The roiling economy appears to be ripping into the ranks of upper management, as the chief executive turnover rate is at an all-time high. This year, 1,132 CEOs have left their posts, according to employment consulting firm Challenger, Gray & Christmas Inc. Challenger chief executive John A. Challenger said the rise in the turnover rate probably reflects increasing pressure on corporate leaders from their boards and shareholders. Turnover was heaviest in the healthcare sector, with 206 departures. In part, however, that stems from the large number of small healthcare businesses, Challenger said.
Hospital operator Universal Health Services Inc. isn't taking a serious hit from the current economic crisis, although a major downturn would be cause for concern, company's chairman and chief executive Alan B. Miller said. Hospital industry stocks have sold off sharply this week, apparently due to concerns that a weak economy and associated job losses will translate into higher levels of uninsured patients and uncollectible bills and lower volumes of patients in commercial health plans. Universal Health had an "exceptional" first half of the year that exceeded the company's expectations, Miller said.
Five Central Florida doctors have been disciplined in separate cases involving wrong-site surgeries or incorrect procedures being carried out. The Florida Board of Medicine voted to fine Orlando surgeon Jonathan Greenberg $5,000 for operating on the wrong disc in a patient's back in September 2006. The board also fined Orlando urologist Stephen Butler $10,000 for operating on the wrong testicle of a patient during an April 2007 procedure. Three other cases involved cataract procedures in which doctors initially put the wrong kind of lens implants in their patients, according to state documents.
Professionals call it elderspeak, the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health, for example. Now studies are finding that the insults can have health consequences.
In this editorial from the Boston Globe, editors say a a spate of health-facility construction in Massachusetts will inevitably add to the medical bills that employers and consumers must pay. "This boom in bricks and mortar is coming just as new data on patients' long waits for appointments with primary-care physicians show that the real need in the healthcare system is for more of these front-line practitioners," the editorial states. The article says that while expanding the corps of primary-care doctors is a problem that will require long-term changes in the incentives for medical students choosing specialties, the state can use its regulatory authority to crack down on questionable new health construction projects.
In this editorial from the New York Times, editors praise the fact that Medicare will no longer pay hospitals for the added cost of treating patients who acquire any of 10 "reasonably preventable" conditions while hospitalized. The editorial says, however, that the policy focuses exclusively on hospitals, as directed by Congress, and lets doctors off scot-free.
Earlier this month, a doctor who serves underinsured patients received a letter from Danville (VA) Regional Medical Center informing him that after 14 years, his services were no longer required. Two days later, he officially lost his job. "I wish I could say I understand it," said Phillip Hale, MD. "It seems to be driven by (the hospital's) bottom line mentality without really looking at the big picture." Hale said Family Healthcare Center where he practiced was losing money and he believes that led to the termination of his contract.
Stress and uncertainty about the stock market, jobs, housing and retirement can actually trigger physical symptoms, doctors say. As a result, America's troubles could lead to more visits to the doctor for some. Doctors say people's financial troubles can, in fact, spread to your body and cause everything from ulcers to heart attacks.
I work hard. My job—like most jobs—requires that I produce quality work even during the most hectic of times. Whether it's of the physical or existential variety, the fatigue resulting from unexpected projects or protracted work hours or numbing repetition just comes with the territory. I confess I'm not above trying to use fatigue as an excuse, mind you—but it's really not an excuse.
Fatigue is a relative term, however. If I were forced to work, say, 80 hours a week, I'd probably last about... a week. My writing would grow less crisp. I'd start missing mistakes in the editing process. I might even doze off in a meeting or two.
Medical residents, of course, don't have that luxury. In fact, they probably view 80 hours as an improvement from years past. Historically, residents have trudged through 100-hour weeks and at times worked 36 hours straight. And even in their most bleary-eyed state, residents have always been expected to maintain their focus on quality and ensuring patient safety. If I'm tired and the quality of my work slips, we print a correction. If a resident is tired and the quality of his or her work slips, someone dies.
The Accreditation Council for Graduate Medical Education in 2003 tried to address the issue of fatigue-related medical errors by limiting residents to 80-hour weeks and 24- to 30-hour shifts. Is it working? Many of you may have seen a study, "Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety," published in Pediatrics magazine that says, for the most part, no. The study of resident work hours at three pediatric training programs drew some grim conclusions. Some examples:
The rate of medication errors did not change.
The rate of physician ordering errors actually crept up, from 1.06 to 1.38 errors per 100 patient days.
Residents' measured total work hours and sleep hours did not change.
Rates of depression, car wrecks, and accidental needle sticks among residents did not change.
The catch is that while the report was released in August 2008, the data is from 2004, according to the ACGME's Ingrid Philibert, senior vice president for field activities. How much change can really be expected in the year between the ACGME's creation of the restrictions and the collection of the data? Won't we continue to see improvements both in error rates and the quality of residents' lives as organizations adapt to the restrictions?
Maybe. But even accepting the premise that the study's value is limited, the extreme physical and psychological demands placed upon residents—demands rooted in a longstanding medical culture that is accepted as gospel—still seem in conflict with the industry's broader push for improved quality. The theme that patients are arming themselves with more information and becoming savvier about choosing a provider is a ubiquitous one. For the sake of our patients and the sake of our organization, we can't lose focus on quality, say countless hospital leaders. So does the pervading industry philosophy of resident work hours align with that quality emphasis?
Don't get me wrong. The life of a medical resident should be demanding—very demanding. There's just no other way to properly prepare them for what lies ahead. But the provider community should continue to at least evaluate long-accepted truths about medical residents' workloads. "It's a balancing act between the number of hours worked safely from the intern and patient perspectives and ensuring they receive a wide variety and depth of experience to become competent physicians," says Sandeep Jauhar, MD, director of the Heart Failure Program at Long Island (NY) Jewish Medical Center who wrote a memoir of his years as a resident called Intern: A Doctor's Initiation. "It depends on a case-by-case basis about what constitutes too many hours. Some doctors can work well sleep-deprived and others can't.
Jay Moore is a managing editor with HealthLeaders Media. He can be reached at jmoore@healthleadersmedia.com.
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Despite performing equally to their male peers, female medical students consistently report decreased self-confidence, according to a study published in Patient Education and Counseling. The study also found that female medical students also appeared less confident to patients. A literature survey which accompanied the observational report and analysis showed that while there is no consistent gender difference in academic performance, female medical students tend to underestimate their abilities while males tend to overestimate theirs.
