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CVMS Bulletin - Shorts
December 24, 2023
To all professionals dedicated to the art and science of patient care:

Short weekly news items relevant to your medical career.

May the Joy and the Blessings of the Season be with you and your Family at this most Wonderful Time of the Year!

Today's Medical News and Healthcare Updates

Get your medical news of the week right here on the CVMS website - all that's relevant in Medicine and Healthcare. Current Medical and Healthcare News

Many Physicians Leaving Academic Medicine

A recent report in JAMA referenced a study showing that at least 1/3 of academic physicians have at least a moderate intention to leave their positions within the next two years. Dissatisfaction with their careers, burnout, lack of professional fulfillment, and a combination of institutional and individual factors were often cited as the primary reasons. This is the result of a survey among almost 19,000 physicians at 15 academic medical institutions. This may have a significant impact on the quantity and quality of current residency programs and even further reduce our nation's ability to deal with the shortage of physicians over the next several years. It further suggests a need to develop institutional programs to address these issues and try to prevent these turnovers as much as possible.

Read more... Academic physician turnover - JAMA

Monoclonal Antibodies: A New Treatment for Long COVID?

A recent, small, but impressive study of only three patients with Long COVID were completely cured within 5 days of receiving acasirivimab-imdevimab infusion. The report appeared in the American Journal of Emergency Medicine written by Kenneth Scheppke, MD and others and will obviously require corroboration with further studies. However, since we have nothing else that will treat Long COVID and since this is so debilitating for many patients, any potential breakthrough is exciting.

Monoclonal Antibodies for Long COVID

Taking Care of our Aging Population

A recent editorial in the Virginian-Pilot addresses the need to do better in our communities in taking care of our aging population.
Caring for Seniors

Virginia CON laws

A excellent editorial published in the Virginian Pilot explained how Certificate of Need laws work in Virginia and how they are interfering with quality healthcare, access to care and causing increasing healthcare prices. These costs have to be paid by patients either directly or indirectly through higher insurance premiums, or by providers who lose money because they cannot get CON approval for outpatient procedures. They can't get approval because current hospitals want to prevent local competition. Hospitals lobby our state legislature with large contributions to political campaigns in return for votes to maintain the current CON laws, even though those laws are harmful to patients, doctors, and the healthcare community at large. The excuses that hospitals use to justify this are nothing more than lame rationalizations about providing so much charity care, that they need to offset further potential losses due to losing business to outpatient clinics and procedures. That is not really happening because they they are so overcrowded already that it takes weeks to schedule many of these procedures. Meanwhile, these healthcare systems get bigger and bigger, charge higher and higher prices. The money they earn from these policies does not seem to go to patient care, at least not where we can see it. So where is it going? Please notify your state representatives that these CON laws are archaic, have no benefit for patients, cause higher prices, reduce access to care, and are harmful to the healthcare in our area as well as across the nation.

Here is a link to the article as it appeared in the newspaper last week...

Editorial in Pilot on CON by Jaimie Cavanaugh and Daryl James

Declining U.S. Health System

According the U.S. News for 2023, the United States is NOT in the top ten list of countries in the world having the best public health care system. That is appalling in and of itself. But what is even more sad and disappointing is that we are not even in the top 20! We are number 23, having dropped two positions since last year. Yet we spend more per capita on health care than any other country. Switzerland is the best.

This report was based on a survey of over 17,000 citizens worldwide answering questions about 73 different attributes of healthcare in 87 countries.

Of course, our healthcare in the U.S. is not exclusively a public healthcare system (except for Medicare and Medicaid) like they have in Switzerland, Britain, or Sweden where the government runs healthcare using taxes from the public. But it might as well be. We are mostly run by huge private entities that have already usurped physician autonomy. They are mostly concerned about the business aspect of care and are probably less concerned about patient care than the government is. The government's main concern is to prevent harm to the public and therefore most of the rules and regulations from lawmakers are in place to prevent fraud and abuse and to save money for Medicare and Medicaid. Commercial Insurance is concerned only about making money and are constantly at odds with physicians who have done the work and want to get paid an appropriate fee commensurate with their education, training and purpose of saving lives and improving health both individually and publically.

Even so our public Medicare and Medicaid systems still should be better than 23rd in the world.

These are sobering statistics and they are getting worse, not better. We physicians think it starts with the fact that our healthcare is currently operating under rules and regulations designed by government lawmakers and big monopolized businesses with public protection and money- making respectively as the primary goals. Most of the rulemakers know very little about patient care. Businesses don't not care about patients. They just approach the problems in healthcare with money and metrics in mind. They tend to disregard the evidence that is already available.

Because of heavy lobbying, The government is too influenced by the business model of making money and saving it rather than thinking about how to make things better for patients and providers. Lawmakers just want to protect the public from "bad doctors" and make a lot of rules that prevent the mostly good ones from enjoying medicine just to control the few bad ones. Doctors don't have anywhere near the amount of money that business and insurance have to lobby our legislators. There are no incentives in government or business to help providers to do better. We're on our own. In fact, the incentives are all lined up to take away rights and income from physicians. In addition, we are demoralized by the systems that have been put into place that assume we are all fraudulent, or lazy, until proven otherwise. Medicare and other insurance companies are constantly trying to think up ways to not pay us what we have earned. There are too many barriers to patient care in order to prevent us from spending too much money, resulting in enormous inefficiencies and delays. Patients and providers are constantly frustrated by these things while the businessmen and administrators are going home happy and retiring in luxury.

The pinnacle of our system should be the primary care physicians, but we treat them poorly, overloading them with more and more paperwork and computer work and taking away actual patient care. We didn't go into this career wanting to make perfect records. We went into this to make patients get better. We don't have time to actually think about complex cases any more. We have to spend that time creating a document that must be all inclusive so that the money makers can charge a big enough fee that will make their organizations even bigger. Has there ever been any proof that a bigger organization takes better care of patients than a smaller one? If so, I have never seen it. Where is the evidence that drives our health systems to believe this?

Have you ever seen or heard of a burned out health insurance executive or healthcare administrator. They did not have to go through advanced education for 12 years and incur $400,000 in debt only to be told later by his/her boss, the administrative vice president, who makes considerably more than the doctor does by the way, that he/she needs to step up and see more patients every day. Otherwise, his/her value to the organization will be questioned?

Physicians need to have a much stronger voice of advocacy in order to make changes. The only way to do this is to get the public to recognize the problems we are facing and to pressure their representatives to change the laws to fix them. The first thing to do in my mind is to break up the huge monopolies of insurance and business systems that are trying to run healthcare like they would a retail outlet mall. Good luck with that. Right? But we have to try.

Please join us. People need to know that we are not the problem. We are the ones who are concerned about these things, and that we need their help to make them better, little by little.

U.S. News report on countries with the best public health care.

Visit from St. Nicholas by Clement Clarke Moore

'Twas the night before Christmas, when all through the house
Not a creature was stirring, not even a mouse;
The stockings were hung by the chimney with care,
In hopes that St. Nicholas soon would be there;
The children were nestled all snug in their beds;
While visions of sugar-plums danced in their heads;
And mamma in her 'kerchief, and I in my cap,
Had just settled our brains for a long winter's nap,
When out on the lawn there arose such a clatter,
I sprang from my bed to see what was the matter.
Away to the window I flew like a flash,
Tore open the shutters and threw up the sash.
The moon on the breast of the new-fallen snow,
Gave a lustre of midday to objects below,
When what to my wondering eyes did appear,
But a miniature sleigh and eight tiny rein-deer,
With a little old driver so lively and quick,
I knew in a moment he must be St. Nick.
More rapid than eagles his coursers they came,
And he whistled, and shouted, and called them by name:
"Now, Dasher! now, Dancer! now Prancer and Vixen!
On, Comet! on, Cupid! on, Donder and Blitzen!
To the top of the porch! to the top of the wall!
Now dash away! dash away! dash away all!"
As leaves that before the wild hurricane fly,
When they meet with an obstacle, mount to the sky;
So up to the housetop the coursers they flew
With the sleigh full of toys, and St. Nicholas too—
And then, in a twinkling, I heard on the roof
The prancing and pawing of each little hoof.
As I drew in my head, and was turning around,
Down the chimney St. Nicholas came with a bound.
He was dressed all in fur, from his head to his foot,
And his clothes were all tarnished with ashes and soot;
A bundle of toys he had flung on his back,
And he looked like a pedler just opening his pack.
His eyes—how they twinkled! his dimples, how merry!
His cheeks were like roses, his nose like a cherry!
His droll little mouth was drawn up like a bow,
And the beard on his chin was as white as the snow;
The stump of a pipe he held tight in his teeth,
And the smoke, it encircled his head like a wreath;
He had a broad face and a little round belly
That shook when he laughed, like a bowl full of jelly.
He was chubby and plump, a right jolly old elf,
And I laughed when I saw him, in spite of myself;
A wink of his eye and a twist of his head
Soon gave me to know I had nothing to dread;
He spoke not a word, but went straight to his work,
And filled all the stockings; then turned with a jerk,
And laying his finger aside of his nose,
And giving a nod, up the chimney he rose;
He sprang to his sleigh, to his team gave a whistle,
And away they all flew like the down of a thistle.
But I heard him exclaim, ere he drove out of sight—
“Happy Christmas to all, and to all a good night.”

Wishing you all a very Merry Christmas! From Coastal Virginia Medical Society

We hope you enjoyed reading the Bulletin Shorts. Any opinions expressed here are those of the authors and not necessarily representative
of any other member or Board member, or anyone else affiliated with Coastal Virginia
Medical Society (CVMS). Any decisions, recommendations, conclusions and/or consensus
approved by the Board or by the CVMS Membership will be stated as such in the newsletter.

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Editor, Author: Dr. Greg Warth
Additional Authors, Contributors: Dr. Alexandria Peck Berger, Dr. David Archer, Dr. Jerome Blackman

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