American Indians in cities across the country are facing startling health challenges unlike those of any other urban population, according to a study by the Seattle-based Urban Indian Health Institute. There are few places urban American Indians can seek out culturally competent healthcare, experts say. Although providing healthcare to all Indians has long been part of the government's trust responsibility, several in the government's network came under fire for mismanagement.
The San Francisco Health Commission has slashed its budget, and as a result nurses won't be making home visits to their homebound patients anymore. In addition, operating rooms at San Francisco General Hospital will be closed eight hours a day. Critics say the budget cuts contradict the city's initiative to provide universal healthcare to its residents because many uninsured people use the programs suffering because of the budget deficit.
Changes in Medicaid funding could cost Georgia more than $2.6 billion during the next five years and potentially shut down dozens of the state's hospitals, health clinics and nursing homes. Under the proposed changes, state funding to Grady Memorial Hospital in Atlanta would be eliminated, which would virtually guarantee its closure. A report released by the House Oversight and Government Reform Committee showed that Georgia would be among the hardest-hit states, unless congressional Democrats can prevent the administration's orders.
A collaboration among four Nashville hospitals or hospital systems calls for the exchange of health information. The agreement between Saint Thomas and Baptist hospitals, Metro General, Vanderbilt and HCA Inc.'s TriStar Health System has the potential to eliminate redundant tests. But before information can be shared, representatives of the hospitals have to decide the types of data to exchange and issues such as regulatory compliance, connectivity and privacy.
A DuPage County, IL board committee has voted to recommend restoring funding for several items reduced or dropped under financial belt-tightening at the end of 2006, including medical care. One of the programs that will see additional funding through the move is Access DuPage, which connects low-income uninsured county residents with doctors and hospitals willing to treat them without a fee.
A federal judge on has granted preliminary approval to a settlement between General Motors Corp. and the United Auto Workers that would set up a trust to fund the automaker's retiree healthcare. GM and the UAW agreed to form the trust as part of contract negotiations, but need court approval for it to take effect. The UAW and attorneys representing several retirees sued GM in an effort to get court approval for the change. If they win the approval, the trust would take on $46.7 billion in healthcare costs starting as early as Jan. 1, 2010.
The Government Accountability Office is investigating whether the Food and Drug Administration's drug-review process cleared two blockbuster medications without sufficient proof of their safety or effectiveness. Sen. Charles Grassley suggested the investigation after recent studies showed the drugs may not lower the risk of heart attack and artery-clogging plaque, as assumed by millions of patients and doctors.
While many of the "high-alert" medications are the most essential to hospitals, healthcare providers are taking steps to prevent errors in the use. These medications have the highest risk of seriously harming or even killing a patient when given in the wrong dose or used incorrectly. Amid growing awareness of medication mistakes and pressure from safety groups, hospitals are scrambling to overhaul their safety practices surrounding these medicines.
Five doctors organizations have launched a Web site and campaign designed to persuade physicians to switch to electronic prescribing. The Web site includes a technology guide to help doctors move to e-prescribing, provides perspectives of other doctors on the benefits of e-prescribing, and points to connected pharmacies. The Get Connected campaign and theGetRxConnected.comWeb site is aimed at the 94 percent of doctors in the U.S. who still do not write prescriptions electronically.
It's no secret that rural areas have a hard time recruiting physicians. Yet according to a survey of nearly 2,000 physicians by LocumTenens.com, roughly 80 percent of doctors who have never practiced in a rural area are not opposed to the idea--at least in theory. So why do only 10 percent of docs choose to practice in rural settings, even though 22 percent of the population lives in rural areas?
The survey found that of those physicians who have never practiced in a rural area:
26 percent never found the right opportunity.
23 percent have never been offered a position.
19 percent never considered it.
12 percent don't want to live there.
9 percent would only be interested in a specific rural area.
4 percent don't want to work there.
7 percent have other miscellaneous objections.
It appears that to get more physicians to choose rural medicine, docs need more exposure to rural jobs. Remember Benjamin Stone, the hotshot doctor in the 1991 comedy Doc Hollywood? Yes, I admit that I have seen this movie--in its entirety. But while the film may not have been Oscar-worthy, the fictional town had an interesting idea: force doctors to stay in your town long enough to see the virtues of rural medicine and the charm of your community. In the movie, Stone (Michael J. Fox) is traveling to a high-paying, low-stress job in California when a judge orders him to perform community service in the local hospital after a traffic accident. Of course, once he finally makes it to his big-money job out West, he realizes that he misses practicing small-town medicine--well, that and a girl. So he comes back.
Now, hospitals can't force physicians to stay in their communities by way of court order, of course. But offering more opportunities for docs to practice in rural areas may not be such a bad idea. For instance, the Pacific Northwest University of Health Sciences College of Osteopathic Medicine, which is expected to open this fall, plans to rotate medical students through hospitals, including rural facilities in the Pacific Northwest, to give them experience and confidence at those sites.
According to many healthcare leaders that I have spoken with, rural areas need to use everything in their arsenal when it comes to recruitment. Invite medical students to your facility to meet staff. Offer clinical rotations in your emergency department on nights and weekends. Use every method at your disposal to find potential candidates, including the Internet, radio, direct mail, cold calling, e-mail campaigns, career fairs and communication with training programs.
Physicians who are willing to practice in a rural area obviously have very specific ideas of what they are looking for, so when a doctor comes calling make sure to have a detailed itinerary, including a facility tour, meetings with key docs, a tour of the town (including real estate), and dinner at the best restaurants. You may never know exactly what a physician wants, but you can showcase the strengths of practicing medicine in a rural area. For example, highlight the fact that the administration is likely to be more responsive to its physicians in a rural community than in larger hospital settings.
Finally, perhaps the most important element is patience. Don't show your frustration even if you have been rejected more times than you would like to count. Stick with it--eventually your Dr. Right will come strolling through town. And just maybe it will be before physicians have come out of retirement to keep your hospital open.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
