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Family physicians’ compensation levels stable in pandemic
to $236,000, up from $234,000 last year, even as many practices saw a decrease in hours and patient visits during the pandemic.
Only pediatricians earned less ($221,000) according to the Medscape Family Physician Compensation Report 2021. Plastic surgeons topped this year’s list, at $526,000, followed by orthopedists, at $511,000, and cardiologists, at $459,000.
Family physicians ranked in the middle of specialties in terms of the percentages of physicians who thought they were fairly compensated: 57% of family physicians said they were fairly paid, and 79% of oncologists said they were. Only 44% of infectious disease physicians said they were fairly compensated.
Survey answers indicate, though, that pay isn’t driving family physicians’ satisfaction.
Only 10% of family physicians in the survey said that “making good money at a job I like” was the most rewarding aspect of the job. The top two answers by far were “gratitude/relationships with patients” (chosen by 34%) and “knowing I’m making the world a better place” (27%). Respondents could choose more than one answer.
Despite the small uptick in earnings overall in the specialty, more than one-third of family physicians (36%) reported a decline in compensation in this year’s survey, which included 18,000 responses from physicians in 29 specialties.
Male family physicians continue to be paid much more than their female colleagues, this year 29% more, widening the gap from 26% last year. Overall, men in primary care earned 27% more than their female colleagues, and male specialists earned 33% more.
As for decline in patients seen in some specialties, family physicians are holding their own.
Whereas pediatricians have seen a drop of 18% in patient visits, family physicians saw a decline of just 5%, from an average of 81 to 77 patients per week.
Most expect return to normal pay within 3 years
Most family physicians (83%) who incurred financial losses this year said they expect that income will return to normal within 3 years. More than one-third of that group (38%) said they expect compensation to get back to normal in the next year.
Almost all of the family physicians who lost income (91%) pointed the finger at COVID-19. Respondents could choose more than one answer, and 18% said other factors were also to blame.
Family physicians averaged $27,000 in incentive bonuses, higher than those in internal medicine, pediatrics, and psychiatry. Orthopedists had by far the highest bonuses, at $116,000.
For family physicians who received a bonus this year, the amount equaled about 12% of their salary, up from 10% last year. Bonuses are usually based on productivity but can also be tied to patient satisfaction, clinical processes, and other factors.
The number of family physicians who achieved more than three-quarters of their potential annual bonus rose to 61% this year, up from 55%.
17 hours a week on administrative tasks
The survey also ranked specialties by the amount of time physicians spent on paperwork and administrative tasks, including participation in professional organizations and clinical reading.
Family physicians fell squarely in the middle, with 17 hours per week spent on such tasks. Infectious disease physicians spent the most time, at 24.2 hours a week, and anesthesiologists spent the least, at 10.1.
Work hours declined for many physicians during the pandemic, and some were furloughed.
But, like most physicians, family physicians are once more working normal hours. They average 49 hours per week, which is slightly more than before the pandemic.
Specialists whose weekly hours are above normal are infectious disease physicians, intensivists, and public health and preventive medicine physicians; all are working 6 to 7 hours a week more than usual, according to the survey responses.
Responses also turned up some uncertainty on the future makeup of patient panels.
Most family physicians (69%) said they would continue to take new and current Medicare/Medicaid patients.
However, close to one-third of family physicians said they would stop treating at least some patients they already have and will not take new ones or haven’t decided yet.
A version of this article first appeared on Medscape.com.
to $236,000, up from $234,000 last year, even as many practices saw a decrease in hours and patient visits during the pandemic.
Only pediatricians earned less ($221,000) according to the Medscape Family Physician Compensation Report 2021. Plastic surgeons topped this year’s list, at $526,000, followed by orthopedists, at $511,000, and cardiologists, at $459,000.
Family physicians ranked in the middle of specialties in terms of the percentages of physicians who thought they were fairly compensated: 57% of family physicians said they were fairly paid, and 79% of oncologists said they were. Only 44% of infectious disease physicians said they were fairly compensated.
Survey answers indicate, though, that pay isn’t driving family physicians’ satisfaction.
Only 10% of family physicians in the survey said that “making good money at a job I like” was the most rewarding aspect of the job. The top two answers by far were “gratitude/relationships with patients” (chosen by 34%) and “knowing I’m making the world a better place” (27%). Respondents could choose more than one answer.
Despite the small uptick in earnings overall in the specialty, more than one-third of family physicians (36%) reported a decline in compensation in this year’s survey, which included 18,000 responses from physicians in 29 specialties.
Male family physicians continue to be paid much more than their female colleagues, this year 29% more, widening the gap from 26% last year. Overall, men in primary care earned 27% more than their female colleagues, and male specialists earned 33% more.
As for decline in patients seen in some specialties, family physicians are holding their own.
Whereas pediatricians have seen a drop of 18% in patient visits, family physicians saw a decline of just 5%, from an average of 81 to 77 patients per week.
Most expect return to normal pay within 3 years
Most family physicians (83%) who incurred financial losses this year said they expect that income will return to normal within 3 years. More than one-third of that group (38%) said they expect compensation to get back to normal in the next year.
Almost all of the family physicians who lost income (91%) pointed the finger at COVID-19. Respondents could choose more than one answer, and 18% said other factors were also to blame.
Family physicians averaged $27,000 in incentive bonuses, higher than those in internal medicine, pediatrics, and psychiatry. Orthopedists had by far the highest bonuses, at $116,000.
For family physicians who received a bonus this year, the amount equaled about 12% of their salary, up from 10% last year. Bonuses are usually based on productivity but can also be tied to patient satisfaction, clinical processes, and other factors.
The number of family physicians who achieved more than three-quarters of their potential annual bonus rose to 61% this year, up from 55%.
17 hours a week on administrative tasks
The survey also ranked specialties by the amount of time physicians spent on paperwork and administrative tasks, including participation in professional organizations and clinical reading.
Family physicians fell squarely in the middle, with 17 hours per week spent on such tasks. Infectious disease physicians spent the most time, at 24.2 hours a week, and anesthesiologists spent the least, at 10.1.
Work hours declined for many physicians during the pandemic, and some were furloughed.
But, like most physicians, family physicians are once more working normal hours. They average 49 hours per week, which is slightly more than before the pandemic.
Specialists whose weekly hours are above normal are infectious disease physicians, intensivists, and public health and preventive medicine physicians; all are working 6 to 7 hours a week more than usual, according to the survey responses.
Responses also turned up some uncertainty on the future makeup of patient panels.
Most family physicians (69%) said they would continue to take new and current Medicare/Medicaid patients.
However, close to one-third of family physicians said they would stop treating at least some patients they already have and will not take new ones or haven’t decided yet.
A version of this article first appeared on Medscape.com.
to $236,000, up from $234,000 last year, even as many practices saw a decrease in hours and patient visits during the pandemic.
Only pediatricians earned less ($221,000) according to the Medscape Family Physician Compensation Report 2021. Plastic surgeons topped this year’s list, at $526,000, followed by orthopedists, at $511,000, and cardiologists, at $459,000.
Family physicians ranked in the middle of specialties in terms of the percentages of physicians who thought they were fairly compensated: 57% of family physicians said they were fairly paid, and 79% of oncologists said they were. Only 44% of infectious disease physicians said they were fairly compensated.
Survey answers indicate, though, that pay isn’t driving family physicians’ satisfaction.
Only 10% of family physicians in the survey said that “making good money at a job I like” was the most rewarding aspect of the job. The top two answers by far were “gratitude/relationships with patients” (chosen by 34%) and “knowing I’m making the world a better place” (27%). Respondents could choose more than one answer.
Despite the small uptick in earnings overall in the specialty, more than one-third of family physicians (36%) reported a decline in compensation in this year’s survey, which included 18,000 responses from physicians in 29 specialties.
Male family physicians continue to be paid much more than their female colleagues, this year 29% more, widening the gap from 26% last year. Overall, men in primary care earned 27% more than their female colleagues, and male specialists earned 33% more.
As for decline in patients seen in some specialties, family physicians are holding their own.
Whereas pediatricians have seen a drop of 18% in patient visits, family physicians saw a decline of just 5%, from an average of 81 to 77 patients per week.
Most expect return to normal pay within 3 years
Most family physicians (83%) who incurred financial losses this year said they expect that income will return to normal within 3 years. More than one-third of that group (38%) said they expect compensation to get back to normal in the next year.
Almost all of the family physicians who lost income (91%) pointed the finger at COVID-19. Respondents could choose more than one answer, and 18% said other factors were also to blame.
Family physicians averaged $27,000 in incentive bonuses, higher than those in internal medicine, pediatrics, and psychiatry. Orthopedists had by far the highest bonuses, at $116,000.
For family physicians who received a bonus this year, the amount equaled about 12% of their salary, up from 10% last year. Bonuses are usually based on productivity but can also be tied to patient satisfaction, clinical processes, and other factors.
The number of family physicians who achieved more than three-quarters of their potential annual bonus rose to 61% this year, up from 55%.
17 hours a week on administrative tasks
The survey also ranked specialties by the amount of time physicians spent on paperwork and administrative tasks, including participation in professional organizations and clinical reading.
Family physicians fell squarely in the middle, with 17 hours per week spent on such tasks. Infectious disease physicians spent the most time, at 24.2 hours a week, and anesthesiologists spent the least, at 10.1.
Work hours declined for many physicians during the pandemic, and some were furloughed.
But, like most physicians, family physicians are once more working normal hours. They average 49 hours per week, which is slightly more than before the pandemic.
Specialists whose weekly hours are above normal are infectious disease physicians, intensivists, and public health and preventive medicine physicians; all are working 6 to 7 hours a week more than usual, according to the survey responses.
Responses also turned up some uncertainty on the future makeup of patient panels.
Most family physicians (69%) said they would continue to take new and current Medicare/Medicaid patients.
However, close to one-third of family physicians said they would stop treating at least some patients they already have and will not take new ones or haven’t decided yet.
A version of this article first appeared on Medscape.com.
Ob.gyn. pay up slightly during pandemic, survey finds
Although 45% of ob.gyns. reported some decline in compensation during the pandemic, they earned more income in 2020 than they did in 2019, according to the 2021 Medscape Ob/Gyn Compensation Report.
The report, which surveyed nearly 18,000 physicians in more than 29 specialties, found that ob.gyns.’ income level was $312,000 in 2020, compared with $308,000 in 2019.
Despite the $4,000 increase, they still ranked near the bottom half in comparison with all other specialties. The lowest-paid specialties were public health & preventive medicine ($237,000), family medicine ($236,000), and pediatrics ($221,000), and the top earning specialties were plastic surgery ($526,000), orthopedics ($511,000), and cardiology ($459,000).
Optimistic about financial bounce back
Most ob.gyns. who experienced income loss cited job loss, reduction in hours, and lower patient volume because of the COVID-19 pandemic as reasons for their wage decline.
The specialty’s average incentive bonus, which is usually based on productivity and can be tied to patient satisfaction and clinical processes, was $48,000, and accounted for about 14% of total salary.
Of the ob.gyns. who reported financial losses during the pandemic, 41% expect their income to return to normal this year. However, 45% believe it will take 2-3 years to bounce back from the pandemic’s financial effect. About 11% believe they will never return to their pre–COVID-19 income.
Working similar hours, seeing fewer patients
The survey also found that ob.gyns. are back to working about the same number of hours they did prepandemic. Ob.gyns. currently work on average 54 hours per week, compared with the 56 hours per week they worked before the pandemic. However, they are only seeing 76 patients per week, compared with 81 patients per week before the pandemic.
Ob.gyns. reported spending 15.1 hours per week on medical-related work outside of patient visits, including paperwork, EHR documentation, administrative and managerial work, and clinical reading. The time required was slightly longer than last year (14.3 hours per week).
Similar to last year’s report, 55% of ob.gyns. said they are fairly compensated. Around 34% of them said the most rewarding part of their job is the relationships they have with their patients, followed by helping others (23%), and being good at what they do (22%). Only 11% said money was the most rewarding part of their job.
Challenges
The pandemic has brought many challenges for physicians, including financial difficulties and the potential to be exposed to SARS-CoV-2. However, when asked about the most challenging part of their job, only 4% of ob.gyns. said the danger or risk associated with treating patients with COVID-19 was the most challenging aspect of their job. By contrast, 21% of ob.gyns. said working long hours and having so many rules and regulations bog down their daily work.
Despite the pandemic-related challenges, 74% of ob.gyns. said they would choose medicine again and work in the same specialty.
A version of this article first appeared on Medscape.com.
Although 45% of ob.gyns. reported some decline in compensation during the pandemic, they earned more income in 2020 than they did in 2019, according to the 2021 Medscape Ob/Gyn Compensation Report.
The report, which surveyed nearly 18,000 physicians in more than 29 specialties, found that ob.gyns.’ income level was $312,000 in 2020, compared with $308,000 in 2019.
Despite the $4,000 increase, they still ranked near the bottom half in comparison with all other specialties. The lowest-paid specialties were public health & preventive medicine ($237,000), family medicine ($236,000), and pediatrics ($221,000), and the top earning specialties were plastic surgery ($526,000), orthopedics ($511,000), and cardiology ($459,000).
Optimistic about financial bounce back
Most ob.gyns. who experienced income loss cited job loss, reduction in hours, and lower patient volume because of the COVID-19 pandemic as reasons for their wage decline.
The specialty’s average incentive bonus, which is usually based on productivity and can be tied to patient satisfaction and clinical processes, was $48,000, and accounted for about 14% of total salary.
Of the ob.gyns. who reported financial losses during the pandemic, 41% expect their income to return to normal this year. However, 45% believe it will take 2-3 years to bounce back from the pandemic’s financial effect. About 11% believe they will never return to their pre–COVID-19 income.
Working similar hours, seeing fewer patients
The survey also found that ob.gyns. are back to working about the same number of hours they did prepandemic. Ob.gyns. currently work on average 54 hours per week, compared with the 56 hours per week they worked before the pandemic. However, they are only seeing 76 patients per week, compared with 81 patients per week before the pandemic.
Ob.gyns. reported spending 15.1 hours per week on medical-related work outside of patient visits, including paperwork, EHR documentation, administrative and managerial work, and clinical reading. The time required was slightly longer than last year (14.3 hours per week).
Similar to last year’s report, 55% of ob.gyns. said they are fairly compensated. Around 34% of them said the most rewarding part of their job is the relationships they have with their patients, followed by helping others (23%), and being good at what they do (22%). Only 11% said money was the most rewarding part of their job.
Challenges
The pandemic has brought many challenges for physicians, including financial difficulties and the potential to be exposed to SARS-CoV-2. However, when asked about the most challenging part of their job, only 4% of ob.gyns. said the danger or risk associated with treating patients with COVID-19 was the most challenging aspect of their job. By contrast, 21% of ob.gyns. said working long hours and having so many rules and regulations bog down their daily work.
Despite the pandemic-related challenges, 74% of ob.gyns. said they would choose medicine again and work in the same specialty.
A version of this article first appeared on Medscape.com.
Although 45% of ob.gyns. reported some decline in compensation during the pandemic, they earned more income in 2020 than they did in 2019, according to the 2021 Medscape Ob/Gyn Compensation Report.
The report, which surveyed nearly 18,000 physicians in more than 29 specialties, found that ob.gyns.’ income level was $312,000 in 2020, compared with $308,000 in 2019.
Despite the $4,000 increase, they still ranked near the bottom half in comparison with all other specialties. The lowest-paid specialties were public health & preventive medicine ($237,000), family medicine ($236,000), and pediatrics ($221,000), and the top earning specialties were plastic surgery ($526,000), orthopedics ($511,000), and cardiology ($459,000).
Optimistic about financial bounce back
Most ob.gyns. who experienced income loss cited job loss, reduction in hours, and lower patient volume because of the COVID-19 pandemic as reasons for their wage decline.
The specialty’s average incentive bonus, which is usually based on productivity and can be tied to patient satisfaction and clinical processes, was $48,000, and accounted for about 14% of total salary.
Of the ob.gyns. who reported financial losses during the pandemic, 41% expect their income to return to normal this year. However, 45% believe it will take 2-3 years to bounce back from the pandemic’s financial effect. About 11% believe they will never return to their pre–COVID-19 income.
Working similar hours, seeing fewer patients
The survey also found that ob.gyns. are back to working about the same number of hours they did prepandemic. Ob.gyns. currently work on average 54 hours per week, compared with the 56 hours per week they worked before the pandemic. However, they are only seeing 76 patients per week, compared with 81 patients per week before the pandemic.
Ob.gyns. reported spending 15.1 hours per week on medical-related work outside of patient visits, including paperwork, EHR documentation, administrative and managerial work, and clinical reading. The time required was slightly longer than last year (14.3 hours per week).
Similar to last year’s report, 55% of ob.gyns. said they are fairly compensated. Around 34% of them said the most rewarding part of their job is the relationships they have with their patients, followed by helping others (23%), and being good at what they do (22%). Only 11% said money was the most rewarding part of their job.
Challenges
The pandemic has brought many challenges for physicians, including financial difficulties and the potential to be exposed to SARS-CoV-2. However, when asked about the most challenging part of their job, only 4% of ob.gyns. said the danger or risk associated with treating patients with COVID-19 was the most challenging aspect of their job. By contrast, 21% of ob.gyns. said working long hours and having so many rules and regulations bog down their daily work.
Despite the pandemic-related challenges, 74% of ob.gyns. said they would choose medicine again and work in the same specialty.
A version of this article first appeared on Medscape.com.
A new take on breathing and a performance-enhancing placebo
No ifs, ands, or butt ventilators
Breathing, on most days, is a pretty simple task. You inhale, the oxygen goes in, fills your lungs, becomes carbon dioxide, and is exhaled. But as certain recent events have made very clear, some diseases make this task difficult, which is where ventilators come in. The issue is, some patients can’t really use ventilators.
Enter a new study from Japan, which tested the ability of mice and pigs to absorb oxygen through the rectum. Yes, breathing through the butt. It’s not actually such a far-fetched idea; several aquatic animals such as sea cucumbers and catfish absorb oxygen through their intestines, and as any drunken frat boy can tell you after a good butt chug, other chemicals can absolutely be absorbed by human intestines.
After an initial successful experiment where a group of mice had their intestines scrubbed, had pure oxygen inserted enterally, and were exposed to a hypoxic environment, the researchers decided to step up their game and avoid the exhaustive act of digestive scrubbing by enlisting the aid of something out of science fiction: perfluorocarbon. If you haven’t seen “The Abyss,” this liquid can absorb massive amounts of oxygen, so you can actually breathe it in the same way you do with air.
In part two of the experiment, a group of hypoxic mice and pigs had perfluorocarbon inserted into their anuses, while another group got saline solution. The saline group did not fare well, but the animals that got perfluorocarbon had their hypoxic symptoms relieved within minutes.
The effectiveness of this procedure in humans clearly has yet to be tested, and while it may not be useful in all, or even most, situations, it is always beneficial to have more ways to combat a problem. Just don’t tell the frat boys: They’ll be hooking oxygen tanks up to their butts and chanting: “Breathe! Breathe! Breathe!”
Better, stronger, faster … pinker
Many people, most of whom aren’t even athletes, commit huge amounts of time, effort, and expense to improve their athletic performance. But what if there’s an easier way?
Research conducted at the University of Westminster (England) showed that participants could, with one fairly simple intervention, get on a treadmill and run 212 meters further in 30 minutes, increasing their speed by an average of 4.4%. Not only that, but “feelings of pleasure were also enhanced, meaning participants found running more enjoyable,” according to a statement from the university.
Is this amazing intervention a new wonder drug? No. Is it a super special nutritional supplement? Negatory. An energy drink that “gives you wiiings”? Nope. The latest designer steroid? Nyet.
Like we said, it’s simple, and it’s pink. Literally, the color pink. We will explain.
Each of the 10 study subjects completed two 30-minute trials on the treadmill. For one, they were given a clear, artificially sweetened drink while they were running. For the other, they received the exact same drink colored pink with food dye. Pink did better. So to recap the last month in our column, faster looks pink, and skinny smells like lemons.
Once again, science demonstrates that you can’t go wrong by fooling a brain. Next week, LOTME tries to find out if purple makes you funnier.
Hey … I’m singing here!
Noise pollution has been linked to plenty of negative outcomes, but the latest target is the poor baby zebra finch.
Researchers at the Max Planck Institute of Ornithology in Germany say traffic noise disrupts the timing of vocal development and impairs learning in the flying finches. The noise was also shown to suppress their immune systems, because of lingering stress.
The good news is that the birds with noise-induced stress sang as much as their peers in a control group, so the delay in development “was not due to a lack of vocal practice,” according to researchers. However, one long-term effect could be that zebra finch birdsongs could change over time due to noise-induced copying errors. Imagine a really long game of birdsong telephone – the song at the beginning is unlikely to be the song years from now.
While not mentioned in the study, one could also imagine that due to all that exposure to traffic, young zebra finches could be developing a salty dialect and impatience with fellow finches taking up too much space on the same tree branch. Hopefully, they don’t give others “the bird.”
Slimy soap
Remember at the beginning of the pandemic when it was almost impossible to find sufficient hand-washing supplies? Just when you thought you’d tried everything, there is soap made from snail slime.
Snail slime, surprisingly, has many beneficial properties for humans. The slime has antiaging and skin healing properties and is actually used in some Korean beauty supplies. The snails even use the slime to help fix their shells if they become damaged.
Happily, no snails are harmed in the slime extraction and making of the soap. Snail farmer Damien Desrochers says, “I only touch it with my finger, you see it’s not violent, it’s simple.”
As you can probably imagine, a lot of slime is needed to have a steady supply of this soap, so Mr. Desrochers has systems in place to get enough slime. Approximately 40 snails are needed to make 15 bars of soap, and he hopes to produce about 3,000 bars in the first year.
Nothing really surprises us anymore in the beauty world: People put eggs in their hair and bee venom on their skin, so what’s wrong with a little snail slime?
No ifs, ands, or butt ventilators
Breathing, on most days, is a pretty simple task. You inhale, the oxygen goes in, fills your lungs, becomes carbon dioxide, and is exhaled. But as certain recent events have made very clear, some diseases make this task difficult, which is where ventilators come in. The issue is, some patients can’t really use ventilators.
Enter a new study from Japan, which tested the ability of mice and pigs to absorb oxygen through the rectum. Yes, breathing through the butt. It’s not actually such a far-fetched idea; several aquatic animals such as sea cucumbers and catfish absorb oxygen through their intestines, and as any drunken frat boy can tell you after a good butt chug, other chemicals can absolutely be absorbed by human intestines.
After an initial successful experiment where a group of mice had their intestines scrubbed, had pure oxygen inserted enterally, and were exposed to a hypoxic environment, the researchers decided to step up their game and avoid the exhaustive act of digestive scrubbing by enlisting the aid of something out of science fiction: perfluorocarbon. If you haven’t seen “The Abyss,” this liquid can absorb massive amounts of oxygen, so you can actually breathe it in the same way you do with air.
In part two of the experiment, a group of hypoxic mice and pigs had perfluorocarbon inserted into their anuses, while another group got saline solution. The saline group did not fare well, but the animals that got perfluorocarbon had their hypoxic symptoms relieved within minutes.
The effectiveness of this procedure in humans clearly has yet to be tested, and while it may not be useful in all, or even most, situations, it is always beneficial to have more ways to combat a problem. Just don’t tell the frat boys: They’ll be hooking oxygen tanks up to their butts and chanting: “Breathe! Breathe! Breathe!”
Better, stronger, faster … pinker
Many people, most of whom aren’t even athletes, commit huge amounts of time, effort, and expense to improve their athletic performance. But what if there’s an easier way?
Research conducted at the University of Westminster (England) showed that participants could, with one fairly simple intervention, get on a treadmill and run 212 meters further in 30 minutes, increasing their speed by an average of 4.4%. Not only that, but “feelings of pleasure were also enhanced, meaning participants found running more enjoyable,” according to a statement from the university.
Is this amazing intervention a new wonder drug? No. Is it a super special nutritional supplement? Negatory. An energy drink that “gives you wiiings”? Nope. The latest designer steroid? Nyet.
Like we said, it’s simple, and it’s pink. Literally, the color pink. We will explain.
Each of the 10 study subjects completed two 30-minute trials on the treadmill. For one, they were given a clear, artificially sweetened drink while they were running. For the other, they received the exact same drink colored pink with food dye. Pink did better. So to recap the last month in our column, faster looks pink, and skinny smells like lemons.
Once again, science demonstrates that you can’t go wrong by fooling a brain. Next week, LOTME tries to find out if purple makes you funnier.
Hey … I’m singing here!
Noise pollution has been linked to plenty of negative outcomes, but the latest target is the poor baby zebra finch.
Researchers at the Max Planck Institute of Ornithology in Germany say traffic noise disrupts the timing of vocal development and impairs learning in the flying finches. The noise was also shown to suppress their immune systems, because of lingering stress.
The good news is that the birds with noise-induced stress sang as much as their peers in a control group, so the delay in development “was not due to a lack of vocal practice,” according to researchers. However, one long-term effect could be that zebra finch birdsongs could change over time due to noise-induced copying errors. Imagine a really long game of birdsong telephone – the song at the beginning is unlikely to be the song years from now.
While not mentioned in the study, one could also imagine that due to all that exposure to traffic, young zebra finches could be developing a salty dialect and impatience with fellow finches taking up too much space on the same tree branch. Hopefully, they don’t give others “the bird.”
Slimy soap
Remember at the beginning of the pandemic when it was almost impossible to find sufficient hand-washing supplies? Just when you thought you’d tried everything, there is soap made from snail slime.
Snail slime, surprisingly, has many beneficial properties for humans. The slime has antiaging and skin healing properties and is actually used in some Korean beauty supplies. The snails even use the slime to help fix their shells if they become damaged.
Happily, no snails are harmed in the slime extraction and making of the soap. Snail farmer Damien Desrochers says, “I only touch it with my finger, you see it’s not violent, it’s simple.”
As you can probably imagine, a lot of slime is needed to have a steady supply of this soap, so Mr. Desrochers has systems in place to get enough slime. Approximately 40 snails are needed to make 15 bars of soap, and he hopes to produce about 3,000 bars in the first year.
Nothing really surprises us anymore in the beauty world: People put eggs in their hair and bee venom on their skin, so what’s wrong with a little snail slime?
No ifs, ands, or butt ventilators
Breathing, on most days, is a pretty simple task. You inhale, the oxygen goes in, fills your lungs, becomes carbon dioxide, and is exhaled. But as certain recent events have made very clear, some diseases make this task difficult, which is where ventilators come in. The issue is, some patients can’t really use ventilators.
Enter a new study from Japan, which tested the ability of mice and pigs to absorb oxygen through the rectum. Yes, breathing through the butt. It’s not actually such a far-fetched idea; several aquatic animals such as sea cucumbers and catfish absorb oxygen through their intestines, and as any drunken frat boy can tell you after a good butt chug, other chemicals can absolutely be absorbed by human intestines.
After an initial successful experiment where a group of mice had their intestines scrubbed, had pure oxygen inserted enterally, and were exposed to a hypoxic environment, the researchers decided to step up their game and avoid the exhaustive act of digestive scrubbing by enlisting the aid of something out of science fiction: perfluorocarbon. If you haven’t seen “The Abyss,” this liquid can absorb massive amounts of oxygen, so you can actually breathe it in the same way you do with air.
In part two of the experiment, a group of hypoxic mice and pigs had perfluorocarbon inserted into their anuses, while another group got saline solution. The saline group did not fare well, but the animals that got perfluorocarbon had their hypoxic symptoms relieved within minutes.
The effectiveness of this procedure in humans clearly has yet to be tested, and while it may not be useful in all, or even most, situations, it is always beneficial to have more ways to combat a problem. Just don’t tell the frat boys: They’ll be hooking oxygen tanks up to their butts and chanting: “Breathe! Breathe! Breathe!”
Better, stronger, faster … pinker
Many people, most of whom aren’t even athletes, commit huge amounts of time, effort, and expense to improve their athletic performance. But what if there’s an easier way?
Research conducted at the University of Westminster (England) showed that participants could, with one fairly simple intervention, get on a treadmill and run 212 meters further in 30 minutes, increasing their speed by an average of 4.4%. Not only that, but “feelings of pleasure were also enhanced, meaning participants found running more enjoyable,” according to a statement from the university.
Is this amazing intervention a new wonder drug? No. Is it a super special nutritional supplement? Negatory. An energy drink that “gives you wiiings”? Nope. The latest designer steroid? Nyet.
Like we said, it’s simple, and it’s pink. Literally, the color pink. We will explain.
Each of the 10 study subjects completed two 30-minute trials on the treadmill. For one, they were given a clear, artificially sweetened drink while they were running. For the other, they received the exact same drink colored pink with food dye. Pink did better. So to recap the last month in our column, faster looks pink, and skinny smells like lemons.
Once again, science demonstrates that you can’t go wrong by fooling a brain. Next week, LOTME tries to find out if purple makes you funnier.
Hey … I’m singing here!
Noise pollution has been linked to plenty of negative outcomes, but the latest target is the poor baby zebra finch.
Researchers at the Max Planck Institute of Ornithology in Germany say traffic noise disrupts the timing of vocal development and impairs learning in the flying finches. The noise was also shown to suppress their immune systems, because of lingering stress.
The good news is that the birds with noise-induced stress sang as much as their peers in a control group, so the delay in development “was not due to a lack of vocal practice,” according to researchers. However, one long-term effect could be that zebra finch birdsongs could change over time due to noise-induced copying errors. Imagine a really long game of birdsong telephone – the song at the beginning is unlikely to be the song years from now.
While not mentioned in the study, one could also imagine that due to all that exposure to traffic, young zebra finches could be developing a salty dialect and impatience with fellow finches taking up too much space on the same tree branch. Hopefully, they don’t give others “the bird.”
Slimy soap
Remember at the beginning of the pandemic when it was almost impossible to find sufficient hand-washing supplies? Just when you thought you’d tried everything, there is soap made from snail slime.
Snail slime, surprisingly, has many beneficial properties for humans. The slime has antiaging and skin healing properties and is actually used in some Korean beauty supplies. The snails even use the slime to help fix their shells if they become damaged.
Happily, no snails are harmed in the slime extraction and making of the soap. Snail farmer Damien Desrochers says, “I only touch it with my finger, you see it’s not violent, it’s simple.”
As you can probably imagine, a lot of slime is needed to have a steady supply of this soap, so Mr. Desrochers has systems in place to get enough slime. Approximately 40 snails are needed to make 15 bars of soap, and he hopes to produce about 3,000 bars in the first year.
Nothing really surprises us anymore in the beauty world: People put eggs in their hair and bee venom on their skin, so what’s wrong with a little snail slime?
Medical homes a boon to patients with bleeding disorders
As bleeding disorders are increasingly recognized as a national health priority, hematologists are focusing on how the patient-centered medical home – a widely accepted concept in primary care and in some specialties – can improve outcomes and quality life for their patients.
The patient-centered medical home is a model of health care delivery in which patients receive comprehensive, accessible care that is fully integrated across all providers and elements of a healthcare system.1 The concept emerged in the 1960s among pediatricians seeking to better coordinate care for children with complex medical needs. Since then, the patient-centered medical home has become a globally recognized standard – not only in primary care, but also in specialties such as endocrinology, oncology, and geriatric medicine. The movement to establish medical homes for patients with bleeding disorders is more recent and is receiving national attention.
Why a medical home?
The advent of prophylactic therapies for bleeding disorders has vastly improved the outlook for many patients compared to just a few decades ago. However, treatment options remain limited, and patients who have severe disease or complications – such as an inadequate treatment response or the development of inhibitory antibodies to replacement clotting factors – are at risk for recurrent breakthrough bleeding that can lead to synovitis and ultimately culminate in progressive, irreversible joint damage. The resulting pain and limitation of motion greatly compromises patients’ quality of life across physical, psychological, and social domains, undermines their ability to live and work independently, and greatly increases treatment costs.2-4 Family members, too, face high stress and lower quality of life when they struggle to obtain and manage treatment while caring for loved ones with bleeding disorders.5
For patients with bleeding disorders, a patient-centered medical home can help address or surmount these challenges, said Amy Shapiro, MD, medical director of the Indiana Hemophilia and Thrombosis Center in Indianapolis, Ind., which was the first hemophilia treatment center in the country to be formally certified as a medical home.
Dr. Shapiro explained that a patient-centered medical home leverages the care of an integrated multidisciplinary team to help optimize therapies and patient outcomes across all domains of life. She sees the medical home concept as a natural fit for patients with bleeding disorders, given the complexity of their needs and the number of specialties involved. “When you have hemophilia, you don’t just need a hematologist to manage your care. You need nurses, physical therapists, and social workers. You need coordinated care for genetic counseling. You also need to coordinate dental hygiene and surgical interventions, if these are required. Patients need nutrition counseling, and they may need assistance with education or career options if too many days are missed from work or school. Patients or their families may need counseling on choosing the right insurance program so they don’t choose a plan that may create more hardships for them because of their chronic disorder.”
Meeting these needs requires the help of an integrated care team, which many individuals with bleeding disorders lack. “If you are just out there in the community and you have medical issues that need to be dealt with, often the individuals themselves have to coordinate their own care, including their medications and their appointments with different specialists,” said Dr. Shapiro. “For example, a care provider may tell a patient that they need a physical therapist and give them some names, and then the patient has to take it from there and not only find the provider, but also determine if their insurance provides coverage.”
A medical home takes a completely different approach, she explained. “At my center, when we say you need a physical therapist, we have a physical therapist on staff. Our therapist provides an assessment and determines the need for ongoing PT and whether that can be done at home with a plan and intermittent oversight, or whether the patient needs a referral, and whether the person the patient is referred to needs education on how to provide PT for someone with hemophilia. A medical home provides all this in one place. It is a place where patients know they will receive either direct services, or support to shepherd their care and outcomes, and oversight of that support as well.”
Few studies have directly assessed the medical home model in the setting of bleeding disorders, but a number have evaluated the impact of integrated care, a more general term for the practice of coordinating multidisciplinary care to improve access and outcomes while eliminating redundancies and unnecessary costs. In a recent systematic review and meta-analysis of 27 nonrandomized studies of patients with hemophilia, integrated care was linked to lower mortality, fewer emergency room visits and hospitalizations, shorter lengths of stay in the hospital, and fewer missed days of school and work.6 Such findings, combined with promising outcomes data from studies of patient-centered medical homes in other disease settings, suggest that the patient-centered medical home can significantly benefit patients with bleeding disorders and their families and caregivers.
Creating a medical home
Establishing a patient-centered medical home can be challenging, involving a plethora of stakeholders and a considerable investment of time, energy, and resources. Organizations such as the National Committee for Quality Assurance and the Accreditation Association for Ambulatory Health Care have formal certification programs to help ensure that an inpatient or outpatient center that calls itself a medical home truly is one.7-8
The certification process requires centers to document activities in areas such as patients’ rights and responsibilities, administration and governance, patient and care team relationships, clinical records and other health information, and quality, comprehensiveness, continuity, and accessibility.7 Achieving certification is rigorous, often requiring centers to document compliance with more than 100 policies, procedures, and standards.
For the Indiana Hemophilia and Thrombosis Center, becoming certified as a medical home “was a multiyear process and an ongoing process,” said Dr. Shapiro. “It involves documentation of quality improvement initiatives, obtaining input from patients to document their satisfaction, and looking at all types of systems within our center and how we integrate care so that all those systems function together. It’s a difficult process, but treatment centers are a medical home for patients with bleeding disorders, and this is an effort to provide some documentation on a national level of how we’re doing everything that we are doing.”
She noted that the process of obtaining medical home certification may require an even higher level of commitment if a bleeding disorder (hemophilia) treatment center is embedded in a university or academic medical center. In this case, more stakeholders are involved, and more hoops may need to be jumped through to implement processes that meet medical home standards while still adhering to any requirements at the organizational level.
Certification programs for patient-centered medical homes are not designed around specific disorders or diseases, but a closer look at their compliance metrics underscores how medical homes can benefit patients with bleeding disorders. For example, to receive medical home certification from the Accreditation Association for Ambulatory Health Care, a center needs to be able to document that patients’ care is not transferred without first making arrangements with a receiving health care provider, that the quality improvement programs are peer-led, and that these programs assess and address diverse measures of clinical performance, cost-effectiveness, and administrative functioning.7-9
Medical homes, the NHPCC, and Healthy People 2030
Creating patient-centered medical homes for patients with bleeding disorders is now a quality improvement objective of the National Hemophilia Program Coordinating Center, or NHPCC. Established in 2012 and funded by the federal Health Resources and Services Administration, the NHPCC partners with the eight regional hemophilia networks and more than 140 federally funded hemophilia treatment centers across the United States to identify gaps, standardize and improve access to care, and share and promote best practices for the treatment and management of blood disorders.10
In the United States, receiving care in a hemophilia treatment center (which, despite its name, typically offers care for other disorders such as von Willebrand disease) has been linked to lower mortality and fewer hospitalizations related to bleeding complications.11 To continue to improve on these outcomes, the NHPCC, regional networks, and hemophilia treatment centers are prioritizing medical homes and ranking their establishments alongside core objectives such as bettering patient and family engagement and improving the transition from pediatric to adult care.12
As part of this quality improvement work, the NHPCC, regional leadership, and hemophilia treatment centers meet regularly to identify needs and priorities, plan programs, and ensure that each center is meeting the goals and objectives set out by its federal grant.13 Such partnerships help improve and integrate care within a coordinated national framework, Dr. Shapiro said. “We all are charged with this same mission,” she added. “That doesn’t mean that every treatment center looks exactly the same, has the same number of staff, or does everything the same way, but we all have the same mission, and we know what that is. That is the work of the NHPCC, to determine and document that and help level and improve care throughout the country.”
The NHPCC also engages other stakeholders, including consumer agencies and professional organizations. Recent achievements have included a first-ever national patient needs assessment, a tandem technical needs assessment of hemophilia treatment centers, an educational outreach program for genetic counselors, a webinar on transitioning care for adolescents, a national survey of the federal 340B Drug Pricing Program, and a survey of minority patients to identify and characterize problems such as language and insurance barriers, the lack of culturally appropriate educational materials on blood disorders, and difficulties getting transportation to treatment centers or educational programs.14
In part because of this advocacy work, the U.S. Department of Health and Human Services recently included hemophilia for the first time in Healthy People, its evidence-based set of decade-long objectives aimed at improving the health of all Americans. In Healthy People 2030, the specific objective for hemophilia is to reduce the proportion of patients with severe disease who experience more than four joint bleeds per year to 13.3% (the current estimate is 16.9%).15
For Healthy People to prioritize hemophilia for the first time alongside much more common conditions such as diabetes and heart disease reflects the challenges of managing bleeding disorders and the efforts by the NHPCC and other stakeholders to raise awareness about current needs. To track progress in meeting the Healthy People 2030 objective, the NHPCC will work with federal partners to analyze patient-level data gathered through the Centers for Disease Control’s Community Counts Registry for Bleeding Disorders Surveillance program, which collects data from hemophilia treatment centers across the United States and includes patients with all levels of disease severity.
“The inclusion of bleeding disorders in Healthy People 2030 is really very significant,” said Dr. Shapiro. “These are disorders that affect less than 200,000 Americans, which is the definition of a rare disease in this context. To have hemophilia considered as a national priority is very important, not only for hemophilia, but also for other rare diseases that may in the future also be considered as being as of national importance in this way.”
References
1. Rodriguez-Saldana J. 2019. The Patient-Centered Medical Home, Primary Care, and Diabetes. In: Rodriguez-Saldana J. (eds) The Diabetes Textbook. Springer, Cham.
2. J Comorb. 2011;1:51-59.
3. Eur J Haematol. 2018 Apr;100 Suppl 1:5-13.
4. Blood. 2003;102(7):2358-63.
5. Haemophilia. 2014 Jul;20(4):541-9.
6. Haemophilia. 2016;22(Suppl 3):31-40.
7. AAAHC. Medical Home.
8. NCQA. Patient-centered medical home (PCMH).
9. AAAHC, 2013. Medical Home On-Site Certification Handbook.
10. Centers for Disease Control and Prevention. HTC Population Profile.
11. Blood Transfus. 2014;12 Suppl 3(Suppl 3):e542-e548.
12. American Thrombosis and Hemostasis Network.
13. The Great Lakes Regional Hemophilia Network.
14. American Thrombosis and Hemostasis Network. What the NHPCC does.
15. U.S. Department of Health and Human Services. Healthy People 2030: Blood Disorders.
As bleeding disorders are increasingly recognized as a national health priority, hematologists are focusing on how the patient-centered medical home – a widely accepted concept in primary care and in some specialties – can improve outcomes and quality life for their patients.
The patient-centered medical home is a model of health care delivery in which patients receive comprehensive, accessible care that is fully integrated across all providers and elements of a healthcare system.1 The concept emerged in the 1960s among pediatricians seeking to better coordinate care for children with complex medical needs. Since then, the patient-centered medical home has become a globally recognized standard – not only in primary care, but also in specialties such as endocrinology, oncology, and geriatric medicine. The movement to establish medical homes for patients with bleeding disorders is more recent and is receiving national attention.
Why a medical home?
The advent of prophylactic therapies for bleeding disorders has vastly improved the outlook for many patients compared to just a few decades ago. However, treatment options remain limited, and patients who have severe disease or complications – such as an inadequate treatment response or the development of inhibitory antibodies to replacement clotting factors – are at risk for recurrent breakthrough bleeding that can lead to synovitis and ultimately culminate in progressive, irreversible joint damage. The resulting pain and limitation of motion greatly compromises patients’ quality of life across physical, psychological, and social domains, undermines their ability to live and work independently, and greatly increases treatment costs.2-4 Family members, too, face high stress and lower quality of life when they struggle to obtain and manage treatment while caring for loved ones with bleeding disorders.5
For patients with bleeding disorders, a patient-centered medical home can help address or surmount these challenges, said Amy Shapiro, MD, medical director of the Indiana Hemophilia and Thrombosis Center in Indianapolis, Ind., which was the first hemophilia treatment center in the country to be formally certified as a medical home.
Dr. Shapiro explained that a patient-centered medical home leverages the care of an integrated multidisciplinary team to help optimize therapies and patient outcomes across all domains of life. She sees the medical home concept as a natural fit for patients with bleeding disorders, given the complexity of their needs and the number of specialties involved. “When you have hemophilia, you don’t just need a hematologist to manage your care. You need nurses, physical therapists, and social workers. You need coordinated care for genetic counseling. You also need to coordinate dental hygiene and surgical interventions, if these are required. Patients need nutrition counseling, and they may need assistance with education or career options if too many days are missed from work or school. Patients or their families may need counseling on choosing the right insurance program so they don’t choose a plan that may create more hardships for them because of their chronic disorder.”
Meeting these needs requires the help of an integrated care team, which many individuals with bleeding disorders lack. “If you are just out there in the community and you have medical issues that need to be dealt with, often the individuals themselves have to coordinate their own care, including their medications and their appointments with different specialists,” said Dr. Shapiro. “For example, a care provider may tell a patient that they need a physical therapist and give them some names, and then the patient has to take it from there and not only find the provider, but also determine if their insurance provides coverage.”
A medical home takes a completely different approach, she explained. “At my center, when we say you need a physical therapist, we have a physical therapist on staff. Our therapist provides an assessment and determines the need for ongoing PT and whether that can be done at home with a plan and intermittent oversight, or whether the patient needs a referral, and whether the person the patient is referred to needs education on how to provide PT for someone with hemophilia. A medical home provides all this in one place. It is a place where patients know they will receive either direct services, or support to shepherd their care and outcomes, and oversight of that support as well.”
Few studies have directly assessed the medical home model in the setting of bleeding disorders, but a number have evaluated the impact of integrated care, a more general term for the practice of coordinating multidisciplinary care to improve access and outcomes while eliminating redundancies and unnecessary costs. In a recent systematic review and meta-analysis of 27 nonrandomized studies of patients with hemophilia, integrated care was linked to lower mortality, fewer emergency room visits and hospitalizations, shorter lengths of stay in the hospital, and fewer missed days of school and work.6 Such findings, combined with promising outcomes data from studies of patient-centered medical homes in other disease settings, suggest that the patient-centered medical home can significantly benefit patients with bleeding disorders and their families and caregivers.
Creating a medical home
Establishing a patient-centered medical home can be challenging, involving a plethora of stakeholders and a considerable investment of time, energy, and resources. Organizations such as the National Committee for Quality Assurance and the Accreditation Association for Ambulatory Health Care have formal certification programs to help ensure that an inpatient or outpatient center that calls itself a medical home truly is one.7-8
The certification process requires centers to document activities in areas such as patients’ rights and responsibilities, administration and governance, patient and care team relationships, clinical records and other health information, and quality, comprehensiveness, continuity, and accessibility.7 Achieving certification is rigorous, often requiring centers to document compliance with more than 100 policies, procedures, and standards.
For the Indiana Hemophilia and Thrombosis Center, becoming certified as a medical home “was a multiyear process and an ongoing process,” said Dr. Shapiro. “It involves documentation of quality improvement initiatives, obtaining input from patients to document their satisfaction, and looking at all types of systems within our center and how we integrate care so that all those systems function together. It’s a difficult process, but treatment centers are a medical home for patients with bleeding disorders, and this is an effort to provide some documentation on a national level of how we’re doing everything that we are doing.”
She noted that the process of obtaining medical home certification may require an even higher level of commitment if a bleeding disorder (hemophilia) treatment center is embedded in a university or academic medical center. In this case, more stakeholders are involved, and more hoops may need to be jumped through to implement processes that meet medical home standards while still adhering to any requirements at the organizational level.
Certification programs for patient-centered medical homes are not designed around specific disorders or diseases, but a closer look at their compliance metrics underscores how medical homes can benefit patients with bleeding disorders. For example, to receive medical home certification from the Accreditation Association for Ambulatory Health Care, a center needs to be able to document that patients’ care is not transferred without first making arrangements with a receiving health care provider, that the quality improvement programs are peer-led, and that these programs assess and address diverse measures of clinical performance, cost-effectiveness, and administrative functioning.7-9
Medical homes, the NHPCC, and Healthy People 2030
Creating patient-centered medical homes for patients with bleeding disorders is now a quality improvement objective of the National Hemophilia Program Coordinating Center, or NHPCC. Established in 2012 and funded by the federal Health Resources and Services Administration, the NHPCC partners with the eight regional hemophilia networks and more than 140 federally funded hemophilia treatment centers across the United States to identify gaps, standardize and improve access to care, and share and promote best practices for the treatment and management of blood disorders.10
In the United States, receiving care in a hemophilia treatment center (which, despite its name, typically offers care for other disorders such as von Willebrand disease) has been linked to lower mortality and fewer hospitalizations related to bleeding complications.11 To continue to improve on these outcomes, the NHPCC, regional networks, and hemophilia treatment centers are prioritizing medical homes and ranking their establishments alongside core objectives such as bettering patient and family engagement and improving the transition from pediatric to adult care.12
As part of this quality improvement work, the NHPCC, regional leadership, and hemophilia treatment centers meet regularly to identify needs and priorities, plan programs, and ensure that each center is meeting the goals and objectives set out by its federal grant.13 Such partnerships help improve and integrate care within a coordinated national framework, Dr. Shapiro said. “We all are charged with this same mission,” she added. “That doesn’t mean that every treatment center looks exactly the same, has the same number of staff, or does everything the same way, but we all have the same mission, and we know what that is. That is the work of the NHPCC, to determine and document that and help level and improve care throughout the country.”
The NHPCC also engages other stakeholders, including consumer agencies and professional organizations. Recent achievements have included a first-ever national patient needs assessment, a tandem technical needs assessment of hemophilia treatment centers, an educational outreach program for genetic counselors, a webinar on transitioning care for adolescents, a national survey of the federal 340B Drug Pricing Program, and a survey of minority patients to identify and characterize problems such as language and insurance barriers, the lack of culturally appropriate educational materials on blood disorders, and difficulties getting transportation to treatment centers or educational programs.14
In part because of this advocacy work, the U.S. Department of Health and Human Services recently included hemophilia for the first time in Healthy People, its evidence-based set of decade-long objectives aimed at improving the health of all Americans. In Healthy People 2030, the specific objective for hemophilia is to reduce the proportion of patients with severe disease who experience more than four joint bleeds per year to 13.3% (the current estimate is 16.9%).15
For Healthy People to prioritize hemophilia for the first time alongside much more common conditions such as diabetes and heart disease reflects the challenges of managing bleeding disorders and the efforts by the NHPCC and other stakeholders to raise awareness about current needs. To track progress in meeting the Healthy People 2030 objective, the NHPCC will work with federal partners to analyze patient-level data gathered through the Centers for Disease Control’s Community Counts Registry for Bleeding Disorders Surveillance program, which collects data from hemophilia treatment centers across the United States and includes patients with all levels of disease severity.
“The inclusion of bleeding disorders in Healthy People 2030 is really very significant,” said Dr. Shapiro. “These are disorders that affect less than 200,000 Americans, which is the definition of a rare disease in this context. To have hemophilia considered as a national priority is very important, not only for hemophilia, but also for other rare diseases that may in the future also be considered as being as of national importance in this way.”
References
1. Rodriguez-Saldana J. 2019. The Patient-Centered Medical Home, Primary Care, and Diabetes. In: Rodriguez-Saldana J. (eds) The Diabetes Textbook. Springer, Cham.
2. J Comorb. 2011;1:51-59.
3. Eur J Haematol. 2018 Apr;100 Suppl 1:5-13.
4. Blood. 2003;102(7):2358-63.
5. Haemophilia. 2014 Jul;20(4):541-9.
6. Haemophilia. 2016;22(Suppl 3):31-40.
7. AAAHC. Medical Home.
8. NCQA. Patient-centered medical home (PCMH).
9. AAAHC, 2013. Medical Home On-Site Certification Handbook.
10. Centers for Disease Control and Prevention. HTC Population Profile.
11. Blood Transfus. 2014;12 Suppl 3(Suppl 3):e542-e548.
12. American Thrombosis and Hemostasis Network.
13. The Great Lakes Regional Hemophilia Network.
14. American Thrombosis and Hemostasis Network. What the NHPCC does.
15. U.S. Department of Health and Human Services. Healthy People 2030: Blood Disorders.
As bleeding disorders are increasingly recognized as a national health priority, hematologists are focusing on how the patient-centered medical home – a widely accepted concept in primary care and in some specialties – can improve outcomes and quality life for their patients.
The patient-centered medical home is a model of health care delivery in which patients receive comprehensive, accessible care that is fully integrated across all providers and elements of a healthcare system.1 The concept emerged in the 1960s among pediatricians seeking to better coordinate care for children with complex medical needs. Since then, the patient-centered medical home has become a globally recognized standard – not only in primary care, but also in specialties such as endocrinology, oncology, and geriatric medicine. The movement to establish medical homes for patients with bleeding disorders is more recent and is receiving national attention.
Why a medical home?
The advent of prophylactic therapies for bleeding disorders has vastly improved the outlook for many patients compared to just a few decades ago. However, treatment options remain limited, and patients who have severe disease or complications – such as an inadequate treatment response or the development of inhibitory antibodies to replacement clotting factors – are at risk for recurrent breakthrough bleeding that can lead to synovitis and ultimately culminate in progressive, irreversible joint damage. The resulting pain and limitation of motion greatly compromises patients’ quality of life across physical, psychological, and social domains, undermines their ability to live and work independently, and greatly increases treatment costs.2-4 Family members, too, face high stress and lower quality of life when they struggle to obtain and manage treatment while caring for loved ones with bleeding disorders.5
For patients with bleeding disorders, a patient-centered medical home can help address or surmount these challenges, said Amy Shapiro, MD, medical director of the Indiana Hemophilia and Thrombosis Center in Indianapolis, Ind., which was the first hemophilia treatment center in the country to be formally certified as a medical home.
Dr. Shapiro explained that a patient-centered medical home leverages the care of an integrated multidisciplinary team to help optimize therapies and patient outcomes across all domains of life. She sees the medical home concept as a natural fit for patients with bleeding disorders, given the complexity of their needs and the number of specialties involved. “When you have hemophilia, you don’t just need a hematologist to manage your care. You need nurses, physical therapists, and social workers. You need coordinated care for genetic counseling. You also need to coordinate dental hygiene and surgical interventions, if these are required. Patients need nutrition counseling, and they may need assistance with education or career options if too many days are missed from work or school. Patients or their families may need counseling on choosing the right insurance program so they don’t choose a plan that may create more hardships for them because of their chronic disorder.”
Meeting these needs requires the help of an integrated care team, which many individuals with bleeding disorders lack. “If you are just out there in the community and you have medical issues that need to be dealt with, often the individuals themselves have to coordinate their own care, including their medications and their appointments with different specialists,” said Dr. Shapiro. “For example, a care provider may tell a patient that they need a physical therapist and give them some names, and then the patient has to take it from there and not only find the provider, but also determine if their insurance provides coverage.”
A medical home takes a completely different approach, she explained. “At my center, when we say you need a physical therapist, we have a physical therapist on staff. Our therapist provides an assessment and determines the need for ongoing PT and whether that can be done at home with a plan and intermittent oversight, or whether the patient needs a referral, and whether the person the patient is referred to needs education on how to provide PT for someone with hemophilia. A medical home provides all this in one place. It is a place where patients know they will receive either direct services, or support to shepherd their care and outcomes, and oversight of that support as well.”
Few studies have directly assessed the medical home model in the setting of bleeding disorders, but a number have evaluated the impact of integrated care, a more general term for the practice of coordinating multidisciplinary care to improve access and outcomes while eliminating redundancies and unnecessary costs. In a recent systematic review and meta-analysis of 27 nonrandomized studies of patients with hemophilia, integrated care was linked to lower mortality, fewer emergency room visits and hospitalizations, shorter lengths of stay in the hospital, and fewer missed days of school and work.6 Such findings, combined with promising outcomes data from studies of patient-centered medical homes in other disease settings, suggest that the patient-centered medical home can significantly benefit patients with bleeding disorders and their families and caregivers.
Creating a medical home
Establishing a patient-centered medical home can be challenging, involving a plethora of stakeholders and a considerable investment of time, energy, and resources. Organizations such as the National Committee for Quality Assurance and the Accreditation Association for Ambulatory Health Care have formal certification programs to help ensure that an inpatient or outpatient center that calls itself a medical home truly is one.7-8
The certification process requires centers to document activities in areas such as patients’ rights and responsibilities, administration and governance, patient and care team relationships, clinical records and other health information, and quality, comprehensiveness, continuity, and accessibility.7 Achieving certification is rigorous, often requiring centers to document compliance with more than 100 policies, procedures, and standards.
For the Indiana Hemophilia and Thrombosis Center, becoming certified as a medical home “was a multiyear process and an ongoing process,” said Dr. Shapiro. “It involves documentation of quality improvement initiatives, obtaining input from patients to document their satisfaction, and looking at all types of systems within our center and how we integrate care so that all those systems function together. It’s a difficult process, but treatment centers are a medical home for patients with bleeding disorders, and this is an effort to provide some documentation on a national level of how we’re doing everything that we are doing.”
She noted that the process of obtaining medical home certification may require an even higher level of commitment if a bleeding disorder (hemophilia) treatment center is embedded in a university or academic medical center. In this case, more stakeholders are involved, and more hoops may need to be jumped through to implement processes that meet medical home standards while still adhering to any requirements at the organizational level.
Certification programs for patient-centered medical homes are not designed around specific disorders or diseases, but a closer look at their compliance metrics underscores how medical homes can benefit patients with bleeding disorders. For example, to receive medical home certification from the Accreditation Association for Ambulatory Health Care, a center needs to be able to document that patients’ care is not transferred without first making arrangements with a receiving health care provider, that the quality improvement programs are peer-led, and that these programs assess and address diverse measures of clinical performance, cost-effectiveness, and administrative functioning.7-9
Medical homes, the NHPCC, and Healthy People 2030
Creating patient-centered medical homes for patients with bleeding disorders is now a quality improvement objective of the National Hemophilia Program Coordinating Center, or NHPCC. Established in 2012 and funded by the federal Health Resources and Services Administration, the NHPCC partners with the eight regional hemophilia networks and more than 140 federally funded hemophilia treatment centers across the United States to identify gaps, standardize and improve access to care, and share and promote best practices for the treatment and management of blood disorders.10
In the United States, receiving care in a hemophilia treatment center (which, despite its name, typically offers care for other disorders such as von Willebrand disease) has been linked to lower mortality and fewer hospitalizations related to bleeding complications.11 To continue to improve on these outcomes, the NHPCC, regional networks, and hemophilia treatment centers are prioritizing medical homes and ranking their establishments alongside core objectives such as bettering patient and family engagement and improving the transition from pediatric to adult care.12
As part of this quality improvement work, the NHPCC, regional leadership, and hemophilia treatment centers meet regularly to identify needs and priorities, plan programs, and ensure that each center is meeting the goals and objectives set out by its federal grant.13 Such partnerships help improve and integrate care within a coordinated national framework, Dr. Shapiro said. “We all are charged with this same mission,” she added. “That doesn’t mean that every treatment center looks exactly the same, has the same number of staff, or does everything the same way, but we all have the same mission, and we know what that is. That is the work of the NHPCC, to determine and document that and help level and improve care throughout the country.”
The NHPCC also engages other stakeholders, including consumer agencies and professional organizations. Recent achievements have included a first-ever national patient needs assessment, a tandem technical needs assessment of hemophilia treatment centers, an educational outreach program for genetic counselors, a webinar on transitioning care for adolescents, a national survey of the federal 340B Drug Pricing Program, and a survey of minority patients to identify and characterize problems such as language and insurance barriers, the lack of culturally appropriate educational materials on blood disorders, and difficulties getting transportation to treatment centers or educational programs.14
In part because of this advocacy work, the U.S. Department of Health and Human Services recently included hemophilia for the first time in Healthy People, its evidence-based set of decade-long objectives aimed at improving the health of all Americans. In Healthy People 2030, the specific objective for hemophilia is to reduce the proportion of patients with severe disease who experience more than four joint bleeds per year to 13.3% (the current estimate is 16.9%).15
For Healthy People to prioritize hemophilia for the first time alongside much more common conditions such as diabetes and heart disease reflects the challenges of managing bleeding disorders and the efforts by the NHPCC and other stakeholders to raise awareness about current needs. To track progress in meeting the Healthy People 2030 objective, the NHPCC will work with federal partners to analyze patient-level data gathered through the Centers for Disease Control’s Community Counts Registry for Bleeding Disorders Surveillance program, which collects data from hemophilia treatment centers across the United States and includes patients with all levels of disease severity.
“The inclusion of bleeding disorders in Healthy People 2030 is really very significant,” said Dr. Shapiro. “These are disorders that affect less than 200,000 Americans, which is the definition of a rare disease in this context. To have hemophilia considered as a national priority is very important, not only for hemophilia, but also for other rare diseases that may in the future also be considered as being as of national importance in this way.”
References
1. Rodriguez-Saldana J. 2019. The Patient-Centered Medical Home, Primary Care, and Diabetes. In: Rodriguez-Saldana J. (eds) The Diabetes Textbook. Springer, Cham.
2. J Comorb. 2011;1:51-59.
3. Eur J Haematol. 2018 Apr;100 Suppl 1:5-13.
4. Blood. 2003;102(7):2358-63.
5. Haemophilia. 2014 Jul;20(4):541-9.
6. Haemophilia. 2016;22(Suppl 3):31-40.
7. AAAHC. Medical Home.
8. NCQA. Patient-centered medical home (PCMH).
9. AAAHC, 2013. Medical Home On-Site Certification Handbook.
10. Centers for Disease Control and Prevention. HTC Population Profile.
11. Blood Transfus. 2014;12 Suppl 3(Suppl 3):e542-e548.
12. American Thrombosis and Hemostasis Network.
13. The Great Lakes Regional Hemophilia Network.
14. American Thrombosis and Hemostasis Network. What the NHPCC does.
15. U.S. Department of Health and Human Services. Healthy People 2030: Blood Disorders.
Pressure on primary care expected to intensify with long-COVID
, experts say.
“It could be as many as 5% to 10% who are still having symptoms at 12 weeks. Those numbers are higher if you’re talking about patients who had been hospitalized with COVID-19,” Russ Phillips, MD, director of the Center for Primary Care at Harvard Medical School, Boston, said in an interview.
A recent study from the Centers for Disease Control and Prevention and Kaiser Permanente Georgia found that among 3,171 nonhospitalized adult patients with COVID-19, 69% had one or more outpatient visits 28 to 180 days after the diagnosis. Two-thirds had a visit for a new primary diagnosis, and about one-third had a new specialist visit. Symptom diagnoses included cough, shortness of breath, chest or throat pain, and fatigue.
These visits have come while cases of acute COVID continue to occur, and there has been an increase in patients returning to primary care after avoiding it while the pandemic surged. For these patients, delay in seeking care has often led a worsening of chronic conditions.
Dr. Phillips pointed to a shortcoming in primary care that will need to be addressed with regard to long-COVID: “We don’t have good systems to follow patients and their symptoms over time.”
Long-COVID will require that kind of care, but current payment systems don’t support proactively reaching out to patients to track them over time, he noted.
“We do a good job of identifying these issues for patients who come in, but it’s the patients who don’t that we worry about the most,” he said.
Dr. Phillips provided examples of the kind of management plans needed to improve outcomes for patients with long-COVID. In anticoagulation clinics, patients who receive blood thinners are monitored closely, and in mental health care, patients with depression are linked with social workers and are monitored regularly.
“Around COVID, those management plans are in their infancy,” he said.
John Brooks, MD, chief medical officer for the CDC’s COVID-19 response, testified in a congressional hearing at the end of April that interim guidance concerning protocols for long-COVID in primary care are forthcoming. He also noted that the CDC is working closely with the Centers for Medicare & Medicaid Services to develop medical coding for long-COVID.
In the meantime, Dr. Phillips said, one strategy is to have patients self-monitor their condition and relay results to primary care physicians electronically.
As an example, Dr. Phillips described a patient with long-COVID who was receiving supplemental oxygen and who wanted to resume her exercise regimen.
She checked her own oxygen saturation levels before and during exercise and reported the levels every few days through their patient portal.
“Very slowly we were able to cut down on her oxygen and increase her exercise capacity until she no longer needed oxygen and could go back to her usual activities of daily living,” he said.
Nurse practitioners, social workers, and other nonphysician care team members may be increasingly relied upon to provide care for long-COVID patients as well, he said.
Additionally, telehealth, which is currently reimbursed the same way as in-person visits are, enables easier access for checking in with patients, he said.
Empathy and listening needed
Sabrina Assoumou, MD, MPH, assistant professor of medicine at Boston University, told this news organization that it will be crucial to address health care disparities as long-COVID cases mount.
COVID disproportionately affects communities of color, and it stands to reason that this will be the case for long-COVID as well, she said. Diversifying the workforce will be vital, inasmuch as diagnosis may depend on how well a physician listens to patients as they describe their symptoms, continued Dr. Assoumou, whose primary care practice centers on HIV patients.
The symptoms of long-COVID are vague, she explained, and include brain fog, fatigue, and shortness of breath, and it takes longer to diagnose than many conditions.
Dr. Assoumou said some people were never tested for COVID and never received a diagnosis, yet they are now experiencing the extended effects.
“Long-COVID will force us to go back to the basics – like really listening to our patients,” she said. “We’re definitely going to need to be more empathetic.”
No large influx yet
Charles Vega, MD, health sciences clinical professor of family medicine at the University of California, Irvine, said he is skeptical that the primary care system will be overwhelmed with long-COVID cases.
Dr. Vega is a family physician working in the largest safety net clinic in Orange County, California. About 90% of his patients are LatinX, a population disproportionately burdened by COVID, yet he hasn’t seen a surge in long-COVID cases.
He said that may be because patients know there isn’t a treatment for long-COVID. They are well connected through online forums such as Body Politic COVID-19 Support Group and may not feel they need to see a doctor.
“It wasn’t scientists finding [long-COVID], it was patients who developed this disease model themselves,” he said. “That’s where most of the data sharing is.”
Yet, for long-COVID patients who do need care, primary care is the best home for them, Dr. Vega said.
He said the most common symptoms he sees are fatigue and poor activity tolerance. “They get winded going to the bathroom,” he said.
The most difficult symptom is dyspnea, he said. Patients describe being breathless, but it’s not bad enough to qualify for supplemental oxygen.
“Being breathless is a pretty desperate thing and hurts quality of life,” he said.
Most patients describe general malaise.
Care for long-COVID will require medical care and mental health care, Dr. Vega notes. Primary care is already set up to screen and to coordinate care with the appropriate provider.
“I think there’s a role for specialists, but primary care has to be involved,” he said.
Dr. Phillips, Dr. Assoumou, and Dr. Vega report no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
, experts say.
“It could be as many as 5% to 10% who are still having symptoms at 12 weeks. Those numbers are higher if you’re talking about patients who had been hospitalized with COVID-19,” Russ Phillips, MD, director of the Center for Primary Care at Harvard Medical School, Boston, said in an interview.
A recent study from the Centers for Disease Control and Prevention and Kaiser Permanente Georgia found that among 3,171 nonhospitalized adult patients with COVID-19, 69% had one or more outpatient visits 28 to 180 days after the diagnosis. Two-thirds had a visit for a new primary diagnosis, and about one-third had a new specialist visit. Symptom diagnoses included cough, shortness of breath, chest or throat pain, and fatigue.
These visits have come while cases of acute COVID continue to occur, and there has been an increase in patients returning to primary care after avoiding it while the pandemic surged. For these patients, delay in seeking care has often led a worsening of chronic conditions.
Dr. Phillips pointed to a shortcoming in primary care that will need to be addressed with regard to long-COVID: “We don’t have good systems to follow patients and their symptoms over time.”
Long-COVID will require that kind of care, but current payment systems don’t support proactively reaching out to patients to track them over time, he noted.
“We do a good job of identifying these issues for patients who come in, but it’s the patients who don’t that we worry about the most,” he said.
Dr. Phillips provided examples of the kind of management plans needed to improve outcomes for patients with long-COVID. In anticoagulation clinics, patients who receive blood thinners are monitored closely, and in mental health care, patients with depression are linked with social workers and are monitored regularly.
“Around COVID, those management plans are in their infancy,” he said.
John Brooks, MD, chief medical officer for the CDC’s COVID-19 response, testified in a congressional hearing at the end of April that interim guidance concerning protocols for long-COVID in primary care are forthcoming. He also noted that the CDC is working closely with the Centers for Medicare & Medicaid Services to develop medical coding for long-COVID.
In the meantime, Dr. Phillips said, one strategy is to have patients self-monitor their condition and relay results to primary care physicians electronically.
As an example, Dr. Phillips described a patient with long-COVID who was receiving supplemental oxygen and who wanted to resume her exercise regimen.
She checked her own oxygen saturation levels before and during exercise and reported the levels every few days through their patient portal.
“Very slowly we were able to cut down on her oxygen and increase her exercise capacity until she no longer needed oxygen and could go back to her usual activities of daily living,” he said.
Nurse practitioners, social workers, and other nonphysician care team members may be increasingly relied upon to provide care for long-COVID patients as well, he said.
Additionally, telehealth, which is currently reimbursed the same way as in-person visits are, enables easier access for checking in with patients, he said.
Empathy and listening needed
Sabrina Assoumou, MD, MPH, assistant professor of medicine at Boston University, told this news organization that it will be crucial to address health care disparities as long-COVID cases mount.
COVID disproportionately affects communities of color, and it stands to reason that this will be the case for long-COVID as well, she said. Diversifying the workforce will be vital, inasmuch as diagnosis may depend on how well a physician listens to patients as they describe their symptoms, continued Dr. Assoumou, whose primary care practice centers on HIV patients.
The symptoms of long-COVID are vague, she explained, and include brain fog, fatigue, and shortness of breath, and it takes longer to diagnose than many conditions.
Dr. Assoumou said some people were never tested for COVID and never received a diagnosis, yet they are now experiencing the extended effects.
“Long-COVID will force us to go back to the basics – like really listening to our patients,” she said. “We’re definitely going to need to be more empathetic.”
No large influx yet
Charles Vega, MD, health sciences clinical professor of family medicine at the University of California, Irvine, said he is skeptical that the primary care system will be overwhelmed with long-COVID cases.
Dr. Vega is a family physician working in the largest safety net clinic in Orange County, California. About 90% of his patients are LatinX, a population disproportionately burdened by COVID, yet he hasn’t seen a surge in long-COVID cases.
He said that may be because patients know there isn’t a treatment for long-COVID. They are well connected through online forums such as Body Politic COVID-19 Support Group and may not feel they need to see a doctor.
“It wasn’t scientists finding [long-COVID], it was patients who developed this disease model themselves,” he said. “That’s where most of the data sharing is.”
Yet, for long-COVID patients who do need care, primary care is the best home for them, Dr. Vega said.
He said the most common symptoms he sees are fatigue and poor activity tolerance. “They get winded going to the bathroom,” he said.
The most difficult symptom is dyspnea, he said. Patients describe being breathless, but it’s not bad enough to qualify for supplemental oxygen.
“Being breathless is a pretty desperate thing and hurts quality of life,” he said.
Most patients describe general malaise.
Care for long-COVID will require medical care and mental health care, Dr. Vega notes. Primary care is already set up to screen and to coordinate care with the appropriate provider.
“I think there’s a role for specialists, but primary care has to be involved,” he said.
Dr. Phillips, Dr. Assoumou, and Dr. Vega report no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
, experts say.
“It could be as many as 5% to 10% who are still having symptoms at 12 weeks. Those numbers are higher if you’re talking about patients who had been hospitalized with COVID-19,” Russ Phillips, MD, director of the Center for Primary Care at Harvard Medical School, Boston, said in an interview.
A recent study from the Centers for Disease Control and Prevention and Kaiser Permanente Georgia found that among 3,171 nonhospitalized adult patients with COVID-19, 69% had one or more outpatient visits 28 to 180 days after the diagnosis. Two-thirds had a visit for a new primary diagnosis, and about one-third had a new specialist visit. Symptom diagnoses included cough, shortness of breath, chest or throat pain, and fatigue.
These visits have come while cases of acute COVID continue to occur, and there has been an increase in patients returning to primary care after avoiding it while the pandemic surged. For these patients, delay in seeking care has often led a worsening of chronic conditions.
Dr. Phillips pointed to a shortcoming in primary care that will need to be addressed with regard to long-COVID: “We don’t have good systems to follow patients and their symptoms over time.”
Long-COVID will require that kind of care, but current payment systems don’t support proactively reaching out to patients to track them over time, he noted.
“We do a good job of identifying these issues for patients who come in, but it’s the patients who don’t that we worry about the most,” he said.
Dr. Phillips provided examples of the kind of management plans needed to improve outcomes for patients with long-COVID. In anticoagulation clinics, patients who receive blood thinners are monitored closely, and in mental health care, patients with depression are linked with social workers and are monitored regularly.
“Around COVID, those management plans are in their infancy,” he said.
John Brooks, MD, chief medical officer for the CDC’s COVID-19 response, testified in a congressional hearing at the end of April that interim guidance concerning protocols for long-COVID in primary care are forthcoming. He also noted that the CDC is working closely with the Centers for Medicare & Medicaid Services to develop medical coding for long-COVID.
In the meantime, Dr. Phillips said, one strategy is to have patients self-monitor their condition and relay results to primary care physicians electronically.
As an example, Dr. Phillips described a patient with long-COVID who was receiving supplemental oxygen and who wanted to resume her exercise regimen.
She checked her own oxygen saturation levels before and during exercise and reported the levels every few days through their patient portal.
“Very slowly we were able to cut down on her oxygen and increase her exercise capacity until she no longer needed oxygen and could go back to her usual activities of daily living,” he said.
Nurse practitioners, social workers, and other nonphysician care team members may be increasingly relied upon to provide care for long-COVID patients as well, he said.
Additionally, telehealth, which is currently reimbursed the same way as in-person visits are, enables easier access for checking in with patients, he said.
Empathy and listening needed
Sabrina Assoumou, MD, MPH, assistant professor of medicine at Boston University, told this news organization that it will be crucial to address health care disparities as long-COVID cases mount.
COVID disproportionately affects communities of color, and it stands to reason that this will be the case for long-COVID as well, she said. Diversifying the workforce will be vital, inasmuch as diagnosis may depend on how well a physician listens to patients as they describe their symptoms, continued Dr. Assoumou, whose primary care practice centers on HIV patients.
The symptoms of long-COVID are vague, she explained, and include brain fog, fatigue, and shortness of breath, and it takes longer to diagnose than many conditions.
Dr. Assoumou said some people were never tested for COVID and never received a diagnosis, yet they are now experiencing the extended effects.
“Long-COVID will force us to go back to the basics – like really listening to our patients,” she said. “We’re definitely going to need to be more empathetic.”
No large influx yet
Charles Vega, MD, health sciences clinical professor of family medicine at the University of California, Irvine, said he is skeptical that the primary care system will be overwhelmed with long-COVID cases.
Dr. Vega is a family physician working in the largest safety net clinic in Orange County, California. About 90% of his patients are LatinX, a population disproportionately burdened by COVID, yet he hasn’t seen a surge in long-COVID cases.
He said that may be because patients know there isn’t a treatment for long-COVID. They are well connected through online forums such as Body Politic COVID-19 Support Group and may not feel they need to see a doctor.
“It wasn’t scientists finding [long-COVID], it was patients who developed this disease model themselves,” he said. “That’s where most of the data sharing is.”
Yet, for long-COVID patients who do need care, primary care is the best home for them, Dr. Vega said.
He said the most common symptoms he sees are fatigue and poor activity tolerance. “They get winded going to the bathroom,” he said.
The most difficult symptom is dyspnea, he said. Patients describe being breathless, but it’s not bad enough to qualify for supplemental oxygen.
“Being breathless is a pretty desperate thing and hurts quality of life,” he said.
Most patients describe general malaise.
Care for long-COVID will require medical care and mental health care, Dr. Vega notes. Primary care is already set up to screen and to coordinate care with the appropriate provider.
“I think there’s a role for specialists, but primary care has to be involved,” he said.
Dr. Phillips, Dr. Assoumou, and Dr. Vega report no relevant financial relationships.
A version of this article originally appeared on Medscape.com.
ID doctors have the most paperwork, administrative demands
Infectious disease physicians are among the doctors carrying the largest burdens in the COVID-19 pandemic.
Perhaps not surprisingly, they were the specialists least likely to feel they were fairly compensated in the Medscape Infectious Diseases Physician Compensation Report 2021.
Only 44% said the pay was fair (down from 51% the prior year) compared with those at the high end – 79% in oncology, 69% in psychiatry, and 68% in plastic surgery who answered that way.
Income, which averaged $245,000, varied little from the previous year overall, according to the survey, but nearly one-third of ID physicians saw a decline in pay.
Again this year, ID physicians ranked near the bottom on the compensation spectrum. Pediatricians were lowest paid at $221,000. Plastic surgeons topped the chart at $526,000, followed by orthopedists at $511,000.
At the same time, the ID specialty is facing increasing shortages, a gap made even more visible in the pandemic. Medscape reported last year that nearly 80% of U.S. counties have no infectious disease specialists.
Thomas File Jr., MD, last year’s president of the Infectious Diseases Society of America, emphasized that COVID-19 is not the only threat that ID specialists have had to deal with or will have. He cited the threats that Zika and SARS posed in past years.
“COVID-19 illustrates the need for more trained ID specialists, because we know we’re going to be seeing more outbreaks in the future,” he said in an interview at the onset of the pandemic in March 2020.
Longer hours in pandemic
ID physicians’ hours generally increased during the pandemic, and they remain inflated by 8 hours per week (60 compared with 52 prepandemic) as the nation struggles to manage continuing COVID-19 infections. Physicians in critical care and public health and preventive medicine are seeing heavier workloads as well, by an average of 6-7 hours per week.
At the same time, ID physicians spent the most time of physicians in all specialties on paperwork and administrative tasks. Those tasks, which include electronic health record entry and clinical reading, took ID doctors 24.2 hours a week, more the twice the hours spent by those in anesthesiology (10.1), ophthalmology (10.3), and radiology (11.6).
The 24.2 hours was a substantial increase from the last report, when ID physicians said they spent 18.5 hours on the tasks.
The survey asked about the most challenging part of the job. ID physicians reported “long hours” as number one followed by “having so many rules and regulations.”
Only 4% said the danger or risk associated with treating COVID-19 patients was the most challenging part.
The top two aspects of their work they deemed most rewarding were “being very good at what I do” (chosen by 33%) and “knowing that I’m making the world a better place” (31%).
Patient volume up 17%
ID physicians reported seeing 78 patients per week in this report compared with 66 prepandemic, a 17% increase. Conversely, pediatricians saw an 18% drop in patient visits, followed by dermatologists, orthopedists and otolaryngologists (all down about 15%).
Despite the challenges and dissatisfaction with pay, the great majority of ID physicians said they would choose both medicine (83%) and their specialty (89%, up from 85% last year) again.
A version of this article first appeared on Medscape.com.
Infectious disease physicians are among the doctors carrying the largest burdens in the COVID-19 pandemic.
Perhaps not surprisingly, they were the specialists least likely to feel they were fairly compensated in the Medscape Infectious Diseases Physician Compensation Report 2021.
Only 44% said the pay was fair (down from 51% the prior year) compared with those at the high end – 79% in oncology, 69% in psychiatry, and 68% in plastic surgery who answered that way.
Income, which averaged $245,000, varied little from the previous year overall, according to the survey, but nearly one-third of ID physicians saw a decline in pay.
Again this year, ID physicians ranked near the bottom on the compensation spectrum. Pediatricians were lowest paid at $221,000. Plastic surgeons topped the chart at $526,000, followed by orthopedists at $511,000.
At the same time, the ID specialty is facing increasing shortages, a gap made even more visible in the pandemic. Medscape reported last year that nearly 80% of U.S. counties have no infectious disease specialists.
Thomas File Jr., MD, last year’s president of the Infectious Diseases Society of America, emphasized that COVID-19 is not the only threat that ID specialists have had to deal with or will have. He cited the threats that Zika and SARS posed in past years.
“COVID-19 illustrates the need for more trained ID specialists, because we know we’re going to be seeing more outbreaks in the future,” he said in an interview at the onset of the pandemic in March 2020.
Longer hours in pandemic
ID physicians’ hours generally increased during the pandemic, and they remain inflated by 8 hours per week (60 compared with 52 prepandemic) as the nation struggles to manage continuing COVID-19 infections. Physicians in critical care and public health and preventive medicine are seeing heavier workloads as well, by an average of 6-7 hours per week.
At the same time, ID physicians spent the most time of physicians in all specialties on paperwork and administrative tasks. Those tasks, which include electronic health record entry and clinical reading, took ID doctors 24.2 hours a week, more the twice the hours spent by those in anesthesiology (10.1), ophthalmology (10.3), and radiology (11.6).
The 24.2 hours was a substantial increase from the last report, when ID physicians said they spent 18.5 hours on the tasks.
The survey asked about the most challenging part of the job. ID physicians reported “long hours” as number one followed by “having so many rules and regulations.”
Only 4% said the danger or risk associated with treating COVID-19 patients was the most challenging part.
The top two aspects of their work they deemed most rewarding were “being very good at what I do” (chosen by 33%) and “knowing that I’m making the world a better place” (31%).
Patient volume up 17%
ID physicians reported seeing 78 patients per week in this report compared with 66 prepandemic, a 17% increase. Conversely, pediatricians saw an 18% drop in patient visits, followed by dermatologists, orthopedists and otolaryngologists (all down about 15%).
Despite the challenges and dissatisfaction with pay, the great majority of ID physicians said they would choose both medicine (83%) and their specialty (89%, up from 85% last year) again.
A version of this article first appeared on Medscape.com.
Infectious disease physicians are among the doctors carrying the largest burdens in the COVID-19 pandemic.
Perhaps not surprisingly, they were the specialists least likely to feel they were fairly compensated in the Medscape Infectious Diseases Physician Compensation Report 2021.
Only 44% said the pay was fair (down from 51% the prior year) compared with those at the high end – 79% in oncology, 69% in psychiatry, and 68% in plastic surgery who answered that way.
Income, which averaged $245,000, varied little from the previous year overall, according to the survey, but nearly one-third of ID physicians saw a decline in pay.
Again this year, ID physicians ranked near the bottom on the compensation spectrum. Pediatricians were lowest paid at $221,000. Plastic surgeons topped the chart at $526,000, followed by orthopedists at $511,000.
At the same time, the ID specialty is facing increasing shortages, a gap made even more visible in the pandemic. Medscape reported last year that nearly 80% of U.S. counties have no infectious disease specialists.
Thomas File Jr., MD, last year’s president of the Infectious Diseases Society of America, emphasized that COVID-19 is not the only threat that ID specialists have had to deal with or will have. He cited the threats that Zika and SARS posed in past years.
“COVID-19 illustrates the need for more trained ID specialists, because we know we’re going to be seeing more outbreaks in the future,” he said in an interview at the onset of the pandemic in March 2020.
Longer hours in pandemic
ID physicians’ hours generally increased during the pandemic, and they remain inflated by 8 hours per week (60 compared with 52 prepandemic) as the nation struggles to manage continuing COVID-19 infections. Physicians in critical care and public health and preventive medicine are seeing heavier workloads as well, by an average of 6-7 hours per week.
At the same time, ID physicians spent the most time of physicians in all specialties on paperwork and administrative tasks. Those tasks, which include electronic health record entry and clinical reading, took ID doctors 24.2 hours a week, more the twice the hours spent by those in anesthesiology (10.1), ophthalmology (10.3), and radiology (11.6).
The 24.2 hours was a substantial increase from the last report, when ID physicians said they spent 18.5 hours on the tasks.
The survey asked about the most challenging part of the job. ID physicians reported “long hours” as number one followed by “having so many rules and regulations.”
Only 4% said the danger or risk associated with treating COVID-19 patients was the most challenging part.
The top two aspects of their work they deemed most rewarding were “being very good at what I do” (chosen by 33%) and “knowing that I’m making the world a better place” (31%).
Patient volume up 17%
ID physicians reported seeing 78 patients per week in this report compared with 66 prepandemic, a 17% increase. Conversely, pediatricians saw an 18% drop in patient visits, followed by dermatologists, orthopedists and otolaryngologists (all down about 15%).
Despite the challenges and dissatisfaction with pay, the great majority of ID physicians said they would choose both medicine (83%) and their specialty (89%, up from 85% last year) again.
A version of this article first appeared on Medscape.com.
COVID-19 in children: Weekly cases drop to 6-month low
Just 1 week after it looked like the COVID-19 situation in children might be taking another turn for the worse, the number of new pediatric cases dropped to its lowest level since October, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.
the AAP and CHA said in their weekly COVID-19 report. During the week of April 30 to May 6 – the same week Rhode Island reported a large backlog of cases and increased its total by 30% – the number of new cases went up slightly after 2 weeks of declines.
Other positive indicators come in the form of the proportion of cases occurring in children. The cumulative percentage of cases in children since the start of the pandemic remained at 14.0% for a second consecutive week, and the proportion of new cases in children held at 24.0% and did not increase for the first time in 6 weeks, based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.
The total number of child COVID-19 cases reported in these jurisdictions is now up to 3.9 million, for a cumulative rate of 5,187 cases per 100,000 children in the United States. Among the states, total counts range from a low of 4,070 in Hawaii to 475,619 in California. Hawaii also has the lowest rate at 1,357 per 100,000 children, while the highest, 9,778 per 100,000, can be found in Rhode Island, the AAP and CHA said.
Deaths in children continue to accumulate at a relatively slow pace, with two more added during the week of May 7-13, bringing the total to 308 for the entire pandemic in 43 states, New York City, Puerto Rico, and Guam. Children’s share of the mortality burden is currently 0.06%, a figure that has not changed since mid-December, and the death rate for children with COVID-19 is 0.01%, according to the report.
Almost two-thirds (65%) of all deaths have occurred in just nine states – Arizona (31), California (21), Colorado (13), Georgia (10), Illinois (18), Maryland (10), Pennsylvania (10), Tennessee (10), and Texas (52) – and New York City (24), while eight states have not reported any deaths yet, the two groups said.
Just 1 week after it looked like the COVID-19 situation in children might be taking another turn for the worse, the number of new pediatric cases dropped to its lowest level since October, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.
the AAP and CHA said in their weekly COVID-19 report. During the week of April 30 to May 6 – the same week Rhode Island reported a large backlog of cases and increased its total by 30% – the number of new cases went up slightly after 2 weeks of declines.
Other positive indicators come in the form of the proportion of cases occurring in children. The cumulative percentage of cases in children since the start of the pandemic remained at 14.0% for a second consecutive week, and the proportion of new cases in children held at 24.0% and did not increase for the first time in 6 weeks, based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.
The total number of child COVID-19 cases reported in these jurisdictions is now up to 3.9 million, for a cumulative rate of 5,187 cases per 100,000 children in the United States. Among the states, total counts range from a low of 4,070 in Hawaii to 475,619 in California. Hawaii also has the lowest rate at 1,357 per 100,000 children, while the highest, 9,778 per 100,000, can be found in Rhode Island, the AAP and CHA said.
Deaths in children continue to accumulate at a relatively slow pace, with two more added during the week of May 7-13, bringing the total to 308 for the entire pandemic in 43 states, New York City, Puerto Rico, and Guam. Children’s share of the mortality burden is currently 0.06%, a figure that has not changed since mid-December, and the death rate for children with COVID-19 is 0.01%, according to the report.
Almost two-thirds (65%) of all deaths have occurred in just nine states – Arizona (31), California (21), Colorado (13), Georgia (10), Illinois (18), Maryland (10), Pennsylvania (10), Tennessee (10), and Texas (52) – and New York City (24), while eight states have not reported any deaths yet, the two groups said.
Just 1 week after it looked like the COVID-19 situation in children might be taking another turn for the worse, the number of new pediatric cases dropped to its lowest level since October, according to a report from the American Academy of Pediatrics and the Children’s Hospital Association.
the AAP and CHA said in their weekly COVID-19 report. During the week of April 30 to May 6 – the same week Rhode Island reported a large backlog of cases and increased its total by 30% – the number of new cases went up slightly after 2 weeks of declines.
Other positive indicators come in the form of the proportion of cases occurring in children. The cumulative percentage of cases in children since the start of the pandemic remained at 14.0% for a second consecutive week, and the proportion of new cases in children held at 24.0% and did not increase for the first time in 6 weeks, based on data from 49 states (excluding New York), the District of Columbia, New York City, Puerto Rico, and Guam.
The total number of child COVID-19 cases reported in these jurisdictions is now up to 3.9 million, for a cumulative rate of 5,187 cases per 100,000 children in the United States. Among the states, total counts range from a low of 4,070 in Hawaii to 475,619 in California. Hawaii also has the lowest rate at 1,357 per 100,000 children, while the highest, 9,778 per 100,000, can be found in Rhode Island, the AAP and CHA said.
Deaths in children continue to accumulate at a relatively slow pace, with two more added during the week of May 7-13, bringing the total to 308 for the entire pandemic in 43 states, New York City, Puerto Rico, and Guam. Children’s share of the mortality burden is currently 0.06%, a figure that has not changed since mid-December, and the death rate for children with COVID-19 is 0.01%, according to the report.
Almost two-thirds (65%) of all deaths have occurred in just nine states – Arizona (31), California (21), Colorado (13), Georgia (10), Illinois (18), Maryland (10), Pennsylvania (10), Tennessee (10), and Texas (52) – and New York City (24), while eight states have not reported any deaths yet, the two groups said.
Internists’ patient visits rebound to near pre-COVID norms: Pay down slightly from previous year
Internists are seeing only 3% fewer patients than they did before the COVID-19 pandemic (72 per week on average now vs. 74 before the pandemic). Comparatively, for pediatricians, patient volume remains down 18%. Dermatologists, otolaryngologists, and orthopedists report that visits are down by about 15%.
The number of hours worked also rebounded for internists. In fact, some report working slightly more hours now than they did before the pandemic (52 hours a week, up from 50).
Pay for internists continues to hover near the bottom of the scale among specialties. In this year’s Medscape Internist Compensation Report 2021, internists averaged $248,000, down from $251,000 last year. Pediatricians were the lowest paid, at $221,000, followed by family physicians, at $236,000. Plastic surgeons made the most, at $526,000, followed by orthopedists, at $511,000.
It helped to be self-employed. These internists made $276,000 on average, compared with $238,000 for their employed counterparts.
Half say pay is fair
Internists are also near the bottom among specialists who feel they are fairly compensated. As in last year’s survey, just more than half of internists (52%) said they felt that they were fairly paid this year. By comparison, 79% of oncologists reported they were fairly compensated, which is on the high end regarding satisfaction, but only 44% of infectious diseases specialists felt that way.
Some indicators in the survey responses may help explain the dissatisfaction.
Internists are near the top in time spent on paperwork. On average, they spent 19.7 hours on paperwork and administration this year, up slightly from 18.5 last year. Infectious disease physicians spent the most time on those tasks (24.2 hours a week), and anesthesiologists spent the fewest, at 10.1 hours per week.
Administrative work was among many frustrations internists reported. The following are the top five most challenging aspects of the job, according to the respondents:
- Having so many rules and regulations (24%)
- Having to work long hours (16%)
- Dealing with difficult patients (16%)
- Working with electronic health records systems (11%)
- Danger/risk associated with treating COVID-19 patients (10%)
Conversely, the most rewarding aspects were “gratitude/relationships with patients” (31%); “knowing that I’m making the world a better place” (26%); and “being very good at what I do” (20%).
More than one-third lost income
More than one-third of internists (36%) reported that they lost some income during the past year.
Among those who lost income, 81% said they expect income to return to prepandemic levels within 3 years. Half of that group expected the rebound would come within the next year.
Slightly more than one-third of internists said they would participate in the merit-based incentive payment system (MIPS), and 12% said they would participate in advanced alternative payment models. The rest either said they would participate in neither, or they hadn’t decided.
“The stakes for the Quality Payment Program – the program that incorporates MIPS – are high, with a 9% penalty applied to all Medicare reimbursement for failure to participate,” says Elizabeth Woodcock, MBA, CPC, president of the physician practice consulting firm Woodcock and Associates, in Atlanta, Georgia.
“With margins already slim,” she told this news organization, “most physicians can’t afford this massive penalty.”
If they could choose again, most internists (76%) said they would choose medicine, which was almost the same number as physicians overall who would pick medicine again. Oncologists (88%) and ophthalmologists (87%) were the specialists most likely to choose medicine again. Those in physical medicine and rehabilitation were least likely to choose medicine again, at 67%.
But asked about their specialty, internists’ enthusiasm decreased. Only 68% said that they would make that same choice again.
That was up considerably, however, from the 2015 survey: For that year, only 25% said they would choose internal medicine again.
A version of this article first appeared on Medscape.com.
Internists are seeing only 3% fewer patients than they did before the COVID-19 pandemic (72 per week on average now vs. 74 before the pandemic). Comparatively, for pediatricians, patient volume remains down 18%. Dermatologists, otolaryngologists, and orthopedists report that visits are down by about 15%.
The number of hours worked also rebounded for internists. In fact, some report working slightly more hours now than they did before the pandemic (52 hours a week, up from 50).
Pay for internists continues to hover near the bottom of the scale among specialties. In this year’s Medscape Internist Compensation Report 2021, internists averaged $248,000, down from $251,000 last year. Pediatricians were the lowest paid, at $221,000, followed by family physicians, at $236,000. Plastic surgeons made the most, at $526,000, followed by orthopedists, at $511,000.
It helped to be self-employed. These internists made $276,000 on average, compared with $238,000 for their employed counterparts.
Half say pay is fair
Internists are also near the bottom among specialists who feel they are fairly compensated. As in last year’s survey, just more than half of internists (52%) said they felt that they were fairly paid this year. By comparison, 79% of oncologists reported they were fairly compensated, which is on the high end regarding satisfaction, but only 44% of infectious diseases specialists felt that way.
Some indicators in the survey responses may help explain the dissatisfaction.
Internists are near the top in time spent on paperwork. On average, they spent 19.7 hours on paperwork and administration this year, up slightly from 18.5 last year. Infectious disease physicians spent the most time on those tasks (24.2 hours a week), and anesthesiologists spent the fewest, at 10.1 hours per week.
Administrative work was among many frustrations internists reported. The following are the top five most challenging aspects of the job, according to the respondents:
- Having so many rules and regulations (24%)
- Having to work long hours (16%)
- Dealing with difficult patients (16%)
- Working with electronic health records systems (11%)
- Danger/risk associated with treating COVID-19 patients (10%)
Conversely, the most rewarding aspects were “gratitude/relationships with patients” (31%); “knowing that I’m making the world a better place” (26%); and “being very good at what I do” (20%).
More than one-third lost income
More than one-third of internists (36%) reported that they lost some income during the past year.
Among those who lost income, 81% said they expect income to return to prepandemic levels within 3 years. Half of that group expected the rebound would come within the next year.
Slightly more than one-third of internists said they would participate in the merit-based incentive payment system (MIPS), and 12% said they would participate in advanced alternative payment models. The rest either said they would participate in neither, or they hadn’t decided.
“The stakes for the Quality Payment Program – the program that incorporates MIPS – are high, with a 9% penalty applied to all Medicare reimbursement for failure to participate,” says Elizabeth Woodcock, MBA, CPC, president of the physician practice consulting firm Woodcock and Associates, in Atlanta, Georgia.
“With margins already slim,” she told this news organization, “most physicians can’t afford this massive penalty.”
If they could choose again, most internists (76%) said they would choose medicine, which was almost the same number as physicians overall who would pick medicine again. Oncologists (88%) and ophthalmologists (87%) were the specialists most likely to choose medicine again. Those in physical medicine and rehabilitation were least likely to choose medicine again, at 67%.
But asked about their specialty, internists’ enthusiasm decreased. Only 68% said that they would make that same choice again.
That was up considerably, however, from the 2015 survey: For that year, only 25% said they would choose internal medicine again.
A version of this article first appeared on Medscape.com.
Internists are seeing only 3% fewer patients than they did before the COVID-19 pandemic (72 per week on average now vs. 74 before the pandemic). Comparatively, for pediatricians, patient volume remains down 18%. Dermatologists, otolaryngologists, and orthopedists report that visits are down by about 15%.
The number of hours worked also rebounded for internists. In fact, some report working slightly more hours now than they did before the pandemic (52 hours a week, up from 50).
Pay for internists continues to hover near the bottom of the scale among specialties. In this year’s Medscape Internist Compensation Report 2021, internists averaged $248,000, down from $251,000 last year. Pediatricians were the lowest paid, at $221,000, followed by family physicians, at $236,000. Plastic surgeons made the most, at $526,000, followed by orthopedists, at $511,000.
It helped to be self-employed. These internists made $276,000 on average, compared with $238,000 for their employed counterparts.
Half say pay is fair
Internists are also near the bottom among specialists who feel they are fairly compensated. As in last year’s survey, just more than half of internists (52%) said they felt that they were fairly paid this year. By comparison, 79% of oncologists reported they were fairly compensated, which is on the high end regarding satisfaction, but only 44% of infectious diseases specialists felt that way.
Some indicators in the survey responses may help explain the dissatisfaction.
Internists are near the top in time spent on paperwork. On average, they spent 19.7 hours on paperwork and administration this year, up slightly from 18.5 last year. Infectious disease physicians spent the most time on those tasks (24.2 hours a week), and anesthesiologists spent the fewest, at 10.1 hours per week.
Administrative work was among many frustrations internists reported. The following are the top five most challenging aspects of the job, according to the respondents:
- Having so many rules and regulations (24%)
- Having to work long hours (16%)
- Dealing with difficult patients (16%)
- Working with electronic health records systems (11%)
- Danger/risk associated with treating COVID-19 patients (10%)
Conversely, the most rewarding aspects were “gratitude/relationships with patients” (31%); “knowing that I’m making the world a better place” (26%); and “being very good at what I do” (20%).
More than one-third lost income
More than one-third of internists (36%) reported that they lost some income during the past year.
Among those who lost income, 81% said they expect income to return to prepandemic levels within 3 years. Half of that group expected the rebound would come within the next year.
Slightly more than one-third of internists said they would participate in the merit-based incentive payment system (MIPS), and 12% said they would participate in advanced alternative payment models. The rest either said they would participate in neither, or they hadn’t decided.
“The stakes for the Quality Payment Program – the program that incorporates MIPS – are high, with a 9% penalty applied to all Medicare reimbursement for failure to participate,” says Elizabeth Woodcock, MBA, CPC, president of the physician practice consulting firm Woodcock and Associates, in Atlanta, Georgia.
“With margins already slim,” she told this news organization, “most physicians can’t afford this massive penalty.”
If they could choose again, most internists (76%) said they would choose medicine, which was almost the same number as physicians overall who would pick medicine again. Oncologists (88%) and ophthalmologists (87%) were the specialists most likely to choose medicine again. Those in physical medicine and rehabilitation were least likely to choose medicine again, at 67%.
But asked about their specialty, internists’ enthusiasm decreased. Only 68% said that they would make that same choice again.
That was up considerably, however, from the 2015 survey: For that year, only 25% said they would choose internal medicine again.
A version of this article first appeared on Medscape.com.
Pediatricians see drop in income during the pandemic
The average income for pediatricians declined slightly from 2019 to 2020, according to the Medscape Pediatrician Compensation Report 2021.
The report, which was conducted between October 2020 and February 2021, found that the average pediatrician income was down $11,000 – from $232,000 in 2019 to $221,000 in 2020, with 48% of pediatricians reporting at least some decline in compensation.
The specialty also earned the least amount of money in 2020, compared with all of the other specialties, which isn’t surprising since pediatricians have been among the lowest-paid physician specialties since 2013. The highest-earning specialty was plastic surgery with an average income of $526,000 annually.
Most pediatricians who saw a drop in income cited pandemic-related issues such as job loss, fewer hours, and fewer patients.
Jesse Hackell, MD, vice president and chief operating officer of Ponoma Pediatrics in New York, said in an interview the reduced wages pediatricians saw in 2020 didn’t surprise him because many pediatric offices saw a huge drop in visits that were not urgent.
“[The report] shows that procedural specialties tended to do a lot better than the nonprocedural specialties,” Dr. Hackell said. “That’s because, during the shutdown, if you broke your leg, you still needed the orthopedist. And even though the hospitals weren’t doing elective surgeries, they were certainly doing the emergency stuff.”
Meanwhile, in pediatrician offices, where Dr. Hackell said office visits dropped 70%-80% at the beginning of the pandemic, “parents weren’t going to bring a healthy kid out for routine visits and they weren’t going to bring a kid out for minor illnesses and expose them to possibly communicable diseases in the office.”
About 52% of pediatricians who lost income because of the pandemic believe their income levels will return to normal in 2-3 years. Meanwhile 30% of pediatricians expect their income to return to normal within a year, and 8% believe it will take 4 years for them to bounce back.
Physician work hours generally declined for some time during the pandemic, according to the report. However, most pediatricians are working about the same number of hours as they did before the pandemic, which is 47 hours per week.
Despite working the same number of hours per week that they did prepandemic, they are seeing fewer patients. They are currently seeing on average 64 patients per week, compared with the 78 patients they used to see weekly before the pandemic.
Dr. Hackell said that might be because pediatric offices are trying to make up the loss of revenue during the beginning of the pandemic, from the reduced number of well visits and immunizations, in the second half of the year with outreach.
“Since about June 2020, we’ve been making concerted efforts to remind parents that preventing other infectious diseases is critically important,” Dr. Hackell explained. “And so actually, for the second half of the year, many of us saw more well visits and immunization volume than in 2019 as we sought to make up the gap. It wasn’t that we were seeing more overall, but we’re trying to make up the gap that happened from March, April, May, [and] June.”
Most pediatricians find their work rewarding. One-third say the most rewarding part of their job is gratitude from and relationships with their patients. Meanwhile, 31% of pediatricians said knowing they are making the world a better place was a rewarding part of their job. Only 8% of them said making money was a rewarding part of their job.
Dr. Hackell said he did not go into pediatrics to make money, it was because he found it stimulating and has “no complaints.”
“I’ve been a pediatrician for 40 years and I wouldn’t do anything else,” Dr. Hackell said. “I don’t know that there’s anything that I would find as rewarding as the relationships that I’ve had over 40 years with my patients. You know, getting invited to weddings of kids who I saw when they were newborns is pretty impressive. It’s the gratification of having ongoing relationships with families.”
Furthermore, the report revealed that 77% of pediatricians said they would pick medicine again if they had a choice, and 82% said they would choose the same specialty.
The experts disclosed no relevant financial interests.
*This story was updated on 5/18/2021.
The average income for pediatricians declined slightly from 2019 to 2020, according to the Medscape Pediatrician Compensation Report 2021.
The report, which was conducted between October 2020 and February 2021, found that the average pediatrician income was down $11,000 – from $232,000 in 2019 to $221,000 in 2020, with 48% of pediatricians reporting at least some decline in compensation.
The specialty also earned the least amount of money in 2020, compared with all of the other specialties, which isn’t surprising since pediatricians have been among the lowest-paid physician specialties since 2013. The highest-earning specialty was plastic surgery with an average income of $526,000 annually.
Most pediatricians who saw a drop in income cited pandemic-related issues such as job loss, fewer hours, and fewer patients.
Jesse Hackell, MD, vice president and chief operating officer of Ponoma Pediatrics in New York, said in an interview the reduced wages pediatricians saw in 2020 didn’t surprise him because many pediatric offices saw a huge drop in visits that were not urgent.
“[The report] shows that procedural specialties tended to do a lot better than the nonprocedural specialties,” Dr. Hackell said. “That’s because, during the shutdown, if you broke your leg, you still needed the orthopedist. And even though the hospitals weren’t doing elective surgeries, they were certainly doing the emergency stuff.”
Meanwhile, in pediatrician offices, where Dr. Hackell said office visits dropped 70%-80% at the beginning of the pandemic, “parents weren’t going to bring a healthy kid out for routine visits and they weren’t going to bring a kid out for minor illnesses and expose them to possibly communicable diseases in the office.”
About 52% of pediatricians who lost income because of the pandemic believe their income levels will return to normal in 2-3 years. Meanwhile 30% of pediatricians expect their income to return to normal within a year, and 8% believe it will take 4 years for them to bounce back.
Physician work hours generally declined for some time during the pandemic, according to the report. However, most pediatricians are working about the same number of hours as they did before the pandemic, which is 47 hours per week.
Despite working the same number of hours per week that they did prepandemic, they are seeing fewer patients. They are currently seeing on average 64 patients per week, compared with the 78 patients they used to see weekly before the pandemic.
Dr. Hackell said that might be because pediatric offices are trying to make up the loss of revenue during the beginning of the pandemic, from the reduced number of well visits and immunizations, in the second half of the year with outreach.
“Since about June 2020, we’ve been making concerted efforts to remind parents that preventing other infectious diseases is critically important,” Dr. Hackell explained. “And so actually, for the second half of the year, many of us saw more well visits and immunization volume than in 2019 as we sought to make up the gap. It wasn’t that we were seeing more overall, but we’re trying to make up the gap that happened from March, April, May, [and] June.”
Most pediatricians find their work rewarding. One-third say the most rewarding part of their job is gratitude from and relationships with their patients. Meanwhile, 31% of pediatricians said knowing they are making the world a better place was a rewarding part of their job. Only 8% of them said making money was a rewarding part of their job.
Dr. Hackell said he did not go into pediatrics to make money, it was because he found it stimulating and has “no complaints.”
“I’ve been a pediatrician for 40 years and I wouldn’t do anything else,” Dr. Hackell said. “I don’t know that there’s anything that I would find as rewarding as the relationships that I’ve had over 40 years with my patients. You know, getting invited to weddings of kids who I saw when they were newborns is pretty impressive. It’s the gratification of having ongoing relationships with families.”
Furthermore, the report revealed that 77% of pediatricians said they would pick medicine again if they had a choice, and 82% said they would choose the same specialty.
The experts disclosed no relevant financial interests.
*This story was updated on 5/18/2021.
The average income for pediatricians declined slightly from 2019 to 2020, according to the Medscape Pediatrician Compensation Report 2021.
The report, which was conducted between October 2020 and February 2021, found that the average pediatrician income was down $11,000 – from $232,000 in 2019 to $221,000 in 2020, with 48% of pediatricians reporting at least some decline in compensation.
The specialty also earned the least amount of money in 2020, compared with all of the other specialties, which isn’t surprising since pediatricians have been among the lowest-paid physician specialties since 2013. The highest-earning specialty was plastic surgery with an average income of $526,000 annually.
Most pediatricians who saw a drop in income cited pandemic-related issues such as job loss, fewer hours, and fewer patients.
Jesse Hackell, MD, vice president and chief operating officer of Ponoma Pediatrics in New York, said in an interview the reduced wages pediatricians saw in 2020 didn’t surprise him because many pediatric offices saw a huge drop in visits that were not urgent.
“[The report] shows that procedural specialties tended to do a lot better than the nonprocedural specialties,” Dr. Hackell said. “That’s because, during the shutdown, if you broke your leg, you still needed the orthopedist. And even though the hospitals weren’t doing elective surgeries, they were certainly doing the emergency stuff.”
Meanwhile, in pediatrician offices, where Dr. Hackell said office visits dropped 70%-80% at the beginning of the pandemic, “parents weren’t going to bring a healthy kid out for routine visits and they weren’t going to bring a kid out for minor illnesses and expose them to possibly communicable diseases in the office.”
About 52% of pediatricians who lost income because of the pandemic believe their income levels will return to normal in 2-3 years. Meanwhile 30% of pediatricians expect their income to return to normal within a year, and 8% believe it will take 4 years for them to bounce back.
Physician work hours generally declined for some time during the pandemic, according to the report. However, most pediatricians are working about the same number of hours as they did before the pandemic, which is 47 hours per week.
Despite working the same number of hours per week that they did prepandemic, they are seeing fewer patients. They are currently seeing on average 64 patients per week, compared with the 78 patients they used to see weekly before the pandemic.
Dr. Hackell said that might be because pediatric offices are trying to make up the loss of revenue during the beginning of the pandemic, from the reduced number of well visits and immunizations, in the second half of the year with outreach.
“Since about June 2020, we’ve been making concerted efforts to remind parents that preventing other infectious diseases is critically important,” Dr. Hackell explained. “And so actually, for the second half of the year, many of us saw more well visits and immunization volume than in 2019 as we sought to make up the gap. It wasn’t that we were seeing more overall, but we’re trying to make up the gap that happened from March, April, May, [and] June.”
Most pediatricians find their work rewarding. One-third say the most rewarding part of their job is gratitude from and relationships with their patients. Meanwhile, 31% of pediatricians said knowing they are making the world a better place was a rewarding part of their job. Only 8% of them said making money was a rewarding part of their job.
Dr. Hackell said he did not go into pediatrics to make money, it was because he found it stimulating and has “no complaints.”
“I’ve been a pediatrician for 40 years and I wouldn’t do anything else,” Dr. Hackell said. “I don’t know that there’s anything that I would find as rewarding as the relationships that I’ve had over 40 years with my patients. You know, getting invited to weddings of kids who I saw when they were newborns is pretty impressive. It’s the gratification of having ongoing relationships with families.”
Furthermore, the report revealed that 77% of pediatricians said they would pick medicine again if they had a choice, and 82% said they would choose the same specialty.
The experts disclosed no relevant financial interests.
*This story was updated on 5/18/2021.
Are more naturopaths trying to compete with docs?
Jon Hislop, MD, PhD, hadn’t been in practice very long before patients began coming to him with requests to order tests that their naturopaths had recommended.
The family physician in North Vancouver, British Columbia, knew little about naturopathy but began researching it.
“I was finding that some of what the naturopaths were telling them was a little odd. Some of the tests they were asking for were unnecessary,” Dr. Hislop said.
The more he learned about naturopathy, the more appalled he became. He eventually took to Twitter, where he wages a campaign against naturopathy and alternative medicine.
“There is no alternative medicine,” he said. “There’s medicine and there’s other stuff. We need to stick to medicine and stay away from the other stuff.”
Dr. Hislop is not alone in his criticism of naturopathic medicine. Professional medical societies almost universally oppose naturopathy, but that has not stopped its spread or prevented it from becoming part of some health care systems.
Americans spent $30.2 billion on out-of-pocket complementary health care, according to a 2016 report from the National Institutes of Health. That includes everything from herbal supplements and massage therapy to chiropractic care.
What is naturopathic medicine?
Naturopathy came to the United States from Germany in the 1800s, but some of its practices are thousands of years old. Naturopathic treatments include homeopathy, IV vitamin infusions, acupuncture, Reiki, and herbal supplements.
Naturopathy is based on the belief that the body has an innate ability to heal itself. It discourages drugs and surgery in favor of supplements, herbs, and other so-called natural treatments. Much of it centers around addressing lifestyle issues and counseling patients to improve their diets, quit smoking, exercise more, lose weight, etc., in order to address the root causes of some health problems.
Practitioners are critical of Western medicine for what they regard as an over-reliance on drugs and technology and for treating symptoms rather than the causes of disease.
“We get a lot of people who are at the end of their ropes, people with hard-to-diagnose diseases who know they are sick but whose labs are normal,” said Jaquel Patterson, ND, former president of the American Association of Naturopathic Physicians (AANP) and medical director of a naturopathic practice in Connecticut.
Separate training and licensing
There are major differences among naturopaths.
At one extreme are unlicensed, self-taught “healers,” who can embrace everything from homeopathy to aromatherapy.
At the other end are naturopathic doctors (NDs), who are more likely to become part of health care systems. These caregivers are trained and licensed, though not by the same institutions as traditional physicians.
To be licensed, NDs must graduate from one of seven accredited naturopathic medical schools in the United States and Canada. In addition to a standard medical curriculum, schools require graduates to complete 4 years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. Medical students intern in clinical settings for 2 years.
NDs are eager to distinguish themselves from their uncredentialed counterparts.
“Some people go to a weekend class and call themselves naturopaths. That’s very concerning. I don’t want those people to be licensed either,” said Hallie Armstrong, ND, who practices in Michigan.
In the United States, there are 6,000 practicing NDs and an unknown number of unlicensed naturopathic healers.
Can naturopaths call themselves ‘physicians’?
Twenty-two states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have licensing or registration laws for naturopathic doctors. Three states – South Carolina, Tennessee, and Florida – prohibit practicing naturopathic medicine without a license, according to the AANP.
States that license NDs differ in what they permit them to do.
Nine states allow licensed NDs to use the term “physician,” although this is prohibited in seven states. Most licensed states allow naturopathic practitioners some prescribing authority, including the prescribing of many controlled substances, although only a few states permit full prescribing rights. Most states that license NDs allow them to prescribe and administer nonprescription therapeutic substances, drugs, and therapies.
Twelve states and the District of Columbia allow licensed naturopathic doctors to perform some minor procedures, such as stitching up wounds. Additionally, 13 states allow NDs to order diagnostic tests.
Although the AANP lobbies to get licensure in more states and to expand the activities that NDs can perform, the medical establishment in those states nearly always opposes the legislation, as do national organizations, such as the American Academy of Family Physicians and the American College of Physicians.
“They absolutely will not stop until they get licenses. They’ve done a really good job of selling themselves as legitimate health care professionals to state legislatures,” said David Gorski, MD, PhD, FACS, a surgical oncologist and managing editor of Science-Based Medicine, a blog that attacks unproven medical claims and defends traditional medicine. Naturopathy is a favorite target.
Are naturopaths gaining ground anyway?
Despite the opposition of the medical establishment and many individual health care professionals, a growing number of health care systems are adopting alternative medicine.
In 2018, the AANP stated that 28 prominent health systems, hospitals, and cancer treatment centers had one or more licensed NDs on staff. Among them were Cancer Treatment Centers of America, Cedars-Sinai, Columbia University’s Herbert Irving Comprehensive Cancer Center, and the Fred Hutchinson Cancer Research Center.
Other health care systems may not have NDs on staff but provide naturopathic treatments, usually under the heading of “complementary medicine” or “integrative medicine.” For example, the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine offers acupuncture, Chinese herbal medicine, Reiki, yoga, and culinary medicine.
Critics find this appalling.
“I think it’s a mistake to integrate that kind of practice into a science-based health care setting. If we learned anything over the past year, it’s that medicine based on magical thinking is dangerous,” said Timothy Caulfield, LLM, FCAHS, research director at the Health Law Institute of the University of Alberta, Edmonton.
Dr. Gorski added: “I’m not exactly sure why doctors who should know better have become more accepting of practices that aren’t science-based or are outright quackery.”
Becoming part of the system
Beaumont Health, Michigan’s largest health care system, added integrative medicine in 2006 and hired its first naturopathic practitioners a year later.
The integrative practitioners began in oncology, offering such things as massage therapy, acupuncture, guided imagery, and Reiki. “Very quickly, people outside oncology began saying, ‘I’ve got a cardiology patient who would really benefit from this ... I’ve got a GI patient who could benefit from this...,’” said Maureen Anderson, MD, medical director of Beaumont Integrative Medicine.
Beaumont now offers integrative medicine at three locations. They average 20,000 visits a year and work with 50 to 60 practitioners, many of whom work part-time.
Because Michigan does not license NDs, their scope of practice at Beaumont is limited. They take patient histories, provide advice on nutrition, diet, and exercise, and prescribe herbs and supplements. Beaumont operates its own herbal and supplement pharmacy.
NDs work under the medical supervision of Dr. Anderson, an emergency medicine physician who became interested in naturopathy because she thought traditional medicine doesn’t do a good job of providing care for chronic conditions. Any initial skepticism on the part of the medical staff has been overcome by seeing the benefits naturopathy provides, Dr. Anderson said. The claim is echoed by Mr. Armstrong, an ND who works in the system part-time: “As soon as [doctors] understand our schooling and where we’re coming from and understand that we want to do the same things, then they’re very accepting.”
The University of California, Irvine, health care system has one of the largest naturopathic medicine programs in the country, the result of a $200 million donation in 2017 from a couple who champion alternative medicine. The Susan Samueli Integrative Health Institute includes 28 health care professionals, including MDs, NDs, RNs, acupuncturists, dietitians, yoga instructors, and others. It includes a research arm, which is focused primarily on acupuncture.
The alternative medicine offerings benefit the system, said Kim Hecht, DO, medical director of inpatient and ambulatory services at the Samueli Institute.
“I’m not against traditional medicine, because I think everything has a time and a place,” Dr. Hecht said. However, she rejects the idea that MDs can offer the same holistic approach as NDs.
“Medical science likes to say we’re interested in treating the whole person, but if you look at medical school courses, that’s not what’s being taught,” she said.
The chance to work within a traditional health care system was attractive to Arvin Jenab, ND, medical director of naturopathic medicine at the institute.
“It offers the opportunity to refine our medicine and trim the things that aren’t necessary or are controversial and concentrate on the things at the core of what we do,” he said.
UCI Health practices a conservative model of naturopathy that supports traditional practitioners, Mr. Jenab said.
Is there any harm?
Some patients clearly want what naturopathy offers. So what’s the harm?
Health care systems that integrate alternative medicine legitimize it and lower the overall standard of care, Mr. Caulfield said. Most naturopathy claims are not backed by evidence, and making it available to patients amounts to deceiving them, he said.
“If there’s good science behind it, it’s not going to be alternative medicine; it’s going to be medicine,” Mr. Caulfield said.
Family physician Dr. Hislop said that refusing to order naturopath-recommended tests interferes with his relationships with patients and often requires lengthy conversations to explain the problems with naturopathy.
Naturopathic medicine can deter patients from seeking proven conventional treatments, which can put their health at risk, Dr. Gorski said.
Some naturopaths could potentially be harmful.
In 2017, a California woman died after receiving an IV preparation of curcumin, a chemical constituent in the Indian spice turmeric featured in alternative medicine. The U.S. Food and Drug Administration found that the treating ND mixed the curcumin emulsion product with ungraded castor oil that had a warning label stating: “CAUTION: For manufacturing or laboratory use only.”
Because naturopathic care is generally not covered by insurance, it can also be expensive for patients who pay out of pocket.
Ironically, the mainstream health care system helps create the environment in which naturopathic medicine thrives.
It offers patients a more relaxed and personal alternative to rushed visits with harried doctors scrambling to see the required number of patients in a day. By contrast, an initial visit with an ND might last a leisurely 60 minutes, with 30-minute follow-up appointments.
Mr. Caulfield acknowledged that the relaxed naturopathic approach can be more attractive to patients but said the answer is to reform the current system: “You don’t fix a broken arm by acupuncture.”
A version of this article first appeared on Medscape.com.
Jon Hislop, MD, PhD, hadn’t been in practice very long before patients began coming to him with requests to order tests that their naturopaths had recommended.
The family physician in North Vancouver, British Columbia, knew little about naturopathy but began researching it.
“I was finding that some of what the naturopaths were telling them was a little odd. Some of the tests they were asking for were unnecessary,” Dr. Hislop said.
The more he learned about naturopathy, the more appalled he became. He eventually took to Twitter, where he wages a campaign against naturopathy and alternative medicine.
“There is no alternative medicine,” he said. “There’s medicine and there’s other stuff. We need to stick to medicine and stay away from the other stuff.”
Dr. Hislop is not alone in his criticism of naturopathic medicine. Professional medical societies almost universally oppose naturopathy, but that has not stopped its spread or prevented it from becoming part of some health care systems.
Americans spent $30.2 billion on out-of-pocket complementary health care, according to a 2016 report from the National Institutes of Health. That includes everything from herbal supplements and massage therapy to chiropractic care.
What is naturopathic medicine?
Naturopathy came to the United States from Germany in the 1800s, but some of its practices are thousands of years old. Naturopathic treatments include homeopathy, IV vitamin infusions, acupuncture, Reiki, and herbal supplements.
Naturopathy is based on the belief that the body has an innate ability to heal itself. It discourages drugs and surgery in favor of supplements, herbs, and other so-called natural treatments. Much of it centers around addressing lifestyle issues and counseling patients to improve their diets, quit smoking, exercise more, lose weight, etc., in order to address the root causes of some health problems.
Practitioners are critical of Western medicine for what they regard as an over-reliance on drugs and technology and for treating symptoms rather than the causes of disease.
“We get a lot of people who are at the end of their ropes, people with hard-to-diagnose diseases who know they are sick but whose labs are normal,” said Jaquel Patterson, ND, former president of the American Association of Naturopathic Physicians (AANP) and medical director of a naturopathic practice in Connecticut.
Separate training and licensing
There are major differences among naturopaths.
At one extreme are unlicensed, self-taught “healers,” who can embrace everything from homeopathy to aromatherapy.
At the other end are naturopathic doctors (NDs), who are more likely to become part of health care systems. These caregivers are trained and licensed, though not by the same institutions as traditional physicians.
To be licensed, NDs must graduate from one of seven accredited naturopathic medical schools in the United States and Canada. In addition to a standard medical curriculum, schools require graduates to complete 4 years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. Medical students intern in clinical settings for 2 years.
NDs are eager to distinguish themselves from their uncredentialed counterparts.
“Some people go to a weekend class and call themselves naturopaths. That’s very concerning. I don’t want those people to be licensed either,” said Hallie Armstrong, ND, who practices in Michigan.
In the United States, there are 6,000 practicing NDs and an unknown number of unlicensed naturopathic healers.
Can naturopaths call themselves ‘physicians’?
Twenty-two states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have licensing or registration laws for naturopathic doctors. Three states – South Carolina, Tennessee, and Florida – prohibit practicing naturopathic medicine without a license, according to the AANP.
States that license NDs differ in what they permit them to do.
Nine states allow licensed NDs to use the term “physician,” although this is prohibited in seven states. Most licensed states allow naturopathic practitioners some prescribing authority, including the prescribing of many controlled substances, although only a few states permit full prescribing rights. Most states that license NDs allow them to prescribe and administer nonprescription therapeutic substances, drugs, and therapies.
Twelve states and the District of Columbia allow licensed naturopathic doctors to perform some minor procedures, such as stitching up wounds. Additionally, 13 states allow NDs to order diagnostic tests.
Although the AANP lobbies to get licensure in more states and to expand the activities that NDs can perform, the medical establishment in those states nearly always opposes the legislation, as do national organizations, such as the American Academy of Family Physicians and the American College of Physicians.
“They absolutely will not stop until they get licenses. They’ve done a really good job of selling themselves as legitimate health care professionals to state legislatures,” said David Gorski, MD, PhD, FACS, a surgical oncologist and managing editor of Science-Based Medicine, a blog that attacks unproven medical claims and defends traditional medicine. Naturopathy is a favorite target.
Are naturopaths gaining ground anyway?
Despite the opposition of the medical establishment and many individual health care professionals, a growing number of health care systems are adopting alternative medicine.
In 2018, the AANP stated that 28 prominent health systems, hospitals, and cancer treatment centers had one or more licensed NDs on staff. Among them were Cancer Treatment Centers of America, Cedars-Sinai, Columbia University’s Herbert Irving Comprehensive Cancer Center, and the Fred Hutchinson Cancer Research Center.
Other health care systems may not have NDs on staff but provide naturopathic treatments, usually under the heading of “complementary medicine” or “integrative medicine.” For example, the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine offers acupuncture, Chinese herbal medicine, Reiki, yoga, and culinary medicine.
Critics find this appalling.
“I think it’s a mistake to integrate that kind of practice into a science-based health care setting. If we learned anything over the past year, it’s that medicine based on magical thinking is dangerous,” said Timothy Caulfield, LLM, FCAHS, research director at the Health Law Institute of the University of Alberta, Edmonton.
Dr. Gorski added: “I’m not exactly sure why doctors who should know better have become more accepting of practices that aren’t science-based or are outright quackery.”
Becoming part of the system
Beaumont Health, Michigan’s largest health care system, added integrative medicine in 2006 and hired its first naturopathic practitioners a year later.
The integrative practitioners began in oncology, offering such things as massage therapy, acupuncture, guided imagery, and Reiki. “Very quickly, people outside oncology began saying, ‘I’ve got a cardiology patient who would really benefit from this ... I’ve got a GI patient who could benefit from this...,’” said Maureen Anderson, MD, medical director of Beaumont Integrative Medicine.
Beaumont now offers integrative medicine at three locations. They average 20,000 visits a year and work with 50 to 60 practitioners, many of whom work part-time.
Because Michigan does not license NDs, their scope of practice at Beaumont is limited. They take patient histories, provide advice on nutrition, diet, and exercise, and prescribe herbs and supplements. Beaumont operates its own herbal and supplement pharmacy.
NDs work under the medical supervision of Dr. Anderson, an emergency medicine physician who became interested in naturopathy because she thought traditional medicine doesn’t do a good job of providing care for chronic conditions. Any initial skepticism on the part of the medical staff has been overcome by seeing the benefits naturopathy provides, Dr. Anderson said. The claim is echoed by Mr. Armstrong, an ND who works in the system part-time: “As soon as [doctors] understand our schooling and where we’re coming from and understand that we want to do the same things, then they’re very accepting.”
The University of California, Irvine, health care system has one of the largest naturopathic medicine programs in the country, the result of a $200 million donation in 2017 from a couple who champion alternative medicine. The Susan Samueli Integrative Health Institute includes 28 health care professionals, including MDs, NDs, RNs, acupuncturists, dietitians, yoga instructors, and others. It includes a research arm, which is focused primarily on acupuncture.
The alternative medicine offerings benefit the system, said Kim Hecht, DO, medical director of inpatient and ambulatory services at the Samueli Institute.
“I’m not against traditional medicine, because I think everything has a time and a place,” Dr. Hecht said. However, she rejects the idea that MDs can offer the same holistic approach as NDs.
“Medical science likes to say we’re interested in treating the whole person, but if you look at medical school courses, that’s not what’s being taught,” she said.
The chance to work within a traditional health care system was attractive to Arvin Jenab, ND, medical director of naturopathic medicine at the institute.
“It offers the opportunity to refine our medicine and trim the things that aren’t necessary or are controversial and concentrate on the things at the core of what we do,” he said.
UCI Health practices a conservative model of naturopathy that supports traditional practitioners, Mr. Jenab said.
Is there any harm?
Some patients clearly want what naturopathy offers. So what’s the harm?
Health care systems that integrate alternative medicine legitimize it and lower the overall standard of care, Mr. Caulfield said. Most naturopathy claims are not backed by evidence, and making it available to patients amounts to deceiving them, he said.
“If there’s good science behind it, it’s not going to be alternative medicine; it’s going to be medicine,” Mr. Caulfield said.
Family physician Dr. Hislop said that refusing to order naturopath-recommended tests interferes with his relationships with patients and often requires lengthy conversations to explain the problems with naturopathy.
Naturopathic medicine can deter patients from seeking proven conventional treatments, which can put their health at risk, Dr. Gorski said.
Some naturopaths could potentially be harmful.
In 2017, a California woman died after receiving an IV preparation of curcumin, a chemical constituent in the Indian spice turmeric featured in alternative medicine. The U.S. Food and Drug Administration found that the treating ND mixed the curcumin emulsion product with ungraded castor oil that had a warning label stating: “CAUTION: For manufacturing or laboratory use only.”
Because naturopathic care is generally not covered by insurance, it can also be expensive for patients who pay out of pocket.
Ironically, the mainstream health care system helps create the environment in which naturopathic medicine thrives.
It offers patients a more relaxed and personal alternative to rushed visits with harried doctors scrambling to see the required number of patients in a day. By contrast, an initial visit with an ND might last a leisurely 60 minutes, with 30-minute follow-up appointments.
Mr. Caulfield acknowledged that the relaxed naturopathic approach can be more attractive to patients but said the answer is to reform the current system: “You don’t fix a broken arm by acupuncture.”
A version of this article first appeared on Medscape.com.
Jon Hislop, MD, PhD, hadn’t been in practice very long before patients began coming to him with requests to order tests that their naturopaths had recommended.
The family physician in North Vancouver, British Columbia, knew little about naturopathy but began researching it.
“I was finding that some of what the naturopaths were telling them was a little odd. Some of the tests they were asking for were unnecessary,” Dr. Hislop said.
The more he learned about naturopathy, the more appalled he became. He eventually took to Twitter, where he wages a campaign against naturopathy and alternative medicine.
“There is no alternative medicine,” he said. “There’s medicine and there’s other stuff. We need to stick to medicine and stay away from the other stuff.”
Dr. Hislop is not alone in his criticism of naturopathic medicine. Professional medical societies almost universally oppose naturopathy, but that has not stopped its spread or prevented it from becoming part of some health care systems.
Americans spent $30.2 billion on out-of-pocket complementary health care, according to a 2016 report from the National Institutes of Health. That includes everything from herbal supplements and massage therapy to chiropractic care.
What is naturopathic medicine?
Naturopathy came to the United States from Germany in the 1800s, but some of its practices are thousands of years old. Naturopathic treatments include homeopathy, IV vitamin infusions, acupuncture, Reiki, and herbal supplements.
Naturopathy is based on the belief that the body has an innate ability to heal itself. It discourages drugs and surgery in favor of supplements, herbs, and other so-called natural treatments. Much of it centers around addressing lifestyle issues and counseling patients to improve their diets, quit smoking, exercise more, lose weight, etc., in order to address the root causes of some health problems.
Practitioners are critical of Western medicine for what they regard as an over-reliance on drugs and technology and for treating symptoms rather than the causes of disease.
“We get a lot of people who are at the end of their ropes, people with hard-to-diagnose diseases who know they are sick but whose labs are normal,” said Jaquel Patterson, ND, former president of the American Association of Naturopathic Physicians (AANP) and medical director of a naturopathic practice in Connecticut.
Separate training and licensing
There are major differences among naturopaths.
At one extreme are unlicensed, self-taught “healers,” who can embrace everything from homeopathy to aromatherapy.
At the other end are naturopathic doctors (NDs), who are more likely to become part of health care systems. These caregivers are trained and licensed, though not by the same institutions as traditional physicians.
To be licensed, NDs must graduate from one of seven accredited naturopathic medical schools in the United States and Canada. In addition to a standard medical curriculum, schools require graduates to complete 4 years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. Medical students intern in clinical settings for 2 years.
NDs are eager to distinguish themselves from their uncredentialed counterparts.
“Some people go to a weekend class and call themselves naturopaths. That’s very concerning. I don’t want those people to be licensed either,” said Hallie Armstrong, ND, who practices in Michigan.
In the United States, there are 6,000 practicing NDs and an unknown number of unlicensed naturopathic healers.
Can naturopaths call themselves ‘physicians’?
Twenty-two states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have licensing or registration laws for naturopathic doctors. Three states – South Carolina, Tennessee, and Florida – prohibit practicing naturopathic medicine without a license, according to the AANP.
States that license NDs differ in what they permit them to do.
Nine states allow licensed NDs to use the term “physician,” although this is prohibited in seven states. Most licensed states allow naturopathic practitioners some prescribing authority, including the prescribing of many controlled substances, although only a few states permit full prescribing rights. Most states that license NDs allow them to prescribe and administer nonprescription therapeutic substances, drugs, and therapies.
Twelve states and the District of Columbia allow licensed naturopathic doctors to perform some minor procedures, such as stitching up wounds. Additionally, 13 states allow NDs to order diagnostic tests.
Although the AANP lobbies to get licensure in more states and to expand the activities that NDs can perform, the medical establishment in those states nearly always opposes the legislation, as do national organizations, such as the American Academy of Family Physicians and the American College of Physicians.
“They absolutely will not stop until they get licenses. They’ve done a really good job of selling themselves as legitimate health care professionals to state legislatures,” said David Gorski, MD, PhD, FACS, a surgical oncologist and managing editor of Science-Based Medicine, a blog that attacks unproven medical claims and defends traditional medicine. Naturopathy is a favorite target.
Are naturopaths gaining ground anyway?
Despite the opposition of the medical establishment and many individual health care professionals, a growing number of health care systems are adopting alternative medicine.
In 2018, the AANP stated that 28 prominent health systems, hospitals, and cancer treatment centers had one or more licensed NDs on staff. Among them were Cancer Treatment Centers of America, Cedars-Sinai, Columbia University’s Herbert Irving Comprehensive Cancer Center, and the Fred Hutchinson Cancer Research Center.
Other health care systems may not have NDs on staff but provide naturopathic treatments, usually under the heading of “complementary medicine” or “integrative medicine.” For example, the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine offers acupuncture, Chinese herbal medicine, Reiki, yoga, and culinary medicine.
Critics find this appalling.
“I think it’s a mistake to integrate that kind of practice into a science-based health care setting. If we learned anything over the past year, it’s that medicine based on magical thinking is dangerous,” said Timothy Caulfield, LLM, FCAHS, research director at the Health Law Institute of the University of Alberta, Edmonton.
Dr. Gorski added: “I’m not exactly sure why doctors who should know better have become more accepting of practices that aren’t science-based or are outright quackery.”
Becoming part of the system
Beaumont Health, Michigan’s largest health care system, added integrative medicine in 2006 and hired its first naturopathic practitioners a year later.
The integrative practitioners began in oncology, offering such things as massage therapy, acupuncture, guided imagery, and Reiki. “Very quickly, people outside oncology began saying, ‘I’ve got a cardiology patient who would really benefit from this ... I’ve got a GI patient who could benefit from this...,’” said Maureen Anderson, MD, medical director of Beaumont Integrative Medicine.
Beaumont now offers integrative medicine at three locations. They average 20,000 visits a year and work with 50 to 60 practitioners, many of whom work part-time.
Because Michigan does not license NDs, their scope of practice at Beaumont is limited. They take patient histories, provide advice on nutrition, diet, and exercise, and prescribe herbs and supplements. Beaumont operates its own herbal and supplement pharmacy.
NDs work under the medical supervision of Dr. Anderson, an emergency medicine physician who became interested in naturopathy because she thought traditional medicine doesn’t do a good job of providing care for chronic conditions. Any initial skepticism on the part of the medical staff has been overcome by seeing the benefits naturopathy provides, Dr. Anderson said. The claim is echoed by Mr. Armstrong, an ND who works in the system part-time: “As soon as [doctors] understand our schooling and where we’re coming from and understand that we want to do the same things, then they’re very accepting.”
The University of California, Irvine, health care system has one of the largest naturopathic medicine programs in the country, the result of a $200 million donation in 2017 from a couple who champion alternative medicine. The Susan Samueli Integrative Health Institute includes 28 health care professionals, including MDs, NDs, RNs, acupuncturists, dietitians, yoga instructors, and others. It includes a research arm, which is focused primarily on acupuncture.
The alternative medicine offerings benefit the system, said Kim Hecht, DO, medical director of inpatient and ambulatory services at the Samueli Institute.
“I’m not against traditional medicine, because I think everything has a time and a place,” Dr. Hecht said. However, she rejects the idea that MDs can offer the same holistic approach as NDs.
“Medical science likes to say we’re interested in treating the whole person, but if you look at medical school courses, that’s not what’s being taught,” she said.
The chance to work within a traditional health care system was attractive to Arvin Jenab, ND, medical director of naturopathic medicine at the institute.
“It offers the opportunity to refine our medicine and trim the things that aren’t necessary or are controversial and concentrate on the things at the core of what we do,” he said.
UCI Health practices a conservative model of naturopathy that supports traditional practitioners, Mr. Jenab said.
Is there any harm?
Some patients clearly want what naturopathy offers. So what’s the harm?
Health care systems that integrate alternative medicine legitimize it and lower the overall standard of care, Mr. Caulfield said. Most naturopathy claims are not backed by evidence, and making it available to patients amounts to deceiving them, he said.
“If there’s good science behind it, it’s not going to be alternative medicine; it’s going to be medicine,” Mr. Caulfield said.
Family physician Dr. Hislop said that refusing to order naturopath-recommended tests interferes with his relationships with patients and often requires lengthy conversations to explain the problems with naturopathy.
Naturopathic medicine can deter patients from seeking proven conventional treatments, which can put their health at risk, Dr. Gorski said.
Some naturopaths could potentially be harmful.
In 2017, a California woman died after receiving an IV preparation of curcumin, a chemical constituent in the Indian spice turmeric featured in alternative medicine. The U.S. Food and Drug Administration found that the treating ND mixed the curcumin emulsion product with ungraded castor oil that had a warning label stating: “CAUTION: For manufacturing or laboratory use only.”
Because naturopathic care is generally not covered by insurance, it can also be expensive for patients who pay out of pocket.
Ironically, the mainstream health care system helps create the environment in which naturopathic medicine thrives.
It offers patients a more relaxed and personal alternative to rushed visits with harried doctors scrambling to see the required number of patients in a day. By contrast, an initial visit with an ND might last a leisurely 60 minutes, with 30-minute follow-up appointments.
Mr. Caulfield acknowledged that the relaxed naturopathic approach can be more attractive to patients but said the answer is to reform the current system: “You don’t fix a broken arm by acupuncture.”
A version of this article first appeared on Medscape.com.