Joel B. Finkelstein

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corporation, a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, said Mr. Hilal. “A multibillion dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corporation, a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, said Mr. Hilal. “A multibillion dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

WASHINGTON — Drug and device manufacturers came under scrutiny at a recent hearing of the Senate Special Committee on Aging, during which witnesses said payments to high-profile physicians appear to be more of a marketing strategy than an attempt to improve patient care.

The hearing was held in part to highlight the need to pass the Physician Payments Sunshine Act (S. 2029), which would require drug and device manufacturers to report payments to physicians. Introduced in the Senate last fall, the bill would require companies to provide physicians' names; the amounts they were paid or the value of gifts, honoraria, or travel; and the date and purpose of the payments.

“Getting enormous sums of money from a company about whose product you're writing—money that might go away if you write a negative paper—makes the research neither objective nor independent,” testified Dr. Charles Rosen, president of the Association for Ethics in Spine Surgery, a professional organization he formed to address conflicts of interest.

Dr. Rosen said he became aware of the undue influence of industry money in 2005 with marketing approval of an artificial lumbar disc replacement based on what appeared to be a poorly designed study. When he tried to raise a red flag with the Food and Drug Administration and within the surgical community, he was rebuffed. When he persisted, the chairman of his department attempted to have him fired, but instead ended up leaving under a cloud.

“Some surgeons have become inextricably beholden to suppliers,” testified Said Hilal, president of Applied Medical Resources Corporation, a small device company in Orange County, Calif.

“We hear of large suppliers approaching hundreds of surgeons with invitations to become consultants. However, these physicians appear to be no more than an extension of the sales and marketing efforts,” he said.

Device makers invited to testify said that they were working to rectify past lapses.

“In this industry, the same physicians we rely on as consultants to develop or train on the safe and effective use of our products may also select products for patients. … In hindsight, it now appears that as industry expanded to meet patients' needs, the use of physician consultants may have been excessive. Such excesses fostered a degree of mistrust of the industry and physicians, and invited the understandable scrutiny of the government and other stakeholders,” testified Chad Phipps, senior vice president and general counsel for Zimmer Holdings Inc.

The company was one of five device makers that recently settled with the Department of Justice over alleged violations of antikickback laws. While none of the companies admitted wrongdoing, collectively they agreed to pay fines totaling $311 million. Each of the companies also agreed to be monitored by an independent auditing firm.

The fines are unlikely to deter the companies from continuing to foster inappropriate financial arrangements with physicians, said Mr. Hilal. “A multibillion dollar medical supplier does not consider $40 million or $400 million in penalties, after years of violations, as painful or prohibitive,” he said.

According to testimony from the Inspector General's office at Health and Human Services, the Department of Justice is also investigating whether to pursue charges against surgeons who might have solicited kickbacks from companies. However, witnesses said that the vast majority of surgeons eschew such conflicts of interest.

Industry critics said there is a need to ensure that the information provided by companies is communicated to the public in a consumer-friendly way, while industry representatives argued that small companies should also be included in the legislation. Currently, the bill applies only to drug and device makers with annual revenues in excess of $100 million.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802). Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives.

Smaller percentages of physicians admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802). Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives.

Smaller percentages of physicians admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802). Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives.

Smaller percentages of physicians admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it.”

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research. The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it.”

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research. The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs. “Health care will become so expensive that the country will no longer be able to support it.”

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research. The group also sent a “candidates pledge” outlining these goals to each of the presidential hopefuls as well as to the group's membership, who can in turn hand them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report issued by the American College of Physicians.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs.

“Health care will become so expensive that the country will no longer be able to support it,” Mr. Doherty said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The college also sent a “candidates pledge” outlining these policy goals to each of the presidential hopefuls as well as to the group's membership, who can in turn forward them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report issued by the American College of Physicians.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs.

“Health care will become so expensive that the country will no longer be able to support it,” Mr. Doherty said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The college also sent a “candidates pledge” outlining these policy goals to each of the presidential hopefuls as well as to the group's membership, who can in turn forward them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

ACP has launched a Web site that provides comparisons of the presidential candidates' health care proposals: www.acponline.org/advocacy/where_we_stand/election

WASHINGTON — Despite the rhetoric favored by presidential candidates, the U.S. health care system is not the best in the world, but ranks near the bottom on most measures when compared with other industrialized nations, according to a new report issued by the American College of Physicians.

“I'm not pleased to say this, but when it comes to health care, too many of us simply are not getting the kind of health care that we need and deserve and, in fact, many Americans do not have access to even basic health care,” said Dr. David Dale, president of the American College of Physicians, speaking at the release of the college's annual State of the Nation's Health Care report at a conference sponsored by Academy Health.

Citing data culled from the Commonwealth Fund, the World Health Organization, and other sources, Dr. Dale noted that the United States ranks behind other industrialized nations in terms of access and equity, in helping patients lead healthier lives, in preventable deaths, and in infant mortality. The United States ranks second to last in overall quality of care, edging out only Canada—a country that spends half as much per capita on health care.

In fact, the United States spends more than double the amount most nations spend on health care, yet continues to have poorer access and outcomes, Dr. Dale said.

And if U.S. health care spending continues to grow at its current pace, it can be expected to increase from 16% of gross domestic product in 2007 to 25% by 2025, according to Peter Orszag, Ph.D., director of the Congressional Budget Office, in congressional testimony that was delivered on the same day as ACP's report.

Efforts to enact major reform of the health care system have consistently failed in the past, but the projected spending growth may force the issue this time around, said Robert Doherty, the college's senior vice president of governmental affairs.

“Health care will become so expensive that the country will no longer be able to support it,” Mr. Doherty said.

In releasing its annual report, the ACP used the opportunity to call for a political commitment to provide universal coverage, bolster primary care, reform the payment system, reduce administrative costs, implement health information technology, and support effectiveness research.

The college also sent a “candidates pledge” outlining these policy goals to each of the presidential hopefuls as well as to the group's membership, who can in turn forward them to candidates for Congress.

“The pledge will help ACP members ask the tough questions of candidates. The number of candidates who actually sign the pledge will be less important than how many of them end up advocating for the policies,” Mr. Doherty said.

The American Medical Association recently launched a national ad campaign designed to spark discussion during the presidential campaigns about the problem of the uninsured.

“By November, millions of Americans will have heard the AMA's concern that one in seven of us is uninsured,” Dr. Samantha Rosman, AMA board member, said in a statement.

Although the two physicians groups are not working together on these campaigns, they share a common end, Mr. Doherty said.

“Part of our hope is to provoke a debate within the profession itself about what is the most effective way of getting everyone covered in this country. But I don't think there is a real disagreement within the profession on the goal,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said. “I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients' welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, recalling the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” Dr. Blumenthal said.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington. “It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said. “I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients' welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, recalling the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” Dr. Blumenthal said.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington. “It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said. “I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients' welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry-provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, recalling the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” Dr. Blumenthal said.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington. “It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

Although 96% of physicians said they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“We've got a disconnect. It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

Although 96% of physicians said they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“We've got a disconnect. It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

Although 96% of physicians said they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events, and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment. “We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“We've got a disconnect. It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, who is the director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

For example, while 96% of physicians said that they should put the patient's welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted that they had received drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, who recalled the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, who is the director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

For example, while 96% of physicians said that they should put the patient's welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted that they had received drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, who recalled the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON – Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

“It's simply not acceptable that bad physicians aren't being reported to the proper authorities,” said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

“Most physicians are trying to do the right thing, under increasingly difficult circumstances,” said Dr. David Blumenthal, who is the director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795-802).

Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits, he said.

“I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people,” said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore

For example, while 96% of physicians said that they should put the patient's welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted that they had received drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

“It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant,” said Dr. Silver-Isenstadt, who recalled the novelty and allure of industry grants and gifts when he was new to the profession.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude. What is needed next is the ability to bridge that divide between attitude and action in a nonpunitive environment.

“We have to create a health care system that is safe for professionalism,” said Dr. Blumenthal.

That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are found to be abusing drugs or alcohol.

“We have hospitals reporting, patients reporting, colleagues reporting. They know that … they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice,” said Dr. Cohen, who also is an adjunct professor of law at Georgetown University, Washington.

“It's not enough to just say 'woe is us, we've got a disconnect.' It's important that people look for the reasons behind the disconnect and do something about it. … As more and more knowledge is gathered, the disconnect will begin to disappear,” he said.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

"It's simply not acceptable that bad physicians aren't being reported to the proper authorities," said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

"Most physicians are trying to do the right thing, under increasingly difficult circumstances," said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802. Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

"I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people," said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

"It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant," said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

"We have to create a health care system that is safe for professionalism," said Blumenthal. That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

"We have hospitals reporting, patients reporting, colleagues reporting. They know that. …they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice," said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

"It's simply not acceptable that bad physicians aren't being reported to the proper authorities," said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

"Most physicians are trying to do the right thing, under increasingly difficult circumstances," said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802. Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

"I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people," said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

"It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant," said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

"We have to create a health care system that is safe for professionalism," said Blumenthal. That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

"We have hospitals reporting, patients reporting, colleagues reporting. They know that. …they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice," said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON — Easier said than done. That may be the take-away message from a study that revealed troubling gaps between physicians' attitudes and behavior when it comes to standards of professionalism.

A national survey of 3,500 primary care and specialist physicians found that 95% said physicians should report incompetent or impaired colleagues. However, only 56% of those who had been in a position to do so, in fact, did.

"It's simply not acceptable that bad physicians aren't being reported to the proper authorities," said Dr. James N. Thompson, president and CEO of the Federation of State Medical Boards, at a press briefing to release the findings.

The survey also showed that 92% of physicians thought they should always report medical errors, but 31% admitted to not doing so on at least one occasion.

"Most physicians are trying to do the right thing, under increasingly difficult circumstances," said Dr. David Blumenthal, director of the Institute for Health Policy at the Massachusetts General Hospital, Boston, and senior author of the study (Ann. Intern. Med. 2007;147:795–802. Those circumstances include not only financial pressures, but also the seemingly constant threat of lawsuits.

"I'm neither surprised nor disheartened by the study's outcome. It just shows that doctors are people," said Dr. Ari Silver-Isenstadt, a pediatrician at Franklin Square Hospital Center in Baltimore.

For example, while 96% of physicians said that they should put the patients welfare above their own financial interests, 84% had accepted food or beverages from drug company representatives. Smaller percentages admitted receiving drug samples, admission to CME events, consulting or speaking fees, travel tickets to sporting events and other industry provided perks.

Physicians may feel they are not influenced by such marketing, but even the appearance of a conflict can undermine patient trust.

"It took me awhile to recognize that I am just as vulnerable as any other Joe to advertising, but given my fiduciary responsibility to my patients, I have to be more vigilant," said Dr. Silver-Isenstadt.

Despite everyday obstacles to professionalism, the authors took it as a hopeful sign that physicians have the right attitude.

"We have to create a health care system that is safe for professionalism," said Blumenthal. That is borne out by the work of both national groups and more local efforts, said Dr. Peter Cohen, a retired anesthesiologist who chairs the physicians health program for the Medical Society of the District of Columbia, which steps in when physicians are abusing drugs or alcohol.

"We have hospitals reporting, patients reporting, colleagues reporting. They know that. …they are doing both the drug-abusing physician and society a favor, because these people do get into treatment and over 90% return to practice," said Dr. Cohen, also an adjunct professor of law at Georgetown University, Washington.

WASHINGTON — There has been a lot of talk, but little done on the national level to address persistent problems in the health care system, according to experts speaking at a conference to release the results of the latest edition of a survey of hospitals and physicians across the country.

When the survey was last conducted 2 years ago, several troubling trends were identified. At the time, there was an ongoing hospital building boom, intense and sometimes acrimonious competition between hospitals and physicians over specialty services, growing stress on community safety net providers, and inadequate cost-control strategies on the part of employers and health plans.

The conclusion: These trends were creating a two-tiered system in which individuals with health insurance had better access to high-cost care and those without had diminishing access to any care.

"For the most part, these trends have continued into 2007," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change, which sponsored the conference and conducts the survey of health care sites in 12 communities every 2 years.

The dichotomy between the haves and have-nots is also appearing among physicians, said Dr. Hoangmai Pham, senior researcher at the center. A growing number of specialists are working exclusively through private hospitals or ambulatory care centers, where they can dictate their hours, don't have to deal with paperwork, and are largely insulated from nonpaying patients. In contrast, many community-based physicians are being shut out of the hospital altogether.

"In many of our sites it's now the norm for most inpatient medical care to be provided by hospitalists. This has led to much more fractured relationships with community-based, primary care physicians and the hospitals that they used to know," she said.

While these trends continue, reforms on the national level have been incremental and modest, such as expanding access to health savings accounts and encouraging more consumerism in health care. That may reflect an apparent disconnect between the level of debate in Washington and what is going on in the field, said Dr. Robert Berenson, a senior fellow at the Urban Institute.

Speaking at the meeting, he recalled a conversation with a physician during a visit at one of the survey sites: "I asked him how's the weather and he launched into, 'What are you people in D.C. drinking? Your fee schedule in Medicare is absurd, and what you're doing to us is making it impossible for us to hire cardiologists. They want to stay in the fee-for-service sector because they are making so much money.'"

Such distortions in the reimbursement system have created perverse incentives that are helping to drive many of these troubling trends, said Don Fisher, Ph.D., president and chief executive officer for the Medical Group Management Association. "The more you do, the more you get paid. Said differently, the worst quality care in this country gets paid the most," he said.

While paying more for poor quality, the current system also punishes innovation.

"Every quality improvement you make on the ambulatory side that reduces the hospital admissions and readmissions… causes a loss in revenue to that institution, to that hospital, large losses of revenue," Dr. Fisher said.

Yet, many institutions are pushing forward with quality improvements anyway, he said.

However, policy makers in Washington may be missing out on that fact. He cited one hospital he visited during the center's survey. The chief medical officer couldn't come up with any quality measures they had implemented, but mentioned that they had recently installed a Tele-ICU.

"That's at least equally significant in the area of quality and safety, but we in the policy world have said quality and safety is about these heart attack measures and congestive heart failure measures," he said.

WASHINGTON — There has been a lot of talk, but little done on the national level to address persistent problems in the health care system, according to experts speaking at a conference to release the results of the latest edition of a survey of hospitals and physicians across the country.

When the survey was last conducted 2 years ago, several troubling trends were identified. At the time, there was an ongoing hospital building boom, intense and sometimes acrimonious competition between hospitals and physicians over specialty services, growing stress on community safety net providers, and inadequate cost-control strategies on the part of employers and health plans.

The conclusion: These trends were creating a two-tiered system in which individuals with health insurance had better access to high-cost care and those without had diminishing access to any care.

"For the most part, these trends have continued into 2007," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change, which sponsored the conference and conducts the survey of health care sites in 12 communities every 2 years.

The dichotomy between the haves and have-nots is also appearing among physicians, said Dr. Hoangmai Pham, senior researcher at the center. A growing number of specialists are working exclusively through private hospitals or ambulatory care centers, where they can dictate their hours, don't have to deal with paperwork, and are largely insulated from nonpaying patients. In contrast, many community-based physicians are being shut out of the hospital altogether.

"In many of our sites it's now the norm for most inpatient medical care to be provided by hospitalists. This has led to much more fractured relationships with community-based, primary care physicians and the hospitals that they used to know," she said.

While these trends continue, reforms on the national level have been incremental and modest, such as expanding access to health savings accounts and encouraging more consumerism in health care. That may reflect an apparent disconnect between the level of debate in Washington and what is going on in the field, said Dr. Robert Berenson, a senior fellow at the Urban Institute.

Speaking at the meeting, he recalled a conversation with a physician during a visit at one of the survey sites: "I asked him how's the weather and he launched into, 'What are you people in D.C. drinking? Your fee schedule in Medicare is absurd, and what you're doing to us is making it impossible for us to hire cardiologists. They want to stay in the fee-for-service sector because they are making so much money.'"

Such distortions in the reimbursement system have created perverse incentives that are helping to drive many of these troubling trends, said Don Fisher, Ph.D., president and chief executive officer for the Medical Group Management Association. "The more you do, the more you get paid. Said differently, the worst quality care in this country gets paid the most," he said.

While paying more for poor quality, the current system also punishes innovation.

"Every quality improvement you make on the ambulatory side that reduces the hospital admissions and readmissions… causes a loss in revenue to that institution, to that hospital, large losses of revenue," Dr. Fisher said.

Yet, many institutions are pushing forward with quality improvements anyway, he said.

However, policy makers in Washington may be missing out on that fact. He cited one hospital he visited during the center's survey. The chief medical officer couldn't come up with any quality measures they had implemented, but mentioned that they had recently installed a Tele-ICU.

"That's at least equally significant in the area of quality and safety, but we in the policy world have said quality and safety is about these heart attack measures and congestive heart failure measures," he said.

WASHINGTON — There has been a lot of talk, but little done on the national level to address persistent problems in the health care system, according to experts speaking at a conference to release the results of the latest edition of a survey of hospitals and physicians across the country.

When the survey was last conducted 2 years ago, several troubling trends were identified. At the time, there was an ongoing hospital building boom, intense and sometimes acrimonious competition between hospitals and physicians over specialty services, growing stress on community safety net providers, and inadequate cost-control strategies on the part of employers and health plans.

The conclusion: These trends were creating a two-tiered system in which individuals with health insurance had better access to high-cost care and those without had diminishing access to any care.

"For the most part, these trends have continued into 2007," said Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change, which sponsored the conference and conducts the survey of health care sites in 12 communities every 2 years.

The dichotomy between the haves and have-nots is also appearing among physicians, said Dr. Hoangmai Pham, senior researcher at the center. A growing number of specialists are working exclusively through private hospitals or ambulatory care centers, where they can dictate their hours, don't have to deal with paperwork, and are largely insulated from nonpaying patients. In contrast, many community-based physicians are being shut out of the hospital altogether.

"In many of our sites it's now the norm for most inpatient medical care to be provided by hospitalists. This has led to much more fractured relationships with community-based, primary care physicians and the hospitals that they used to know," she said.

While these trends continue, reforms on the national level have been incremental and modest, such as expanding access to health savings accounts and encouraging more consumerism in health care. That may reflect an apparent disconnect between the level of debate in Washington and what is going on in the field, said Dr. Robert Berenson, a senior fellow at the Urban Institute.

Speaking at the meeting, he recalled a conversation with a physician during a visit at one of the survey sites: "I asked him how's the weather and he launched into, 'What are you people in D.C. drinking? Your fee schedule in Medicare is absurd, and what you're doing to us is making it impossible for us to hire cardiologists. They want to stay in the fee-for-service sector because they are making so much money.'"

Such distortions in the reimbursement system have created perverse incentives that are helping to drive many of these troubling trends, said Don Fisher, Ph.D., president and chief executive officer for the Medical Group Management Association. "The more you do, the more you get paid. Said differently, the worst quality care in this country gets paid the most," he said.

While paying more for poor quality, the current system also punishes innovation.

"Every quality improvement you make on the ambulatory side that reduces the hospital admissions and readmissions… causes a loss in revenue to that institution, to that hospital, large losses of revenue," Dr. Fisher said.

Yet, many institutions are pushing forward with quality improvements anyway, he said.

However, policy makers in Washington may be missing out on that fact. He cited one hospital he visited during the center's survey. The chief medical officer couldn't come up with any quality measures they had implemented, but mentioned that they had recently installed a Tele-ICU.

"That's at least equally significant in the area of quality and safety, but we in the policy world have said quality and safety is about these heart attack measures and congestive heart failure measures," he said.

WASHINGTON — Community health centers, public hospitals, and other safety net providers are seeing a steadily growing number of low-income patients, while specialty care for these patients is becoming scarce, according to the results of a biennial national survey conducted by the Center for Studying Health System Change.

“The saga continues with rising demands and expectations on safety net providers. They have, lucky them, solidified their lock on the uninsured market in most of our communities,” Robert Hurley, Ph.D., of the department of health administration at Virginia Commonwealth University, Richmond, said at a conference sponsored by the Center for Studying Health System Change (HSC).

For example, despite strong growth in the capacity of community health centers across the country, many still are overwhelmed not only by uninsured patients and immigrants but also, increasingly, insured patients.

“[The number of] private insurance patients [is] growing at twice the rate of the general population growth in health centers,” said Daniel Hawkins, senior vice president at the National Association of Community Health Centers.

Health centers have absorbed a 60% increase in patients since 2001 and are now seeing 16 million patients a year.

“The privately insured patient population is over 2.1 million out of those 16 million. It's literally one of every six health center patients,” he said.

High-deductible and cost-sharing policies are a big part of that, but so is paltry coverage, Mr. Hawkins said.

Community health centers are also struggling to meet the demand for specialty care, which has grown scarce for low-income patients in the 12 communities surveyed by HSC.

“If you looked at our communities, virtually every one of our communities, and looked at the needs for specialty care for the Medicaid as well as the uninsured populations, if you took away the employed positions in safety net hospitals and the faculty positions in the academic health centers, specialty care would not be available,” Dr. Hurley said at a conference to release the findings of the most recent center survey.

WASHINGTON — Community health centers, public hospitals, and other safety net providers are seeing a steadily growing number of low-income patients, while specialty care for these patients is becoming scarce, according to the results of a biennial national survey conducted by the Center for Studying Health System Change.

“The saga continues with rising demands and expectations on safety net providers. They have, lucky them, solidified their lock on the uninsured market in most of our communities,” Robert Hurley, Ph.D., of the department of health administration at Virginia Commonwealth University, Richmond, said at a conference sponsored by the Center for Studying Health System Change (HSC).

For example, despite strong growth in the capacity of community health centers across the country, many still are overwhelmed not only by uninsured patients and immigrants but also, increasingly, insured patients.

“[The number of] private insurance patients [is] growing at twice the rate of the general population growth in health centers,” said Daniel Hawkins, senior vice president at the National Association of Community Health Centers.

Health centers have absorbed a 60% increase in patients since 2001 and are now seeing 16 million patients a year.

“The privately insured patient population is over 2.1 million out of those 16 million. It's literally one of every six health center patients,” he said.

High-deductible and cost-sharing policies are a big part of that, but so is paltry coverage, Mr. Hawkins said.

Community health centers are also struggling to meet the demand for specialty care, which has grown scarce for low-income patients in the 12 communities surveyed by HSC.

“If you looked at our communities, virtually every one of our communities, and looked at the needs for specialty care for the Medicaid as well as the uninsured populations, if you took away the employed positions in safety net hospitals and the faculty positions in the academic health centers, specialty care would not be available,” Dr. Hurley said at a conference to release the findings of the most recent center survey.

WASHINGTON — Community health centers, public hospitals, and other safety net providers are seeing a steadily growing number of low-income patients, while specialty care for these patients is becoming scarce, according to the results of a biennial national survey conducted by the Center for Studying Health System Change.

“The saga continues with rising demands and expectations on safety net providers. They have, lucky them, solidified their lock on the uninsured market in most of our communities,” Robert Hurley, Ph.D., of the department of health administration at Virginia Commonwealth University, Richmond, said at a conference sponsored by the Center for Studying Health System Change (HSC).

For example, despite strong growth in the capacity of community health centers across the country, many still are overwhelmed not only by uninsured patients and immigrants but also, increasingly, insured patients.

“[The number of] private insurance patients [is] growing at twice the rate of the general population growth in health centers,” said Daniel Hawkins, senior vice president at the National Association of Community Health Centers.

Health centers have absorbed a 60% increase in patients since 2001 and are now seeing 16 million patients a year.

“The privately insured patient population is over 2.1 million out of those 16 million. It's literally one of every six health center patients,” he said.

High-deductible and cost-sharing policies are a big part of that, but so is paltry coverage, Mr. Hawkins said.

Community health centers are also struggling to meet the demand for specialty care, which has grown scarce for low-income patients in the 12 communities surveyed by HSC.

“If you looked at our communities, virtually every one of our communities, and looked at the needs for specialty care for the Medicaid as well as the uninsured populations, if you took away the employed positions in safety net hospitals and the faculty positions in the academic health centers, specialty care would not be available,” Dr. Hurley said at a conference to release the findings of the most recent center survey.