Continuing Education for Doctors: What Your State Requires

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Medicine is highly dynamic. By one report, there are 4,500 pages of new findings produced every day — that’s a huge amount of material. A conscientious practitioner is going to spend hours each day on homework. Some doctors do, some don’t.

What do states require? There are requirements for continuing education in most (but not all) states in the US. That’s simple recognition of the fact that what one learns in medical school will become obsolete over time.

The states vary from no requirement for continuing education to a requirement of an average of 50 hours per year.  Here are the tiers. (1)

  • No requirement:
    • Colorado
    • Indiana
    • Montana
    • New York
    • South Dakota
  • 15 hours per year (average):
    • Vermont
    • Wisconsin
  • 20 hours per year (average):
    • Arizona
    • Arkansas
    • Delaware
    • Florida
    • Georgia
    • Idaho
    • Iowa
    • Kentucky
    • Louisiana
    • Mississippi
    • Nevada
    • North Carolina
    • North Dakota
    • Oklahoma
    • Oregon
    • Rhode Island
    • South Carolina
    • Tennessee
    • Utah
    • Wyoming
  • 24 hours per year (average):
    • Texas
  • 25 hours per year (average):
    • Alabama
    • Alaska
    • California
    • Connecticut
    • District of Columbia
    • Maryland
    • Minnesota
    • Missouri
    • Nebraska
    • New Mexico
    • West Virginia
  • 30 hours per year (average):
    • Virginia
  • 33 hours per year (average):
    • Kansas
  • 50 hours per year (average):
    • Hawaii
    • Illinois
    • Maine
    • Massachusetts
    • Michigan
    • New Hampshire
    • New Jersey
    • Ohio
    • Pennsylvania
    • Washington

How much is enough? None is probably not good. Even 3 days per year seems light.

The problem is that doctors can’t be counted upon to sign up for training when it isn’t required. In one example, in 2015, to counter the current epidemic of painkiller abuse, the FDA required drug makers to offer opioid training classes for physicians. Unfortunately, only 38,000 of the roughly 320,000 physicians who prescribe these drugs signed up for the classes. (2)

What training has your doctor taken recently?


Sources:

  1. Medscape, “State CME Requirements,” last updated April 2016. http://www.medscape.org/public/staterequirements
  2. Bloomberg, “Undertrained Doctors, Overprescribed Drugs,” 4 May 2016. https://www.bloomberg.com/view/articles/2016-05-04/undertrained-doctors-overprescribed-drugs

Early surgery for hip fractures can save lives

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This is something that any senior or anyone caring for a senior should see.

Researchers at Southmead Hospital (UK) report that surgery within 24 hours of injury save lives among elderly patients with hip fractures.

They analyzed data from 241,446 British patients, measuring the death rate in the 30 days after admission. They found that if surgery were delayed past 24 hours, the death rate increased by 8%. The death rate increased by 20% if surgery were delayed 48 hours.

The concern with elderly patients is whether they need time to stabilize after an injury. It turns out that taking that time can add to their risk.

Has your doctor seen that report?


Sources:

  1. BBC News, “Early Hip Fracture Surgery Will Save Hundreds of Lives,” 20 April 2017. http://www.bbc.com/news/uk-england-bristol-39655669

 

ACA Repeal, Again

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According to Bloomberg, the White House wants Congress to vote on a revised bill next week.  There are some proposed amendments to the bill that failed in March in an effort to try to unify GOP House members to support the bill, but nothing has been finalized.

One item being considered is a proposal by Representative Tom MacArthur (R, NJ):

The amendment, reported earlier by Huffington Post, would allow insurers to charge higher premiums to people with pre-existing conditions in states that get a waiver. To obtain the waiver, states would have to provide sick people priced out of commercial insurance access to a so-called high-risk pool run by the federal government, or establish their own, and satisfy other conditions. (1)

A separate commentary on the same issue goes further:

According to a draft of the tentative deal obtained by POLITICO, the latest proposal would allow states to apply for “limited waivers” that would undermine Obamacare’s protections for pre-existing conditions. Under these waivers, states could opt out of Obamacare standards setting minimum benefits that health plans must offer and a requirement — called community rating — forbidding insurers from charging different prices to people based on health status. Both are provisions that the GOP’s ultraconservatives have pushed to eliminate as part of the repeal effort, contending that these coverage mandates drive up the cost of insurance.

What this means in practice is a two-tiered health system based on where people live. People in places like Mississippi and Kentucky that have relatively poor healthcare now, will have less access to healthcare and higher costs in the future. Conversely, states that offer better healthcare will maintain existing benefits. That’s a compromise that could pass, or could just make everyone unhappy.

Overall, this attempt keeps the negatives associated with the bill, and adds one more. Historically, risk pools haven’t worked. They’ve been budget-breakers when they’ve been tried for auto and health insurance in several states. If anything, more people will lose health coverage and costs will escalate as predicted by the CBO.


Sources:

  1. Billy House, Jennifer Jacobs, “White House, GOP leaders at odds over plans for Obamacare vote,” BenefitsPro, 20 April 2017. http://www.benefitspro.com/2017/04/20/white-house-gop-leaders-at-odds-over-plans-for-oba?kw=White%20House%2C%20GOP%20leaders%20at%20odds%20over%20plans%20for%20Obamacare%20vote&et=editorial&bu=BenefitsPRO&cn=20170420&src=EMC-Email_editorial&pt=News%20Alert
  2. Adam Cancryn and Josh Dawsey, “White House plans Obamacare showdown next week,” Politico, 20 April 2017. http://www.politico.com/story/2017/04/20/obamacare-repeal-republicans-new-deal-237397

 

Surgical Safety

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This finding appeared today, and it raises all sorts of questions about the quality of care in some hospitals in the US:

South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist. (1)

In the South Carolina test, 14 hospitals volunteered to use the checklist, and saw a decline in deaths within the thirty days following surgery. Other hospitals in the state saw a slight increase in deaths during the same period. The trial program was run in these hospitals between 2010 and 2013.

The writers make a point that hospitals need to truly commit to the procedure, not treat it  as “a checkbox.”

There are two items that are shocking about this:

  • That the country with the most expensive healthcare in the world needs to learn this from others, and
  • The checklist has been in existence since 2008. (2)

Has your hospital adopted this checklist? If not, do you want to find one that has?

 


Sources:

  1. Alex B. Haynes, Lizabeth Edmondson, Stuart R. Lipsitz, George Molina, Bridget A. Neville, Sara J. Singer, Aunyika T. Moonan, Ashley Kay Childers, Richard Foster, Lorri R. Gibbons, Atul A. Gawande, William R. Berry. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of Surgery, 2017; 1 DOI: 10.1097/SLA.0000000000002249
  2. Institute for Healthcare Improvement, “World Health Organization (WHO) Surgical Safety Checklist and Getting Started Kit.” http://www.ihi.org/resources/Pages/Tools/WHOSurgicalSafetyChecklistGettingStartedKit.aspx

Aspirin and Cancer

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A low dose aspirin regimen may

  • Reduce the risk of heart attack
  • For persons over 50, reduce the risk of certain types of cancer including colorectal.

The risk associated with daily aspirin use is internal bleeding. Thus, for example, its not recommended for people with stomach ulcers. The bleeding risk increases with age, so some doctors are reluctant to recommend an aspirin regimen for people over age 60. A task force has recommended that use over age 60 be left to the individual, and be based on whether an individual is more concerned about the bleed risk or the potential benefits with regard to cancer and heart disease.


Soources:

  1. Arefa Cassoobhoy, MD, MPH, “Aspirin to Prevent Cancer: What to Tell Patients,” Medscape, 14 April 2017. http://www.medscape.com/viewarticle/878567?nlid=114187_1521&src=WNL_mdplsfeat_170418_mscpedit_wir&uac=153634BV&spon=17&impID=1330937&faf=1
  2. Mayo Clinic, “Daily aspirin therapy: Understand the benefits and risks.” http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/ART-20046797

 

ATVs, Children and ERs

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With summer temperatures hitting much of the US this week, this is a timely topic.

In the most recent year for which data is available (2013), there were 99,600 ATV accidents in the US that required treatment at an Emergency Room. One-quarter of these involved riders younger than 16. That’s approximately 25,000 kids.

Five states account for 80% of child deaths on ATVs: Texas, California, West Virginia, Pennsylvania and Kentucky.

The Consumer Products Safety Commission actually warns against having kids drive or ride as a passenger on an adult ATV. That and the lack of safety gear are what make this a public health nuisance and a contributor to health insurance rates.

ATVInfographicStates


Sources:

 

  • Wake Forest Baptist Medical Center. “ATV-related injuries in children remain large public health problem.” ScienceDaily. ScienceDaily, 15 April 2017. <www.sciencedaily.com/releases/2017/04/170415182157.htm>.
  • US Government Accountability Office, “All Terrain Vehicles,” April 2010.
    US Consumer Products Safety Comission, “ATV Safety Center.” https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/ATV-Safety-Information-Center/
  • US Consumer Products Safety Comission, “Five States Account for 25 Percent of All Reported ATV-Related Deaths in the United States,” 17 Feb. 2017.

More on Diabetes

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The US is seeing modest, steady growth in the incidence of diabetes among children and teens. A new analysis of data from 2012 to 2012 shows

  • An increase in Type 1 Diabetes of 1.8% per year and
  • An increase in Type 2 Diabetes of 4.8% per year.

While there’s a genetic component, diabetes risk is associated with

  • Family history
  • Immune system issues
  • Diet and weight (and exercise)
  • Blood pressure

Europeans understand that how you care for yourself affects health care costs and health insurance rates for everyone around you. It’s not just about you. Teaching a child to veg in front of a computer or TV simply shortens the child’s life.

However, one of the frustrations with public health data is lack of currency. Has the situation gotten better or worse in the last five years?  My guess is worse, but we simply don’t know.


Sources:

  1. Elizabeth J. Mayer-Davis, Jean M. Lawrence, Dana Dabelea, Jasmin Divers, Scott Isom, Lawrence Dolan, Giuseppina Imperatore, Barbara Linder, Santica Marcovina, David J. Pettitt, Catherine Pihoker, Sharon Saydah, Lynne Wagenknecht. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. New England Journal of Medicine, 2017; 376 (15): 1419 DOI: 10.1056/NEJMoa1610187
  2. NIH/National Institute of Diabetes and Digestive and Kidney Diseases. “Rates of new diagnosed cases of type 1 and 2 diabetes on the rise among children, teens: Fastest rise seen among racial/ethnic minority groups.” ScienceDaily. ScienceDaily, 14 April 2017. <www.sciencedaily.com/releases/2017/04/170414105821.htm>.
  3. International Diabetes Foundation, “Risk Factors.” http://www.idf.org/about-diabetes/risk-factors
  4. Mayo Clinic, “Diabetes.” http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/con-20033091