Mary Ellen Schneider

Hospitalists may soon find themselves at the center of health care reform.

The Obama administration is likely to zero in on hospital care when taking the first steps toward health care reform, said Dr. Ron Angus, a Dallas-based hospitalist and a member of the public policy committee of the Society of Hospital Medicine. The federal government can examine data on care in the hospital more easily than it can review outpatient data, making inpatient care a more likely target for initial policy changes, he noted.

He predicted that Congress will mandate more “flavors of pay for performance.” For example, one much-discussed proposal is for the federal government to stop paying hospitals for care delivered to patients when they are readmitted to the hospital with the same condition as their original admission. Medicare and several private insurers have already started down this path by refusing to pay for costs associated with certain preventable complications in the hospital.

If Medicare and other payers restrict payment for readmissions, hospitals are likely to lean heavily on hospitalists to help improve the discharge process. As part of the effort to avoid readmissions, the hospitalist would become the point person making contact with patients after hospital discharge to ensure that they follow their treatment plans, said Dr. Angus, a past president of the Society of Hospital Medicine and founder of MD On Call, one of the first hospitalist groups in Dallas.

An emphasis on pay for performance in health care reform legislation is also likely to mean that hospitalists will take on a larger role in ensuring that their hospitals have health information technology systems in place. Such systems can analyze data about care provided and submit it to government pay-for-performance programs.

Many eyes will be on hospitalists if such reforms are implemented, Dr. Angus said. “We all need to take a deep breath over the next 3 months,” he said. The initial challenge will be to pay close attention to Congress this summer as legislators begin marking up the first pieces of health care reform legislation. It's essential to be involved when the bills are being drafted, rather than waiting until they become law.

Hospitalists are uniquely positioned to carry out quality improvement changes in the hospital, and if all goes well, physicians from many other specialties and in other settings of care will be looking toward hospitalists as leaders, he said.

The next challenge will be to manage the workflow so that hospitalists don't become overwhelmed, Dr. Angus said. Many hospitalists are feeling squeezed already as their role in the hospital evolves and expands.

When Dr. Angus started in hospital medicine in 1992, before the term hospitalist was in use, he envisioned his job as being a primary care physician who worked only in the hospital. Today, his role has grown to include new areas, including comanagement of complex patients and involvement in systems changes. He offered a word of warning to new hospitalists, who can find themselves taking on unforeseen tasks: “Be careful with what you say yes to, because those yeses will pile up quickly as the facilities you work at realize how valuable you are.”

To avoid burnout, it's critical to avoid taking on more than you can manage, Dr. Angus advised. Don't expand your services until you have the staff to handle it. And develop a plan for your growth that covers more than the next 6 months, including the potential for new health policy mandates.

Physicians from many other specialties and in other settings will be looking toward hospitalists as leaders. DR. ANGUS

Hospitalists may soon find themselves at the center of health care reform.

The Obama administration is likely to zero in on hospital care when taking the first steps toward health care reform, said Dr. Ron Angus, a Dallas-based hospitalist and a member of the public policy committee of the Society of Hospital Medicine. The federal government can examine data on care in the hospital more easily than it can review outpatient data, making inpatient care a more likely target for initial policy changes, he noted.

He predicted that Congress will mandate more “flavors of pay for performance.” For example, one much-discussed proposal is for the federal government to stop paying hospitals for care delivered to patients when they are readmitted to the hospital with the same condition as their original admission. Medicare and several private insurers have already started down this path by refusing to pay for costs associated with certain preventable complications in the hospital.

If Medicare and other payers restrict payment for readmissions, hospitals are likely to lean heavily on hospitalists to help improve the discharge process. As part of the effort to avoid readmissions, the hospitalist would become the point person making contact with patients after hospital discharge to ensure that they follow their treatment plans, said Dr. Angus, a past president of the Society of Hospital Medicine and founder of MD On Call, one of the first hospitalist groups in Dallas.

An emphasis on pay for performance in health care reform legislation is also likely to mean that hospitalists will take on a larger role in ensuring that their hospitals have health information technology systems in place. Such systems can analyze data about care provided and submit it to government pay-for-performance programs.

Many eyes will be on hospitalists if such reforms are implemented, Dr. Angus said. “We all need to take a deep breath over the next 3 months,” he said. The initial challenge will be to pay close attention to Congress this summer as legislators begin marking up the first pieces of health care reform legislation. It's essential to be involved when the bills are being drafted, rather than waiting until they become law.

Hospitalists are uniquely positioned to carry out quality improvement changes in the hospital, and if all goes well, physicians from many other specialties and in other settings of care will be looking toward hospitalists as leaders, he said.

The next challenge will be to manage the workflow so that hospitalists don't become overwhelmed, Dr. Angus said. Many hospitalists are feeling squeezed already as their role in the hospital evolves and expands.

When Dr. Angus started in hospital medicine in 1992, before the term hospitalist was in use, he envisioned his job as being a primary care physician who worked only in the hospital. Today, his role has grown to include new areas, including comanagement of complex patients and involvement in systems changes. He offered a word of warning to new hospitalists, who can find themselves taking on unforeseen tasks: “Be careful with what you say yes to, because those yeses will pile up quickly as the facilities you work at realize how valuable you are.”

To avoid burnout, it's critical to avoid taking on more than you can manage, Dr. Angus advised. Don't expand your services until you have the staff to handle it. And develop a plan for your growth that covers more than the next 6 months, including the potential for new health policy mandates.

Physicians from many other specialties and in other settings will be looking toward hospitalists as leaders. DR. ANGUS

Hospitalists may soon find themselves at the center of health care reform.

The Obama administration is likely to zero in on hospital care when taking the first steps toward health care reform, said Dr. Ron Angus, a Dallas-based hospitalist and a member of the public policy committee of the Society of Hospital Medicine. The federal government can examine data on care in the hospital more easily than it can review outpatient data, making inpatient care a more likely target for initial policy changes, he noted.

He predicted that Congress will mandate more “flavors of pay for performance.” For example, one much-discussed proposal is for the federal government to stop paying hospitals for care delivered to patients when they are readmitted to the hospital with the same condition as their original admission. Medicare and several private insurers have already started down this path by refusing to pay for costs associated with certain preventable complications in the hospital.

If Medicare and other payers restrict payment for readmissions, hospitals are likely to lean heavily on hospitalists to help improve the discharge process. As part of the effort to avoid readmissions, the hospitalist would become the point person making contact with patients after hospital discharge to ensure that they follow their treatment plans, said Dr. Angus, a past president of the Society of Hospital Medicine and founder of MD On Call, one of the first hospitalist groups in Dallas.

An emphasis on pay for performance in health care reform legislation is also likely to mean that hospitalists will take on a larger role in ensuring that their hospitals have health information technology systems in place. Such systems can analyze data about care provided and submit it to government pay-for-performance programs.

Many eyes will be on hospitalists if such reforms are implemented, Dr. Angus said. “We all need to take a deep breath over the next 3 months,” he said. The initial challenge will be to pay close attention to Congress this summer as legislators begin marking up the first pieces of health care reform legislation. It's essential to be involved when the bills are being drafted, rather than waiting until they become law.

Hospitalists are uniquely positioned to carry out quality improvement changes in the hospital, and if all goes well, physicians from many other specialties and in other settings of care will be looking toward hospitalists as leaders, he said.

The next challenge will be to manage the workflow so that hospitalists don't become overwhelmed, Dr. Angus said. Many hospitalists are feeling squeezed already as their role in the hospital evolves and expands.

When Dr. Angus started in hospital medicine in 1992, before the term hospitalist was in use, he envisioned his job as being a primary care physician who worked only in the hospital. Today, his role has grown to include new areas, including comanagement of complex patients and involvement in systems changes. He offered a word of warning to new hospitalists, who can find themselves taking on unforeseen tasks: “Be careful with what you say yes to, because those yeses will pile up quickly as the facilities you work at realize how valuable you are.”

To avoid burnout, it's critical to avoid taking on more than you can manage, Dr. Angus advised. Don't expand your services until you have the staff to handle it. And develop a plan for your growth that covers more than the next 6 months, including the potential for new health policy mandates.

Physicians from many other specialties and in other settings will be looking toward hospitalists as leaders. DR. ANGUS

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, study results showed.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas. “That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from UpToDate Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult work-flow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, study results showed.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas. “That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from UpToDate Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult work-flow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.

Less than 11% of U.S. hospitals have a “basic” electronic health record system operating in at least one major clinic unit, study results showed.

Even fewer hospitals have a “comprehensive” EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628–38).

The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.

The results are based on a 2008 survey of nearly 3,000 nonfederal acute care general hospitals in the United States.

About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions—such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements—across all major clinical units in the hospital.

Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.

The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.

Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas. “That suggests that we have a good place to start,” Dr. Jha said. “Many hospitals have just not put it together in a way that really would help them deliver high-quality care.”

The study was funded by the Robert Wood Johnson Foundation and the federal Office of the National Coordinator for Health Information Technology.

The study was conducted by researchers at Massachusetts General Hospital, the Veterans Affairs Boston Healthcare System, and the Brigham and Women's Hospital, all in Boston, and George Washington University in Washington. The researchers reported receiving consulting fees and grant support from UpToDate Inc. and GE Healthcare.

The goal of the survey was to establish a baseline for EHR adoption in hospital settings. Before the survey, published estimates of EHR adoption by U.S. hospitals ranged widely, from 5% to 59%, reflecting differing definitions of an EHR system, convenience samples, and low response rates.

Cost continues to be a significant barrier to the implementation of EHRs in hospital settings, the survey found. Among hospitals that had not implemented EHR systems, 74% cited inadequate capital for purchase of a system, 44% had concerns about maintenance costs, and 32% were wary of the unclear return on investment.

But responses from hospitals that had successfully implemented an EHR system indicated that financial incentives could spur adoption. About 82% of hospitals that had adopted EHRs said that additional reimbursement for the use of an electronic system could help, and 75% said financial incentives for adoption would be a positive step.

“This is really hard work,” said John P. Glaser, Ph.D., vice president and chief information officer of Partners HealthCare System in Boston, which has put such advanced clinical decision support features as computerized provider-order entry into 11 of its hospitals and has implemented EHRs in outpatient settings for about 3,000 physicians.

The implementation of an EHR system in a large multihospital system can cost hundreds of millions of dollars, involves difficult work-flow and behavior changes for the staff, and requires sustained leadership, Dr. Glaser said. “These are not trivial undertakings,” he cautioned.

Some hospitals may not have access to sufficient capital to purchase and implement a system, while others may be hesitant about their ability to recoup some of the costs. At Dr. Glaser's institution, they have worked with area managed care companies to build financial incentives into the contracts, so their physicians are more willing to adopt EHRs, he explained.

A new recommendation from the U.S. Preventive Services Task Force endorses the need for routine screening of all adolescents for clinical depression.

The task force recommended that physicians screen adolescent patients aged 12–18 years for major depressive disorder provided that systems are in place to ensure further evaluation, psychotherapy, and follow-up. But the task force concluded that there was insufficient evidence to make a recommendation about screening younger children aged 7–11 years (Pediatrics 2009;123:1223–8).

In 2002, the task force examined depression screening in adolescents and found there was not enough evidence at that time to recommend for or against routine screening. However, new evidence on the effectiveness of medications and psychotherapy to treat depressed adolescents and the reliability of screening instruments to detect depression in this group prompted the task force members to recommend screening.

In its recommendation, the task force concluded that adolescents aged 12–18 years could be effectively treated for major depressive disorder with selective serotonin reuptake inhibitors or with a combination of SSRIs and either cognitive-behavioral therapy or interpersonal psychotherapy. But because of the suicide risks associated with the use of SSRIs, the task force recommended that they be prescribed only when the patient can be closely monitored.

The best approach is likely to be a combination of careful medication management and a referral for psychotherapy, Dr. Tom DeWitt, a member of the task force and director of general and community pediatrics at Cincinnati Children's Hospital Medical Center, said in an interview.

Widespread screening is critical because of the high prevalence of depression among adolescents and the serious consequences of leaving the condition untreated, he said. It is estimated that about 6% of adolescents have major depressive disorder, with the lifetime prevalence among adolescents possibly as high as 20%, according to the report.

Although the recommendation is meant to apply to all teens, physicians should pay special attention to adolescents who have a parental history of depression, have comorbid mental health or chronic medical conditions, experience a major negative life event, or have other risk factors for depression.

Other professional organizations have already come out in favor of somewhat more limited screening of adolescents for depression. For example, the American Medical Association recommends screening adolescents for depression if they have risk factors such as a family history or substance abuse.

Despite support for screening adolescents for depression, most physicians don't have systems in place to ensure formal, routine screening. Instead, physicians might ask some general questions about the adolescent's mood or changes in behavior, Dr. DeWitt said.

Part of the reason for the failure to do routine preventive screening may be financial, said Dr. Ted Epperly, president of the American Academy of Family Physicians. The current reimbursement system doesn't pay physicians for providing depression screening and when a service isn't paid for, it often doesn't get done, he said in an interview.

The payment system needs to be realigned to offer incentives for preventive screening, including depression screening, said Dr. Epperly of Boise, Idaho. That type of investment in prevention would have enormous clinical and systemwide financial benefits.

Most depression screening tools are questionnaires that can be filled out in the waiting room and quickly scored by the physician. Although this requires practices to invest time and energy in ensuring that screening occurs, the bigger challenge may be what to do when the screen raises a red flag. Currently, there are not enough adolescent psychiatrists to meet the demand. One option is to reach out to local psychologists to provide the psychotherapy component of treatment, Dr. Epperly said.

For primary care physicians who have the time and the interest, resources are available to help them provide more mental health treatment within their own practices, said Dr. Cathryn Galanter of the division of child and adolescent psychiatry at Columbia University in New York.

One resource is the REACH Institute's Mini-Fellowship in Primary Pediatric Psychopharmacology. As part of this program, Dr. Galanter trains primary care clinicians to screen, evaluate, diagnose, and treat adolescents with mental health problems in their practices. Another resource is the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) toolkit.

A new recommendation from the U.S. Preventive Services Task Force endorses the need for routine screening of all adolescents for clinical depression.

The task force recommended that physicians screen adolescent patients aged 12–18 years for major depressive disorder provided that systems are in place to ensure further evaluation, psychotherapy, and follow-up. But the task force concluded that there was insufficient evidence to make a recommendation about screening younger children aged 7–11 years (Pediatrics 2009;123:1223–8).

In 2002, the task force examined depression screening in adolescents and found there was not enough evidence at that time to recommend for or against routine screening. However, new evidence on the effectiveness of medications and psychotherapy to treat depressed adolescents and the reliability of screening instruments to detect depression in this group prompted the task force members to recommend screening.

In its recommendation, the task force concluded that adolescents aged 12–18 years could be effectively treated for major depressive disorder with selective serotonin reuptake inhibitors or with a combination of SSRIs and either cognitive-behavioral therapy or interpersonal psychotherapy. But because of the suicide risks associated with the use of SSRIs, the task force recommended that they be prescribed only when the patient can be closely monitored.

The best approach is likely to be a combination of careful medication management and a referral for psychotherapy, Dr. Tom DeWitt, a member of the task force and director of general and community pediatrics at Cincinnati Children's Hospital Medical Center, said in an interview.

Widespread screening is critical because of the high prevalence of depression among adolescents and the serious consequences of leaving the condition untreated, he said. It is estimated that about 6% of adolescents have major depressive disorder, with the lifetime prevalence among adolescents possibly as high as 20%, according to the report.

Although the recommendation is meant to apply to all teens, physicians should pay special attention to adolescents who have a parental history of depression, have comorbid mental health or chronic medical conditions, experience a major negative life event, or have other risk factors for depression.

Other professional organizations have already come out in favor of somewhat more limited screening of adolescents for depression. For example, the American Medical Association recommends screening adolescents for depression if they have risk factors such as a family history or substance abuse.

Despite support for screening adolescents for depression, most physicians don't have systems in place to ensure formal, routine screening. Instead, physicians might ask some general questions about the adolescent's mood or changes in behavior, Dr. DeWitt said.

Part of the reason for the failure to do routine preventive screening may be financial, said Dr. Ted Epperly, president of the American Academy of Family Physicians. The current reimbursement system doesn't pay physicians for providing depression screening and when a service isn't paid for, it often doesn't get done, he said in an interview.

The payment system needs to be realigned to offer incentives for preventive screening, including depression screening, said Dr. Epperly of Boise, Idaho. That type of investment in prevention would have enormous clinical and systemwide financial benefits.

Most depression screening tools are questionnaires that can be filled out in the waiting room and quickly scored by the physician. Although this requires practices to invest time and energy in ensuring that screening occurs, the bigger challenge may be what to do when the screen raises a red flag. Currently, there are not enough adolescent psychiatrists to meet the demand. One option is to reach out to local psychologists to provide the psychotherapy component of treatment, Dr. Epperly said.

For primary care physicians who have the time and the interest, resources are available to help them provide more mental health treatment within their own practices, said Dr. Cathryn Galanter of the division of child and adolescent psychiatry at Columbia University in New York.

One resource is the REACH Institute's Mini-Fellowship in Primary Pediatric Psychopharmacology. As part of this program, Dr. Galanter trains primary care clinicians to screen, evaluate, diagnose, and treat adolescents with mental health problems in their practices. Another resource is the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) toolkit.

A new recommendation from the U.S. Preventive Services Task Force endorses the need for routine screening of all adolescents for clinical depression.

The task force recommended that physicians screen adolescent patients aged 12–18 years for major depressive disorder provided that systems are in place to ensure further evaluation, psychotherapy, and follow-up. But the task force concluded that there was insufficient evidence to make a recommendation about screening younger children aged 7–11 years (Pediatrics 2009;123:1223–8).

In 2002, the task force examined depression screening in adolescents and found there was not enough evidence at that time to recommend for or against routine screening. However, new evidence on the effectiveness of medications and psychotherapy to treat depressed adolescents and the reliability of screening instruments to detect depression in this group prompted the task force members to recommend screening.

In its recommendation, the task force concluded that adolescents aged 12–18 years could be effectively treated for major depressive disorder with selective serotonin reuptake inhibitors or with a combination of SSRIs and either cognitive-behavioral therapy or interpersonal psychotherapy. But because of the suicide risks associated with the use of SSRIs, the task force recommended that they be prescribed only when the patient can be closely monitored.

The best approach is likely to be a combination of careful medication management and a referral for psychotherapy, Dr. Tom DeWitt, a member of the task force and director of general and community pediatrics at Cincinnati Children's Hospital Medical Center, said in an interview.

Widespread screening is critical because of the high prevalence of depression among adolescents and the serious consequences of leaving the condition untreated, he said. It is estimated that about 6% of adolescents have major depressive disorder, with the lifetime prevalence among adolescents possibly as high as 20%, according to the report.

Although the recommendation is meant to apply to all teens, physicians should pay special attention to adolescents who have a parental history of depression, have comorbid mental health or chronic medical conditions, experience a major negative life event, or have other risk factors for depression.

Other professional organizations have already come out in favor of somewhat more limited screening of adolescents for depression. For example, the American Medical Association recommends screening adolescents for depression if they have risk factors such as a family history or substance abuse.

Despite support for screening adolescents for depression, most physicians don't have systems in place to ensure formal, routine screening. Instead, physicians might ask some general questions about the adolescent's mood or changes in behavior, Dr. DeWitt said.

Part of the reason for the failure to do routine preventive screening may be financial, said Dr. Ted Epperly, president of the American Academy of Family Physicians. The current reimbursement system doesn't pay physicians for providing depression screening and when a service isn't paid for, it often doesn't get done, he said in an interview.

The payment system needs to be realigned to offer incentives for preventive screening, including depression screening, said Dr. Epperly of Boise, Idaho. That type of investment in prevention would have enormous clinical and systemwide financial benefits.

Most depression screening tools are questionnaires that can be filled out in the waiting room and quickly scored by the physician. Although this requires practices to invest time and energy in ensuring that screening occurs, the bigger challenge may be what to do when the screen raises a red flag. Currently, there are not enough adolescent psychiatrists to meet the demand. One option is to reach out to local psychologists to provide the psychotherapy component of treatment, Dr. Epperly said.

For primary care physicians who have the time and the interest, resources are available to help them provide more mental health treatment within their own practices, said Dr. Cathryn Galanter of the division of child and adolescent psychiatry at Columbia University in New York.

One resource is the REACH Institute's Mini-Fellowship in Primary Pediatric Psychopharmacology. As part of this program, Dr. Galanter trains primary care clinicians to screen, evaluate, diagnose, and treat adolescents with mental health problems in their practices. Another resource is the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) toolkit.

Soldiers returning from Iraq and Afghanistan who have suffered severe or moderate traumatic brain injury are at increased risk for certain neurodegenerative symptoms such as Alzheimer-type dementia and parkinsonism, according to an Institute of Medicine report.

The IOM also found limited but suggestive evidence of a link between mild traumatic brain injury (TBI) accompanied by loss of consciousness and Alzheimer-type dementia and parkinsonism.

The findings highlight the potential to underestimate adverse neurologic consequences in returning soldiers, many of whom have been exposed to some type of explosion resulting in traumatic brain injury, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM Committee on Gulf War and Health.

“We really have absolutely no idea about how much of a blast injury you need in order to have a neurological health outcome,” Dr. Potolicchio said.

Physicians need to take a careful history of all returning service members to determine their exposure to explosions and other hazards in a war zone, he said.

The increasing power of explosive devices as well as other weapons accounts for rates of nonpenetrating TBI and blast-related injury in the current Iraq and Afghanistan wars that are much higher than in previous conflicts. During the Vietnam War, for example, TBI accounted for about 12%–14% of combat casualties, compared with about 22% in Iraq and Afghanistan, according to the IOM report.

The Department of Defense estimates that more than 5,500 military personnel have suffered TBI in Iraq and Afghanistan as of January 2008.

Most of these veterans will seek medical treatment in a Department of Veterans Affairs clinic, but VA providers may be unable to keep up with the demand in certain areas, or the VA clinic may be too far away from the patient's home and civilian neurologists might see some of these patients, Dr. Potolicchio noted.

The IOM committee reviewed about 1,900 peer-reviewed studies to determine the long-term consequences of exposure to both penetrating and closed TBI, including blast injuries. The committee focused on clinical and epidemiologic studies of adults who suffered long-term health effects due to occupational injury, motor vehicle accident, sports injury, gunshot wound, and military combat. The review was requested by officials at the VA.

In addition to the evidence of neurodegenerative effects, the IOM committee found a positive association between moderate or severe TBI and hypopituitarism and growth hormone insufficiency. There also was a positive link to long-term adverse social functioning, such as unemployment and diminished social relationships. Moreover, mild to severe TBI was associated with depression, aggressive behaviors, and postconcussion symptoms, including memory problems, dizziness, and irritability.

The committee also identified sufficient evidence of a causal relationship between penetrating TBI and unprovoked seizures, and severe or moderate TBI and unprovoked seizures.

Despite the existing evidence, the committee noted a need for continued research, with a special emphasis on blast-induced neurotrauma. The Department of Defense and the VA should support prospective, longitudinal studies that could confirm reports of long-term or latent effects of blast exposure, and answer questions about recovery times and other factors that could improve or worsen outcomes.

To gain more data on the effects of TBI, the IOM committee also called on the VA to include a comparison group of veterans as part of its Traumatic Brain Injury Veterans Health Registry. One of the flaws in the available evidence is the lack of adequate control groups, the committee wrote.

The committee called for the Defense Department to conduct predeployment neurocognitive testing of all deployed military personnel and postdeployment testing of a representative sample of military personnel, including those with TBI, those with non-TBI injuries, and uninjured service members who did not have blast exposure. This type of information would help researchers address questions that cannot be answered with the currently available research—such as the predeployment cognitive ability of an individual and the extent to which TBI affects baseline functioning.

Soldiers returning from Iraq and Afghanistan who have suffered severe or moderate traumatic brain injury are at increased risk for certain neurodegenerative symptoms such as Alzheimer-type dementia and parkinsonism, according to an Institute of Medicine report.

The IOM also found limited but suggestive evidence of a link between mild traumatic brain injury (TBI) accompanied by loss of consciousness and Alzheimer-type dementia and parkinsonism.

The findings highlight the potential to underestimate adverse neurologic consequences in returning soldiers, many of whom have been exposed to some type of explosion resulting in traumatic brain injury, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM Committee on Gulf War and Health.

“We really have absolutely no idea about how much of a blast injury you need in order to have a neurological health outcome,” Dr. Potolicchio said.

Physicians need to take a careful history of all returning service members to determine their exposure to explosions and other hazards in a war zone, he said.

The increasing power of explosive devices as well as other weapons accounts for rates of nonpenetrating TBI and blast-related injury in the current Iraq and Afghanistan wars that are much higher than in previous conflicts. During the Vietnam War, for example, TBI accounted for about 12%–14% of combat casualties, compared with about 22% in Iraq and Afghanistan, according to the IOM report.

The Department of Defense estimates that more than 5,500 military personnel have suffered TBI in Iraq and Afghanistan as of January 2008.

Most of these veterans will seek medical treatment in a Department of Veterans Affairs clinic, but VA providers may be unable to keep up with the demand in certain areas, or the VA clinic may be too far away from the patient's home and civilian neurologists might see some of these patients, Dr. Potolicchio noted.

The IOM committee reviewed about 1,900 peer-reviewed studies to determine the long-term consequences of exposure to both penetrating and closed TBI, including blast injuries. The committee focused on clinical and epidemiologic studies of adults who suffered long-term health effects due to occupational injury, motor vehicle accident, sports injury, gunshot wound, and military combat. The review was requested by officials at the VA.

In addition to the evidence of neurodegenerative effects, the IOM committee found a positive association between moderate or severe TBI and hypopituitarism and growth hormone insufficiency. There also was a positive link to long-term adverse social functioning, such as unemployment and diminished social relationships. Moreover, mild to severe TBI was associated with depression, aggressive behaviors, and postconcussion symptoms, including memory problems, dizziness, and irritability.

The committee also identified sufficient evidence of a causal relationship between penetrating TBI and unprovoked seizures, and severe or moderate TBI and unprovoked seizures.

Despite the existing evidence, the committee noted a need for continued research, with a special emphasis on blast-induced neurotrauma. The Department of Defense and the VA should support prospective, longitudinal studies that could confirm reports of long-term or latent effects of blast exposure, and answer questions about recovery times and other factors that could improve or worsen outcomes.

To gain more data on the effects of TBI, the IOM committee also called on the VA to include a comparison group of veterans as part of its Traumatic Brain Injury Veterans Health Registry. One of the flaws in the available evidence is the lack of adequate control groups, the committee wrote.

The committee called for the Defense Department to conduct predeployment neurocognitive testing of all deployed military personnel and postdeployment testing of a representative sample of military personnel, including those with TBI, those with non-TBI injuries, and uninjured service members who did not have blast exposure. This type of information would help researchers address questions that cannot be answered with the currently available research—such as the predeployment cognitive ability of an individual and the extent to which TBI affects baseline functioning.

Soldiers returning from Iraq and Afghanistan who have suffered severe or moderate traumatic brain injury are at increased risk for certain neurodegenerative symptoms such as Alzheimer-type dementia and parkinsonism, according to an Institute of Medicine report.

The IOM also found limited but suggestive evidence of a link between mild traumatic brain injury (TBI) accompanied by loss of consciousness and Alzheimer-type dementia and parkinsonism.

The findings highlight the potential to underestimate adverse neurologic consequences in returning soldiers, many of whom have been exposed to some type of explosion resulting in traumatic brain injury, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM Committee on Gulf War and Health.

“We really have absolutely no idea about how much of a blast injury you need in order to have a neurological health outcome,” Dr. Potolicchio said.

Physicians need to take a careful history of all returning service members to determine their exposure to explosions and other hazards in a war zone, he said.

The increasing power of explosive devices as well as other weapons accounts for rates of nonpenetrating TBI and blast-related injury in the current Iraq and Afghanistan wars that are much higher than in previous conflicts. During the Vietnam War, for example, TBI accounted for about 12%–14% of combat casualties, compared with about 22% in Iraq and Afghanistan, according to the IOM report.

The Department of Defense estimates that more than 5,500 military personnel have suffered TBI in Iraq and Afghanistan as of January 2008.

Most of these veterans will seek medical treatment in a Department of Veterans Affairs clinic, but VA providers may be unable to keep up with the demand in certain areas, or the VA clinic may be too far away from the patient's home and civilian neurologists might see some of these patients, Dr. Potolicchio noted.

The IOM committee reviewed about 1,900 peer-reviewed studies to determine the long-term consequences of exposure to both penetrating and closed TBI, including blast injuries. The committee focused on clinical and epidemiologic studies of adults who suffered long-term health effects due to occupational injury, motor vehicle accident, sports injury, gunshot wound, and military combat. The review was requested by officials at the VA.

In addition to the evidence of neurodegenerative effects, the IOM committee found a positive association between moderate or severe TBI and hypopituitarism and growth hormone insufficiency. There also was a positive link to long-term adverse social functioning, such as unemployment and diminished social relationships. Moreover, mild to severe TBI was associated with depression, aggressive behaviors, and postconcussion symptoms, including memory problems, dizziness, and irritability.

The committee also identified sufficient evidence of a causal relationship between penetrating TBI and unprovoked seizures, and severe or moderate TBI and unprovoked seizures.

Despite the existing evidence, the committee noted a need for continued research, with a special emphasis on blast-induced neurotrauma. The Department of Defense and the VA should support prospective, longitudinal studies that could confirm reports of long-term or latent effects of blast exposure, and answer questions about recovery times and other factors that could improve or worsen outcomes.

To gain more data on the effects of TBI, the IOM committee also called on the VA to include a comparison group of veterans as part of its Traumatic Brain Injury Veterans Health Registry. One of the flaws in the available evidence is the lack of adequate control groups, the committee wrote.

The committee called for the Defense Department to conduct predeployment neurocognitive testing of all deployed military personnel and postdeployment testing of a representative sample of military personnel, including those with TBI, those with non-TBI injuries, and uninjured service members who did not have blast exposure. This type of information would help researchers address questions that cannot be answered with the currently available research—such as the predeployment cognitive ability of an individual and the extent to which TBI affects baseline functioning.

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased from about 1 million to 1.1 million, a 6% increase. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, rising to more than 400,000 procedures, but microdermabrasion fell somewhat in 2008. The number of microdermabrasion procedures was down 6%, to about 841,000.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami.

"This is not surprising," she said. "Patients quickly realize that these ineffective procedures are a waste of money."

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then aggregated and extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color. Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians.

He urged physicians to use care when treating patients with skin of color even if the laser used is marketed for all skin types. Without understanding the nuances of darker skin, patients can be harmed. "These patients cannot be treated as guinea pigs," he said.

Procedures rose 18% in Hispanic and 10% in black patients. Success relies on knowing the nuances of skin of color. DR. BATTLE

ELSEVIER GLOBAL MEDICAL NEWS

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased from about 1 million to 1.1 million, a 6% increase. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, rising to more than 400,000 procedures, but microdermabrasion fell somewhat in 2008. The number of microdermabrasion procedures was down 6%, to about 841,000.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami.

"This is not surprising," she said. "Patients quickly realize that these ineffective procedures are a waste of money."

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then aggregated and extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color. Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians.

He urged physicians to use care when treating patients with skin of color even if the laser used is marketed for all skin types. Without understanding the nuances of darker skin, patients can be harmed. "These patients cannot be treated as guinea pigs," he said.

Procedures rose 18% in Hispanic and 10% in black patients. Success relies on knowing the nuances of skin of color. DR. BATTLE

ELSEVIER GLOBAL MEDICAL NEWS

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased from about 1 million to 1.1 million, a 6% increase. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, rising to more than 400,000 procedures, but microdermabrasion fell somewhat in 2008. The number of microdermabrasion procedures was down 6%, to about 841,000.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami.

"This is not surprising," she said. "Patients quickly realize that these ineffective procedures are a waste of money."

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then aggregated and extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color. Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians.

He urged physicians to use care when treating patients with skin of color even if the laser used is marketed for all skin types. Without understanding the nuances of darker skin, patients can be harmed. "These patients cannot be treated as guinea pigs," he said.

Procedures rose 18% in Hispanic and 10% in black patients. Success relies on knowing the nuances of skin of color. DR. BATTLE

ELSEVIER GLOBAL MEDICAL NEWS

Medical student interest in primary care continued its gradual slip, according to the latest data from the National Resident Matching Program.

In the 2009 resident match, the percentage of U.S. medical school seniors choosing residencies dropped slightly in both internal medicine and family medicine.

This year, 4,922 internal medicine residencies were offered and 98.6% were filled. Of those, 53.5% were filled by U.S. medical graduates. Last year, 97.8% of the 4,858 positions were filled, with 54.8% filled by U.S. medical graduates. This is the third consecutive year in which interest in internal medicine has dipped among graduates of U.S. medical schools.

Family medicine residency programs experienced a similar trend: Of the 2,535 family medicine residencies that were offered, 91.2% were filled, with 42.2% of those filled by U.S. medical graduates. Last year, 90.6% of total positions were filled, with 43.9% going to U.S. medical graduates. Family medicine experienced a small increase in U.S. seniors matching to its residency programs last year, but dropped back down this year.

In raw numbers, only 2,632 U.S. seniors matched to an internal medicine residency program this year, compared with 3,884 in 1985, according to the American College of Physicians. The decline is compounded, the ACP said, because currently only 20%–25% of internal medicine residents ultimately choose to practice general internal medicine, compared with more than 50% in 1998.

“We are witnessing a generational shift from medical careers that specialize in preventive care, diagnostic evaluation, and long-term treatment of complex and chronic diseases, to specialties and subspecialties that provide specific procedures or a very limited focus of care,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP.

The problem for society as a whole, Dr. Weinberger said, is that this shift is happening at the same time that demand for primary care physicians is growing rapidly with the aging of the U.S. population. But Dr. Weinberger added that he is “cautiously optimistic” that efforts to enact comprehensive health reform in the coming years could help make primary care more attractive to medical students.

Match Day data show that interest continues to be strong in medical specialties with a heavy procedural focus, such as dermatology, neurologic surgery, orthopedic surgery, and otolaryngology.

Overall, this was the largest Match Day in history, with 29,890 participants, up 1,153 from last year and up more than 4,500 positions from 5 years ago, according to the National Resident Matching Program (NRMP). The increase included 400 more U.S. medical school seniors and 570 more international medical graduates. In addition, more students with osteopathic degrees participated in this year's match, as did more physicians who had graduated from medical school prior to this year.

“We saw an across-the-board increase in match applicants this year, particularly among U.S. medical school seniors,” said Mona M. Signer, NRMP executive director. “This is likely the result of medical school expansion across the nation in anticipation of a future physician shortage. Existing medical schools have increased their class sizes and new medical schools are in development.”

ELSEVIER GLOBAL MEDICAL NEWS

Medical student interest in primary care continued its gradual slip, according to the latest data from the National Resident Matching Program.

In the 2009 resident match, the percentage of U.S. medical school seniors choosing residencies dropped slightly in both internal medicine and family medicine.

This year, 4,922 internal medicine residencies were offered and 98.6% were filled. Of those, 53.5% were filled by U.S. medical graduates. Last year, 97.8% of the 4,858 positions were filled, with 54.8% filled by U.S. medical graduates. This is the third consecutive year in which interest in internal medicine has dipped among graduates of U.S. medical schools.

Family medicine residency programs experienced a similar trend: Of the 2,535 family medicine residencies that were offered, 91.2% were filled, with 42.2% of those filled by U.S. medical graduates. Last year, 90.6% of total positions were filled, with 43.9% going to U.S. medical graduates. Family medicine experienced a small increase in U.S. seniors matching to its residency programs last year, but dropped back down this year.

In raw numbers, only 2,632 U.S. seniors matched to an internal medicine residency program this year, compared with 3,884 in 1985, according to the American College of Physicians. The decline is compounded, the ACP said, because currently only 20%–25% of internal medicine residents ultimately choose to practice general internal medicine, compared with more than 50% in 1998.

“We are witnessing a generational shift from medical careers that specialize in preventive care, diagnostic evaluation, and long-term treatment of complex and chronic diseases, to specialties and subspecialties that provide specific procedures or a very limited focus of care,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP.

The problem for society as a whole, Dr. Weinberger said, is that this shift is happening at the same time that demand for primary care physicians is growing rapidly with the aging of the U.S. population. But Dr. Weinberger added that he is “cautiously optimistic” that efforts to enact comprehensive health reform in the coming years could help make primary care more attractive to medical students.

Match Day data show that interest continues to be strong in medical specialties with a heavy procedural focus, such as dermatology, neurologic surgery, orthopedic surgery, and otolaryngology.

Overall, this was the largest Match Day in history, with 29,890 participants, up 1,153 from last year and up more than 4,500 positions from 5 years ago, according to the National Resident Matching Program (NRMP). The increase included 400 more U.S. medical school seniors and 570 more international medical graduates. In addition, more students with osteopathic degrees participated in this year's match, as did more physicians who had graduated from medical school prior to this year.

“We saw an across-the-board increase in match applicants this year, particularly among U.S. medical school seniors,” said Mona M. Signer, NRMP executive director. “This is likely the result of medical school expansion across the nation in anticipation of a future physician shortage. Existing medical schools have increased their class sizes and new medical schools are in development.”

ELSEVIER GLOBAL MEDICAL NEWS

Medical student interest in primary care continued its gradual slip, according to the latest data from the National Resident Matching Program.

In the 2009 resident match, the percentage of U.S. medical school seniors choosing residencies dropped slightly in both internal medicine and family medicine.

This year, 4,922 internal medicine residencies were offered and 98.6% were filled. Of those, 53.5% were filled by U.S. medical graduates. Last year, 97.8% of the 4,858 positions were filled, with 54.8% filled by U.S. medical graduates. This is the third consecutive year in which interest in internal medicine has dipped among graduates of U.S. medical schools.

Family medicine residency programs experienced a similar trend: Of the 2,535 family medicine residencies that were offered, 91.2% were filled, with 42.2% of those filled by U.S. medical graduates. Last year, 90.6% of total positions were filled, with 43.9% going to U.S. medical graduates. Family medicine experienced a small increase in U.S. seniors matching to its residency programs last year, but dropped back down this year.

In raw numbers, only 2,632 U.S. seniors matched to an internal medicine residency program this year, compared with 3,884 in 1985, according to the American College of Physicians. The decline is compounded, the ACP said, because currently only 20%–25% of internal medicine residents ultimately choose to practice general internal medicine, compared with more than 50% in 1998.

“We are witnessing a generational shift from medical careers that specialize in preventive care, diagnostic evaluation, and long-term treatment of complex and chronic diseases, to specialties and subspecialties that provide specific procedures or a very limited focus of care,” said Dr. Steven E. Weinberger, senior vice president for medical education and publishing at the ACP.

The problem for society as a whole, Dr. Weinberger said, is that this shift is happening at the same time that demand for primary care physicians is growing rapidly with the aging of the U.S. population. But Dr. Weinberger added that he is “cautiously optimistic” that efforts to enact comprehensive health reform in the coming years could help make primary care more attractive to medical students.

Match Day data show that interest continues to be strong in medical specialties with a heavy procedural focus, such as dermatology, neurologic surgery, orthopedic surgery, and otolaryngology.

Overall, this was the largest Match Day in history, with 29,890 participants, up 1,153 from last year and up more than 4,500 positions from 5 years ago, according to the National Resident Matching Program (NRMP). The increase included 400 more U.S. medical school seniors and 570 more international medical graduates. In addition, more students with osteopathic degrees participated in this year's match, as did more physicians who had graduated from medical school prior to this year.

“We saw an across-the-board increase in match applicants this year, particularly among U.S. medical school seniors,” said Mona M. Signer, NRMP executive director. “This is likely the result of medical school expansion across the nation in anticipation of a future physician shortage. Existing medical schools have increased their class sizes and new medical schools are in development.”

ELSEVIER GLOBAL MEDICAL NEWS

Physicians and researchers charged with updating the Diagnostic and Statistical Manual of Mental Disorders expect significant changes for the next edition, to debut in about 3 years.

The proposed revisions will affect not only the DSM-V's specific disorder criteria, but also the clinical approach to diagnosis. Plans call for a greater emphasis on the disability and functioning associated with psychiatric illness, experts said in interviews at the annual meeting of the American Psychopathological Association.

One possible change would be to separate symptoms from functioning entirely, as in the World Health Organization's International Classification of Functioning, Disability, and Health.

Such a separation would place more emphasis on the patient's level of functioning and disability, said Dr. David J. Kupfer, chair of the DSM-V Task Force and chair of the department of psychiatry at the University of Pittsburgh. It also would get away from the tricky issue of determining which of several comorbid conditions is most responsible for creating disability, Dr. Kupfer said.

In the current DSM, Axis V is a kind of global assessment of function that involves a combination of symptoms and functional impairment. It is the only dimensional measure in the DSM-IV, according to Dr. Darrel A. Regier, director of the division of research at the American Psychiatric Association and vice chair of the DSM-V Task Force. But it also creates some confusion by linking symptoms and functioning, he said.

By separating symptoms, impairment, and distress, the process would potentially be “cleaner” and more clinically useful, Dr. Kupfer said. It also would make the process of assessing a patient's level of functioning a standard part of any psychiatric diagnosis, he said.

Members of the DSM-V Task Force are also considering a dimensional, rather than solely categorical, approach to diagnosing mood disorders.

These new approaches are designed to address some of the manual's limitations in guiding management of complex patients with comorbid conditions, as well as making the document easier to use and more clinically relevant.

“The current DSM has resulted in a lot of people not meeting criteria, and yet needing care,” Dr. Regier said.

The current DSM edition fails to account for the significant amount of not otherwise specified (NOS) diagnoses, patients who are subthreshold but have significant impairment, and the significant comorbidities of many psychiatric patients, he said.

In an effort to address this, Dr. Regier and other members of the DSM-V Task Force are looking at including more dimensional measures, but they want to use measures of symptoms that will cut across more than one diagnosis. For example, it would be helpful clinically if physicians could have measures of anxiety, mood, and cognitive impairment when diagnosing psychosis, he said.

“We really need to have a diagnostic system that describes people as they are,” Dr. Regier said.

That information could then be used to generate clinical trials, as well as genetic and pathophysiology studies, that would yield more precise treatments for patients, he said.

Another change under consideration by the DSM-V Task Force is whether to add dimensional approaches to the diagnostic manual, said Dr. Ellen Frank, a professor of psychiatry and psychology at the University of Pittsburgh and a member of the DSM-V Mood Disorders Work Group.

Under the dimensional approach, clinicians might be less concerned with whether all of the symptoms occur at the same time. Instead, they would be looking for a greater number of symptoms that might have occurred at various times in the patient's lifetime.

The final version of the DSM-V is expected to be published in May 2012, though work began in 1999. Currently, the DSM-V Task Force is drafting revisions and developing new dimensional measures, Dr. Regier said. The next step will be to field test those proposed changes starting in June 2009 and continuing until June 2010.

“We've got to get into the field with real patients and see how this is going to work,” Dr. Regier said.

Another new feature of the DSM-V is that it will be a living document: The task force will be able to make changes periodically before issuing the next formal edition. A process for updating the criteria and associated features will be established in between releasing formal editions of the DSM, Dr. Regier said, in much the same way that treatment guidelines are periodically revised.

DSM-V may separate symptoms from functioning, Dr. David J. Kupfer said. Karen Meyers

Physicians and researchers charged with updating the Diagnostic and Statistical Manual of Mental Disorders expect significant changes for the next edition, to debut in about 3 years.

The proposed revisions will affect not only the DSM-V's specific disorder criteria, but also the clinical approach to diagnosis. Plans call for a greater emphasis on the disability and functioning associated with psychiatric illness, experts said in interviews at the annual meeting of the American Psychopathological Association.

One possible change would be to separate symptoms from functioning entirely, as in the World Health Organization's International Classification of Functioning, Disability, and Health.

Such a separation would place more emphasis on the patient's level of functioning and disability, said Dr. David J. Kupfer, chair of the DSM-V Task Force and chair of the department of psychiatry at the University of Pittsburgh. It also would get away from the tricky issue of determining which of several comorbid conditions is most responsible for creating disability, Dr. Kupfer said.

In the current DSM, Axis V is a kind of global assessment of function that involves a combination of symptoms and functional impairment. It is the only dimensional measure in the DSM-IV, according to Dr. Darrel A. Regier, director of the division of research at the American Psychiatric Association and vice chair of the DSM-V Task Force. But it also creates some confusion by linking symptoms and functioning, he said.

By separating symptoms, impairment, and distress, the process would potentially be “cleaner” and more clinically useful, Dr. Kupfer said. It also would make the process of assessing a patient's level of functioning a standard part of any psychiatric diagnosis, he said.

Members of the DSM-V Task Force are also considering a dimensional, rather than solely categorical, approach to diagnosing mood disorders.

These new approaches are designed to address some of the manual's limitations in guiding management of complex patients with comorbid conditions, as well as making the document easier to use and more clinically relevant.

“The current DSM has resulted in a lot of people not meeting criteria, and yet needing care,” Dr. Regier said.

The current DSM edition fails to account for the significant amount of not otherwise specified (NOS) diagnoses, patients who are subthreshold but have significant impairment, and the significant comorbidities of many psychiatric patients, he said.

In an effort to address this, Dr. Regier and other members of the DSM-V Task Force are looking at including more dimensional measures, but they want to use measures of symptoms that will cut across more than one diagnosis. For example, it would be helpful clinically if physicians could have measures of anxiety, mood, and cognitive impairment when diagnosing psychosis, he said.

“We really need to have a diagnostic system that describes people as they are,” Dr. Regier said.

That information could then be used to generate clinical trials, as well as genetic and pathophysiology studies, that would yield more precise treatments for patients, he said.

Another change under consideration by the DSM-V Task Force is whether to add dimensional approaches to the diagnostic manual, said Dr. Ellen Frank, a professor of psychiatry and psychology at the University of Pittsburgh and a member of the DSM-V Mood Disorders Work Group.

Under the dimensional approach, clinicians might be less concerned with whether all of the symptoms occur at the same time. Instead, they would be looking for a greater number of symptoms that might have occurred at various times in the patient's lifetime.

The final version of the DSM-V is expected to be published in May 2012, though work began in 1999. Currently, the DSM-V Task Force is drafting revisions and developing new dimensional measures, Dr. Regier said. The next step will be to field test those proposed changes starting in June 2009 and continuing until June 2010.

“We've got to get into the field with real patients and see how this is going to work,” Dr. Regier said.

Another new feature of the DSM-V is that it will be a living document: The task force will be able to make changes periodically before issuing the next formal edition. A process for updating the criteria and associated features will be established in between releasing formal editions of the DSM, Dr. Regier said, in much the same way that treatment guidelines are periodically revised.

DSM-V may separate symptoms from functioning, Dr. David J. Kupfer said. Karen Meyers

Physicians and researchers charged with updating the Diagnostic and Statistical Manual of Mental Disorders expect significant changes for the next edition, to debut in about 3 years.

The proposed revisions will affect not only the DSM-V's specific disorder criteria, but also the clinical approach to diagnosis. Plans call for a greater emphasis on the disability and functioning associated with psychiatric illness, experts said in interviews at the annual meeting of the American Psychopathological Association.

One possible change would be to separate symptoms from functioning entirely, as in the World Health Organization's International Classification of Functioning, Disability, and Health.

Such a separation would place more emphasis on the patient's level of functioning and disability, said Dr. David J. Kupfer, chair of the DSM-V Task Force and chair of the department of psychiatry at the University of Pittsburgh. It also would get away from the tricky issue of determining which of several comorbid conditions is most responsible for creating disability, Dr. Kupfer said.

In the current DSM, Axis V is a kind of global assessment of function that involves a combination of symptoms and functional impairment. It is the only dimensional measure in the DSM-IV, according to Dr. Darrel A. Regier, director of the division of research at the American Psychiatric Association and vice chair of the DSM-V Task Force. But it also creates some confusion by linking symptoms and functioning, he said.

By separating symptoms, impairment, and distress, the process would potentially be “cleaner” and more clinically useful, Dr. Kupfer said. It also would make the process of assessing a patient's level of functioning a standard part of any psychiatric diagnosis, he said.

Members of the DSM-V Task Force are also considering a dimensional, rather than solely categorical, approach to diagnosing mood disorders.

These new approaches are designed to address some of the manual's limitations in guiding management of complex patients with comorbid conditions, as well as making the document easier to use and more clinically relevant.

“The current DSM has resulted in a lot of people not meeting criteria, and yet needing care,” Dr. Regier said.

The current DSM edition fails to account for the significant amount of not otherwise specified (NOS) diagnoses, patients who are subthreshold but have significant impairment, and the significant comorbidities of many psychiatric patients, he said.

In an effort to address this, Dr. Regier and other members of the DSM-V Task Force are looking at including more dimensional measures, but they want to use measures of symptoms that will cut across more than one diagnosis. For example, it would be helpful clinically if physicians could have measures of anxiety, mood, and cognitive impairment when diagnosing psychosis, he said.

“We really need to have a diagnostic system that describes people as they are,” Dr. Regier said.

That information could then be used to generate clinical trials, as well as genetic and pathophysiology studies, that would yield more precise treatments for patients, he said.

Another change under consideration by the DSM-V Task Force is whether to add dimensional approaches to the diagnostic manual, said Dr. Ellen Frank, a professor of psychiatry and psychology at the University of Pittsburgh and a member of the DSM-V Mood Disorders Work Group.

Under the dimensional approach, clinicians might be less concerned with whether all of the symptoms occur at the same time. Instead, they would be looking for a greater number of symptoms that might have occurred at various times in the patient's lifetime.

The final version of the DSM-V is expected to be published in May 2012, though work began in 1999. Currently, the DSM-V Task Force is drafting revisions and developing new dimensional measures, Dr. Regier said. The next step will be to field test those proposed changes starting in June 2009 and continuing until June 2010.

“We've got to get into the field with real patients and see how this is going to work,” Dr. Regier said.

Another new feature of the DSM-V is that it will be a living document: The task force will be able to make changes periodically before issuing the next formal edition. A process for updating the criteria and associated features will be established in between releasing formal editions of the DSM, Dr. Regier said, in much the same way that treatment guidelines are periodically revised.

DSM-V may separate symptoms from functioning, Dr. David J. Kupfer said. Karen Meyers

Study: Abortion Consent Ineffective

Laws mandating parental involvement in minors' access to abortion have shown “mixed results,” according to a literature review published by the Guttmacher Institute.

Although many studies have shown a small decrease in the abortion rate among young women in states with parental consent or notification laws, most such research has not accounted for the important factor of minors traveling out of restrictive states for abortions.

Researchers from the Guttmacher Institute, Ibis Reproductive Health, and the City University of New York reviewed 29 studies that examined various types of parental-involvement laws. Many of the studies had “serious limitations,” the team reported.

As of 2008, 34 states had laws in effect that require either parental consent or notification before a minor can receive an abortion.

ACOG Calls for Rural Services

The American College of Obstetricians and Gynecologists is calling on ob.gyns. in all areas of the country to do their part to reduce health care disparities for women living in rural areas.

In a committee opinion released in February, ACOG issued a list of suggestions for how ob.gyns. can help by undertakings ranging from telemedicine initiatives to working with rural health agencies to identify rural women's needs and barriers to their care.

ACOG also encouraged its members to partner with family physicians to ensure that appropriate training and consultation are available to providers in rural areas. Women who live outside urban areas are more likely to have cesarean deliveries, less likely to be offered a vaginal birth after cesarean, and more at risk of giving birth to low-birth-weight babies. They are also less likely to have received any family planning service within the past year, according to ACOG.

“Ob.gyns. have the ability to help improve health care for rural women,” Dr. Alan G. Waxman, chair of ACOG's Committee on Health Care for Underserved Women, said in a statement.

“ACOG encourages ob.gyns. to get involved in the process because every woman deserves to be cared for, no matter where she lives.”

REAL Act Introduced

Congress is considering legislation that would authorize federal funding for comprehensive and medically accurate sexual education.

The Responsible Education About Life (REAL) Act, introduced by Sen. Frank Lautenberg (D-N.J.) and Rep. Barbara Lee (D-Calif.), would establish the first grant program for comprehensive sex education. Programs funded would be age appropriate, medically accurate, and inclusive of both contraception and abstinence information.

Currently, federal funding is available only for sex-ed programs that exclusively promote abstinence before marriage—programs that opponents contend are unrealistically short on information about contraception and sexually transmitted diseases.

Group Targets Abortion Votes

The Susan B. Anthony List, an organization devoted to advancing “pro-life” women in politics, is launching a new campaign aimed at unseating members of Congress who support abortion rights.

The new effort, called the Votes Have Consequences initiative, will specifically attempt to unseat members of Congress whom the antiabortion group says vote according to proabortion views that are out of sync with those of their constituents.

Marjorie Dannenfelser, president of the Susan B. Anthony List, said the project will probably identify a few key problem members, then pour as much money as possible into each of those districts. In the last election cycle, the group said it raised more than $7 million for antiabortion education and mobilization efforts.

However, at press time, Ms. Dannenfelser had not yet announced a fundraising target or identified which members of Congress are to be the focus of the campaign.

Most Newborns Are Now Screened

All 50 states and the District of Columbia now require that every newborn be screened for most life-threat-ening disorders, although Pennsylvania and West Virginia still are in the process of implementing their expanded programs, according to a report from the March of Dimes.

State laws and rules vary, but all states require screening for 21 or more of the 29 serious genetic or functional disorders on the panel recommended by the American College of Medical Genetics, the March of Dimes said in its report.

The screening laws and rules are a marked improvement over 3 years ago, when the charity's report card found that only 38% of infants were born in states that required screening for 21 or more of the 29 “core” conditions. Now, 24 states and Washington, D.C., require screening for all 29 disorders, with more states expected to join them this year, the report said.

“This is a sweeping advance for public health,” Dr. R. Rodney Howell, chairman of the federal Health and Human Services Secretary's Advisory Committee on Heritable Disorders in Newborns and Children, said in a statement.

Study: Abortion Consent Ineffective

Laws mandating parental involvement in minors' access to abortion have shown “mixed results,” according to a literature review published by the Guttmacher Institute.

Although many studies have shown a small decrease in the abortion rate among young women in states with parental consent or notification laws, most such research has not accounted for the important factor of minors traveling out of restrictive states for abortions.

Researchers from the Guttmacher Institute, Ibis Reproductive Health, and the City University of New York reviewed 29 studies that examined various types of parental-involvement laws. Many of the studies had “serious limitations,” the team reported.

As of 2008, 34 states had laws in effect that require either parental consent or notification before a minor can receive an abortion.

ACOG Calls for Rural Services

The American College of Obstetricians and Gynecologists is calling on ob.gyns. in all areas of the country to do their part to reduce health care disparities for women living in rural areas.

In a committee opinion released in February, ACOG issued a list of suggestions for how ob.gyns. can help by undertakings ranging from telemedicine initiatives to working with rural health agencies to identify rural women's needs and barriers to their care.

ACOG also encouraged its members to partner with family physicians to ensure that appropriate training and consultation are available to providers in rural areas. Women who live outside urban areas are more likely to have cesarean deliveries, less likely to be offered a vaginal birth after cesarean, and more at risk of giving birth to low-birth-weight babies. They are also less likely to have received any family planning service within the past year, according to ACOG.

“Ob.gyns. have the ability to help improve health care for rural women,” Dr. Alan G. Waxman, chair of ACOG's Committee on Health Care for Underserved Women, said in a statement.

“ACOG encourages ob.gyns. to get involved in the process because every woman deserves to be cared for, no matter where she lives.”

REAL Act Introduced

Congress is considering legislation that would authorize federal funding for comprehensive and medically accurate sexual education.

The Responsible Education About Life (REAL) Act, introduced by Sen. Frank Lautenberg (D-N.J.) and Rep. Barbara Lee (D-Calif.), would establish the first grant program for comprehensive sex education. Programs funded would be age appropriate, medically accurate, and inclusive of both contraception and abstinence information.

Currently, federal funding is available only for sex-ed programs that exclusively promote abstinence before marriage—programs that opponents contend are unrealistically short on information about contraception and sexually transmitted diseases.

Group Targets Abortion Votes

The Susan B. Anthony List, an organization devoted to advancing “pro-life” women in politics, is launching a new campaign aimed at unseating members of Congress who support abortion rights.

The new effort, called the Votes Have Consequences initiative, will specifically attempt to unseat members of Congress whom the antiabortion group says vote according to proabortion views that are out of sync with those of their constituents.

Marjorie Dannenfelser, president of the Susan B. Anthony List, said the project will probably identify a few key problem members, then pour as much money as possible into each of those districts. In the last election cycle, the group said it raised more than $7 million for antiabortion education and mobilization efforts.

However, at press time, Ms. Dannenfelser had not yet announced a fundraising target or identified which members of Congress are to be the focus of the campaign.

Most Newborns Are Now Screened

All 50 states and the District of Columbia now require that every newborn be screened for most life-threat-ening disorders, although Pennsylvania and West Virginia still are in the process of implementing their expanded programs, according to a report from the March of Dimes.

State laws and rules vary, but all states require screening for 21 or more of the 29 serious genetic or functional disorders on the panel recommended by the American College of Medical Genetics, the March of Dimes said in its report.

The screening laws and rules are a marked improvement over 3 years ago, when the charity's report card found that only 38% of infants were born in states that required screening for 21 or more of the 29 “core” conditions. Now, 24 states and Washington, D.C., require screening for all 29 disorders, with more states expected to join them this year, the report said.

“This is a sweeping advance for public health,” Dr. R. Rodney Howell, chairman of the federal Health and Human Services Secretary's Advisory Committee on Heritable Disorders in Newborns and Children, said in a statement.

Study: Abortion Consent Ineffective

Laws mandating parental involvement in minors' access to abortion have shown “mixed results,” according to a literature review published by the Guttmacher Institute.

Although many studies have shown a small decrease in the abortion rate among young women in states with parental consent or notification laws, most such research has not accounted for the important factor of minors traveling out of restrictive states for abortions.

Researchers from the Guttmacher Institute, Ibis Reproductive Health, and the City University of New York reviewed 29 studies that examined various types of parental-involvement laws. Many of the studies had “serious limitations,” the team reported.

As of 2008, 34 states had laws in effect that require either parental consent or notification before a minor can receive an abortion.

ACOG Calls for Rural Services

The American College of Obstetricians and Gynecologists is calling on ob.gyns. in all areas of the country to do their part to reduce health care disparities for women living in rural areas.

In a committee opinion released in February, ACOG issued a list of suggestions for how ob.gyns. can help by undertakings ranging from telemedicine initiatives to working with rural health agencies to identify rural women's needs and barriers to their care.

ACOG also encouraged its members to partner with family physicians to ensure that appropriate training and consultation are available to providers in rural areas. Women who live outside urban areas are more likely to have cesarean deliveries, less likely to be offered a vaginal birth after cesarean, and more at risk of giving birth to low-birth-weight babies. They are also less likely to have received any family planning service within the past year, according to ACOG.

“Ob.gyns. have the ability to help improve health care for rural women,” Dr. Alan G. Waxman, chair of ACOG's Committee on Health Care for Underserved Women, said in a statement.

“ACOG encourages ob.gyns. to get involved in the process because every woman deserves to be cared for, no matter where she lives.”

REAL Act Introduced

Congress is considering legislation that would authorize federal funding for comprehensive and medically accurate sexual education.

The Responsible Education About Life (REAL) Act, introduced by Sen. Frank Lautenberg (D-N.J.) and Rep. Barbara Lee (D-Calif.), would establish the first grant program for comprehensive sex education. Programs funded would be age appropriate, medically accurate, and inclusive of both contraception and abstinence information.

Currently, federal funding is available only for sex-ed programs that exclusively promote abstinence before marriage—programs that opponents contend are unrealistically short on information about contraception and sexually transmitted diseases.

Group Targets Abortion Votes

The Susan B. Anthony List, an organization devoted to advancing “pro-life” women in politics, is launching a new campaign aimed at unseating members of Congress who support abortion rights.

The new effort, called the Votes Have Consequences initiative, will specifically attempt to unseat members of Congress whom the antiabortion group says vote according to proabortion views that are out of sync with those of their constituents.

Marjorie Dannenfelser, president of the Susan B. Anthony List, said the project will probably identify a few key problem members, then pour as much money as possible into each of those districts. In the last election cycle, the group said it raised more than $7 million for antiabortion education and mobilization efforts.

However, at press time, Ms. Dannenfelser had not yet announced a fundraising target or identified which members of Congress are to be the focus of the campaign.

Most Newborns Are Now Screened

All 50 states and the District of Columbia now require that every newborn be screened for most life-threat-ening disorders, although Pennsylvania and West Virginia still are in the process of implementing their expanded programs, according to a report from the March of Dimes.

State laws and rules vary, but all states require screening for 21 or more of the 29 serious genetic or functional disorders on the panel recommended by the American College of Medical Genetics, the March of Dimes said in its report.

The screening laws and rules are a marked improvement over 3 years ago, when the charity's report card found that only 38% of infants were born in states that required screening for 21 or more of the 29 “core” conditions. Now, 24 states and Washington, D.C., require screening for all 29 disorders, with more states expected to join them this year, the report said.

“This is a sweeping advance for public health,” Dr. R. Rodney Howell, chairman of the federal Health and Human Services Secretary's Advisory Committee on Heritable Disorders in Newborns and Children, said in a statement.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheim-er's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group, which Congress created in 2007 and included politicians, advocates, physicians, and researchers. The group's “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition. “An investment in Alzheimer's is not only good social policy, it is an economic necessity,” said Harry Johns, president and CEO of the association.

Dementias Three Times as Costly

In a separate report, the Alzheimer's Association said that Medicare pays out three times as much for the care of beneficiaries with dementias, averaging $15,000 annually, as it does for people who are free of the brain diseases. The association estimated that 5.3 million Americans are living with Alzheimer's, 500,000 new cases will emerge in 2010, and that the toll will rise to a million new cases annually by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taxing family members, who care for 70% of people with Alzheimer's. For example, a survey in Washington State found that half of caregivers said that stress was their greatest difficulty.

Bill Seeks to Speed Neuro Research

Federal lawmakers are turning their attention to neurologic research, citing the $1 trillion annual economic burden of brain and central nervous system conditions. Sen. Patty Murray (D-Wash.) and Rep. Patrick Kennedy (D-R.I.) introduced the National Neurotechnology Initiative Act of 2009 in the House (H.R. 1483) and Senate (S. 586) in March. The bill would increase funding to the National Institutes of Health, coordinate neurologic research across federal agencies, and streamline the approval process for neurologic drugs at the Food and Drug Administration. “With mental health parity now law, we are moving in the direction of bringing greater attention to brain-related illness,” Rep. Kennedy said in a statement.

Stem Cells Could Spur Business

President Obama's recent executive order lifting certain restrictions on federal funding for embryonic stem cell research could result not only in new therapies, but also in a new and profitable worldwide market. If stem cell therapies emerge, regulatory acceptance comes quickly, and insurers cover the therapies, the market for stem cell treatments could grow to $500 million by 2013, according to Kalorama Information, a life science market research firm. That's nearly 30 times the size of the stem cell market in 2008, according to Kalorama's estimates.

MS Repository Is Expanding

The Accelerated Cure Project for Multiple Sclerosis has added a new collection site for multiple sclerosis blood samples and data. Beth Israel Deaconess Medical Center in Boston will join academic and research institutions in Massachusetts, Maryland, Texas, New York, Arizona, Ohio, and Georgia partnering with the national nonprofit organization. The repositories, intended to support research in genetics, nutrition, virology, and other areas, contain samples and information from not only people with multiple sclerosis, but also those with certain other rare neurologic disorders.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration reported that the proportion of treatment admissions attributable to prescription painkiller misuse rose from 1% in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still predominate but have declined from 50% to 40% over the 10-year period. Heroin-treatment admissions remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The data set is not comprehensive because it comes only from state-licensed treatment facilities.

87 Million Americans Uninsured

Nearly 87 million Americans—1 out of 3 people under age 65—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level—between $21,200 and $42,400 in annual income for a family of four in 2008—went without health insurance at some point in 2007–2008, the report said. In addition, most of those who went uninsured did so for extended periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone employed full time, the report said.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheim-er's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group, which Congress created in 2007 and included politicians, advocates, physicians, and researchers. The group's “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition. “An investment in Alzheimer's is not only good social policy, it is an economic necessity,” said Harry Johns, president and CEO of the association.

Dementias Three Times as Costly

In a separate report, the Alzheimer's Association said that Medicare pays out three times as much for the care of beneficiaries with dementias, averaging $15,000 annually, as it does for people who are free of the brain diseases. The association estimated that 5.3 million Americans are living with Alzheimer's, 500,000 new cases will emerge in 2010, and that the toll will rise to a million new cases annually by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taxing family members, who care for 70% of people with Alzheimer's. For example, a survey in Washington State found that half of caregivers said that stress was their greatest difficulty.

Bill Seeks to Speed Neuro Research

Federal lawmakers are turning their attention to neurologic research, citing the $1 trillion annual economic burden of brain and central nervous system conditions. Sen. Patty Murray (D-Wash.) and Rep. Patrick Kennedy (D-R.I.) introduced the National Neurotechnology Initiative Act of 2009 in the House (H.R. 1483) and Senate (S. 586) in March. The bill would increase funding to the National Institutes of Health, coordinate neurologic research across federal agencies, and streamline the approval process for neurologic drugs at the Food and Drug Administration. “With mental health parity now law, we are moving in the direction of bringing greater attention to brain-related illness,” Rep. Kennedy said in a statement.

Stem Cells Could Spur Business

President Obama's recent executive order lifting certain restrictions on federal funding for embryonic stem cell research could result not only in new therapies, but also in a new and profitable worldwide market. If stem cell therapies emerge, regulatory acceptance comes quickly, and insurers cover the therapies, the market for stem cell treatments could grow to $500 million by 2013, according to Kalorama Information, a life science market research firm. That's nearly 30 times the size of the stem cell market in 2008, according to Kalorama's estimates.

MS Repository Is Expanding

The Accelerated Cure Project for Multiple Sclerosis has added a new collection site for multiple sclerosis blood samples and data. Beth Israel Deaconess Medical Center in Boston will join academic and research institutions in Massachusetts, Maryland, Texas, New York, Arizona, Ohio, and Georgia partnering with the national nonprofit organization. The repositories, intended to support research in genetics, nutrition, virology, and other areas, contain samples and information from not only people with multiple sclerosis, but also those with certain other rare neurologic disorders.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration reported that the proportion of treatment admissions attributable to prescription painkiller misuse rose from 1% in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still predominate but have declined from 50% to 40% over the 10-year period. Heroin-treatment admissions remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The data set is not comprehensive because it comes only from state-licensed treatment facilities.

87 Million Americans Uninsured

Nearly 87 million Americans—1 out of 3 people under age 65—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level—between $21,200 and $42,400 in annual income for a family of four in 2008—went without health insurance at some point in 2007–2008, the report said. In addition, most of those who went uninsured did so for extended periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone employed full time, the report said.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheim-er's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group, which Congress created in 2007 and included politicians, advocates, physicians, and researchers. The group's “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition. “An investment in Alzheimer's is not only good social policy, it is an economic necessity,” said Harry Johns, president and CEO of the association.

Dementias Three Times as Costly

In a separate report, the Alzheimer's Association said that Medicare pays out three times as much for the care of beneficiaries with dementias, averaging $15,000 annually, as it does for people who are free of the brain diseases. The association estimated that 5.3 million Americans are living with Alzheimer's, 500,000 new cases will emerge in 2010, and that the toll will rise to a million new cases annually by 2050. From 2000 to 2006, Alzheimer's disease deaths rose 47%, whereas deaths from other major diseases declined. The disease is also taxing family members, who care for 70% of people with Alzheimer's. For example, a survey in Washington State found that half of caregivers said that stress was their greatest difficulty.

Bill Seeks to Speed Neuro Research

Federal lawmakers are turning their attention to neurologic research, citing the $1 trillion annual economic burden of brain and central nervous system conditions. Sen. Patty Murray (D-Wash.) and Rep. Patrick Kennedy (D-R.I.) introduced the National Neurotechnology Initiative Act of 2009 in the House (H.R. 1483) and Senate (S. 586) in March. The bill would increase funding to the National Institutes of Health, coordinate neurologic research across federal agencies, and streamline the approval process for neurologic drugs at the Food and Drug Administration. “With mental health parity now law, we are moving in the direction of bringing greater attention to brain-related illness,” Rep. Kennedy said in a statement.

Stem Cells Could Spur Business

President Obama's recent executive order lifting certain restrictions on federal funding for embryonic stem cell research could result not only in new therapies, but also in a new and profitable worldwide market. If stem cell therapies emerge, regulatory acceptance comes quickly, and insurers cover the therapies, the market for stem cell treatments could grow to $500 million by 2013, according to Kalorama Information, a life science market research firm. That's nearly 30 times the size of the stem cell market in 2008, according to Kalorama's estimates.

MS Repository Is Expanding

The Accelerated Cure Project for Multiple Sclerosis has added a new collection site for multiple sclerosis blood samples and data. Beth Israel Deaconess Medical Center in Boston will join academic and research institutions in Massachusetts, Maryland, Texas, New York, Arizona, Ohio, and Georgia partnering with the national nonprofit organization. The repositories, intended to support research in genetics, nutrition, virology, and other areas, contain samples and information from not only people with multiple sclerosis, but also those with certain other rare neurologic disorders.

Painkiller Admissions on Rise

The Substance Abuse and Mental Health Services Administration reported that the proportion of treatment admissions attributable to prescription painkiller misuse rose from 1% in 1997 to 5% in 2007. The data come from the Treatment Episode Data Set 2007 Highlights report, which also found that alcohol-related admissions still predominate but have declined from 50% to 40% over the 10-year period. Heroin-treatment admissions remained steady for a decade, at 14%, and methamphetamine admissions hit 8% in 2007, up from 4% in 1997. The data set is not comprehensive because it comes only from state-licensed treatment facilities.

87 Million Americans Uninsured

Nearly 87 million Americans—1 out of 3 people under age 65—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level—between $21,200 and $42,400 in annual income for a family of four in 2008—went without health insurance at some point in 2007–2008, the report said. In addition, most of those who went uninsured did so for extended periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone employed full time, the report said.

Arthritis Bill Reintroduced

Advocates for expanding federal support for arthritis research and education are once again trying to push legislation through Congress. Rep. Anna Eshoo (D-Calif.) and Rep. Fred Upton (R-Mich.) have introduced the Arthritis Prevention, Control, and Cure Act (H.R. 1210), which would expand public health activities related to arthritis, set up a juvenile arthritis population database, and establish a loan repayment program for pediatric rheumatologists. Similar legislation has been introduced in the last three congresses without success. The Arthritis Foundation and the American College of Rheumatology cheered the recent introduction of the legislation, citing the significant societal toll of arthritis. “Arthritis and rheumatic diseases will likely touch every American in some stage of their lives—either as patients or caregivers,” Dr. Sherine Gabriel, ACR president, said in a statement. “This is a serious issue and should be treated as seriously as we treat other diseases.”

Lupus Research Gets Budget Boost

Congress has dedicated about $5 million to lupus research and education as part of the recently enacted fiscal year 2009 Omnibus Appropriations Act. The law, which was signed in March, includes $4 million to support the National Lupus Patient Registry, about $1 million more than in FY 2008. Congress provided another $1 million for health provider education aimed at improving early diagnosis and treatment of lupus and reducing health disparities. That education program will be operated jointly by the Office of Minority Health and the Office of Women's Health in the Department of Health and Human Services, and by the U.S. Surgeon General. The Lupus Foundation of America praised the legislation, specifically the health provider education initiative. Educational programs that improve the time to diagnosis are critical, the organization said, because more than half of individuals with lupus report that they suffered symptoms of the disease for at least 4 years and visited at least three physicians before receiving a diagnosis of lupus.

Path Outlined for Biosimilars

A small bipartisan group of legislators has joined to introduce a bill that would create a pathway for the approval of follow-on biologics, or biosimilars. The Pathway for Biosimilars Act (H.R. 1548) is designed to accomplish for follow-on biologics what the Hatch-Waxman Act of 1984 did for generic drugs. Coming as the original patents on biologics are beginning to expire, the biosimilars legislation would set up a process within the Food and Drug Administration for the expedited approval of new biologics based on innovative products that are already on the market. The bill includes safeguards for patient safety and incentives for companies to continue to create innovative products. Specifically, the bill provides 12 years of exclusivity for the original biologic product. The bill was introduced in March by Rep. Eshoo, Rep. Jay Inslee (D-Wash.), and Rep. Joe Barton (R-Tex.), the ranking member of the House Committee on Energy and Commerce. “Congress needs to finally act on this issue,” Rep. Barton said in a statement. “Our bill promotes competition through biosimilars in a way that puts patient safety first and also encourages new therapies and medical advancement.” Similar legislation (H.R. 1427) was also introduced last month by Henry Waxman (D-Calif.), chairman of that committee. Under that bill, lawmakers provided 5 years of exclusivity for the original biologic product.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow for concentration on certain patient groups.

87 Million Uninsured in 2007–08

Nearly 87 million Americans— one in three people younger than 65 years—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level ($21,200–$42,400 in annual income for a family of four in 2008) went without health insurance at some point during those 2 years, the report said. In addition, most of those who went uninsured did so for long periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone who was employed full time, the report said.

Arthritis Bill Reintroduced

Advocates for expanding federal support for arthritis research and education are once again trying to push legislation through Congress. Rep. Anna Eshoo (D-Calif.) and Rep. Fred Upton (R-Mich.) have introduced the Arthritis Prevention, Control, and Cure Act (H.R. 1210), which would expand public health activities related to arthritis, set up a juvenile arthritis population database, and establish a loan repayment program for pediatric rheumatologists. Similar legislation has been introduced in the last three congresses without success. The Arthritis Foundation and the American College of Rheumatology cheered the recent introduction of the legislation, citing the significant societal toll of arthritis. “Arthritis and rheumatic diseases will likely touch every American in some stage of their lives—either as patients or caregivers,” Dr. Sherine Gabriel, ACR president, said in a statement. “This is a serious issue and should be treated as seriously as we treat other diseases.”

Lupus Research Gets Budget Boost

Congress has dedicated about $5 million to lupus research and education as part of the recently enacted fiscal year 2009 Omnibus Appropriations Act. The law, which was signed in March, includes $4 million to support the National Lupus Patient Registry, about $1 million more than in FY 2008. Congress provided another $1 million for health provider education aimed at improving early diagnosis and treatment of lupus and reducing health disparities. That education program will be operated jointly by the Office of Minority Health and the Office of Women's Health in the Department of Health and Human Services, and by the U.S. Surgeon General. The Lupus Foundation of America praised the legislation, specifically the health provider education initiative. Educational programs that improve the time to diagnosis are critical, the organization said, because more than half of individuals with lupus report that they suffered symptoms of the disease for at least 4 years and visited at least three physicians before receiving a diagnosis of lupus.

Path Outlined for Biosimilars

A small bipartisan group of legislators has joined to introduce a bill that would create a pathway for the approval of follow-on biologics, or biosimilars. The Pathway for Biosimilars Act (H.R. 1548) is designed to accomplish for follow-on biologics what the Hatch-Waxman Act of 1984 did for generic drugs. Coming as the original patents on biologics are beginning to expire, the biosimilars legislation would set up a process within the Food and Drug Administration for the expedited approval of new biologics based on innovative products that are already on the market. The bill includes safeguards for patient safety and incentives for companies to continue to create innovative products. Specifically, the bill provides 12 years of exclusivity for the original biologic product. The bill was introduced in March by Rep. Eshoo, Rep. Jay Inslee (D-Wash.), and Rep. Joe Barton (R-Tex.), the ranking member of the House Committee on Energy and Commerce. “Congress needs to finally act on this issue,” Rep. Barton said in a statement. “Our bill promotes competition through biosimilars in a way that puts patient safety first and also encourages new therapies and medical advancement.” Similar legislation (H.R. 1427) was also introduced last month by Henry Waxman (D-Calif.), chairman of that committee. Under that bill, lawmakers provided 5 years of exclusivity for the original biologic product.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow for concentration on certain patient groups.

87 Million Uninsured in 2007–08

Nearly 87 million Americans— one in three people younger than 65 years—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level ($21,200–$42,400 in annual income for a family of four in 2008) went without health insurance at some point during those 2 years, the report said. In addition, most of those who went uninsured did so for long periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone who was employed full time, the report said.

Arthritis Bill Reintroduced

Advocates for expanding federal support for arthritis research and education are once again trying to push legislation through Congress. Rep. Anna Eshoo (D-Calif.) and Rep. Fred Upton (R-Mich.) have introduced the Arthritis Prevention, Control, and Cure Act (H.R. 1210), which would expand public health activities related to arthritis, set up a juvenile arthritis population database, and establish a loan repayment program for pediatric rheumatologists. Similar legislation has been introduced in the last three congresses without success. The Arthritis Foundation and the American College of Rheumatology cheered the recent introduction of the legislation, citing the significant societal toll of arthritis. “Arthritis and rheumatic diseases will likely touch every American in some stage of their lives—either as patients or caregivers,” Dr. Sherine Gabriel, ACR president, said in a statement. “This is a serious issue and should be treated as seriously as we treat other diseases.”

Lupus Research Gets Budget Boost

Congress has dedicated about $5 million to lupus research and education as part of the recently enacted fiscal year 2009 Omnibus Appropriations Act. The law, which was signed in March, includes $4 million to support the National Lupus Patient Registry, about $1 million more than in FY 2008. Congress provided another $1 million for health provider education aimed at improving early diagnosis and treatment of lupus and reducing health disparities. That education program will be operated jointly by the Office of Minority Health and the Office of Women's Health in the Department of Health and Human Services, and by the U.S. Surgeon General. The Lupus Foundation of America praised the legislation, specifically the health provider education initiative. Educational programs that improve the time to diagnosis are critical, the organization said, because more than half of individuals with lupus report that they suffered symptoms of the disease for at least 4 years and visited at least three physicians before receiving a diagnosis of lupus.

Path Outlined for Biosimilars

A small bipartisan group of legislators has joined to introduce a bill that would create a pathway for the approval of follow-on biologics, or biosimilars. The Pathway for Biosimilars Act (H.R. 1548) is designed to accomplish for follow-on biologics what the Hatch-Waxman Act of 1984 did for generic drugs. Coming as the original patents on biologics are beginning to expire, the biosimilars legislation would set up a process within the Food and Drug Administration for the expedited approval of new biologics based on innovative products that are already on the market. The bill includes safeguards for patient safety and incentives for companies to continue to create innovative products. Specifically, the bill provides 12 years of exclusivity for the original biologic product. The bill was introduced in March by Rep. Eshoo, Rep. Jay Inslee (D-Wash.), and Rep. Joe Barton (R-Tex.), the ranking member of the House Committee on Energy and Commerce. “Congress needs to finally act on this issue,” Rep. Barton said in a statement. “Our bill promotes competition through biosimilars in a way that puts patient safety first and also encourages new therapies and medical advancement.” Similar legislation (H.R. 1427) was also introduced last month by Henry Waxman (D-Calif.), chairman of that committee. Under that bill, lawmakers provided 5 years of exclusivity for the original biologic product.

Physicians Postponing Retirement

Fewer physicians left group practices in 2008 than in 2007, and a majority of group practice leaders believe that this change reflects more physicians' postponement of retirement because of the poor economy, said the American Medical Group Association. The group's annual survey of AMGA members reported about a 6% turnover of group practice physicians in 2008, compared with nearly 7% in 2007. The top reasons cited for leaving a group included poor fit with one's practice and the need to relocate to be closer to family. Flexibility can keep physicians in a practice, according to respondents, nearly half of whom said that part-time options encourage physicians either to stay while meeting personal needs, or to delay retirement. Almost three-quarters of group practices offer preretirement physicians reduced hours, 56% allow for no call responsibility, and 20% allow for concentration on certain patient groups.

87 Million Uninsured in 2007–08

Nearly 87 million Americans— one in three people younger than 65 years—were uninsured at some point during 2007–2008, according to a report from the advocacy group Families USA. More than half of individuals and families with incomes between the federal poverty level and twice the poverty level ($21,200–$42,400 in annual income for a family of four in 2008) went without health insurance at some point during those 2 years, the report said. In addition, most of those who went uninsured did so for long periods: Almost two-thirds were uninsured for 9 months or more. Four of five of the uninsured were in working families, and most of these families included someone who was employed full time, the report said.