Many physicians are active on social media platforms to some degree. While it remains participatory work, engaging in digital dialogue is becoming a major part of the medical world and is pertinent in maintaining a professional reputation.

Whether a physician is serving as a brand ambassador for his or her institution or marketing for his or her own practice — should a physician be paid to disseminate, curate medical knowledge and participate in online conversations?

Furthermore, do doctors have a responsibility to be a part of the social media world in addition to caring for the sick?

“I believe that some providers should be paid to participate professionally. It would be smart for large hospital systems and medical schools to create time for one or a small number of staff to be front and center sharing, curating, talking and making.” — Dr. Bryan Vartabedian

Read the article/comments (33 Charts)

Additional reading:

• Social Media and the Dissemination of Medical Knowledge
• Social Media Serves as the New Doctors’ Lounge

You’ve worked many, many years to complete decades of schooling.  You are finally a full-fledged physician.  You are probably wondering what to do now and you may need to make that decision quickly so that you can pay back your student loans without too much interest accruing.  Many may think that this is the time to find a good job and settle down; however, what if you could find a lot of good jobs and get to travel around the country?

That’s exactly what many young physicians are doing.  Similar to dating, these physicians are “trying out” or “dating” their field to narrow their interests.  Why? Because, before making a major life commitment, a person has a natural instinct to want to know exactly what they are getting themselves into.  In the case of locum tenens assignments, you are probably going to test a certain location, hospital, clinic, or other variable on a short-term basis.  While this may not exactly parallel testing your interests in blondes, brunettes and redheads in dating, it does give you a test run to see what your ultimate goal would be.

Working in a locums position is also a good way to pay off medical school loans much faster.  In a locums position, you not only earn great money and don’t have to worry about medical malpractice insurance, but, a locums physician can also eliminate the burden of your everyday living expense, also known as pesky, expensive rent. By redirecting those funds into your student loans, you’ll be that much closer to being debt free. And in a world where student loans are outrageous, this is one way to combat a ballooning payment.  Read more about student loans. (Wall Street Journal)

Insurance companies are attempting to reduce reimbursements for intensive care which puts pressure on hospitals to cut spending.  As somewhat grim economic times have fallen upon us, there is a major move for hospitals to make cuts and Advanced ICU Care is supposed to save hospitals money. This may put nursing support staff on edge because, perhaps, their position’s value in the ICU could be questioned if technology like this were to be perfected.

Opponents of this type of software argue that the patient receives lesser care and situational outcomes are too calculated.   Furthermore, many health care industry professionals reason that there needs to be a bedside relationship and a point of contact for the patient and their family.  In the long-run, one would hope that technology and well-trained medical staff will purely complement each other’s weaknesses, and neither would replace the other, to provide greater patient care. Read the article. (Fortune Tech)

The use of locums physicians by agencies and hospitalist groups is not the underlying reason for concern here. There are underlying reasons why Hospitalists choose to work locum tenens rather than commit to more permanent positions. These underlying reasons vary based on the actual provider.

There was mention of locums Hospitalists making more money than the permanent Hospitalists at a facility. If you compare only hourly rate of compensation, that may be true. However what is not mentioned is that the locums Hospitalist does not have guaranteed work. They may be at a facility for a week or a month and then may not have anything else as a source of income for an extended period of time.

• There is no paid time off as a locum tenens physician.
• There are no employment benefits.
• The Hospitalists who work on the permanent staff have the perks and benefits of being assured they have income as well as the perks and benefits that come with being employed.

This also comes into play when hospitals and groups state locum tenens costs more than employing the physician. They are not considering all of the ancillary costs that go with hiring someone permanently, like employment taxes, paid time off, healthcare benefits, unemployment insurance, etc. At the end of the day, considering all costs involved, working locum tenens providers is generally not a more expensive option.

I agree with the reasons a physician may choose to work locum tenens instead of accepting a permanent position. There is usually a very good reason why they choose to work in this manner. Generally locum tenens Hospitalist care deeply about patient care, safety, and overall patient satisfaction. The percentages of quality Hospitalists working as locum tenens versus those that may work permanently are no different. Actuarial studies have indicated that from a claims standpoint, locum tenens do not pose a higher risk than using a permanent provider would.

I have found that with more and more financial pressure being applied, hospitals are asking more of their Hospitalists when it comes to the volume of patients they are asked to care for in a given shift.

Typically, a hospital may even expect more from a locum tenens physician because they have the perception that they are paying more for them. At the end of the day, it is all about the patient and the care that is administered.

Locum tenens is a necessity in today’s Hospitalist environment.

More and more contract management groups are forming and taking over the Hospitalist services at hospitals all over the country. Locum tenens is a way for them to get the care required for the patients while they recruit more permanent providers. My experience does not show any indication that locum tenens is being used any differently than its intention, to fill the gap.

Additional Reading:

• Why Hospitals Employ Hospitalists
• Number of Hospitalists Who Worked As Locum Tenens Increased
• Hospital Medicine: What Does the Future Hold?

Well, as a representative from CompHealth told New York Magazine, “the way to keep quality high and costs low is to use locum tenens doctors. You can add staff and subtract staff very quickly. It moves your costs from fixed to variable.”

So, that’s why the hospital has hired Dr. Janet. She has such a great background, why would Dr. Janet solely work on locum tenen assignments?  After many years of schooling and practice, Dr. Janet, like many other physicians, wanted to be continuously engaged by a full time position that excited her, but, it’s more difficult than anticipated.  So, she instead chose to work full time in an ever-changing location, one that she could enjoy for a set time period.

As a locum tenens, you can fill in for another physician for days, weeks, months, or even longer. Physicians take leave for many different reasons. Some leave just on a short-term basis for a maternity leave or vacation, some wish to teach for a semester or year, some want to go back to school.  In reality, the reason probably isn’t important to you, but, what is important is that the same level of care for patients is maintained while the physician is on leave.  This is your opportunity to step in and step up without waiting for an actual “open” position. Read the article (New York Magazine) click here.

Webster’s Dictionary defines business as a partnership engaged in commerce, or a place of work.  While perhaps traditional businesses don’t impact lives as profoundly as a hospital, by definition, a hospital is a business.  When someone with a vested interest in the financial well-being of the business looks at financials, they surely will have operating costs, profit and return on investment in mind.  So, the looming question for many is: what is my return on investment for a physician?

At Becker’s Hospital Review Annual Meeting, they discussed this very topic. For example, let’s look at the return on investment for physicians who serve as Hospitalists, a growing field with nearly 77 percent of hospitals employing these specialists.

After conducting an ROI analysis that took into account billing, nursing support, salaries, efficiency, improved work flow, patient care and a variety of other factors, it was concluded that hospitalists have a strong ROI.  From a financial standpoint, it would seem that this specialty will continue to grow as hospitals certainly benefit from having hospitalists.  Learn more here.

The physician shortage in America, especially in rural communities, is widespread and is only going to get worse. A 2009 policy brief from the federal Office of Rural Health Policy highlighted that 77% of rural counties are facing a major shortage of primary care providers, and 8% don’t have a single primary care physician.

An additional 30 million Americans are set to gain health coverage through Medicaid expansion and insurance exchanges, but many of the residents of these under-served communities still won’t have direct access to a physician and will be forced to drive hundreds of miles for care.

Many hospitals in these rural areas have increased the starting salaries of primary care physicians to attract new hires, but many hospitals can’t bill enough to justify the lucrative pay. They have to rely on assistance from the National Health Service Corps to provide incentives including loan repayment for physicians willing to practice in these regions.

The Patient Protection and Affordable Care Act also tries to combat these issues by providing more resources to medical schools and the National Health Service Corps to help with training and recruiting.

“Some places in this country have unique challenges,” Neil MacKinnon, director of the Center for Rural Health at the University of Arizona, said. “We try to look at what is the best fit. The real key is knowing your state and the attributes of the communities.”

Read the article (ModernHealthcare.com)

Additional reading: Pros and Cons of the Rural Hospital Movement

But, with so many more patients coming to the emergency department, what happens when emergency rooms and trauma centers are shutting their doors? As it is now, statistics show that people may find themselves traveling longer to get to a trauma center or even an emergency room than they were just a year ago.

In the case of an accident or emergency, the CDC has found that trauma centers are extremely beneficial: they actually reduce the risk of death by 25 percent. With such a positive impact, it would seem detrimental to the public to keep closing these facilities; however, they are expensive to run and depend greatly on public funding. Published in the Annals of Emergency Medicine, when hospitals admitted more Medi-Cal patients (the California Medicaid program), or were for-profit, their emergency departments were more likely to close. The study also drew links between the demographic being treated and the likelihood of emergency room closure. To read more, click here.

Federal officials require doctors and hospitals to use EHR systems in order to receive federal money to defray the cost of converting to EHRs. However, the ONC says that no one had tried to receive federal funding to pay for installation of an EHRMagic system. Since 2011, more than 234,000 organizations and individuals have received a total of $12.7 billion in EHR incentives to install one of the 1,700 systems eligible for payments.

“We want to be clear, the office of certification’s role doesn’t stop after EHR certification. We are also going to monitor certified EHRs to determine whether they continue to meet our specific requirements. The doctors, hospitals and other providers that are adopting – and have already adopted – EHRs deserve this and should feel confident that the tools they are using are up to the job of helping their patients get the best care possible”, a blog post from the director of the certification office at the ONC explains.

Read the article (Modern Healthcare)

According to a survey conducted by Premier healthcare alliance’s spring 2013 Economic Outlook, 69% of healthcare leaders predict that outpatient volume will rise in 2013, and as outpatient admissions rise — inpatient volume will drop.

With the impending reimbursement cuts and care delivery model changes, healthcare providers face a significant change as they transition toward more value-based care models. “Ensuring patients are cared for in the most efficient manner — without compromising quality- is key to success. This means more care is being shifted to less intensive and expensive outpatient care sites, with lower reimbursement rates,” said Mike Alkire, chief operating officer of Premier.

Read the article (Modern Healthcare)

The state of Georgia recently approved a bill that would protect physicians from civil liability for breaching federal health system reform requirements.

The Georgia law would essentially prevent health reform metrics, such as those authorized by the Affordable Care Act, from being used as evidence in liability cases. Georgia’s law states that payer guidelines and quality criteria under federal law shall not establish a legal basis for negligence or a standard of care for the purposes of determining medical liability.

“This legislation provides that lawsuits cannot be brought against health care providers based simply on whether [they] followed national guidelines created by the health care law,” Dr. Gingrey stated in an email to American Medical News.

Physician leaders hope this bill is replicated in other states.

Read the article (American Medical News)

Additional Reading: Healthcare Reform

• Retains the regular physician’s existing patients
• Introduces new patients
• Maintains patient level
• Keeps revenue with regular physician
• Limits burnouts with existing staff
• Lower liability risk
• Higher patient satisfaction

However, it is vital to understand how to bill for locum tenens physicians to ensure a return on investment for the practice. Most practices use a locum tenens recruiting agency when hiring a locums physician. These agencies will take care of licensing requirements, professional liability insurance, and screening. It is important to remember to:

• Train staff about locums physicians to retain patients with the regular physician and give an incentive for them to see the locum tenens physician without fear: the locum tenens’ experience and expertise are the same as the regular physician

The period for which a single locum tenens physician may substitute cannot be more than 60 days. The 60 day period begins the first day the physician provides services for Medicare patients of the regular physician.

A locum tenens physician:

• fills in for 60 continuous calendar days
• Cannot substitute more than 60 continuous days unless there is a break in the calendar by the regular physician
• Generally does not have a practice of his or her own and moves from area to area
• Is an independent contractor rather than an employee
• Does not have to be enrolled in the Medicare program to see Medicare patients in the state
• Cannot bill Medicare for services within the 60 days period in his or her own name or NPI

Read the article (AAPC)

Resource: Billing for Locum Tenens

The success of the hospitalist model for primary care can be applied to many specialties that have been experiencing similar problems, including increased concerns about workforce, quality of life, and quality of care issues.

Each year, 670 orthopaedic residents enter the workforce, but this number is offset by the number of practicing orthopaedists who retire, resulting in a zero net gain and potentially a loss in the total number of practicing orthopaedists.

The shortage’s impact is particularly acute in the delivery of emergency care. In the past, orthopaedists would participate in the call rotation for community hospitals to build their practices by generating ongoing referrals of patients through the ED. In fact, most hospitals included provisions in their by-laws requiring participation in the call rotation.

Today three out of four ED medical directors reported that their hospitals have inadequate on-call specialist coverage. Another survey reported that 42 percent of ED administrators believed that the lack of specialty coverage in the ED poses as a risk to patients.

Most hospitals now pay orthopaedic surgeons to take ED call, but this does not guarantee that all hospitals will have continuous coverage — either for ED admissions or for surgical emergencies for in-hospital patients.

Could an orthopaedic surgicalist be an answer to the shortage? Can a slightly modified hospitalist model be applied to this specialty and have a similar result? Experts say the orthopaedic surgicalist model could solve the ED coverage problem, while allowing most orthopaedists to have very efficient elective practices.

Read the article (American Academy of Orthopaedic Surgeons)

With input from a number of specialty organizations, the American Board of Internal Medicine Foundation has put together a list of 90 commonly used medical tests and treatments that it deems overused. Here are a few examples:

Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer diseases.
American Board of Family Physicians

Don’t indiscriminately prescribe antibiotics for uncomplicated acute sinusitis.
American Academy of Allergy, Asthma and Immunology

Don’t perform EEGs for headaches.
American Academy of Neurology

Don’t order antibiotics for conjunctivitis (“pink eye”).
American Academy of Ophthalmology

Cough and cold medications should not be prescribed or recommended for respiratory illnesses in children under four years of age.
American Academy of Pediatrics

Don’t perform annual stress cardiac imaging as part of routine follow-up in asymptomatic patients.
American College of Cardiology

Don’t schedule elective, non-medically indicated induction of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
American College of Obstetricians and Gynecologists

Don’t obtain imaging studies in patients with non-specific low back pain.
American College of Physicians

Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
American College of Radiology

Do not repeat colorectal cancer screening (by any method) for 10 years after a high quality colonoscopy is negative in average-risk individuals.
American Gastroenterological Association

Don’t order coronary artery calcium scoring for screening purpose on low-risk asymptomatic individuals except for those with a family history of premature coronary artery disease.
Society of Cardiovascular Computed Tomography

To see the complete list and the reasons behind the recommendations, go to www.choosingwisely.org.

Despite the medical field being one of the most technologically advanced professional fields, it lags considerably and is largely ineffective when it comes to social media and the dissemination of medical knowledge.

It is no surprise that physicians are influenced by thought-leaders and peer groups with whom they work. Typically, the medical knowledge pattern begins with key opinion leaders, then spreads to community physicians and then to other physicians with social ties to the community. This model is reinforced by the current training that emphasizes the knowledge and value of thought-leaders and the practice habits of local communities.

However, through the emergence of healthcare-specific social and professional networks – this way of disseminating medical knowledge has the potential to change the way physicians interact and ultimately distribute medical knowledge. These physician-based online platforms are in the early stages of development, yet early trends already suggest a shift away from these locally based relationships to digital media.

Read the article (Healthcare Informatics)

With major changes coming to the health care industry, many physicians are considering leaving their practices to work as a hospital employees, locum tenens physicians or simply retiring. The slowly improving economy is fueling this trend.

According to the Physician Retention Survey conducted by the American Medical Group Assn. and Cejka Search the physician departure rate at large practices was 6.8% in 2012, the highest it’s been in eight years. The AMGA, which represents smaller practices, concluded the same turnover rate for its members.

Meanwhile, the number of improving house markets has expanded for the sixth consecutive month, according to a report from the National Assn. of Home Builders and Corelogic (which tracks foreclosures and homes in mortgage default) said that 2.2 million homes were in that “shadow inventory” at the end of 2012, down 28% from the 2010 peak.

The stock market also hit record highs in March 2013 adding to the overall economy boost. Many physicians saw their 401 (k)’s shrink in 2009 and decided not to leave jobs, sell their homes and simply wait the bear market out for a few more years. Now, with economic improvements, physicians feel more confident leaving certain employment situations and can focus on the deeper reasons to change jobs — stability, dissatisfaction and salary increase.

Read the article (Amednews)

The increasing fragmentation of patient care is a big part of the problem. Not too long ago, the primary care physician would follow the patient from hospital admission to discharge. Today, the patient may be cared for by five or six physicians during one hospitalization: an emergency room doctor, three or four hospitalists, perhaps two or three consultants. Each exchange increases the risk that vital information will be overlooked.

An estimated 80% of serious medical errors are caused by miscommunication between caregivers during the patient handoff, according to the Joint Commission’s Center for Transforming Healthcare. ”There are 4000 handoffs a day in a typical teaching hospital,” says Joint Commission President Dr. Mark Chassin. ”If 90% go flawlessly, that’s still 400 failures per day.” When a lawsuit occurs, everyone whose name is in the chart will have to defend their actions, including how effectively they communicated with their peers at the time of handoff.  “Almost all claims have multiple defendants and points of contact,” says Dr. Alan Lembitz of the liability carrier COPIC.

How can we make handoffs less prone to error? First, we have to acknowledge that this is a really serious problem. When our colleagues in the operating room started using checklists, their error rates went down significantly. Creating a standardized checklist to be used at the time of a handoff could help as well. For example, a handoff checklist might include this basic information:

~ differential diagnosis
~ medications and the patient’s reaction to these medications
~ pending laboratory and imaging studies
~ names and contact numbers of all caregivers
~ names of key family contacts
~ physician now assuming primary responsibility for the patient

Other suggestions: Make every effort to communicate with the next provider face to face, and make sure the next caregiver not only receives and reads your report but understands it. Remember: Information is not communication.

(Reference: Malpractice Threats in Well-Intended Patient Handoffs. Medscape, October 4, 2012).

Like many physicians, Dr. Katie Noorbaksh decided to begin medical school immediately following completion of her undergraduate studies. She declared that she would graduate medical school, join a private practice, would not have children until after residency and would never go into emergency medicine (among other declarations). This career model was standard 10 years ago and many medical students assume this is their path today.

However, life did not go exactly as planned for Dr. Noorbaksh. She married a surgeon, had a baby half way through residency, lost a child during her chief year and became pregnant two months later with her third child. Oh, and she decided to specialize in pediatric emergency medicine.

Having a family has divided her responsibilities as a mother, wife and doctor. Therefore she works part-time and has reaped the benefits.

“My schedule is flexible enough that I can trade shifts and cover for coworkers without difficulty. I love being able to do this without sweating whether I am sacrificing time with my kids.”

Read the article (KevinMD)

What happens when a doctor begins sharing symptoms that he easily dismisses to his own patients, or what if an OB/GYN becomes pregnant for the first time and hears a doctor inform her that the baby looks a little small for its gestational age?  Their reactions as a patient can be life-altering and may change the very nature of the way they look at their patients.

A pediatrician whose own child is diagnosed with autism will no doubt take a parent’s concern very seriously when they suspect their child is exhibiting symptoms of the same disorder.  What if a nephrologist’s elderly mother starts dialysis, chances are he will have a broader perspective and more personal relationship with his own elderly patients who also face similar disease and treatment options.

When a doctor finds themselves on the flip side, it can change the way they look at their patients, the health care system and their own spiritual and mental well-being.

• Treatment: When a doctor treats a patient for an illness, they are often eager to find a diagnosis, to run the necessary tests and to limit the length of time commencing treatment.  However, this doesn’t often apply when facing their own illness.  They are much less likely to seek the same strategies, minimizing symptoms and delaying a diagnosis out of fear and denial.  We all know the adage, doctors make the worst patients, and this was borne from the idea that many physicians thrive on perfectionism, control and authority.  When this has been stripped away from them it can cause them to question their very role as care provider.  But there can be a silver lining, too.  They have an intimate knowledge in prognosis, in treatment options and expectations.  By going through the same experience a patient does can give them a true insight to how to be a better provider as well.  They are likely to be more sympathetic to someone who is going through the same treatment.
• Asking for Help: this can be one of the most difficult positions for a physician to find themselves in as oftentimes they considered themselves above illness, weakness and the very idea of needing assistance.  But by allowing someone else to take helm of caregiver and provide them with needed care can be a humbling and transforming experience.  When a doctor starts the process of treatment and also the often frustrating bureaucratic world of red tape, paper work and referrals, they can begin to empathize with their patients who have complained of similar circumstances, often they can become huge advocates of patient-rights and a unique voice in the eternal struggle for quality healthcare in our country.
• Sharing knowledge: Sometimes by sharing with a patient that you truly understand what they are feeling, helps humanize the doctor/patient relationship.  There are two camps of thought here, one is that a doctor is strictly there to treat your condition, not discuss their own health, but if they too acknowledge how you are feeling, not with a mere nod of the head, but with a complicit understanding because they have experienced the same problem, they are much less likely to dismiss your concerns as well as strengthen the patient/doctor relationship.

Oftentimes after a diagnosis, a patient can be left feeling overwhelmed as their once normal and routine world has now been shaken to their very core, but if their own physician can be that beacon of strength, comfort and knowledge it will help ease the transition.  Doctors as patients can share these same emotions and sometimes at a much deeper level since they will have intimate knowledge of how a body reacts to conditions as well as treatment options and a host of symptoms.  However, the silver lining is that doctors can bring their experiences back to their office, their colleagues and most importantly, their patients.  Which in turn can make them far more compassionate and knowledgeable as both caregiver and survivor.

About the Author

Adam Ghosh has over twenty years’ experience as a researcher in the medical field. In that time he has worked with allergists and vascular surgeons, and everyone in between. Now he supplements his early retirement by contributing to Weatherby Healthcare.

Historically, locum tenens physicians were used mostly to fill short-term gaps in coverage, created when a physician vacationed, recovered from an illness or took maternity leave. Today, the number one reason facilities use locum tenens physicians is to fill in while they recruit permanent doctors. The impending physician shortage will make it even more difficult to recruit these coveted permanent doctors, increasing the overall value and demand for locum tenens physicians.

In addition to the shortage, physicians are opting out of independent practice and are becoming hospital employees. When a physician becomes a hospital employee, he or she is subject to the high turnover rates associated with larger institutions. This is fueling the need for locum tenens physician to fill gaps created when employed physicians walk out the door.

Read the article (Recruiting Trends)

For the unfamiliar, a locum tenens (Latin for “place-holder”) is like a substitute teacher for doctors, nurses, PAs, etc. Clinics or hospitals will reach out to a locums PA when they have a temporary employment gap to close for whatever reason. While MD locums terms can be a year or more, the tenure of locums PAs are more often a few days to a few months.

As fair warning before I get into the benefits of working a locum tenens gig- it’s not for everyone. If you are established at a clinic or hospital you love; doing work you find satisfying and enjoy; are making a salary you’re happy with and have settled in with a family, or at least a family that isn’t fond of uprooting however often, working as a locum is maybe not for you.

However, for the recently graduated and lettered, adventurous, bored, curious or wanderlust-afflicted, working locums stints can be one of the best career decisions you’ll make. Not that the chief appeal of locum tenens engagements is the whimsy of travel and adventure. Because temporary positions require someone who is flexible, willing to travel, quick to adapt and possibly funding their own travel and accommodations, locums work usually pays better than a comparable full-time position does. Furthermore, exciting as new work in a new place is, that experience also has huge practical value.

It’s value that will be added to both your resume and, very possibly, future vocational contentment. If you’ve worked largely in the radiology department of a rural clinic, putting locums time in the emergency department of an urban hospital is going to look great on a resume and a fascinating change. I don’t know how many docs, nurses or PAs I’m acquainted with that have adopted specializations they’d never have considered after pulling an unexpected shift (or shifts) in the oncology ward, pediatrics, OB/GYN, whatever. As was the case with classes in school, working in a specific field is as much or more about finding out what you don’t like than it is what you like.

Dedicating your career to obstetrics at an inner-city hospital in the verdant Pacific Northwest may sound like your dream job until you land that dream job to discover you don’t like the reality of the work, can’t stand the city and hate the rain. Doing one or several locum turns in different parts of the country, with varying urban/suburban/rural backdrops and at the service of different departments can be an absolute godsend for establishment of an actual dream job. Curious about working in Hawaii, Alaska, the South, Northern California…? Jump on the net and check out the possibilities waiting for you.

Some trustworthy locum tenens employment sites include:

• Interim Physicians- http://www.interimphysicians.com
• Weatherby Healthcare- http://www.weatherbylocums.com
• Mint Physician Staffing- http://www.mintphysicians.com

About the Author

Adam Ghosh has over twenty years’ experience as a researcher in the medical field. In that time he has worked with allergists and vascular surgeons, and everyone in between. Now he supplements his early retirement by contributing to Weatherby Healthcare.

Personal items are an easy way to obtain some semblance of the familiar feeling of home.

• Entertainment items. I personally think items like laptops, mp3 players, movies and video games consoles are must. They provide a great way to unwind after a long hard day. Furthermore, if you are relying on public transit to get around portable devices like mp3 players and tablet computers can be a fantastic way to pass the time.
• What items will you need for your day to day living situation? It is easy to forget these things because you may not need them every day, but you do use them regularly. Why not retrace your steps from the previous week and figure out what items you used. Items like nail clippers, utensils, pots, pans, bed sheets, blankets and other items similar to these are often easy to overlook, but also can cause financial and personal stress if you have to purchase them once again.
• Clothes. The obvious items like socks, underwear and work clothing are essential to survival in a new place. However, make sure that you remember to bring clothes for going out and other social events. In addition, it would be wise to prepare for any elements you might encounter while living in a new place.

While it is safe to assume a majority of the medical supplies will be provided by the hospital you are contracted to work at it won’t hurt to bring some of your own professional items.

• Disposable scrubs, face masks and belts are always a must to have on hand. In addition, a comfortable set of shoes are also essential to the job. Beyond that it would be wise to check in with the hospital you are working for and make sure that you have all the requirements for the uniform.
• Sanitizers and cleansers. This could include hand sanitizers, sterilization products, eye washing fluids and surface cleaners.
• Suture kits, anti-venoms, splints and etc. might be necessary depending on your assignment.

Emergency items are great to have for any travel scenario.

• If you are choosing to drive to your new job it would be wise to be prepared for any problems that may arise on the road. A tire iron, jack, spare tire and jumper cables are some of the more obvious items to have on hand, but also make sure you have extra oil, water, gasoline reserves and coolant for any other unexpected problems
• An emergency credit card, back up prescriptions and insurance information are always great to have on hand in case a situation was to arise that required them. Motion sickness, diarrhea and allergy medicine are a great items to have in case the new environment affects you adversely.

While I am certain that this list does not cover everything a traveling health professional might need, it should get you on the right path to begin preparation for your upcoming adventure. Hopefully it will help ease the stress that comes with preparing for such a big step in one’s life and allow you to focus on the adventure ahead of you.

About the author:

Vance Hobbes is a freelance writer and former medical researcher. Hobbes writes about many facets of the medical field, and works with CompHealth. When he’s not writing the day away, he spends his free time tending to his prizewinning garden and attending any basketball game he can find.

•  An 80-hour weekly work limit, averaged over 4 weeks.
• A minimum of one day off every week, averaged over 4 weeks.
• A 16-hour limit on continuous duty for first-year residents.
• A 24-hour limit on continuous duty for other residents.
• In-house call no more than once every 3 nights, averaged over 4 weeks.

To keep their accreditation, residency training programs must report regularly to the Accreditation Council for Graduate Medical Education (ACGME) to show they they are following the rules.  “I think we should challenge the whole idea of having a central committee dictate work limitations for all residency programs,” says Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons.

But, they don’t comply with the guidelines anyway, says Dr. Steven Lockley, sleep medicine specialist at Harvard Medical School.  “A study by our research team [at Harvard] found 85% of residency programs were non-compliant with the work-hour rules.”

A survey done by the ACGME found only 5% non-compliance.

So what about patient safety?  “When hours are reduced,” says Dr. Lockley, medical error rates fall enormously.  No other simple solution comes as close as a way of cutting errors.”  He adds that longer shifts affect physicians health and safety as well.  “In surveys conducted by our group, residents working 24 or more hours in a row reported sticking themselves with needles 60% more often … as compared with [those working] shorter shifts.” “Yes,” says Dr. Orient, “people do tend to make more mistakes when tired. But the bigger reason for mistakes by physicians-in-training is lack of experience.”  Dr. Orient believes that shorter shifts short-change the learning experience:  “Many physicians, myself included, think new physicians are less well-trained.  They have seen fewer patients and have done fewer procedures.  [Consequently], future patients may pay the price when the less-experienced physician is working without close supervision.”

It’s almost impossible to take a neutral stance on this issue.  As might be expected, older physicians are more likely to see the so-called “shift-work culture” as a threat to the traditional doctor-patient relationship in which doctors are customarily available outside “office hours.”  Younger physicians are more likely to see patient care as “the collective responsibility of the team, rather than primarily the responsibility of ‘their doctor’.” Since this controversy is in part driven by differing attitudes between generations, it will take a while before it’s resolved.

“How do we eliminate or at least shrink the gap between available physicians and patients?” This is a question that is spinning all over medical news sites and causing a lot of chatter and stress amongst the healthcare world. To properly identify solutions, we must look more at the current situation.

Current state of affairs 
It’s no secret that it’s much harder to gain attention to physician jobs over specialist medical jobs. Students entering the primary care field have declined in the past 15 years due to the separation among average earnings between primary care physicians and specialists. According to a survey done in 2011, primary care physicians make less than that of medical specialists.

With tuition and fees continuing to rise, it’s no surprise that more students are taking physician jobs that pay more. Rural areas are also having a harder time acquiring physicians in comparison to much larger metropolis areas.

So what are physicians up to? Many physicians are taking their physician jobs through much larger practices. One of the perks of a much larger practice is access to more support staff, space, and supplies, all of which make it much easier to manage a larger client load. Physicians and nurses are playing a much larger role than in the past. They’re being given more responsibility and are handling more routine activities like ear infections and throat checkups. This is allowing for doctor’s to increase their patient population.

Patients are entering the healthcare system through an emergency department instead of identifying and forming a relationship with a primary care physician. By forming a relationship with a primary care physician, they could actually be kept from getting sicker in the end. That’s not to say that patients aren’t still getting care, because they are, it’s just a slower and more complicated process due to a lack of physicians.

As previously mentioned, both doctors and patients are getting older. With older age comes additional healthcare, often times with multiple issues at hand. In fact, about 1/3 of the country’s doctors are 55 years old or older and are nearing retirement soon according to a recent survey.

I’m not saying these aren’t the only issues at hand, but based on many common themes I’ve been seeing throughout the medical news, these are what I chose to outline. Now that there’s a clear understanding of where our current state of healthcare is at, what needs to be done to better our chances with the future physician shortage?

Possible solutions
Finding possible solutions to the future physician shortage will not be easy, but it’s not impossible. Trying to tackle the issue head on with every issue involved could be problematic, but looking at specific needs and issues, practical and possible solutions are achievable.

Let’s start with schools. It’s been said that some medical schools are going to start advocating their students to focus more on areas of primary care practice. As beneficial as it is that the healthcare community are paid quite well, money isn’t the only reason individuals take hospital jobs. There’s a real sense of selflessness and care involved with the healthcare community. If schools can properly articulate the growing demand for physicians in the future and show much they’ll be helping those less fortunate and in need of medical help, that could really make a positive impact on the number of physicians in the future.

The Obama administration has said to increased Medicaid primary care payments rates in 2013 and 2014. This will include funds to train primary care doctors and compensate for working in underserved areas. By demonstrating the need and benefits of going into the primary care profession through both higher education and the Obama administration, the primary care job search could be more appealing than in previous years.

Going beyond what physicians can do for you, but what can patients do for themselves. A much stronger push in the terms of personal wellness and prevention could make a real positive impact. By educating both patients and the public on why and how personal wellness and prevention can help you, it could shrink the demand for physicians and the amount of hospital visits. Often times, many of our illnesses are preventable and we have the means to prevent them, but we just don’t have the proper medical information to understand how or why. If we can demonstrate and energize the public with wellness and prevention, both physicians will be in less demand and be able to devote more personal time to their patients.

All in all, we do have a critical issue that we’re all facing in the immediate future. The medical articles are saying it, research is indicating it, and we need to do something about it. It won’t be easy and it might not happen overnight, but if we try some of the ideas mentioned here, along with others, the physician job search looks more promising and the future of healthcare can be brighter.

About the author:

Joe Baxter worked in medical research for the majority of his life. In his spare time, he enjoys traveling abroad, working in his wood shop and freelance writing about medical news.

Janice Boughton, MD, decided to leave her practice due to losing a couple of partners and wanting to re-evaluate her career. She decided to work as a locum tenens physician “to travel and interact with places and people in a meaningful way, have adventures, roll up my sleeves, get my feet wet…”.

To date, she has worked in California, Washington, Oregon, Idaho and Alaska as a locum tenens physician. She describes her experiences as fascinating as she met new colleagues, made friends for life and saw various patients with mysterious and interesting problems. She also appreciated the schedule as she worked full time, but the locums schedule still allowed her more time off than her full time primary care job did. However, the locums physician’s schedule does include travel and lots of time away from home, friends and family.

“Locum tenens work is truly a great option. It allows me to know that I will be able to stay busy in my field and make enough money to support my family and to have breathing space to do other important things.”

Read the article (KevinMD)