Philadelphi-based CIGNA has completed its purchase of Great-West Healthcare Holdings Inc. in Denver for $1.5 billion. The deal is part of a push by CIGNA to sell health insurance to small companies. Great-West specializes in insuring companies that have fewer than 200 employees.
Indianapolis-based insurer WellPoint has announced it is halting reimbursement payments to hospitals and doctors for 11 medical errors considered preventable. The 11 errors identified by WellPoint are those that have been defined as preventable by the Centers for Medicare and Medicaid Services and the National Quality Forum. Officials will use several methods for identifying the errors, including comparing a patient's diagnosis and condition upon admission to a hospital with the treatment received during the hospital stay.
The Catholic ownership of the 410-bed St. Francis Hospital & Health Center in Blue Island, IL, said it will shutter the hospital because nobody would buy it. The development underscores the plight of non-profit hospitals struggling with the increase in uninsured patients--St. Francis was saddled with tens of millions of dollars in losses from the uninsured. The closing will force Blue Island residents to travel further from home and potentially stress other facilities with an influx of thousands of patients, many who are uninsured and of limited means.
A $2.13 million telemedicine project links hospitals in Ethiopia with the Hyderabad-based Care Group of Hospitals, India's leading cardiac institute. The project is part of the joint initiative between the African Union and India which was launched in Ethiopia last year to improve Internet links and communication. There is just one doctor for every 37,000 people in Ethiopia, and the project aims to alleviate some of the country's healthcare burdens.
Birmingham-based Medical Properties Trust has completed a $138 million deal for seven hospitals from HCP Inc. With the completed transaction, Medical Properties Trust now has hospitals in Cleveland and Webster, TX; Cheraw and Bennettsville, SC; Bossier City, LA; Idaho Falls, ID; and Tucson, AZ.
The Pennsylvania House has approved legislation that would impose new guidelines on health insurance plans offered to individuals and small businesses. The legislation would limit the ability of health insurers to consider certain factors such as health history in setting rates for those plans. Insurers could still consider age and geographic region in setting rates, however. The bill, which now moves to the state Senate for review, also would require insurers to spend 85 percent of premiums on healthcare.
Although Jewish Hospital Medical Center South in Hillview, KY, has an emergency room, many Bullit County residents wish the facility had in-patient beds so they could be closer to their family in case of a serious medical problem. Legislators are currently working with the Kentucky Hospital Association and the Kentucky Cabinet for Health and Human Services to find a way to allow Bullitt County to have in-patient beds at a medical facility. Bills had been proposed in the House and the Senate to let medical centers such as Jewish add up to 60 in-patient beds, allowing them to serve as small hospitals. The bills were withdrawn, however, due to amendments that were tacked on.
The Kansas Board of Healing Arts will decide in a special meeting how to respond to legislators' requests that it remove Executive Director Lawrence Buening and its legal counsel. Critics say the board is slow to act on complaints and is too lenient on doctors. The Kansas Board of Healing Arts regulates physicians in the state.
The School of Nursing at the University of North Carolina-Chapel Hill is trying to increase the number of mental health providers by retraining nurses to diagnose and treat psychiatric illness. The program also recruits at least half its students from North Carolina counties with the greatest shortfall of providers, and hopes the new providers will return to practice where they are most needed. UNC-CH is one of a handful of universities across the country that trains registered nurses to be psychiatric nurse practitioners.
Ask the average physician and you'll likely find that he didn't go into medicine for the money. Despite fairly universal frustration with the contemporary constraints of practicing medicine, today's physicians profess motivations similar to those of their predecessors: the desire to serve, a fascination with medical science, or an attraction to the intellectual and social stimulation medical practice offers.
Firms like LocumTenens.com do at least 60 percent of their business in rural America, where Health Professional Shortage Areas outnumber those in major metropolitan areas by more than 2-to-1 (2,157 to 910, respectively). Access to rural mental healthcare is even more restricted, with approximately 90 percent of almost 1,700 Mental Health Professional Shortage Areas located in rural areas.
The Center for Studying Health System Change indicates that rural Americans have access to significantly fewer physicians than their urban counterparts. For example, there are roughly 1.5 times more primary-care physicians (internists, family practitioners and pediatricians) per 100,000 people in metropolitan areas than there are in rural areas (78 versus 53, respectively). And the balance for specialists is even less proportionate. There are almost 2.5 times more specialists per 100,000 metropolitan Americans than per 100,000 rural Americans (134 versus 54, respectively).
In a world--and a healthcare industry--of increasing specialization, it's safe to predict that these disparities will continue to grow over the next few decades. Because there is a less-dense population to serve in rural America, it makes sense that more generalists and fewer specialists will locate there. This partially explains the common perception that rural doctors earn less than their urban colleagues, since generalists' compensation generally lags behind that of specialists.
Countering myths about rural medicine There are other conditions that draw physicians to, or repel physicians from, one setting or the other. In a presentation to rural medical students in Nebraska, Robert Boyer, MD, a now-retired family practitioner, illuminated several "myths" that, he believes, keep many family physicians from choosing to practice rural medicine.
Myth #1: You won't make much money. Data from several sources indicate that rural physician incomes don't differ significantly from those of metropolitan-area physicians. Further, because housing, labor and many other products and services cost less outside of major urban centers, rural doctors generally enjoy a lifestyle of greater affluence.
A study published by the Center for Studying Health System Change in January 2005 indicated that, "After accounting for the local cost of living, rural physician incomes on average provide about 13 percent more purchasing power than urban physician incomes."
Moreover, based on responses from more than 2,400 physicians from a variety of specialties, LocumTenens.com's 2007 Survey on Physician Compensation and Satisfaction indicates that the average rural physician salary is about $7,300 higher than the average metropolitan salary ($241,690 in rural areas versus $234,400 in metro areas). And according to LocumTenens.com's 2007 survey on practicing medicine in rural America, nearly 800 U.S. physician respondents with rural healthcare experience indicated that rural profitability is about the same as (35 percent), or more profitable than (23 percent) urban or suburban practice. Another 14 percent said that, "The greater purchasing power in a rural community compensates for the lower profitability of rural practice."
Add to these statistics the growing number of financial incentives being offered by federal, state and local levels of government to physicians who are willing to commit--for a certain number of years, at least--to rural practice and the economic arguments against rural medicine just don't hold water.
Myth #2: You'll be on call 24 hours a day, 7 days a week (so you won't have time for yourself or your family). Boyer's experience was that if a rural physician learns to set proper boundaries regarding his or her practice, the physician actually ends up with more time for nonprofessional pursuits.
LocumTenens.com survey results indicate Boyer was probably right. Among almost 800 physicians who had practiced medicine in rural areas, 61 percent said the pace of rural practice is slower, while another 31 percent said it was about the same as in urban or suburban practices. Eighty-four percent said that rural practice is about the same as (47 percent), or less frustrating than (37 percent), larger-city practice.
In addition, almost half of those physicians who had practiced rural medicine said that they either preferred rural life more (30 percent) or that life was about the same regardless of where they lived (16 percent).
Even with the possibility of a heavier call schedule, many rural doctors still enjoy more personal and family time because they aren't spending one to three hours each day getting to and from work.
Myth #3: You can't possibly know enough. (You'll be isolated and "in over your head" professionally.) The shortage of providers in rural areas often makes it easier for early-career professionals to get a job, set up private practice, advance in their careers, and "network" through statewide professional societies, according to a qualitative study highlighted in the December 2006 issue of the National Rural Health Association's Rural Roads magazine.
Many respondents to LocumTenens.com's survey agree. Here's what they had to say:
"The connectedness between components of the care delivery system is closer and easier to navigate in rural areas."
"Practicing in a rural area is more immediately gratifying. Many patients return, as do their friends and family members, and you build a relationship over time."
"Medicine in rural practice is clinical medicine. In an urban setting it is defensive medicine."
"As a radiologist, it has been much easier for me to meet and get to know the clinical referring docs in a rural area. The threat of litigation is, in general, much lower. Rural patients are more appreciative of good medical practice and service than more demanding city dwellers."
Facing lifestyle concerns So what's not to like about practicing rural medicine? Industry observers note that today's physicians are more concerned about leading balanced lives than their predecessors were. Based on more than 600 physicians' responses regarding what they like and dislike most about rural medical practice, physicians fear being more isolated professionally with fewer resources and career options in rural practice. Personally they fear having less privacy and fewer entertainment options than they would in larger metropolitan areas.
Spousal influence also plays a role in physicians' decisions about where to practice. Career opportunities for spouses; good schools for growing families; and access to cultural attractions, plentiful shopping and other entertainment options factor heavily into many physicians' decision-making processes about where to practice.
Attracting physicians to rural medicine Physicians need more exposure to rural practice options and opportunities. Among more than 600 physicians who said they had no rural healthcare experience, 29 percent indicated they never had been offered a position in a rural area, 25 percent said they just never considered it, and 33 percent said they'd never found the right opportunity.
Here are four steps toward attracting more physicians to rural America and keeping them there:
Rural communities must market the lifestyle advantages of rural medicine and offer creative benefits focused on making that lifestyle more attractive to physician recruits. The inherent advantages include:
Slower pace of life
Greater feeling of safety for self and family
Less traffic and pollution
Shorter commutes
Equivalent or higher net income
Lower housing costs
Less competitive lifestyle
Closer proximity to outdoor recreational opportunities
Elevated status in community
More medical schools need to develop 'rural practice tracks' in their curricula to expose students firsthand to rural medicine.
Rural residents need to align themselves regarding the critical importance of maintaining healthcare services in their immediate areas.
Financial incentives--some offered through the federal government--are critical.
David Roush is president and chief operations officer of LocumTenens.com, a physician recruiting firm.
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