen, Central Michigan College of Medicine</li> <li> Neurobiology: Tanya Khasnavis, Medical College of Georgia School of Medicine</li> <li> Public Health: Nicole Sitkin, Yale University School of Medicine</li> <li> Radiology: Fazila Aseem, Wake Forest University School of Medicine</li> <li> Surgery: Jae Kim, University of Central Florida College of Medicine</li> </ul> <p> Also on Friday, the MSS National Service Project partnered with the Minority Affairs Section and together conducted two successful, Doctors Back to School™ visits at local elementary schools in Atlanta. Over 40 medical student volunteers presented entertaining exhibits to the students, teaching healthy eating, anti-bullying, asthma, safety and exercise. The visits encourage minority students to consider a career in medicine.</p> <p> The AMA-MSS considered topics including clinical documentation and studying the use of incentives to increase the national organ donor pool. The reference committee had drafted a final reference committee report using testimony presented online via its Virtual Reference Committee.</p> <p> This year represented the fourth implementation of the completely virtual testimony process. The Virtual Reference Committee generated more than 242 posts and offered the opportunity for all medical student members to provide testimony on the items of business, regardless of whether they were able to attend the meeting.</p> <p> The clinical skills workshop was held on Saturday afternoon and drew a crowd of approximately 200 medical students. It featured hands-on training in airway management, blood pressure checks, ultrasound administration, casting and suturing.</p> <p> The section elected Omar Maniya, Georgetown University School of Medicine, to the AMA Board of Trustees 2016-2017, and Christopher Libby, University of Massachusetts Medical School, as MSS Governing Council Chair-Elect 2016-2017.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e2b77845-2e4b-4e58-856f-e91b98b52cf7 AMA Organized Medical Staff Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-organized-medical-staff-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:03:00 GMT <p> The AMA Organized Medical Staff Section (OMSS) held its 33<sup>rd</sup> Interim Meeting from November 12 through 14 in Atlanta with more than 100 OMSS representatives and guests in attendance.</p> <p> As part of its continuing dedication to educating medical staff leaders and other physicians on emerging issues in health care, OMSS hosted six thought-provoking education programs offering a total of five hours of AMA PRA Category 1 Credit:</p> <ul> <li style="margin-left:0.25in;"> Legal and ethical issues in telemedicine</li> <li style="margin-left:0.25in;"> The future of quality</li> <li style="margin-left:0.25in;"> Avera Marshall legal case update: Contractual status of medical staff bylaws</li> <li style="margin-left:0.25in;"> Transforming roles in healthcare leadership: How physicians can effectively communicate with non-physician administrative leaders (co-sponsored by the Integrated Physician Practice Section and the Women Physicians Section)</li> <li style="margin-left:0.25in;"> Common bylaws mistakes and how to fix them</li> <li style="margin-left:0.25in;"> Physician employment: Key considerations (co-sponsored by the Young Physicians Section)</li> </ul> <p> The section also hosted an update on the AMA’s strategic focus area on professional satisfaction and practice sustainability, presented by Michael Tutty, PhD, AMA Group Vice President for Professional Satisfaction and Practice Sustainability, and an update on advocacy efforts in Washington and across the country, presented by Richard Deem, AMA Senior Vice President for Advocacy.</p> <p> Education program presentations are available for download on the <a href="http://www.ama-assn.org/go/omssinterim" target="_blank">OMSS webpage</a>.</p> <p> AMA President Steven J. Stack, MD, addressed the Section on Friday afternoon, discussing the AMA’s ongoing efforts to improve electronic health records (EHR).</p> <p> The held robust discussion on issues including the use of temporary medical staff privileges, EHR interoperability and vendor accountability, exclusion of certain patient groups from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and more. The Section transmitted four resolutions to the House of Delegates for consideration at the 2015 Interim Meeting.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:129cc528-d27c-41de-a2b0-0260980a40dc AMA Women Physicians Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-women-physicians-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:02:00 GMT <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page" target="_blank">AMA Women Physicians Section</a> (WPS) hosted its business meeting and reception, featuring presentations by <strong>Elizabeth H. Ellinas, MD</strong> and <strong>Sneha Harshad Shah, MD</strong>, the 2014 recipients of the Joan F. Giambalvo, MD, Fund for the Advancement of Women.</p> <p> Dr. Ellinas shared results from her study, “Gender differences in promotion and retention: Enhancing the position of female faculty in higher academic rank and leadership positions.” While Dr. Shah discussed her study, “Gender differences in empathy and burnout amongst emergency medicine residents.”</p> <p> The business meeting concluded with a review of the AMA-HOD Handbook. The AMA-WPS Governing Council reviewed its <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page?" target="_blank">positions</a> on various items of business before the AMA House of Delegates that focus on issues of concern to women physicians, medical students and patients.</p> <p> The section’s liaison lunch and business meeting featured updates from around the country about what state and specialty medical societies are doing to address important issues related to women physicians. Members of the WPS Liaisons Network participated in a roundtable discussion on advancing women in healthcare leadership positions.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:322a7861-da1d-45e1-aafb-22df9b15517e AMA Young Physicians Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-young-physicians-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:01:00 GMT <p> At the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a>, young physicians from across the country discussed priority issues and worked diligently to help shape AMA policy during the 2015 AMA Young Physicians Section Interim Assembly meeting.</p> <p> After reviewing the House of Delegates handbook, the AMA-YPS Assembly identified items of particular relevance to the section and developed testimony for reference committee hearings and on the House floor. Details of all YPS positions can be found on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/young-physicians-section.page" target="_blank">AMA-YPS home page</a>.</p> <p> Additionally, the AMA-YPS forwarded Resolution 223, “Infertility Benefits for Wounded Warriors,” for consideration by the AMA House of Delegates.</p> <p> The theme for this year’s AMA-YPS C. Clayton Griffin, MD, Memorial Luncheon was “Criminal Justice Reform - A Health Advocacy Issue.” The luncheon featured three physicians:</p> <ul> <li style="margin-left:0.25in;"> Erick Eiting, MD, Medical Director, USC Correctional Health</li> <li style="margin-left:0.25in;"> Nzinga A. Harrison, MD, Chief Medical Officer, Anka, Behavioral Health Inc.</li> <li style="margin-left:0.25in;"> Edjah Nduom, MD, Neurosurgeon, University of Texas MD Anderson Cancer Center</li> </ul> <p> This session provided attendees with an opportunity to learn how physicians can play a role in facilitating changes that could improve the interaction between the criminal justice system and the U.S. population.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fa6377ff-b9f7-4744-a81b-0741721ee281 AMA Senior Physicians Section: 2015 Interim Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-senior-physicians-section-2015-interim-meeting-highlights Sun, 15 Nov 2015 15:00:00 GMT <p> The AMA Senior Physicians Section (SPS) sponsored a presentation by Daniel P. Hunt, MD, a professor at Emory University School of Medicine, on teaching, mentoring and coaching “wired” learners in medicine.</p> <p> The program focused on strategies for addressing the needs of students, residents, early career physicians and peers who seek mentor relationships. In addition, Richard E. Hawkins, MD, AMA vice president for medical education outcomes, provided an update on the senior physician competency task force.  </p> <p> The meeting included discussion of AMA House of Delegates business items and future AMA-SPS activities. The AMA-SPS Chair Barbara A. Hummel, MD, from Muskego, Wisc., also reviewed the election process for the section’s Governing Council. The process will begin early next year.</p> <p> The AMA-SPS Governing Council also met Nov. 13 to complete its strategic planning for the coming year. The council discussed resolutions and reports related to senior physician issues and received an update from AMA advocacy staff on the rise in Medicare premiums. In addition, the council invited several locum tenens companies based in Atlanta to discuss national trends for physicians as they transition into retirement. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6d31a996-e844-428a-9b8d-4c8da78d8c7f Future physicians honored for top research at AMA symposium http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_future-physicians-honored-top-research-ama-symposium Sun, 15 Nov 2015 00:15:00 GMT <p> Eighteen young medical researchers stepped into the spotlight Saturday as winners of the 2015 AMA Research Symposium, one of the most competitive in the event’s 13-year history. Find out who won this distinguished award.</p> <p> Competing among 368 of the nation’s brightest medical students, residents, fellows and international medical graduates (IMG) awaiting residency, the winners were selected based on the outstanding quality of their research.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/f4e8ff7a-f781-4598-91b1-0377bea6b33d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/f4e8ff7a-f781-4598-91b1-0377bea6b33d.Large.jpg?1" style="margin:15px;float:right;" /></a>Overall medical student winners are:</p> <ul> <li> Maxine Warren, poster presentation</li> <li> Kishore Jayakumar, podium presentation</li> </ul> <p style="margin-left:0.75pt;"> Overall resident and fellow winners are:</p> <ul> <li> Abhishek Maiti, MD, podium presentation</li> <li> Vinita Alexander, MD, poster presentation</li> <li> Almatmed Abdelsalam, MD, poster presentation</li> </ul> <p> Overall IMG winners are:</p> <ul> <li> Remi Okwechime, MD, poster presentation</li> <li> Rupesh Natarajan, MD, podium presentation</li> </ul> <p> The symposium, which took place Friday night as part of the <a href="http://www.ama-assn.org/sub/meeting/" target="_blank">2015 AMA Interim Meeting</a> in Atlanta, included hundreds of poster presentations and presentations as part of the oral competition. Participants submitted their work under several research categories, spanning more than a dozen specialties. View the <a href="https://download.ama-assn.org/resources/doc/mss/x-pub/abstract-book.pdf" target="_blank">abstracts</a> (log in) of the research by this year’s participants.</p> <p> <strong>How the symposium fosters competitive students, residents</strong></p> <p> Shauna Campbell, a fourth-year medical student at Chicago College of Osteopathic Medicine, has held various positions on the AMA committees since she began medical school, but this year was the first time she submitted research to the symposium—and she’s certainly glad she did.</p> <p> Campbell said discussing her research before a reputable panel of judges from around the country put her on the fast-track to building a strong CV.</p> <p> “I’m in a specialty that is very research heavy,” she said. “I’m applying for radiation oncology, so research is one of the biggest factors for our applications, so this is a great event to [attend]. What’s even better than that is if you’re going into a field like pediatrics, internal medicine, family medicine, [which] may not stress research as much, having this on your e-reservation or CV can really push your application to a whole new level.”</p> <p> Unlike other research conferences, she also said the research symposium, which doesn’t require a fee from AMA members to participate, offers an affordable way for students to submit research and network with their peers in a collaborative setting.</p> <p> “A lot of students go to various meetings … [that] often … are very costly,” Campbell said. “Registration for those meetings can between $200 and $400, but the great thing about the AMA meeting is that there is no registration fee. Plus everyone has the same interest here, [so] this is a great time to be amongst your peers to submit your research.” </p> <p> Others said the symposium offered a rare chance to receive helpful feedback and ideas from judges that can help bolster their research for future publishing. That’s one of the main aspects of the symposium, Emilie Prot, MD, a resident in preventive medicine at Austin State Department of Health said she appreciated.</p> <p> “The judging process here was well-done,” Dr. Prot said. “I’ve done research competitions at other national meetings, but at the symposium, you’re actually able to talk to judges and ask personal questions—and the judges are really nice about offering feedback.”</p> <p> Dr. Prot said judges encouraged symposium participants to think about how their research fits into “the bigger picture” of their respective field.</p> <p> For instance, Dr. Prot said, “If you’re doing research in public health, judges may ask, ‘How are you going to be able to design an intervention afterward? Is your research simply about gathering data and then presenting it, or is there a way to go back to the area where you conducted your research [and explore a new way to apply it]?’”</p> <p> Participants presented research covering a broad range of topics, such as the effects of education on childhood obesity, specialty choice among sexual and gender minorities, population health in India and more.</p> <p> <strong>The benefits of being a symposium judge </strong></p> <p> The versatility of these research subjects is one of the many reasons Hala Bedri, MBBS, a surgical researcher at the University of Iowa Surgery Burn Treatment Center, said she enjoyed reviewing the presentations this year.</p> <p> “There’s a lot of interesting research being done,” Dr. Bedri said. “The presenters are well-informed, and I felt all around it was a positive experience.”</p> <p> Plus, she stumbled upon a surprising bonus: As a judge, Dr. Bedri said she gained a behind-the-scenes look into how a large, competitive symposium is conducted, which offers valuable information that will help inform her own research and future submissions to conferences or publications.</p> <p> “In preparation for judging, I now know the criteria judges use to evaluate each presentation, which is quite different from when you’re just following the guidelines that a publication gives you,” she said. </p> <p> Dr. Bedri said she’d recommend physicians sign up to judge at the symposium because it offers a symbiotic exchange of ideas and information that can benefit medical researchers across the continuum of their careers.</p> <p> “I don’t see this as judging,” she said. “I see this as giving feedback to your peers, and that’s what I would like people to give me when I’m presenting my work as well.”</p> <p> The AMA Research Symposium is organized by the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section.page" target="_blank">Medical Student Section</a>, the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/resident-fellow-section.page?" target="_blank">Resident and Fellow Section</a> and the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates.page?" target="_blank">AMA-IMG Section</a>.</p> <p> In addition to the overall awards, winners were selected for each category in the medical student and resident and fellow competitions:</p> <p> Resident and fellow winners:</p> <ul> <li> J. Saadi Imam, MD, clinical vignette</li> <li> Rafael De Leon Borras, MD, clinical medicine</li> <li> Eric Melancon, MD, improving health outcomes</li> </ul> <p> Medical student winners:</p> <ul> <li> Michael Lause, biochemistry/cell biology</li> <li> Kathleen Wiest, clinical outcome/health care improvement</li> <li> Eun Beattie, immunology/infectious disease/inflammation</li> <li> Taylor Wallen, improving health outcomes</li> <li> Tanya Khasnavis, neurobiology/neuroscience</li> <li> Nicole Sitkin, public health and epidemiology</li> <li> Fazilia Aseem, radiology/imaging</li> <li> Jae Kim, surgery/biomedical</li> </ul> <p> <strong>Planning to present or publish your own research? Don’t miss these must-have resources:</strong></p> <ul> <li> Learn how to publish your research like a pro with <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_blank">these five strategies</a>.</li> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals that accept research from physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_blank">these 9 expert tips</a> for getting published in a medical journal.</li> <li> Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_blank">how to handle it.</a></li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9e4de485-b2f7-4174-896a-271ea8b604b3 Moments matter--and physicians must take them back: AMA president http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_moments-matter-physicians-must-back-ama-president Sat, 14 Nov 2015 22:38:00 GMT <p class="p1"> In an address during Saturday’s opening session of the <a href="http://www.ama-assn.org/sub/meeting/" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a>, AMA President Steven J. Stack, MD, spoke from the heart as he discussed the current state of health care in our country and insisted that in medicine, moments matter. When more and more moments are stolen from physicians, it is the patient who suffers most—and this cannot stand.</p> <p class="p1"> Dr. Stack spoke first of a recent incident that left him thinking about “exactly what is wrong with health care today and exactly” what is needed to “make medicine right again.” <object align="right" data="http://www.youtube.com/v/s4rCAx3EBXE" height="350" hspace="10" id="ltVideoYouTube" src="http://www.youtube.com/v/s4rCAx3EBXE" type="application/x-shockwave-flash" vspace="10" width="450"><param name="movie" value="http://www.youtube.com/v/s4rCAx3EBXE" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="10" quality="best" src="http://www.youtube.com/v/s4rCAx3EBXE" type="application/x-shockwave-flash" vspace="10" width="450" wmode="transparent"></embed></object></p> <p class="p1"> Because of overwhelming Medicaid protocol, Dr. Stack said, he was unable to carve out the amount of time he needed to deliver a diagnosis of terminal cancer to a patient in the way he had wished. A series of frustrating phone calls, interruptions and unnecessary bureaucratic protocols stole precious time he had intended to give his patient.</p> <p class="p1"> “It actually makes me sick,” he said, “that I didn’t have time to be the physician I know I am, the partner that patient deserved in his time of need.”</p> <p class="p1"> “We simply cannot tolerate this … it is a theft of our time [and] our passion,” Dr. Stack continued. “Providing excellent care to patients is not negotiable.”</p> <p class="p1"> <b>Momentum is on our side</b></p> <p class="p1"> Physicians have gained ground on many key health care issues, Dr. Stack said. The AMA boldly <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers?utm_source=BulletinHealthCare&utm_medium=email&utm_term=111415&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_blank"><span class="s1">opposed the proposed mergers</span></a> in the health insurance industry because patients deserve options, and physicians and patients alike must have decision-making power when it comes to treatment and timing of care.</p> <p class="p1"> Additionally, he pointed out, focusing on what is really important—strengthening the patient-physician relationship—is critical. One way physicians are accomplishing this goal is through the AMA’s <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank"><span class="s1">Break the Red Tape campaign</span></a>, in which “thousands of physicians from across the country have shared their stories online or emailed Congress to tell them that the ever-increasing bureaucracy is stealing their time and threatening the quality of care physicians can deliver to their patients,” Dr. Stack said. </p> <p class="p1"> The AMA also held two electronic health records (EHR) town hall events this year in <a href="http://www.ama-assn.org/ama/ama-wire/post/regulations-sidelining-patients-physicians-talk-ehrs" target="_blank"><span class="s1">Boston</span></a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank"><span class="s1">Atlanta</span></a> to provide a platform from which physicians could deliver their concerns and shine light on what one physician called “the abysmal state of EHR usability.”</p> <p class="p1"> Dr. Stack also pointed to significant victories this year, including:</p> <ul> <li class="p3"> The AMA and other medical association partners “won the epic battle to repeal Medicare’s fatally flawed and poorly conceived” <a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" target="_blank"><span class="s1">SGR formula</span></a>, Dr. Stack pointed out.<br />  </li> <li class="p3"> Through the AMA, physicians “<a href="http://www.ama-assn.org/ama/ama-wire/post/6-things-need-icd-10-transition" target="_blank"><span class="s1">smoothed the transition</span></a> to the new ICD-10 code set by achieving a grace period, an <a href="http://www.ama-assn.org/ama/ama-wire/post/cms-continues-icd-10-education-names-ombudsman" target="_blank"><span class="s1">ombudsman</span></a> assigned to triage issues as they arise and a pledge from CMS for a period of leniency,” Dr. Stack said.</li> </ul> <p class="p1"> But there is still much to do for the state of public health in our country, Dr. Stack reminded physicians at the meeting. <a href="http://www.ama-assn.org/ama/ama-wire/post/opioid-use-disorders-increase-physicians-offer-solutions" target="_blank"><span class="s1">Prescription opioid abuse and overdose</span></a><span class="s2">, </span>for instance, is now considered the largest public health crisis in our country since the AIDS epidemic. </p> <p class="p1"> The AMA <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-can-stop-opioid-overdose-epidemic" target="_blank"><span class="s1">convened a task force</span></a> with the American Osteopathic Association, the American Dental Association and 24 physician organizations to “combat the growing … crisis of opioid dependency and abuse,” he said. With the support of the White House, the AMA has pressed for greater funding and improvements to prescription drug monitoring programs (PDMP) that will help physicians in the fight to curb the epidemic.</p> <p class="p1"> “Physicians must be leaders,” Dr. Stack said. “We must turn the tide for people who currently suffer and for those who are at risk in the future.”</p> <p class="p4" style="text-align:right;"> <i>By AMA staff writer </i><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><span class="s1"><i>Troy Parks</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:17b3f586-3642-4aea-a3a9-d1187bf2e6ca Standing together, physicians welcome and lead change: AMA CEO http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_standing-together-physicians-welcome-lead-change-ama-ceo Sat, 14 Nov 2015 22:34:00 GMT <p class="p1"> “The American health care system evolves at a pace that would not have seemed possible not too long ago,” AMA Executive Vice President and CEO James L. Madara, MD, said in his address Saturday at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank"><span class="s1">2015 AMA Interim Meeting</span></a>. That’s why focusing on producing thriving practices that provide quality patient care is the most important aspect of health care today.</p> <p class="p1"> The pace of change in the health care system is rapid, “but change is a human constant,” Dr. Madara said. “To deal with such change, physician voices must be as unified as possible.”<object align="right" data="http://www.youtube.com/v/yy0RDpedi68" height="350" hspace="10" id="ltVideoYouTube" src="http://www.youtube.com/v/yy0RDpedi68" type="application/x-shockwave-flash" vspace="10" width="450"><param name="movie" value="http://www.youtube.com/v/yy0RDpedi68" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="10" quality="best" src="http://www.youtube.com/v/yy0RDpedi68" type="application/x-shockwave-flash" vspace="10" width="450" wmode="transparent"></embed></object></p> <p class="p1"> “Thankfully, physicians aren’t just watching,” he added. “We’re actively working to shape the future for the betterment of public health.”</p> <p class="p1"> With the intent of sculpting the future more sensibly, the AMA has taken action in several ways:</p> <ul> <li class="p3"> When two <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_blank"><span class="s1">proposed mergers</span></a> of some of the nation’s largest health insurers were announced earlier this year, “the AMA strongly stated concerns and laid bare the potential negative ramifications,” Dr. Madara said. Allowing these mergers to take place would be destructive to patients’ ability to choose the most appropriate care plan and would hinder physicians’ ability to provide quality care to those patients.<br />  </li> <li class="p3"> In an effort to shape the changes in payment and delivery with the <a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" target="_blank"><span class="s1">Medicare Access and CHIP Reauthorization Act (MACRA)</span>,</a> the AMA, acting through collaboration with working groups of state and specialty society CEOs “assembled to shape changes legislated by the Medicare Reform Law,” Dr. Madara said.<br />  </li> <li class="p3"> Tangible results produced by the AMA’s strategic work have garnered national attention. “AMA experts are being called to participate in deep dives, ideation panels and other brainstorming events at <a href="http://www.tedmed.com/" rel="nofollow" target="_blank"><span class="s1">TEDMED</span></a>, <a href="http://www.health2con.com/" rel="nofollow" target="_blank"><span class="s1">Health 2.0</span></a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-personalized-medicine-next-level" target="_blank"><span class="s1">Aspen Ideas Festival</span></a>, National Academy of Medicine and many other highly visible venues,” Dr. Madara said. <br />  </li> <li class="p3"> <span class="s1"><a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a></span> already provides 27 physician-authored modules that offer concrete steps to help physicians thrive in their practices. Topics range from work flow to physician health to payment support and health IT implementation. These new products provide ways to “revitalize our practice and improve patient care,” Dr. Madara added.<br />  </li> <li class="p3"> “We’ve also extended the reach of our work with what I refer to as the AMA innovation ecosystem,” Dr. Madara said. “Chicago-based <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-finally-say-tech-development" target="_blank"><span class="s1">MATTER</span></a>, an incubator/accelerator that now has more than 120 health care startups, is an AMA partner.” The goal at MATTER is to provide physicians with opportunities to get involved at the point of creation as new technologies are developed for health care.</li> </ul> <p class="p1"> “What’s important [to physicians] is time with our patients, tools that work, practices poised to thrive,” Dr. Madara said. “Things may have to change so these historic aspects of practice can be secured and continued.”</p> <p class="p5" style="text-align:right;"> <i>By AMA staff writer </i><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><span class="s1"><i>Troy Parks</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2018e44e-2a59-490d-aaf1-0813c77c3591 5 trends that will impact how quality of care is measured http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-trends-will-impact-quality-of-care-measured Fri, 13 Nov 2015 22:05:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/4/fc6c493b-3951-4747-a4d1-3ffbacc3e33d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/4/fc6c493b-3951-4747-a4d1-3ffbacc3e33d.Large.jpg?1" style="margin:15px;float:right;" /></a>New health technologies have allowed physicians to collect ever-increasing amounts of data to help measure—and ultimately, improve—patient care. As more of this data continues to impact how practices are evaluated and paid, here are five key trends one expert recommends that every physician follow.</p> <p> Quality measurements have proven to bolster patient care, with plenty of evidence of improvements in such critical areas as hospital readmissions, early elective delivery and central line infections, Richard Bankowitz, MD (pictured right), told physicians at an education session during the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2015 AMA Interim Meeting</a>. Dr. Bankowitz is chief medical officer for Premier Inc., which collects and measures data to improve efficiencies for physicians and health care facilities.</p> <p> Despite these improvements, physicians still grapple with challenges when they are forced to report quality measures that don’t necessarily align with their practice setting, specialty or payment model, Dr. Bankowitz said.</p> <p> When faced with copious patient data and federal regulations on reporting quality metrics, Dr. Bankowitz said physicians must ask themselves: “Are we measuring what even matters, and what are we looking to find using these quality measures?"</p> <p> To successfully address this question, he suggested that physicians note these five key trends when it comes to quality measurement:</p> <p style="margin-left:40px;"> <strong>1.     </strong><strong>Transparency. </strong>Successful quality measurement will embody a level of transparency that allows patients to easily understand their health costs. “There’s a good chance your patient will want to know how much that [health procedure] costs when [she] walks through the door for that hip replacement,” Dr. Bankowitz said, noting that pricing for health procedures will be essential to future care quality.</p> <p style="margin-left:40px;"> <strong>2.     </strong><strong>Understand the value of “big picture” measurements.</strong> “Measurement should begin with the end [goal] in mind,” he said. Physicians shouldn’t mire themselves down measuring every piece of granular patient data but instead focus on measuring “things that matter” and align with essential goals, such as those listed in the National Academy of Medicine (formerly the Institute of Medicine) <a href="http://iom.nationalacademies.org/Reports/2015/Vital-Signs-Core-Metrics.aspx" rel="nofollow" target="_blank">report</a> “Vital signs: Core metrics for health and health care progress.”</p> <p style="margin-left:40px;"> <strong>3.     </strong><strong>Value will be everything.</strong> As practices shift from time- to value-based payment models, patients and employers will want to know the value of the actual health procedure they are receiving. Physicians will have to incorporate value into how they measure quality care, Dr. Bankowitz said.</p> <p style="margin-left:40px;"> <strong>4.     </strong><strong>Measurement will span the continuum of care</strong>. Gone are the days when physicians only had to think about their immediate practice procedures. Instead, “quality measurements [are moving] outside silos” to capture metrics on patients across health care facilities and specialties, Dr. Bankowitz said. Programs will “hold [physicians] accountable for measures across a continuum of care,” he said.</p> <p style="margin-left:40px;"> <strong>5.     </strong><strong>Focus on digital data</strong>. Despite complications with electronic health records (EHR), physicians will have to know how to define quality measures within an EHR system, Dr. Bankowitz said, noting that organizations such as the <a href="https://www.ama-assn.org/ama/pub/physician-resources/physician-consortium-performance-improvement.page" target="_blank">Physician Consortium for Performance Improvement</a> are working to help physicians make better use of EHR data.</p> <p> Learn more about the AMA’s efforts related to <a href="https://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality.page?" target="_blank">quality measurement and performance improvement</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b8f6cdbf-1986-438e-960c-e762c72d9890 5 Medicare payment policy updates you need to know for 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-medicare-payment-policy-updates-need-2016 Fri, 13 Nov 2015 21:20:00 GMT <p> With the release of a nearly 1,360-page <a href="https://www.federalregister.gov/articles/2015/11/16/2015-28005/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions" target="_blank" rel="nofollow">final rule</a>, the Centers for Medicare & Medicaid Services (CMS) has issued the policies that will govern physicians’ Medicare payments in 2016. From the comprehensive list of updates, we’ve identified five particularly noteworthy changes you should know.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Payment rates will drop slightly.</strong> The conversation factor that is used to calculate physician payment rates for the year was influenced by no less than three different laws. With the 0.5 percent payment update from the Medicare Access and Chip Reauthorization Act (MACRA) included, next year’s conversion factor will be $35.83—down 10 cents from 2015.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Advanced care planning will be a covered service. </strong>Medicare will begin paying for two CPT codes for advanced care planning services, which include conversations between patients and their physicians before an illness progresses and during treatment. Previously, advanced care planning only was covered as part of the “Welcome to Medicare” visit for new enrollees.<br /> <br /> The new payment policy, adopted at the <a href="http://www.ama-assn.org/ama/ama-wire/post/advance-care-planning-could-become-routine-part-of-care" target="_blank">AMA’s recommendation</a>, recognizes both the additional time that is needed to conduct these important conversations and provides the flexibility to hold these planning sessions at the most appropriate time for patients and their families.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>“Incident to” services will not be restricted to certain professionals. </strong>A proposed change to the regulatory language about who would be able to bill for incident to services threatened to let Medicare administrative contractors and auditors prohibit billing by a supervising physician who wasn’t managing the patient’s overall care.<br /> <br /> The AMA pointed out in a <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/physician-fee-schedule-letter-08sept2015.pdf" target="_blank">comment letter</a> (log in) to CMS that such a change would have posed serious problems to group practices and multispecialty clinics that provide recurring treatments that often are not supervised by the physician managing the care. Accordingly, CMS has issued modified language, making it clear that such services do not need to be supervised by the same physician who is “treating the patient more broadly.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>The requirement to consult appropriate use criteria has been delayed.</strong> Under the Protecting Access to Medicare Act of 2014, physicians who order advanced diagnostic imaging services must consult appropriate use criteria via a clinical decision support mechanism. CMS has not yet specified the appropriate use criteria that must be followed, the mechanisms that must be consulted or developed a prior authorization program as required, so the agency has delayed the consultation requirement that would have taken effect Jan. 1, 2017.<br /> <br /> CMS also is considering the AMA’s recommendation to exclude emergency departments from this consultation requirement so they can swiftly provide necessary urgent care.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Opting out of Medicare won’t require biennial renewals. </strong>In the past, physicians who have wished to renew their opt-out status were required to file new valid affidavits with their Medicare administrative contractors every two years. Thanks to a provision in the MACRA, physicians who filed valid opt-out affidavits on or after June 16, 2015, will not need to file renewal affidavits.<br /> <br /> The only action required will be if these physicians choose to cancel their opt-out status. In that case, they simply will need to provide written notice to the Medicare administrative contractors with which they have filed an affidavit at least 30 days before the start of the new two-year opt-out period.</p> <p> Learn more about these policy changes and others from the 2016 Medicare Physician Fee Schedule final rule in an <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/2016-physician-fee-schedule-final-rule.pdf" target="_blank">AMA synopsis</a> (log in).</p> <p align="right" style="margin-left:.25in;"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" target="_blank" rel="nofollow">Amy Farouk</a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f9f94a59-6674-427f-ac13-a21ec3dc2139 Update your coding resources for 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_update-coding-resources-2016 Fri, 13 Nov 2015 15:00:00 GMT <p> ICD-10 is officially underway, and updates to CPT® and other code sets are only months away. Now’s the time to order the 2016 edition codebooks and resources to help you correctly report and bill medical procedures and services—and save 20 percent.</p> <p> From pocket sized to full reference guides, find what you need to make sure your practice is up to date as we head into 2016. If you order before Dec. 30, you can save 20 percent when you update your resources for the coming year.</p> <p> Including titles such as:</p> <ul> <li style="margin-left:0.25in;"> <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2610015&navAction=push" target="_blank">CPT® 2016 Professional Edition</a></li> <li style="margin-left:0.25in;"> <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2610006&navAction=push" target="_blank">CPT® Changes 2016: An Insider’s View</a></li> <li style="margin-left:0.25in;"> <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2610008&navAction=push" target="_blank">ICD-10-PCS 2016: The Complete Official Codebook</a></li> <li style="margin-left:0.25in;"> <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2610017&navAction=push" target="_blank">HCPCS 2016 Level II Codebook</a></li> <li style="margin-left:0.25in;"> <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2610007&navAction=push" target="_blank">ICD-10-CM 2016 Edition</a></li> </ul> <p> Visit the AMA Store for the <a href="https://commerce.ama-assn.org/store/content/2016-annual-titles?node_id=2016-annual-titles" target="_blank">2016 annual titles</a> and to take advantage of the 20 percent discount. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:37b8a4c6-c2ff-41da-ab95-3f63d03fbc0c 2015 AMA Interim Meeting gets underway--follow daily updates http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_2015-ama-interim-meeting-gets-underway-follow-daily-updates Thu, 12 Nov 2015 20:57:00 GMT <p> The nation’s physicians, residents and students are gathering Nov. 14-17 in Atlanta to weigh new AMA policy that will help advance the practice of medicine and improve the health of the nation. Members of the medical community who aren’t able to attend still can benefit from highlights of special educational sessions and follow the policymaking in daily updates.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/14/59ed7985-75d3-4ed1-8efe-483c6c1b4829.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/14/59ed7985-75d3-4ed1-8efe-483c6c1b4829.Large.jpg?1" style="margin:5px 15px;float:right;" /></a></p> <div> <p> <strong>Policy discussion</strong></p> <p> Among the dozens of issues up for discussion are such timely topics as:</p> <ul> <li style="margin-left:0.25in;"> Halting the accelerated consolidation of health insurers</li> <li style="margin-left:0.25in;"> Preserving patient-physician relationships during hospitalizations</li> <li style="margin-left:0.25in;"> Exploring alternative funding sources for graduate medical education</li> <li style="margin-left:0.25in;"> Addressing national drug shortages</li> <li style="margin-left:0.25in;"> Supporting the health and wellness of physicians and physicians in training</li> </ul> <p> Physicians representing every state and specialty will share perspectives and evaluate proposed solutions to national health care concerns.</p> <p> <strong>Special sessions</strong></p> <p> In addition to the policymaking portion of the meeting, physicians will hear from leading experts about pressing medical and professional issues, and other events will give physicians in training a chance to develop their skills.</p> <ul> <li style="margin-left:0.25in;"> Infectious disease experts from the Centers for Disease Control and Prevention (CDC) will delve into the global public health threat of antimicrobial resistance and the need for action.</li> <li style="margin-left:0.25in;"> CDC Director Thomas R. Frieden, MD, and leaders from a professional physician task force will discuss the nation’s opioid epidemic and strategies for combatting it.</li> <li style="margin-left:0.25in;"> Physicians will hear about practical solutions that can help address physician burnout and professional dissatisfaction while boosting practice efficiency.</li> </ul> <p> Hundreds of students, residents and international medical graduates will present original research during the 13th annual AMA Research Symposium, and students will get a chance to hone their clinical skills during a hands-on workshop.</p> <p> <strong>How to follow the meeting </strong></p> <p> You can find meeting news—covering both policymaking and educational sessions—in several places. Beginning Friday night, look for daily updates at <em>AMA Wire</em>®, visit the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">meeting website</a>, and check the AMA’s <a href="https://www.facebook.com/AmericanMedicalAssociation/" rel="nofollow" target="_blank">Facebook</a> and <a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">Twitter</a> (#AMAmtg) news feeds.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6370c1b4-4dca-4c1f-9595-1a159f588811 Med school explores new way to assess millennial learners http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-school-explores-new-way-assess-millennial-learners Thu, 12 Nov 2015 20:35:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/15/2ebdb20e-0311-4d4a-af76-a576dfd8febc.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/15/2ebdb20e-0311-4d4a-af76-a576dfd8febc.Large.jpg?1" style="float:right;margin:15px;" /></a>As medical schools shift from time-based to competency-based curricula, portfolios have emerged as a progressive tool to assess student learning. Here’s how Vanderbilt University School of Medicine uses e-portfolios to transform students’ assessments, strengthen partnerships with faculty and track students’ progress as they advance in training. </p> <p> Using open-source software, Vanderbilt has created a complex e-portfolio system that charts students’ performance across a core set of competencies based on the Accreditation Council for Graduate Medical Education’s graduate medical education (GME) milestones. The project was <a href="http://www.ama-assn.org/ama/ama-wire/post/one-medical-school-created-student-gps" target="_blank">first announced</a> last year as part of Vanderbilt’s novel work as a founding member of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education Consortium</a>.</p> <p> Since the announcement, Anderson Spickard, III, MD, (pictured right), assistant dean of educational informatics and technology at Vanderbilt, has worked among a group of dedicated faculty who are refining the e-portfolio system—and their efforts are paying off.</p> <p> Faculty have created new ways to collect data on students across multiple written, audio and electronic files. This data is linked to each student’s individual e-portfolio profile and used to create unique performance measures for student training.</p> <p> One e-portfolio can contain data from faculty, coaches and peers as well as self- or clinical assessments, Dr. Spickard told educators during the <a href="http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now" target="_blank">AMA’s CHANGE<strong>MEDED2015</strong> conference</a>. “We even collect their notes from electronic health records and use natural language techniques to automatically display all of the major concepts of each note,” he said. Faculty use this information to monitor clinical cases students encounter and provide students feedback on their notes in each case. “Accumulating and sorting this information for personal feedback is a part of creating individualized learning, especially for students on clinical rotations.”</p> <p> <strong>Effective data meets effective coaching</strong></p> <p> “The assessments and information that come into these portfolios, as you can imagine, can be overwhelming,” Dr. Spickard said, which is why students are paired with e-portfolio coaches, who also help them read their portfolios and properly assess their dashboard metrics.</p> <p> Each student is assigned a portfolio coach for the entirety of their education. Teachers who elect to become portfolio coaches work with 10 students each. Students meet with their coaches three times a year to review their educational data and determine what areas they need to work on.</p> <p> “This leads to two very important outcomes,” Dr. Spickard said. “One, the student makes reflective summary goals and designs a personal learning plan [that] captures data from his or her portfolio dashboard and timeline. Secondly, the summation from the portfolio coach … offers an important piece of information for Vanderbilt’s promotion committee, [which] evaluates when students are ready to progress to the next stage of training.”</p> <p> <strong>How educators use e-portfolios to chart student progress </strong></p> <p> During a demonstration of the e-portfolio system, Dr. Spickard logged into an anonymous student’s e-portfolio profile and selected “systems-based practice” from a list of domains on the portfolio dashboard.</p> <p> A Web page loads with a graph featuring a series of dots—each representing individual forms and notes related to the student’s performance in systems-based practice—mapped over a series of months. </p> <p> “I can search by date, or I can search by the type of form to see the story of this student as he or she moves along in our new curriculum,” he said, pointing his cursor to one of the dots, which featured information on the student’s grades in systems-based practice.</p> <p> In one click, he sorted the student’s grades going back to December, noting that “scores were initially low from student and faculty assessments.” But after expanding the dashboard screen, he could see that the student’s systems-based learning grades actually improved by the summer.</p> <p> “We can also click on one of these student dash points to see who entered the student’s data or form,” he said. This helps faculty determine if the data they’re using for each student represents a high-stakes assessment or one-time encounter with faculty or clinicians.</p> <p> Tracking assessments is simply one way to use e-portfolio data, Dr. Spickard said. The portfolio system’s fluid functionality allows faculty and students to ask multiple questions about their performance, explores progress trends and compares student assessments across all courses and training years. </p> <p> <strong>Tapping technology for millennials  </strong></p> <p> Because more students are encountering data about themselves, Vanderbilt faculty also are capturing data on students’ receptivity to assessments. </p> <p> “Currently, we’ve learned that second-year students are rated more highly in receptivity to feedback than they were when they were first-years, and that may just be a development that’s natural or a result of the portfolio review process,” Dr. Spickard said. “And finding such group results only takes about 30 seconds to determine …. This starts to really paint the picture of how we are doing.”</p> <p> As more data accumulates in the e-portfolio system, Vanderbilt will continue refining how e-portfolios capture student data, Dr. Spickard said.</p> <p> The school has already launched a mobile app for clinicians to provide quick narrative reports or record audio notes in real time and send them directly to students’ e-portfolios. The app aims to give tech-savvy residents a new way to capture their observations about students in the busy clinical environment.</p> <p> “We want to connect with millennial learners and meet the expectations they have” for innovative models, technology, learning and progress reports, Dr. Spickard said.</p> <p> <strong>Interested in more med ed innovations?</strong></p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now" target="_blank">9 med ed challenges</a> educators and consortium members want to solve right now.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/creating-impossible-key-innovations-solutions-med-ed" target="_blank">how educators are creating the impossible</a> for future physician training.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">current projects</a> the 11 founding members of the AMA’s Accelerating Change in Medical Education Consortium have underway.</li> <li> Find out about the <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank">21 schools that are new members of the consortium</a>. </li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c1859b7a-7b76-4ad2-92c9-5d2195c09a7a Physicians stand up against mergers of powerful insurers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-stand-up-against-mergers-of-powerful-insurers Thu, 12 Nov 2015 11:00:00 GMT <p> Two marriages are in the works among the nation’s largest health insurers—and physicians are speaking up, refusing to forever hold their peace. The proposed mergers, which would reduce competition in the health insurance market, pose a substantial risk of harm to patients and physicians in terms of health care access, quality and affordability.</p> <p> Health insurers have claimed that the mergers—Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna—will lead to greater efficiencies and innovative payment and care management programs. But is the claim based on fact?</p> <p> “There is no evidence supporting the insurers’ claim,” the AMA said in <a href="https://download.ama-assn.org/resources/doc/washington/proposed-health-insurance-mergers-letter-to-doj-11nov2015.pdf" target="_blank">a letter</a> (log in) delivered to the U.S. Assistant Attorney General earlier this week The letter points to studies and analyses that speak to how the opposite is often the case.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/10/28ee193a-2d0b-4406-8a55-adba293e2672.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/10/28ee193a-2d0b-4406-8a55-adba293e2672.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <div> <p> The mergers would exceed federal antitrust guidelines put in place to preserve competition around the country. According to special AMA analyses released in September, the proposed mergers of <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" target="_blank">Anthem and Cigna</a> (log in) and of <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/competition-aetna-humana-merger-full.pdf" target="_blank">Aetna and Humana</a> (log in) would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states. The mergers also would raise significant competitive concerns in additional areas. All told, nearly one-half of all <a href="http://www.ama-assn.org/ama/ama-wire/post/states-health-insurers-squeezing-out-competition" target="_blank">states could see reduced competition</a> in local health insurance markets.</p> <p> The AMA letter urges the Department of Justice to “block the proposed mergers,” emphasizing that “fostering competition, not consolidation, benefits American consumers through lower prices, better quality and greater choice.”</p> <p> <strong>How would the merger affect physicians and patients?</strong></p> <p> The proposed mergers would give the merging health insurers monopoly power in the sale of insurance to consumers and create a highly concentrated health insurance market where little competition exists.  When no competing options are available, these insurers could  raise patients’ premiums and may no longer feel required to develop ways to improve quality and lower costs to compete in a healthy market.</p> <p> The proposed mergers also would give the insurers monopsony power, or buyer power, over physicians. This would allow the insurers to control physician payment rates, making it impossible for physicians to make practice investments that would improve patient access and care. Without competitive contract terms and rates, physicians may be unable to afford new equipment and technology, struggle to train staff and be forced to spend less time with patients as they work to keep their practices afloat.</p> <p> In competitive markets, however, consumers are in the driver’s seat. If insurers were to obtain further monopsony power, harm would come to consumers.</p> <p> “Competition in health insurance, not consolidation, is the right prescription for health insurer markets,” the AMA said. “Competition will lower premiums … [and] allow physicians to bargain for contract terms that touch all aspects of patient care.”</p> <p> <strong>Speaking up</strong></p> <p> In addition to this week’s letter, the AMA has testified twice before the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law.</p> <p> AMA Board of Trustees Member Barbara L. McAneny, MD, delivered <a href="http://judiciary.house.gov/_cache/files/f4b44a1e-8d63-4aa1-90ac-e2764fb8fd3b/mcaneny-testimony.pdf" target="_blank" rel="nofollow">testimony</a> at the Sept. 10 hearing on the <a href="http://judiciary.house.gov/index.cfm/hearings?ID=417B9E62-CB8D-4FC7-905D-40F39B91E5E7" target="_blank" rel="nofollow">state of competition in the health care marketplace</a>, where she told members of Congress, “Providing patients with more choices for health care services and coverage stimulates innovation and incentivizes improved care, lower costs and expanded access.”</p> <p> AMA President-Elect Andrew W. Gurman, MD, <a href="http://judiciary.house.gov/_cache/files/ffc68590-e407-49e7-be59-d988850ebfa8/gurman-testimony.pdf" target="_blank" rel="nofollow">testified</a> at the Sept. 29 hearing on <a href="http://judiciary.house.gov/index.cfm/hearings?ID=020363B9-F9EF-4623-8E67-28A0B260675A" target="_blank" rel="nofollow">examining the proposed health insurance mergers and the consequent impact on competition</a>, where he urged federal and state regulators, “to closely scrutinize the proposed health insurer mergers and utilize enforcement tools to protect consumers and preserve competition.”</p> <p> The AMA is offering continued assistance to state medical associations around the country as they assess how to position themselves regarding the proposed mergers and the actions of their state regulatory agencies.</p> <p> If the mergers are allowed, the impact could be detrimental to physicians’ ability to provide the quality care they strive for each day, while simultaneously increasing patients’ premiums and limiting their access to the care they deserve.</p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow">Troy Parks</a></em></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4caccd15-95dd-4f53-b0fa-8c9e420f0f00 How residents are beating burnout with help from the theatre http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residents-beating-burnout-theatre Wed, 11 Nov 2015 21:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/11/37cf64d9-f0ee-4856-9bed-7ac8fcbddb27.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/11/37cf64d9-f0ee-4856-9bed-7ac8fcbddb27.Large.jpg?1" style="float:right;margin:15px;" /></a>Residents want work-life balance, but finding time to preserve your own wellness while successfully caring for your patients requires self-awareness and boundaries, two things many residents struggle to establish amid pressures in training. That’s why one physician created a play as a wellness solution that helps residents tackle tough conversations about balancing family, personal identity and practice. </p> <p> When Bill Thomas (right), MD, sat down to pen the first scene of his play, a blaring trumpet is all that came to mind. He planned to start the play with a brassy trill but didn’t know what would come next. He imagined how one horn would help him capture the physician who hasn’t spoken to his spouse in days, the resident who stopped playing cello or the intern dreaming of a full night’s sleep. He knew he wanted to write an honest play that followed familiar physician stories and a theatrical format any medical team could perform.</p> <p> After a year of rewrites, what started as a looping sound boomed into <em>Play What’s Not There, </em>a<em> </em>one-act play exploring honest life challenges physicians confront while juggling practice, self-fulfillment and family. <em>AMA Wire<sup>®</sup></em> spoke to Dr. Thomas about the play and how the arts can help young physicians discover new ways to boost wellness.</p> <p> Plus a bonus: <em>AMA Wire</em> readers can host their own free production of the show. Read on for details.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What prompted you to create <em>Play What’s Not There</em>? </strong></p> <p> <strong>Dr. Thomas: </strong>It started after I gave a speech at <a href="http://www.harvardartmuseums.org/" rel="nofollow" target="_blank">Harvard University’s Fogg Museum</a> about searching for the balance between work and life. The idea of the speech was that art could be a way of finding balance.</p> <p> Carl Patow, MD, who is the regional vice president of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Program, called me after the event and said he had this idea that we should do something beyond talking about [work-life balance] and actually try creating some solutions, so Carl ended up commissioning me to write the play.</p> <p> This was conceived of as being an entirely practical thing. We knew we had some limits we wanted to put on the play: It had to be simple to stage, limited to five characters and … limited to one act.</p> <p> It took about a year of writing to get the play into good shape, and then we premiered it at the Guthrie Theatre in Minneapolis, which is an unbelievably great theater. Dr. Patow arranged for medical students, residents, faculty members, and attending staff and their families to all come to the show. We filled the auditorium with people who were struggling with the same issues in the play. After each performance, I would come on stage, along with the actors, and we’d do a “talk-back” with the audience [by responding] to their questions. It really made a difference.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are your goals for the play?<br /> <br /> Dr. Thomas: </strong>If there’s one important thing I’ve learned in this process, it’s this: If you have a room full of doctors, and you look at them and say, ‘Let’s talk about your work-life balance,’ you’re going to hit a great big stone wall. But if you put them in a dark theatre, and let them watch a play with characters who are also struggling [with work-life balance ], then these physicians—who are good people but work under tremendous pressure—will be able to discuss issues and ask their questions in terms of the play. This gives them enough distance to really talk about their lives and difficulties without admitting weakness, so to speak.</p> <p> Medicine has excelled tremendously by understanding life through science, which I embrace, endorse and love. But I think medicine has not done as good a job of using art as a tool for understanding the world, our lives and our place in the world. This play really represents a step in that direction. To really excel at taking care of people, physicians need access to both arts and sciences—and right now the playing field is really tipped one way. That’s part of the reason we do have this problem with burnout and people questioning why they’re [in medicine].</p> <p> <strong><em>AMA Wire</em></strong><strong>: Related to burnout, can you talk a bit about wellness within the “culture of medicine”? How can young physicians advocate for real work-life balance while grappling with pressures that so many physicians say are intrinsic to the field? Is work-life balance even possible for the modern physician in training?  </strong></p> <p> <strong>Dr. Thomas:</strong> I’m an optimist, and I think it is [possible]. One of the things physicians of all ages need to do is start raising the alarm whenever conversations veer toward a purely quantitative expression of worth and value.</p> <p> Physicians are constantly placed under pressure that is entirely quantitative—how many patients, RVUs, admissions, procedures, etc. There is a place for that, but what happens—and the trap we fall into when life becomes entirely mediated and measured by quantifiable measures—is that physicians begin missing out on the very thing that brought us to medicine in the first place. If we only [cared] about the numbers, we’d probably all be bench scientists in a chemistry lab. But we were drawn into medicine because something appealed to a blend of our humanity and scientific understanding.</p> <p> When you have people with those inclinations, and you put them in an entirely quantitatively driven system, something gets damaged—and often, it’s that human sensibility. So for young docs [combating burnout], the thing to do is to push back on purely quantifiable measures of worth.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Your play explores various themes related to resident wellness, especially through its main character, Dr. Beatrice Long, a resident who recently started her program only to struggle with maintaining work-life balance. Can you briefly describe the play and some of the ideas Dr. Long’s character exemplifies? </strong></p> <p> <strong>Dr. Thomas:</strong> The play uses a literary technique known as magical realism. In the play, characters encounter Asklepios, the Greek god of medicine, in human form. What’s interesting is that elements of fantasy are introduced into the plot but at the fundamental level. This is a realistic play about people struggling with real problems, such as families and pressures at work.</p> <p> What we have in this character Beatrice Long is a young person who is very qualified and talented. Really, she has everything we’d all say would make her a great physician, but she hasn’t entered the profession because she’s been so wary of losing herself and her ability to maintain a coherent self outside of medicine. So a very crusty senior chief of medicine gives her one more chance to enter the profession and become an intern. And what follows is that instead of being mentored by the very crusty chief of medicine, she ends up being mentored by Asklepios, the god of medicine. Asklepios helps her see the world and people around her more clearly, and in essence, the audience does the same.</p> <p> By the end of the play, without giving too much away, Beatrice’s humanity ultimately leads her to make a thoughtful and generous decision at the end of the show that emphasizes the need for life balance.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What’s next for <em>Play What’s Not There</em>? If residents or programs wish to learn more about the play, what should they do? </strong></p> <p> <strong>Dr. Thomas: </strong>If they would like to receive a copy of the script and put on their own staged reading of the show, it’s easy to do: All they have to do is <a href="http://changingaging.org/contact-us/" rel="nofollow">write me</a>. We can provide a copy of the script, and they can perform the play—no charge or obligation. I’m just really interested in allowing physicians to play with these ideas and use them as a spark for conversation.</p> <p> <strong>Want more on balancing wellness and residency? Don’t miss these resources:</strong></p> <ul> <li> See how physicians rank <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_blank">residency work-life balance based on specialties</a>.</li> <li>  Check out <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">these tips from residents who have conquered burnout</a>.</li> <li> Educate yourself on the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">signs of burnout</a> and how to <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">increase satisfaction in training</a>.</li> <li> Explore this new method one residency program devised to <a href="http://www.ama-assn.org/ama/ama-wire/post/tired-of-miserable-schedules-one-residency-programs-solution" target="_blank">get rid of miserable schedules.</a></li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/one-residency-program-improved-documentation-reduced-stress" target="_blank">this residency program intervention</a> that decreased stress by improving documentation timeliness.</li> <li> Check out Stanford University School of Medicine’s <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">successful wellness program</a>, and learn why taking time for fun (and the occasional sailing lesson) can improve resiliency in training.</li> </ul> <p align="right" style="margin-left:18.75pt;"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6dd47857-e9b3-4623-a1c8-c3de1e83833f Is 120 mm Hg the new BP target? What headlines aren’t telling you http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_120-mm-hg-new-bp-target-headlines-arent-telling Wed, 11 Nov 2015 15:32:00 GMT <p> The results of the SPRINT trial are in, and you’ve probably heard that making 120 mm Hg the new blood pressure target helped lower mortality rates. Yet the study outcomes apply only to a specific subset of patients with hypertension. See whether or not your patients may fit into this category.</p> <p> In the much-anticipated results of the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleTop" rel="nofollow" target="_blank">SPRINT trial</a>, the relative risk of death from cardiovascular causes was 43 percent lower for patients receiving more intensive treatment for a 120 mm Hg target versus those who received standard treatment for a 140 mm Hg target.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/15/c7af145a-5f39-4d7a-8f09-3321d60d01f4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/15/c7af145a-5f39-4d7a-8f09-3321d60d01f4.Large.jpg?1" style="margin:5px;float:right;" /></a></p> <p> While these results were unexpected and are noteworthy, what you won’t see in much of the news that summarizes this study is that these benefits only apply for patients who meet the same criteria used for study participants. In fact, five out of six patients currently being treated for hypertension do not meet the criteria of the study—and therefore wouldn’t benefit from its results.</p> <p> In order to participate in the trial, patients needed to meet these eligibility criteria:</p> <ul> <li style="margin-left:0.25in;"> Are at least 50 years old (the average age was nearly 69)</li> <li style="margin-left:0.25in;"> Have systolic blood pressure of 130-180 mm Hg</li> <li style="margin-left:0.25in;"> Have high risk of a cardiovascular event (one or more of the following):</li> </ul> <ol style="margin-left:40px;"> <li style="margin-left:0.25in;"> Cardiovascular disease other than stroke</li> <li style="margin-left:0.25in;"> Chronic kidney disease</li> <li style="margin-left:0.25in;"> A Framingham Risk Score for 10-year cardiovascular disease risk above 15 percent (but the study mean was 20 percent)</li> <li style="margin-left:0.25in;"> Be 75 years or older</li> </ol> <ul> <li style="margin-left:0.25in;"> Have not had a stroke</li> <li style="margin-left:0.25in;"> Not have diabetes</li> </ul> <p> <strong>What should you do with these results?</strong></p> <p> The simple answer: Don’t do anything yet. Associated with a lower target blood pressure were increased adverse events, including kidney failure, low blood pressure and loss of consciousness. Patients who do not meet the eligibility criteria may be exposed to the harms and possibly not the benefits and should continue their course of treatment.</p> <p> Luckily, the SPRINT results have been released in time for the American Heart Association (AHA) and American College of Cardiology writing group to consider them for the much-anticipated guideline on the management of hypertension, which will be released sometime next year.</p> <p> <strong>More cardiovascular news and resources</strong></p> <p> Coinciding with the AHA Scientific Sessions earlier this week, <em>JAMA</em> released a <a href="http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=934661&direction=P" rel="nofollow" target="_blank">special theme issue</a> on cardiovascular disease. Among various topics, the issue digs into the potential implications of recently approved PCSK-9 inhibitors, screening for atrial fibrillation, treating exercise as a “dose” of medicine and an investigation into the common problem of the assessing patients with chest pain.</p> <p> Also at the Scientific Sessions, the AMA and AHA announced <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-09-prioritize-blood-pressure-control.page" target="_blank">Target: BP</a>, a joint initiative to help improve outcomes around heart disease. The initiative is designed to address the growing burden of high blood pressure and help physicians and patients improve health outcomes by achieving better blood pressure control.</p> <p> Additional resources that can help you ensure your patients receive the treatment they need to get their blood pressure under control include:</p> <ul> <li style="margin-left:0.25in;"> The <a href="http://www.ama-assn.org/ama/ama-wire/post/one-video-need-accurate-blood-pressure-readings" target="_blank">one video you need</a> for accurate blood pressure readings</li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-heart-disease.page" target="_blank">M.A.P.</a> to improve blood pressure control</li> <li style="margin-left:0.25in;"> <a href="https://www.stepsforward.org/modules/hypertension-blood-pressure-control" rel="nofollow" target="_blank">3 steps to help patients improve blood pressure control</a></li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3e8c5efc-6c4c-48ba-b199-f888f3eba3ea Why technology makes physicians more relevant than ever http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_technology-physicians-relevant-ever Tue, 10 Nov 2015 22:36:00 GMT <p> <strong>Why technology makes physicians more relevant than ever </strong></p> <p> Technology may empower patients with more information, but new websites or gadgetry will never replace the intuition of a good physician, according to <a href="http://community.the-hospitalist.org/bobs-bio/" target="_blank" rel="nofollow">Bob Wachter</a>, MD, author of <em>New York Times</em> science bestseller <em>The Digital Doctor.</em> He recently shared his comments as part of a special preview event for <a href="http://www.tedmed.com/event/stage2015" target="_blank" rel="nofollow">TEDMED 2015.</a><em> </em>Here’s why he says experienced physicians—even in an era of tech-savvy patients and health IT—are still modern medicine’s most valuable commodity.</p> <p> <strong>Physician intuition in the digital age </strong></p> <p> Just as generations of physicians before him, Dr. Wachter listens attentively to his patients’ grievances and uses notes about their symptoms to help guide an informed diagnosis.</p> <p> Patients’ complaints often will help him crack the code on an elusive diagnosis, he said, but sometimes, especially when treating patients with complex conditions, he has to consult another source of information.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/bbddcee7-2768-4758-8998-55650d0bb5ea.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/bbddcee7-2768-4758-8998-55650d0bb5ea.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> When confronted with challenging questions, “I came to realize that I was using what we physicians call the ‘eyeball test’ or that funny sense of intuition and experience,” Dr. Wachter said. “In some ways, it’s that ‘Spidey’ sense that tickles a part of the physicians’ cerebral cortex that says, ‘I wonder if this could be,’ and it makes [him] think a little harder.”</p> <p> While this intuition has helped physicians successfully treat patients for years, modern technology, data and online articles are now causing patients to not trust physicians’ intuitive decisions.  In fact, Dr. Wachter noted, “sometimes it even seems like patients and doctors are on different teams.”</p> <p> “But I’m here to argue that I believe medicine is fundamentally different [than other industries], and patients will always need physicians,” Dr. Wachter said. “This idea of patients becoming their own doctors is actually a little dangerous.”</p> <p> <strong>The human art of diagnosis </strong></p> <p> Dr. Wachter said he especially fears patients’ overreliance on technology for two critical reasons: Patients are over-diagnosing and misdiagnosing themselves.</p> <p> Certain information patients find online may cause them to believe their symptoms are benign and overlook urgent medical conditions an experienced physician would catch if the patient were to see them.</p> <p> “As an internist and hospitalist, when I see a sick patient, I’m collecting sometimes 100-200 pieces of data—everything from a patient’s chief complaint to their blood pressure to their temperature, travel and tone of their voice. And taking those 200 facts and distilling them into five salient points I’m trying to solve turns out to be a massively complicated act of cognition—and one that computers cannot replicate.”</p> <p> Dr. Wachter said claims that computers and advanced algorithms will one day morph into diagnostic generators are more fodder for futuristic fable than imminent reality.</p> <p> “Can computers ever get smart enough to take over the role of doctors as diagnosticians? Maybe,” Dr. Wachter said. “But they aren’t there today, and I don’t believe they will be there in the next several years. When will they get there? I suspect they will get there when they’re also able to write award-winning poetry, skate at the Olympics and become the CEOs of Fortune 500 companies. In other words, I think we have quite a while before we get there.”</p> <p> <strong>Watch TEDMED 2015 live Nov. 18-20</strong><br /> AMA members have complimentary virtual access to the stage program for TEDMED 2015, which brings together the global community dedicated to shaping a healthier world.</p> <p> Dr. Wachter and other thought leaders and change agents will share compelling personal stories as this year’s theme, “Breaking Through,” focuses on shattering the status quo and fostering a shift in our daily mindset to change established routines and habits to shape a healthier nation. Visit the <a href="http://www.ama-assn.org/ama/no-index/news/tedmed-2015.page" target="_blank">AMA website</a> to learn more. AMA members should watch for an email with special instructions to gain exclusive access via the AMA’s custom online channel.</p> <p align="right"> <em>By AMA staff writer</em> <a href="http://twitter.com/Lyndra_AMAWire" target="_blank" rel="nofollow"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7cfcee0d-60d2-43f7-9376-d45d4cdd6075 Boost your residency application with these 5 writing tips http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_boost-residency-application-5-writing-tips Tue, 10 Nov 2015 21:06:00 GMT <p> Summarizing years of training, your passion for medicine or why you’re choosing a particular specialty in one eloquent personal statement can feel daunting. That’s why professors designed a special workshop to teach medical students how to beat “writer’s block” and craft effective essays for their residency applications. Follow these steps to begin writing your personal statement. </p> <p> Professors at the Medical College of Wisconsin offered 109 fourth-year students a two-hour writing workshop and found that certain tools—such as writing prompts and peer critiques—helped students overcome anxiety about reflective writing, generate original essay topics and begin writing effective first drafts, according to a <a href="http://www.ncbi.nlm.nih.gov/pubmed/26287917" rel="nofollow" target="_blank">recent study</a> in <em>Academic Medicine. </em></p> <p> In fact, 94 percent of students who completed a post-workshop questionnaire reported that “the workshop had been effective in getting their essay launched” and that “the writing generated at the workshop was included in their final essay,” study authors wrote. </p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/12/c997641a-52ed-47e7-bca6-4dd5fa970a10.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/12/c997641a-52ed-47e7-bca6-4dd5fa970a10.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Whether you have access to a formal workshop setting, you’re pulling together several of your peers to discuss ideas or you’re writing alone, try these recommendations to put your personal statement on the path to success:</p> <p> <strong>1. </strong><strong>Start with writing prompts.</strong> A quick question or statement can serve as a catalyst for brainstorming effective essay topics. These writing prompts can stimulate creativity and break down “writer’s block” so you can freely express yourself on the page, study authors noted.</p> <p> During the workshop, facilitators guided students “through the process of selecting their own personalized writing prompts by reading a list of specific incidents or examples of personal experiences and asking the participants to jot down a word to two about each. Students then picked one or two experiences they found compelling to use as subjects for speedwriting,” according to the study. </p> <p> The prompts were designed to help students recall pivotal moments or personal interests that may have impacted their desire to pursue a career in medicine. For instance, one writing prompt asked students to recall “what you were doing the moment you decided to enter your chosen specialty.” Other prompts referenced more personal, reflective topics, such as “two moments where you couldn’t stop laughing” or hobbies students may have outside of medicine (see right for additional writing prompts).   </p> <p> <strong>2. </strong><strong>Speedwrite, and don’t worry about perfection.</strong> Once students jotted responses to at least two writing prompts, they were instructed to elaborate on their responses by “speedwriting,” which entails “writing continuously and without editing, focusing on narrative, story and action,” according to the study.</p> <p> Students were encouraged to write without stopping for 20 minutes, and if they struggled to think of words during the allotted time, instructors advised them to simply write, “I can’t think of anything” until additional phrases came to mind. “Just keep going!” was the mantra of the speedwriting session, study authors noted.</p> <p> “I liked the free writing,” one student from the workshop wrote in a questionnaire comment. “It is not something I would have ever done on my own, but [it] surprised me in how much it helped just getting thoughts on paper.”  <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/c2c7146c-c279-4d6a-80e2-8b1166e1b777.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/c2c7146c-c279-4d6a-80e2-8b1166e1b777.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> <strong>3.  </strong><strong>Edit for clarity.</strong> After speedwriting, students reworked what they had written using “cross-outs, arrows to indicate reordering and basic editing.” When they finished editing their speedwriting responses, students submitted them to instructors, who photocopied and distributed the responses to workshop participants for peer critique. Students in each workshop group received a stack of photocopied essays from their peers to review.</p> <p> <strong>4. </strong><strong>Request a peer-critique and read your work aloud (this part may take some practice). </strong>Peer critiques followed a simple set of rules: Each “student writer” had to read his or her essay aloud while “listeners followed along, marking their copies where their interest was piqued or where they found wording unclear,” according to the study. </p> <p> Listeners were given additional time to write comments on each students’ essay, including a summary of the main topic they believe the essay addressed. Afterward, they discussed these comments with student writers who had to sit quietly and listen as their peers offered written feedback, observations and suggestions.</p> <p> Student writers could attentively listen and take notes based on peer comments, but they were not allowed to verbalize or defend their thoughts during peer critiques. This allowed students to focus on ways to improve their essays instead of using peer evaluation to defend their writing.</p> <p> Of all the writing activities, study authors noted that reading speedwriting responses aloud was “the most intimidating aspect of the workshop” for students. Yet the majority of students also reported that receiving peer feedback was “the most helpful task” in the workshop.</p> <p> <strong>5.  </strong><strong>Analyze mistakes for revision. </strong>After peer critiques, instructors allowed time for personal reflection and analysis. Students discussed what they discovered while listening to comments and writing insights from their peers. This allowed them to assess the effectiveness of the critique and note major lessons to implement in future personal statement revisions, according to the study.</p> <p> <strong>Want more writing and residency application tips? Check out these resources:</strong></p> <ul> <li> Learn how to write a competitive CV using <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">these six strategic steps</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty).</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get published</a><u>,</u> and review <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list of the top journals</a> seeking to publish work from physicians in training.</li> <li> If you’re just still in the early years of your training but are getting a head start preparing for residency, also be sure to consult <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank">this must-have checklist</a> of tasks to prioritize during your first and second years of training. Also, save this second checklist <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank">for success during your third year</a> of med school.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:57f013da-d193-48d9-b12f-f1ab925b3ae5 6 things physicians wish health IT developers knew http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-things-physicians-wish-health-developers-knew Tue, 10 Nov 2015 04:06:00 GMT <div> Input from physicians and patients is vital to the development of successful digital health solutions, but what are some of the top things developers need to know to start this process? Physicians, developers, professors, bloggers and med students all weighed in last week during a vibrant <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/healthier-nation/build-a-healthier-nation.page" target="_blank">#AHealthierNation</a> tweet chat on the future of digital health.</div> <div>  </div> <div> Designing the future is an indefinite process. The input of those who will live in that future is critical. Here are six things to take away from Thursday’s tweet chat:</div> <div>  </div> <div> <strong>1. Physician interest exists. </strong></div> <div> Many participants agreed that physicians don’t need a push to get involved in digital medicine. </div> <div>  </div> <ul> <li> @jkvedar: “Where I am, many want to innovate—so not too much nudging required.” </li> </ul> <ul> <li> @Geneia: Physician involvement “allows for their insight so that solutions fit seamlessly into existing work flow [at the] point of care.” </li> </ul> <div> Physicians embrace new technologies and want to be involved in their development. On the flip side, when these innovations do not fit into practice work flows, they only cause more frustration.</div> <div>  </div> <div> <strong>2. Start with the problem, not the solution.</strong></div> <div> Though digital health products often solve problems, they aren’t always the problems that physicians experience every day. </div> <div>  </div> <ul> <li> @BreastDocUK identified the problem: Physicians are “too often presented with a solution for [a] problem we didn’t recognize.” </li> </ul> <ul> <li> @Geneia added: “Which actually doesn’t solve anything—but increases frustration.”</li> </ul> <ul> <li> @Cascadia offered a suggestion: “Have docs identify problems they want solved and do a reverse pitch to [the] tech community.”</li> </ul> <div> Physicians want to be involved from the ground floor, and their voices need to be heard at the crucial moments of development. So where does the door open to this ground floor?</div> <div>  </div> <ul> <li> @AmerMedicalAssn pointed to a simple way: “A tangible way for physicians to connect to entrepreneurs is via our new network.” The <a href="https://innovationmatch.ama-assn.org/" target="_blank">Physician Innovation Network</a>, which aims to put physicians in direct communication with developers from the beginning of projects based on interests and needs, is part of a recent collaboration between the AMA and Chicago health tech incubator MATTER. </li> </ul> <ul> <li> @jkvedar noted another option: There are “lots of hackathons and pitch offs in the Boston area,” but he added that he is “not sure that is the best way.”</li> </ul> <ul> <li> @HavasLifeMetro offered a resource to <a href="http://blog.econocom.com/en/blog/hackinghealth-a-hackathon-to-ensure-faster-innovation/" rel="nofollow" target="_blank">learn more</a> about the effectiveness of hackathons. </li> </ul> <div> <strong>3. Get both physician and patient feedback.</strong></div> <div> There are two kinds of end users when it comes to health IT—physicians and patients. Both must offer feedback and insight in the development of digital health solutions. </div> <div>  </div> <ul> <li> @nxtstop1: Physician feedback is “very important. … [There is] a LOT of unhappiness that's scattered thr[ough]out [the] clinical landscape, with no one listening.”</li> </ul> <ul> <li> @VerbalCare: “As a company designing these solutions, involve physicians AND patients in the dev[elopment]. Take into acc[ou]nt their feedback!!”</li> </ul> <ul> <li> @jashenson: “Close the feedback loop. Help doctors see how their feedback leads to new [and] improved digital health tools.”</li> </ul> <ul> <li> @drnic: “Build the feedback mechanism into the app/work flow and make it easy.”</li> </ul> <div> <strong>4. Simplicity in design leads to efficiency … and happy end users.</strong></div> <div> In response to the question, “What are the biggest challenges for two very different users: physicians and patients?” the crowd concluded that too much design can stunt the evolution of digital health technology. </div> <div>  </div> <ul> <li> @StevenStackMD: “They really need different tools and different designs. EHRs fail by trying to be too many things to too many people.”</li> </ul> <div> Often, overdesign can lead to parallel work flow, which does not solve problems but rather adds additional processes to daily practice.</div> <div>  </div> <ul> <li> Michael Hodgkins, MD, via @AmerMedicalAssn: “The common ingredient and most important factor, no matter who the user is, is accurate and easy data/info sharing.”<br />  </li> <li> @StevenStackMD: “Too many ‘tools’ cause inefficiency without creating better work flow.”</li> </ul> <p> So how many “tools” are too many? <a href="http://www.imedicalapps.com/2013/07/apple-android-medical-app/" rel="nofollow" target="_blank">Thousands of medical apps</a> already exist from multiple developers. </p> <ul> <li> @mandl: “HIT should resemble the iPhone so that ‘apps’ can be substitutable. Substitutable apps drive innovation—they can be deleted if they don’t satisfy [with the] end user in control.”</li> </ul> <p> Check out how <a href="http://smarthealthit.org/" rel="nofollow" target="_blank">SMARThealthIT</a> is developing substitutable, user-friendly apps that allow connection to health care data at the point of care and for patients in their homes.</p> <ul> <li> @nxtstop1: "Poor usability for tools designed [for] MDs … many tools asked to serve too many, serve none well.”</li> </ul> <div> <strong>5. Physician-patient engagement is a two-way street.</strong></div> <div> Getting patients involved in their own care is a key contributor to satisfaction for both patients and physicians. If patients can see their medical data, better understand results and gain access to more information regarding their health, then a partnership begins, and the relationship sees equal effort from both sides. And that results in even higher quality care.</div> <div>  </div> <ul> <li> @Geneia: “Patient engagement & good physician-patient relationship helps involve the patient as a key contributor to their [own] care. ... We’ve found w[ith] remote monitoring when patients see their data, they’re more empowered.”</li> </ul> <div> One physician disagreed that wearables are currently ready for implementation, citing that they need more accuracy and must provide more clinically relevant data in order to avoid the many inaccuracies with wearables that clinicians have seen so far. </div> <div>  </div> <div> Wearables can be mistaken for a trend, but physician adoption and promotion could validate wearables as an added layer to patient engagement. </div> <div>  </div> <ul> <li> @BreastDocUK: “We engage patients by showing that we are interested and that they are genuinely central. Give [patients] the tools to lead.”</li> </ul> <div> <strong>6. Developers need to understand physician work flow.</strong></div> <div> Even when physicians are presented with a digital solution that solves one of their most critical problems, often the solution does not fit into their work flow and only adds chaos. </div> <div>  </div> <ul> <li> @jashenson: “Need for efficiences is well accepted, but lack of work flow understanding prevents efficient tools.”</li> </ul> <div> So how can developers gain insight into physician work flow? Physician input is the only answer. To avoid another disconnect between development and work flow—like the one we saw with electronic health records—physicians need to speak up, and developers need to listen.</div> <div>  </div> <ul> <li> Dr. Hodgkins: “We have a chance to avoid that disconnect with this new wave of technology intended to improve patient care.”</li> </ul> <ul> <li> @drnic1: “Let’s hope it’s a chance we grab with both hands.”</li> </ul> <div style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:baf495fb-4ee6-404e-859e-f88075273e97 Now comes the hard part: Turning national attention into action http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_now-comes-hard-part-turning-national-attention-action Mon, 09 Nov 2015 15:17:00 GMT <p> <em>An</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" target="_blank"><em>AMA Viewpoints</em></a> <em>post by Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees</em></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/4/3d9d0cb3-04fd-4d94-9428-f36373f0254e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/4/3d9d0cb3-04fd-4d94-9428-f36373f0254e.Large.jpg?1" style="margin:15px;float:left;" /></a>A father of five in Charleston, W. Va., last month told President Obama at a public event that if it weren’t for the quick response of police and paramedics earlier this year, his daughter would have died from a drug overdose. She is now in recovery, and the president—and the rest of us in the East End Community Center that day—wished him and his daughter the best.</p> <p> Recovering from addiction, however, is not like recovering from a broken bone. It is a chronic medical disease that demands our care and compassion—as physicians and as a nation. We know that more than 24,000 Americans die from a prescription opioid or heroin-related overdose every year. Last month in Charleston, the president, the AMA and dozens of national and local organizations from across the country <a href="https://www.whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector" rel="nofollow" target="_blank">pledged to take action</a>.</p> <p> The hard part is now before us. We need to turn national attention on the problem and the need for greater education and treatment into measurable reductions in opioid-related harm. And we need to do this while preserving access to safe and effective pain care. For physicians, this means that we must act in several clear ways:</p> <p> <strong>1.     </strong><strong>Register for and use your state prescription drug monitoring program (PDMP).</strong> Do this whether you prescribe opioids or not. An effective PDMP can help inform your prescribing decisions by letting you review the patient’s prescription history and identify signs of potential red flags for substance use disorder. Visit the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_blank">PDMP directory</a> to access your state’s PDMP.</p> <p> <strong>2.     </strong><strong>Bolster your education. </strong>When was the last time you took a course on safe opioid prescribing, diagnosis and treatment of substance use disorder, pain management, or other related topics specific to your specialty? The AMA Task Force to Reduce Opioid Abuse has collected the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?" target="_blank">best resources</a> from more than 70 medical societies and other organizations to help you enhance your education as you work to improve patient outcomes.</p> <p> <strong>3.     </strong><strong>Become trained to provide medication assisted treatment.</strong> If there was one message that rang loudest in Charleston, it was the call to remove the stigma of suffering from  substance use disorders. This also includes increasing access to treatment—and that means more physicians need to be able to offer that treatment. If you are interested in being a part of this solution, the American Society of Addiction Medicine offers <a href="http://www.asam.org/education/live-and-online-cme/buprenorphine-course" rel="nofollow" target="_blank">waiver qualifying buprenorphine training</a> in multiple formats, which covers what you need to know. </p> <p> <strong>4.     </strong><strong>Co-prescribe naloxone.</strong> This drug, which helped save the life of the daughter in Charleston, has saved tens of thousands of lives in communities across the country. Now it’s time for us physicians to help increase the number of lives saved by co-prescribing naloxone when it is clinically indicated. The AMA has <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_blank">resources</a> that can help provide more information.</p> <p> At the end of the day in Charleston, we all were energized by the partnership and alignment on what needs to be done to help end the nation’s opioid epidemic. Through our ongoing advocacy and work with the <a href="http://www.ama-assn.org/go/endopioidabuse" target="_blank">AMA Task Force to Reduce Opioid Abuse</a>, the AMA is committed to equipping physicians to accomplish these goals. I urge you to join us.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:dc795975-198f-4d3e-9067-cbbb44eb21c1 Explore new leadership opportunities in med ed http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_explore-new-leadership-opportunities-med-ed Fri, 06 Nov 2015 23:00:00 GMT <p> Are you interested in being a leader in medicine? Seek nomination for several positions in these key medical education organizations.</p> <p> The AMA is accepting nomination applications from AMA members for positions with the following organizations:</p> <ul> <li style="margin-left:57pt;"> <strong>Liaison Committee on Medical Education</strong>: The deadline for nominations is Dec. 4.</li> <li style="margin-left:57pt;"> <strong>National Resident Matching Program</strong>: The deadline for nominations is Dec. 4.</li> <li style="margin-left:57pt;"> <strong>American Board of Family Medicine</strong>:  The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>American Board of Psychiatry and Neurology</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Allergy and Immunology</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Anesthesiology</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Emergency Medicine</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for General Surgery</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Internal Medicine</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Medical Genetics & Genomics</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Neurological Surgery</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Neurology</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Obstetrics & Gynecology</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Orthopedic Surgery</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Pathology</strong> : The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Physical Medicine & Rehabilitation</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Plastic Surgery</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Thoracic Surgery</strong>: The deadline for nominations is February 1, 2016.</li> <li style="margin-left:57pt;"> <strong>ACGME Review Committee for Urology</strong> The deadline for nominations is February 1, 2016.</li> </ul> <p> To learn more about these opportunities or to apply, visit the Council on Medical Education’s <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education/leadership.page?" target="_blank">leadership opportunities</a> Web page. Should you have questions, please contact <a href="mailto:mary.oleary@ama-assn.org" rel="nofollow">Mary O’Leary</a> of the AMA at <a href="tel:312-464-4515" rel="nofollow">312-464-4515</a>. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ac385736-73c7-4946-b055-c7fcd2314b7b How to spur Congress to act: 7 essential elements of storytelling http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_spur-congress-act-7-essential-elements-of-storytelling Fri, 06 Nov 2015 20:24:00 GMT <p> The struggle with electronic health records (EHR) is real, and Congress needs to hear from physicians.  But how can you make your story compelling? How can you pen a tale that cuts to the heart of the matter and inspires your members of Congress to take action? These seven elements of storytelling—recommended by an expert on engaging members of Congress—will help you craft the most potent version of your story.</p> <p> In an AMA Very Influential Physicians (VIP) webinar last week, Brad Fitch, president and CEO of the Congressional Management Foundation, delivered expert advice on how physicians can compose and position their personal EHR stories in an effort to persuade Congress to take action against meaningful use Stage 3 and further progression of the program’s troublesome regulations.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/0/57f8323e-ea0b-4c48-b069-8b17f6d8c503.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/0/57f8323e-ea0b-4c48-b069-8b17f6d8c503.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Why is storytelling important for this cause?</strong></p> <p> Storytelling is a key part of the psychology of persuasion. We feel, and then we decide. In order for Congress to understand the detrimental effect meaningful use regulations have on daily practice, physicians need to deliver a perspective that will show the impact on their lives and the lives of their patients.</p> <p> Members of Congress deal with a lot of data, spreadsheets and graphs every day, Fitch said. This type of information is being delivered to them all the time. But only physicians can communicate the personal stories from the front lines and drive them to act.</p> <p> <strong>The 7 elements of storytelling</strong></p> <p> Your story should be brief. One page, single-spaced, is about 500 words. This length will take approximately four to six minutes to read aloud. If a story is too long, your members of Congress could lose interest, particularly with the numerous other demands for their attention, Fitch said, answering a listener’s question</p> <p> Mark Twain once said, “I would have written a shorter letter, but I didn’t have the time.” Condensing your story can be difficult, but take the time to make it concise. A shorter story is more memorable and can leave a lasting impression, Fitch said.</p> <p> When crafting your story, Fitch recommends using these seven elements of storytelling to most effectively communicate your experience with EHRs and regulations:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>“The Want”:</strong> <strong>Begin with the end in mind.</strong><br /> Know what you want before you begin. Do you want your member of Congress to understand how EHRs have increased costs to your practice or impacted the delivery of care to patients? A good storyteller begins knowing what the end product should deliver emotionally.<br /> <br /> Consider various tactics and methods to achieve your goal in the story. Your goal can be to flatter, surprise, or evoke empathy or urgency. You are the Steven Spielberg of your story. What effect do you want to have on your audience?</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>“The Opening”:</strong> <strong>Set the stage and establish the stakes.</strong><br /> Your first sentence or two should make your reader want to know more. What is at stake for patients, their families or you as the physician providing their care? As much as possible, think about the effect these regulations have on your ability to deliver quality care to your patients.<br /> <br /> Members of Congress are listening for the component that tells them, “If I don’t do X, then Y will happen.”</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>“Paint the Picture”:</strong> <strong>The details and senses of your story.</strong><br /> When you experienced the moment you are writing about, what did you see, hear, touch, taste and smell? These are the elements that will get your members of Congress involved in the story.<br /> <br /> Remember to use adjectives to enhance the power of your narrative. Make it real. Be practical, specific and graphic—don’t hold anything back! What descriptive words could make your story compelling and interesting? For example, substitute “morose” for “sad” or use the word “devastated” rather than “upset.” These are the kinds of impact words that paint the picture of your story.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>“The Struggle”:</strong> <strong>Describe the fight.</strong><br /> Identify the conflict. Real struggles in life are mental, philosophical, emotional, physical—even internal. Every story has a protagonist and an antagonist, and the interactions between these two is where the conflict lies.<br /> <br /> Don’t hesitate to play the underdog. Members of Congress love to come to the aid of the underdog. They want to help David win the battle against Goliath. Play that strength.</p> <p style="margin-left:40px;"> <strong>5.   </strong><strong>“The Discovery”:</strong> <strong>Always surprise the legislator.</strong><br /> What did you learn or realize in the moment of your story? Find this answer and deliver it when it will have the most impact. Then describe how that learning impacted your life, the lives of your patients, the future of your practice and your ability to deliver quality care.<br /> <br /> You may not have a discovery, but is there a part of your story that might surprise the legislator? If you can add a twist—a moment that truly delivers the scope of your struggle—then use it.</p> <p style="margin-left:40px;"> <strong>6.   </strong><strong>“We Can Win!”:</strong> <strong>Introduce the potential of success and joy.</strong><br /> Success in a story is when the hero or heroine wins the fight or struggle. Joy is when the audience can participate and take part in the celebration of victory. If you can hook your members of Congress into feeling the impact of success and the joy that will follow, they become a part of your cause.<br /> <br /> Think: “Senator/Representative, we have the opportunity to ….” Then describe how that victory will enhance your practice and the lives of patients and their families.</p> <p style="margin-left:40px;"> <strong>7.   </strong><strong>“The Button”:</strong> <strong>Finish with a hook.</strong><br /> As you end your story, come up with a last line your members of Congress will always remember. Be thoughtful when composing your final line. Write it out and make it perfect. Have your ending sentence memorized when you’re speaking in person. This way, your member of Congress will remember it for the rest of the day.<br /> <br /> Fitch related a particularly salient example. While delivering his story to a Congressman regarding his inability to acquire necessary medication, a veteran described a moment when his granddaughter asked him, “Poppy, why do your hands shake?” He looked at the Congressman and said, “What should I tell her?” This kind of hook will tug at the heart strings of your members of Congress and stay with them.</p> <p> Once your story is drafted, revised and final, deliver it to your member of Congress. Visit <a href="http://breaktheredtape.org/email-congress" target="_blank" rel="nofollow">breaktheredtape.org</a> to send your story directly to Congress by email.</p> <p> Remember to take your time. A well-crafted story, no matter how small, can hold remarkable power.</p> <p> <strong>How to more actively reach your members of Congress</strong></p> <p> Become a member of the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/grassroots-advocacy/very-influential-physicians.page?" target="_blank">“Very Influential Physicians (VIP)”</a> program by visiting the AMA Grassroots Advocacy Web page to take part in future activities. You also can log in to view the full <a href="https://cc.readytalk.com/cc/playback/Playback.do?id=fa1v1a" target="_blank" rel="nofollow">7 elements of storytelling webinar</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1d706d9a-7e41-421c-b017-a1af7417b604 AMA-IMG Section member named president-elect of Medical Society of Virginia http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-img-section-member-named-president-elect-of-medical-society-of-virginia Fri, 06 Nov 2015 20:00:00 GMT <p> Bhushan Pandya, MD, chair-elect of the AMA International Medical Graduates (IMG) Section Governing Council, has recently been appointed as the 2016 president-elect of the Medical Society of Virginia. </p> <p> Dr. Pandya is the founder and president of the Gastroenterology Center in Danville, Va., and has been in practice for several years. Dr. Pandya will advocate for physicians in Virginia. A hearty congratulations to Dr. Pandya!</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9f27fd29-af00-4236-9706-563bf0fd2704 National Health Hispanic Foundation Scholarship Gala Dec. 3 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_national-health-hispanic-foundation-scholarship-gala-dec-3 Fri, 06 Nov 2015 19:00:00 GMT <p> You are invited to attend National Hispanic Health Foundation Scholarship Gala Dec. 3 at the New York Academy of Medicine in New York City. The foundation honors 20 outstanding medical, dental, nursing, public health and health policy students who have stellar academic records, documented leadership and commitment to working in Hispanic communities.</p> <p> The awards gala provides a unique opportunity to network with members of the National Hispanic Medical Association board, Council of Young Physicians, Council of Residents, medical and premedical students who come from across the nation.</p> <p> Visit the <a href="http://www.nhmafoundation.org/" rel="nofollow" target="_blank">foundation website</a> to learn more, purchase tickets or sponsor a table for 10. If you cannot attend, consider making a tax-deductible contribution. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:50a07d6e-a56f-481e-841e-8088482cf638 Get a crash course about CME credit systems at this special session http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cme-crash-course-this-special-session Fri, 06 Nov 2015 16:00:00 GMT <p> Are you new to the continuing medical education (CME) profession and attending the 41st annual conference of the Alliance for Continuing Education in the Health Professions (ACEhp)? Learn about credit systems that help physicians advance their careers through lifelong learning during a session hosted by the AMA, the American Academy of Family Physicians (AAFP) and the American Osteopathic Association (AOA).</p> <p> The session takes place Jan. 14 during ACEhp’s annual conference, to be held Jan. 13-16 in the Washington, D.C. area.</p> <p> The world of CME credit can be difficult to navigate, which is why this session will help CME beginners learn the differences between organizational accreditation and activity-level CME credit, offer clear interpretations of a complex environment and provide a visual journey down the alternative paths to CME credit. </p> <p> Learners will hear an explanation of the AAFP, AMA and AOA CME credit systems, and how each of these systems do—or do not—relate to the Accreditation Council for Continuing Medical Education.</p> <p> These discussions will clarify how the credit systems work together toward a common goa—to help evolve CME and improve educational programs, so that physicians have the knowledge, skills and professional performance needed to provide better care to patients and improve public health. </p> <p> Whether you’re a CME novice or just looking to better understand complex credit systems, don’t miss this chance to gain the tools you need to determine the appropriate credit pathway for your CME activities.</p> <p> Visit the <a href="http://www.acehp.org/p/ca/vi/sid=86" target="_blank" rel="nofollow">ACEhp site</a> for additional information about the conference.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8a96a908-4f18-44bc-8b10-946a460b7ab9 Physicians (finally) get a say in tech development http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-finally-say-tech-development Thu, 05 Nov 2015 23:27:00 GMT <p> The future of health IT just grew brighter Tuesday with the unveiling of a new collaboration space that will ensure that physicians’ perspectives and needs are taken into account from Day 1 as entrepreneurs develop new technologies. This space will give physicians a chance to collaborate with health care entrepreneurs both physically and virtually on solutions to frustrating practice challenges and opportunities to advance medicine.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/172e3668-c21c-474f-8d41-9ce95201c0ad.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/172e3668-c21c-474f-8d41-9ce95201c0ad.Large.jpg?1" style="margin:5px;float:right;" /></a></p> <p> The <a href="https://vimeo.com/144530495" rel="nofollow" target="_blank">AMA Interaction Studio at MATTER</a>, a health tech incubator in the heart of Chicago, will take opportunities for practical feedback into a new phase. The AMA-MATTER partnership <a href="http://www.ama-assn.org/ama/ama-wire/post/innovators-tap-physicians-technology-insights" target="_blank">launched in February</a>, and so far hundreds of physicians have offered insight and feedback to entrepreneurs working on technological solutions to improve the health of the nation.</p> <p> “This is a day we’ve been excited about since the day we opened,” said Steven Collens, CEO of MATTER. “If you are an entrepreneur, you need access to physicians.”</p> <p> “This environment brings the interaction inside of the building,” he added.</p> <p> <strong>A place to build the future</strong></p> <p> The AMA Interaction Studio provides a space to create unique learning experiences and simulations using cutting-edge exam room equipment in order to build greater technology that streamlines work flows, saves time and allows physicians to spend more time providing quality care to patients.</p> <p> “It’s not just about that space,” said James L. Madara, MD, CEO and executive vice president of the AMA. “[It’s] also about the dialogue that can change the technology that helps us become a healthier nation.”</p> <p> In the front of the studio is a 130-inch projection screen for interaction between physicians from anywhere in the country through Skype and entrepreneurs seated before a webcam. Physicians tuning in to offer their experiences and insights can see the whole studio from this position as if they are in the room.</p> <p> “A lot of people have an idea, and they fly blind and build [the product] with the idea that ‘if I build it they will come’—and that’s a horrible way,” said Danny Bernstein, CEO and founder of metaME Health.</p> <p> Ali Manji, MD, an emergency medicine resident, noted how valuable the technology in the Interaction Studio could be. “If we can get to a point where these products are implemented into practice,” he said, “the time it takes to assess a patient’s condition could be reduced significantly and that will definitely save more lives.”<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/13/bb817969-a04e-44ea-8d95-263b82821d1b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/13/bb817969-a04e-44ea-8d95-263b82821d1b.Large.jpg?1" style="margin:5px;float:right;" /></a></p> <p> Here are some of the products that populate the exam room:</p> <ul> <li style="margin-left:0.25in;"> An exam table that can take blood pressure readings, weigh patients digitally, calculate BMI and send the data to an EHR</li> <li style="margin-left:0.25in;"> An electronic wall board that allows for interactive conversations between physicians and their patients</li> <li style="margin-left:0.25in;"> A 49-inch high resolution monitor to display medical images for patient education</li> <li style="margin-left:0.25in;"> A 3D imaging device that provides immersive, virtual holographic experiences with CT and MRI content for education and research enrichment</li> </ul> <p> <strong>Join the development team</strong></p> <p> The partnership with MATTER reflects the AMA’s commitment to investigating long-term paths to <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/enhancing-professional-satisfaction-and-practice-sustainability.page?" target="_blank">practice sustainability and professional satisfaction</a>. The Interaction Studio was conceived to meet the need for easier connections between entrepreneurs and physicians to gain insights as to what challenges are faced in the day-to-day work flow of their practice so they can build the right solutions to the right problems.</p> <p> In an effort to scale interactions between entrepreneurs and physicians nationwide, the AMA Physician Innovation Network is in beta development to connect and match physicians and health tech companies based on their interests and needs. Physicians can <a href="https://innovationmatch.ama-assn.org/members/home" target="_blank">sign up today</a> for an invitation for the beta release of the site.</p> <p align="right"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:48ac862e-d72a-4883-95c4-ff50c245ccc7 AMA members take on new med ed leadership roles http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_organized-medicine-gets-lift-new-ama-members Thu, 05 Nov 2015 23:00:00 GMT <div> <p style="margin-left:.5in;"> These AMA members were recently appointed by external organizations to leadership positions. These individuals were nominated by the AMA to the respective organizations. Each organization made the final appointment decision from among the candidates it received:</p> <p style="margin-left:.5in;"> <strong>Colleen K. Cagno, MD</strong>, Tucson, Arizona, has been appointed to the<strong> Accreditation Council for Graduate Medical Education Review Committee (ACGME) Review Committee for Family Medicine</strong>, effective July 2016.  Dr. Cagno has been an AMA member for 2 years.</p> <p style="margin-left:.5in;"> <strong>Gregory R.D. Evans, MD,</strong> Tustin, California, has been appointed to the<strong> ACGME for Plastic Surgery</strong>, effective July 2016.  Dr. Evans has been an AMA member for 28 years.</p> <p style="margin-left:.5in;"> <strong>Pierre B. Fayad, MD</strong>, Omaha, Nebraska, has been appointed to the<strong> ACGME Review Committee for Neurology</strong>, effective July 2016.  Dr. Fayad has been an AMA member for 21 years.</p> <p style="margin-left:.5in;"> <strong>Howard W. Francis, MD,</strong> Baltimore, has been appointed to the<strong> ACGME Review Committee for Otolaryngology</strong>, effective July 2016.  Dr. Francis has been an AMA member for 16 years.</p> <p style="margin-left:.5in;"> <strong>Amit Garg, MD</strong>, Manhasset, New York, has been appointed to the<strong> Accreditation Council for Graduate Medical Education Review Committee ACGME for Dermatology</strong>, effective July 2016. Dr. Evans has been an AMA member for 7 years.</p> <p style="margin-left:.5in;"> <strong>Padmaja Kandula, MD</strong>, New York, has been appointed to the<strong> ACGME Review Committee for Neurology</strong>, effective July 2016.  Dr. Kandula has been an AMA member for 2 years.</p> <p style="margin-left:.5in;"> <strong>Cheryl W. O’Malley, MD</strong>, Tempe, Arizona, has been appointed to the<strong> ACGME Review Committee for Internal Medicine</strong>, effective July 2016.  Dr. O’Malley has been an AMA member for 11 years.</p> <p style="margin-left:.5in;"> <strong>Richard S. Pieters, MD</strong>, Duxbury, Massachusetts, has been appointed to the<strong> Accreditation Council for Continuing Medical Education Review Board of Directors</strong>, effective January 2016.  Dr. Pieters has been an AMA member for 35 years.</p> <p style="margin-left:.5in;"> <strong>Liana Puscas, MD</strong>, Durham, North Carolina, has been appointed to the<strong> ACGME Review Committee for Otolaryngology</strong>, effective July 2016.  Dr. Puscas has been an AMA member for 23 years.</p> <p style="margin-left:.5in;"> <strong>Ann E. Van Heest, MD</strong>, Golden Valley, Minnesota, has been appointed to the<strong> American Board of Orthopaedic Surgery, Inc. Board of Directors</strong>, effective October 2015.  Dr. Van Heest has been an AMA member for 10 years.</p> <p style="margin-left:.5in;"> <strong>Joseph S. Yusin, MD</strong>, Los Angeles, has been appointed to the<strong> ACGME Allergy and Immunology</strong>, effective July 2016.  Dr. Yusin has been an AMA member for 3 years.</p> <p> AMA members can apply for AMA nomination for leadership positions with other organizations. To be considered for nomination by the AMA, visit the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education/leadership.page?%5d." target="_blank">leadership opportunities Web page</a>.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cc6dcad3-7ccf-4361-ae09-8b8b06d43f54 Publish like a pro: 5 expert strategies for innovative research http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_publish-like-pro-5-expert-strategies-innovative-research Wed, 04 Nov 2015 22:03:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/c5bc6bf2-02b2-4a88-b2b0-b65190d3c497.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/c5bc6bf2-02b2-4a88-b2b0-b65190d3c497.Large.jpg?1" style="float:right;margin:15px;" /></a>Whether you’re training in an academic medical center, teaching first-year students or investigating novel topics as a fellow, publishing research can <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">boost your CV</a> and make you a more appealing candidate to employers. This is especially true for residents and fellows who plan to pursue careers in academic medicine. Want to write like a med ed pro? It’s never too early to learn. Follow these expert strategies to effectively write and publish research on innovations in graduate medical education (GME).</p> <p> <strong>Finding your next “innovative” idea</strong><br /> When you hear the words “medical education” and “innovation,” what comes to mind? Perhaps futuristic simulations, expansive curriculum overhauls or even thousand-dollar modules promising the next breakthrough in clinical training.</p> <p> But the most creative academic research often originates with a simple quest for new ways to solve existing problems or to improve education, according to authors of a recent <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00228.1" rel="nofollow" target="_blank">editorial article</a> in the <em>Journal of Graduate Medical Education</em>.</p> <p> Far-reaching or exorbitantly expensive ideas don’t automatically embody originality, which is why the article authors encourage educators (and those of you planning to become educators) to “harvest the low-hanging fruits”—assessment tools, faculty development or curriculum changes—of medical education and write about them in bold scholarly research.</p> <p> <strong>How to write and publish GME innovations</strong><br /> From devising <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-devise-better-way-learn-night-float-rotations" target="_blank">a better way to learn during night floats</a> to piloting <a href="http://www.ama-assn.org/ama/ama-wire/post/tired-of-miserable-schedules-one-residency-programs-solution" target="_blank">solutions for tricky schedule conflicts</a>, residents encounter an abundance of “low-hanging fruit” to harvest as ripe publishing material. If you plan to write about future med ed innovations, the article recommends:</p> <p> <strong>1.  </strong><strong>Finding a mentor</strong>. “Writing mentors can be peers, but more often they are senior faculty members with a record of publication success,” the authors wrote. “Mentors can help with the technical aspects of writing—how to clearly write about an innovation and how to navigate the publication process—as well as with organizing and regulating one’s time and motivation. Writing mentors can be found at regional and national education meetings.”</p> <p> <strong>2. </strong><strong>Organizing a writing team or community of education scholars.</strong> Discussing and sharing ideas with a group of trusted peers can help innovation writers overcome barriers in the publication process. Writing teams foster shared member resources, tasks and skills.</p> <p> “These communities also help members stay motivated and accountable to agreed-on writing deadlines,” the authors noted.</p> <p> <strong>3. </strong><strong>Approaching education activities in a scholarly manner. </strong>Authors of the article recommend educators follow six standards for successful scholarship established by the <a href="http://www.carnegiefoundation.org/" rel="nofollow" target="_blank">Carnegie Foundation for the Advancement of Teaching.</a> According to the foundation, high-quality scholarship is characterized by:</p> <ul> <li> Clear goals</li> <li> Adequate preparation</li> <li> Appropriate methods</li> <li> Significant results</li> <li> Effective presentation</li> <li> Reflective critique</li> </ul> <p> “From a practical perspective, these six standards are a useful framework for guiding a rigorous and scholarly approach to the work of medical educators,” the article authors wrote.</p> <p> <strong>4. </strong><strong>Scheduling time for writing. </strong>“Just as a meeting goes on the calendar, so too should time for writing. Although we prefer a minimum of one hour for writing, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23228107" rel="nofollow" target="_blank">studies show</a> that even <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-13-00204.1" rel="nofollow" target="_blank">15 minutes weekly</a> can be sufficient for progress. Also, educators should not become discouraged by very rough first drafts: Often the best ideas come later, during the revision phase,” the authors suggest.</p> <p> <strong>5. </strong><strong>Reading academic publications and following their social media. </strong>While reading every health profession publication is not possible, the article authors recommend educators “ask their library to set up a saved search on a specific area of interest. For example, GME and outcomes, resident wellness and resiliency, or predicting performance and standardized tests.”</p> <p> These searches will generate articles that the library can send to a personal email address.</p> <p> The article also suggests educators peruse the table of contents in medical journals and follow publications’ Twitter handles for relevant information related to their research. Starting a medical education journal club is also a great way to build a community of peers to discuss publishing and written material.</p> <p> <strong>Ready to get published? Start with these resources:</strong></p> <ul> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals for physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_blank">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_blank">these 9 expert tips</a> for getting published in a medical journal.</li> <li> Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_blank">how to handle it.</a></li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7dbe3844-4622-4d9d-92a3-0b3cf1f6baf8 21 more schools tapped to transform physician training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_20-schools-tapped-transform-physician-training Wed, 04 Nov 2015 16:05:00 GMT <p> <object align="right" data="http://www.youtube.com/v/esg2NT0ko1c" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/esg2NT0ko1c" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/esg2NT0ko1c" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" quality="best" src="http://www.youtube.com/v/esg2NT0ko1c" type="application/x-shockwave-flash" width="450" wmode="transparent"></embed></object>A panel of medical education leaders has selected 21 new members of the Accelerating Change in Medical Education Consortium to transform the way future physicians will be trained. Find out which schools were selected and what these transformations will look like.</p> <p> <strong>Expanding a community of innovation</strong><br /> Established in 2013, the AMA’s Accelerating Change in Medical Education Consortium has consisted of 11 founding members that have implemented novel projects to prepare future physicians to care for patients in the rapidly evolving health care environment. The 21 new member schools will build upon many of these <a href="http://www.ama-assn.org/resources/doc/about-ama/x-pub/ace-monograph-interactive.pdf" target="_blank">programs and curricular models</a>.</p> <p> With the added schools, the new 32-school consortium will soon support training for an estimated 19,000 medical students who will one day care for 33 million patients each year.</p> <p> “Our goal throughout this initiative has been to spread the robust work being done by our consortium to accelerate systemic change throughout medical education,” said AMA CEO James L. Madara, MD. “By tripling the number of schools participating in this effort, we know that we will be able to more quickly disseminate the consortium schools’ innovative curriculum models to even more schools—leading to the type of seismic shift that our medical education system needs so that our future physicians can better care for their patients.”</p> <p> <strong>How adding 21 schools will accelerate the transformation of med ed</strong><br /> Each new consortium school will receive $75,000 over the next three years to advance the AMA’s innovative work aimed at transforming undergraduate medical education to better align with the health care system of the 21st century.</p> <p> A national advisory panel evaluated and selected each school’s proposal based on criteria such as how the project would align with or have the potential to enhance the 11 founding schools’ work, as well as the project’s uniqueness and feasibility for implementation in other medical schools. The schools were selected from the108 U.S. medical schools that applied to join the consortium. A total of 170 MD- and DO-granting institutions were eligible to apply.</p> <p> Each school will help advance the work of the consortium around six key themes in medical education including:</p> <p> 1.  Developing flexible, <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-education-explores-competency-based-assessment" target="_blank">competency-based</a> pathways</p> <p> 2.  Teaching and/or assessing new content in <a href="http://www.ama-assn.org/ama/ama-wire/post/new-third-science-bedrock-transforming-med-ed" target="_blank">health care delivery sciences</a></p> <p> 3.  Working with <a href="http://www.ama-assn.org/ama/ama-wire/post/pivoting-new-way-of-training-future-physicians-mayo-clinic" target="_blank">health care delivery systems in novel ways</a></p> <p> 4.  Making <a href="http://www.ama-assn.org/ama/ama-wire/post/equip-new-doctors-digital-health-frontier" target="_blank">technology work</a> to support learning and assessment</p> <p> 5.  Envisioning <a href="http://www.ama-assn.org/ama/ama-wire/post/training-adaptive-learners-will-essential-med-ed" target="_blank">the master adaptive learner</a></p> <p> 6.  Shaping <a href="http://www.ama-assn.org/ama/ama-wire/post/one-schools-new-approach-producing-physician-leaders" target="_blank">tomorrow’s leaders</a></p> <p> The selected schools are:</p> <ul> <li> A.T. Still University—School of Osteopathic Medicine in Arizona</li> <li>   Case Western Reserve University School of Medicine</li> <li> Dell Medical School at the University of Texas at Austin</li> <li> Eastern Virginia Medical School</li> <li>  Emory University School of Medicine</li> <li> Florida International University Herbert Wertheim College of Medicine</li> <li> Harvard Medical School</li> <li> Michigan State University College of Osteopathic Medicine</li> <li> Morehouse School of Medicine</li> <li> Ohio University Heritage College of Osteopathic Medicine</li> <li> Pritzker School of Medicine at the University of Chicago</li> <li> Rutgers Robert Wood Johnson Medical School</li> <li> Sidney Kimmel Medical College at Thomas Jefferson University</li> <li> Sophie Davis School of Biomedical Education/City College of New York</li> <li> University of Connecticut School of Medicine</li> <li> University of Nebraska Medical Center</li> <li> University of North Carolina School of Medicine</li> <li>  University of North Dakota School of Medicine and Health Sciences</li> <li> University of Utah School of Medicine</li> <li> University of Texas Rio Grande Valley School of Medicine</li> <li> University of Washington School of Medicine</li> </ul> <p> “Together, the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_blank">32 schools</a> will collectively work to quickly identify and widely share the best models for educational change to ensure our future physicians hit the ground running as soon as they graduate and begin caring for patients,” said Susan E. Skochelak, MD, AMA group vice president for medical education. “We believe that by working together, the crux of this work can be accomplished in the next five years, which will be a huge win for patients and the health of our nation.”</p> <p> <strong>Interested in more med ed innovations?</strong></p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now" target="_blank">9 med ed challenges</a> educators and consortium members want to solve right now.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/creating-impossible-key-innovations-solutions-med-ed" target="_blank">how educators are creating the impossible</a> for future physician training.</li> <li> Read about the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_blank">11 medical schools</a> in the AMA’s Accelerating Change in Medical Education Consortium.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">current projects</a> these 11 founding members have underway.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/schools-students-transforming-med-ed-now-can" target="_blank">why the consortium is expanding</a>—and how your ideas can help. </li> </ul> <p align="right" style="margin-left:4in;"> <em>By AMA staff writer</em> <a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:09023115-567a-4e1b-91ed-a5551b2c736b New era of high-value care meets medical ethics http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-era-of-high-value-care-meets-medical-ethics Tue, 03 Nov 2015 22:18:00 GMT <p> Medicine is entering the era of high-value care—and physician stewardship is at its core. Should a physician provide care that may only be marginally beneficial because a patient requests it? How should tests be handled in the inpatient versus outpatient setting? And what kind of training should students receive so they can give high-value care? Learn more about these questions and physicians’ ethical obligations in managing health care resources.</p> <div> <p> The <a href="http://journalofethics.ama-assn.org/" target="_blank">November issue</a> of the <em>AMA Journal of Ethics</em> investigates the increasing call for cost transparency as well as the roles physicians and patients should play in achieving high-value care in the changing health care landscape.</p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/4/c0564d99-7b23-4b74-8442-61aa895122ce.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/4/c0564d99-7b23-4b74-8442-61aa895122ce.Large.jpg?1" style="margin:15px;float:right;" /></a> <p> This issue features:</p> <ul> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/11/fred1-1511.html" target="_blank">“The era of high-value care.”</a> A new ethos for practicing medicine emphasizes reducing medical errors, minimizing waste, containing costs and improving adherence to quality metrics.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/11/ecas2-1511.html" target="_blank">“The high-value care considerations of inpatient versus outpatient testing.”</a> These decisions must consider the patient’s best interest, overall needs of the health care system, and costs to other patients whose testing may be delayed.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/11/stas1-1511.html" target="_blank">“The challenge of understanding health care costs and charges.”</a> The price transparency movement seeks to make actual medical costs clear to patients and clinicians.</li> <li style="margin-left:0.25in;"> <a href="http://journalofethics.ama-assn.org/2015/11/coet1-1511.html" target="_blank">AMA <em>Code of Medical Ethics’</em> opinion on physician stewardship</a>. How does the need for physician stewardship of health care resources fit with the ethical obligation is to promote the well-being of individual patients? Find out what the <em>Code</em> says.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/site/ethics-talk-nov-2015.mp3" target="_blank">November podcast</a>, Wendy Levinson, MD, explains how the Choosing Wisely campaign fosters change in medical culture by stimulating dialogue about overuse of tests and treatments. Dr. Levinson is Professor of Medicine at the University of Toronto and leads Choosing Wisely Canada and International.</p> <p> <strong>Ethics poll: Your chance to weigh in</strong></p> <p> What do you think is the largest contributor to wasted spending in the health care system? <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">Share your response</a> in this week’s ethics poll.</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insight for medical students and physicians. Submit your work for publication at <a href="https://www.rapidreview.com/" rel="nofollow" target="_blank">Rapid Review</a>.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:80c3d6ce-4f57-49d2-bea8-0dd50c69bcb0 Examining the physician’s role in evolution of digital medicine http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_examining-physicians-role-evolution-of-digital-medicine Tue, 03 Nov 2015 22:01:00 GMT <p> The potential impact of digital technology on health care is simultaneously undeniable and unexplainable. How can physicians collaborate with innovators to shape the future of digital medicine? Join the AMA in a tweet chat Thursday to investigate the physician’s role in the evolution of digital medicine.</p> <p> <object align="right" data="http://www.youtube.com/v/eARWBVGd5io" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/eARWBVGd5io" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/eARWBVGd5io" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="http://www.youtube.com/v/eARWBVGd5io" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <div> <p> Connect with innovators in digital medicine to examine topics such as user-centered design, wearables, digital solutions and the effect these kinds of innovations will have on physician work flow and the physician-patient relationship.</p> <p> Visit the Web page for <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/healthier-nation/build-a-healthier-nation.page" target="_blank">AHealthierNation</a> and submit your answer to the latest poll: How can physicians lend their voices to the development of digital medicine technology?</p> <p> What developments need to occur in order to make patient-provided data a trusted source of information? What does “user-centered design” mean when there are two very different users in the picture—physicians and patients?</p> <p> Jump into the conversation on the <a href="https://twitter.com/AmerMedicalAssn" target="_blank" rel="nofollow">AMA’s Twitter feed</a>, and tweet your own questions or answers to others using the hashtag <a href="https://twitter.com/search?q=%23AHealthierNation&src=tyah" target="_blank" rel="nofollow">#AHealthierNation</a> Nov. 5 at 4 p.m. Eastern time.</p> <p> <strong>What can you expect from an AMA tweet chat? </strong></p> <p> Check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/top-9-takeaways-heart-health-tweet-chat" target="_blank">top 9 takeaways</a> from a vibrant AMA hosted tweet chat, which took place earlier this fall on World Heart Day, to explore answers to the question: How can physicians partner with their patients to ensure a healthy heart environment? Primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page?" target="_blank">Improving Health Outcomes</a> initiative, sat down with leading cardiologist Clyde Yancy, MD, as his guest.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:312f9af1-0293-4670-aa4e-fe50426a14b9 EHR meaningful use doomed unless Congress steps in http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehr-meaningful-use-doomed-unless-congress-steps Tue, 03 Nov 2015 13:00:00 GMT <p> Congress just received an urgent call to action from physicians: Unless lawmakers intervene in the federal electronic health record (EHR) meaningful use program, physicians—who are frustrated by the “near impossibility of compliance with meaningless and ill-informed bureaucratic requirements”—likely will abandon the program completely. Physicians laid out the bleak situation in letters delivered to Congress Monday night.</p> <p> <strong>Complex requirements and clear-cut problems</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/4/3291bedc-46e7-4ba5-94a2-4c25d46c0bda.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/4/3291bedc-46e7-4ba5-94a2-4c25d46c0bda.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> In the face of <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">new regulations</a> that will make program requirements under Stage 3 even less achievable and more disruptive, the AMA and 110 other medical associations sent letters to members of the <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-senate-02nov2015.pdf" target="_blank">Senate</a> (log in) and the <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-sign-on-letter-house-02nov2015.pdf" target="_blank">House</a> (log in), urging them to intervene.</p> <p> The letters point out that “the Centers for Medicare & Medicaid Services (CMS) has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”</p> <p> Negative consequences of the program have been significant. The letters underscore some of the most serious ones lawmakers need to understand:</p> <ul> <li> Physician time is being diverted from patient care to data entry.</li> <li> Patient records are being filled with unnecessary documentation that is unrelated to providing high-quality care.</li> <li> The program has created new barriers to exchanging data and other information across care settings.</li> </ul> <p> <strong>Ignoring physician concerns, CMS sets unrealistic expectations</strong></p> <p> Although more than 80 percent of physicians have EHRs in their practices, only 12 percent of physicians have been able to successfully participate in Stage 2 of meaningful use. The statistic speaks volumes about how physicians embrace new technology while ill-conceived regulations hold back progress.</p> <p> Physicians have been pointing to the problems with the program for years, asking for remedies that would support physicians in providing the best care possible for patients. Not the least among these concerns is that innovative EHR technologies need to be developed to meet the needs of physicians’ practices and advance the sharing of patient data among the professionals who are providing their care.</p> <p> “It is unrealistic to expect that doing the same thing over and over again will result in a different outcome,” the letters state of how CMS has handled meaningful use regulations over the years.</p> <p> “It is time for Congress to act to refocus the meaningful use program on the goal of achieving a truly interoperable system of EHRs that will support, rather than hinder, the delivery of high-quality care,” physicians said in the letters.</p> <p> <strong>3 things you can do</strong></p> <p> Decision-makers in the nation’s capital need to hear from you. If you haven’t already done so, now is the time to speak out about meaningful use. Here are three important ways you can make your voice heard:</p> <ul> <li> <a href="http://breaktheredtape.org/email-congress" rel="nofollow" target="_blank"><strong>Email</strong></a><strong> your members of Congress.</strong> Tell them that the nation’s patients and physicians need significant changes to Stage 3 of meaningful use. It takes less than a minute to do so via the AMA’s Break the Red Tape website.</li> <li> <a href="http://breaktheredtape.org/submit-comments-cms" rel="nofollow" target="_blank"><strong>Submit comments</strong></a><strong> on the Stage 3 regulations.</strong> CMS is allowing a 60-day comment period for feedback on the final rule. You have until Dec. 15 to help create a groundswell of physician responses that call for changes to the proposal. BreakTheRedTape.org makes it simple to comment.</li> <li> <a href="http://breaktheredtape.org/share-your-story" rel="nofollow" target="_blank"><strong>Share your story</strong></a><strong>. </strong>Join your peers in telling your story about how meaningful use regulations are affecting your patient-physician relationships.</li> </ul> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/Amy_AMAWire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7fcf334c-f80f-46bd-a98a-61ca7be13bc8 Here’s what this year’s medical class looks like http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_heres-this-years-medical-class-looks-like Mon, 02 Nov 2015 22:05:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/0/9ca9ef68-042e-4931-8009-19959a5b4453.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/0/9ca9ef68-042e-4931-8009-19959a5b4453.Full.jpg?1" style="width:501px;height:1654px;margin:15px;float:right;" /></a>More students are entering medicine than ever before, and diversity among students continues to rise, according to <a href="https://www.aamc.org/download/445796/data/2015applicantenrollmentdatacharts.pdf" rel="nofollow" target="_blank">new data</a> from the Association of American Medical Colleges (AAMC). </p> <p> A record-breaking 20,630 students enrolled in medical school for the first time this year, contributing to a 25 percent increase in medical school enrollment since 2002.</p> <p> <strong>How this class is more diverse</strong><br /> Medical school classes are diversifying across ethnic and racial groups, as data shows:</p> <ul> <li> A 6.9 percent increase in Hispanic and Latino enrollees, from 1,859 in 2014 to 1,988 in 2015</li> <li> A 11.6 percent increase in African-American enrollees, from 1,412 to 1,576</li> <li> A 6.9 percent increase in Asian enrollees, from 4,320 to 4,617</li> </ul> <p> The gender breakdown of students in 2015 mirrors that of<a href="http://www.ama-assn.org/ama/ama-wire/post/newest-medical-class-looks-like" target="_blank"><u> last year’s class</u></a>, with male enrollees accounting for roughly 52 percent of students, while females accounted for nearly 48 percent. Among African-Americans, male enrollees increased 9.2 percent over the previous year, from 597 to 652. This increase marks a glimmer of progress for black men, who have historically been among the <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">smallest group of minorities</a> to apply to medical school.</p> <p> “It is very encouraging to see consistent increases in the number and diversity of students in medical school,” AAMC President and CEO Darrell Kirch, MD, said in a news release. “We are hopeful that this becomes a long-term trend as medical schools continue working in their communities to diversify the applicant pool through pipeline programs, outreach efforts and holistic review initiatives.”</p> <p> <strong>A broader picture of students </strong><br /> In addition, white students make up 57 percent of enrollees at 11,767. Students identifying as Native Americans or Alaskan Natives number 195, another 69 are students identifying as Native Hawaiian and other Pacific Islander. A total of 1,655 students identified as other or unknown ethnicity.  </p> <p> <strong>Osteopathic enrollment rises</strong><br /> Medical student enrollment in U.S. osteopathic medical schools also increased by 3.5 percent over 2014 enrollment, with 7,025 students enrolling this year, according to the American Association of Colleges of Osteopathic Medicine.</p> <p> Most of <a href="http://www.aacom.org/news-and-events/news-detail/2015/10/21/2015-enrollment-data" rel="nofollow" target="_blank">this growth is attributed</a> to the creation of two new accredited teaching locations, the Edward Via College of Osteopathic Medicine-Auburn and the Ohio University Heritage College of Osteopathic Medicine Cleveland campus, enrolling their first classes this fall.</p> <p> <strong>The tightening GME bottleneck</strong><br /> The number of applicants to medical school for 2015 rose by 6.2 percent since last year to 52,550, which<a href="https://www.aamc.org/newsroom/newsreleases/446400/applicant-and-enrollment-data.html" rel="nofollow" target="_blank"> AAMC says is </a> exactly double the percentage increase from the previous year. </p> <p> While this record-breaking spike in applicants “shows that medical schools are doing their part to prepare