Longer looks: A break for sleep-deprived docs; Gruber profile

Aug 12 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

New York Times: The Phantom Menace Of Sleep-Deprived Doctors
Last month something extraordinary happened at teaching hospitals around the country: Young interns worked for 16 hours straight — and then they went home to sleep. After decades of debate and over the opposition of nearly every major medical organization and 79 percent of residency-program directors, new rules went into effect that abolished 30-hour overnight shifts for first-year residents. Sanity, it seemed to people who had long been fighting for a change, had finally won out. Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. … But over the last three decades, a counterpoint archetype has emerged: the sleep-deprived, judgment-impaired young doctor in training who commits a serious medical error (Dr. Darshak Sanghavi, 8/5).

Related, earlier from KHN: New Rules Provide Relief For Sleep-Deprived Medical Residents (Gold, 7/1)

Slate: Jonathan Gruber, Professor of Economics, MIT
If health care reform is a major issue in the 2012 presidential campaign, which seems likely, and if President Obama's opponent is former Massachusetts Gov. Mitt Romney, who currently leads in polls of Republican, voters, then a central figure of debate will be a silver-tongued economist at MIT. Jonathan Gruber advised both the governor and the president on health care, and even though Romney now derides Obama's law as "disastrous," Gruber's ideas animate both efforts. Gruber says both proposals stand on a "three-legged stool": preventing insurance companies from denying coverage for pre-existing conditions, requiring universal coverage to eliminate "free riding," and subsidizing insurance plans to make them affordable to all. This "incremental universalism," fixing the existing system instead of starting from scratch, appeals to Republicans for its private-sector involvement and to Democrats for its universal coverage (Christina Gossman, 8/9).

American Medical News: Med Schools Seek Right Fit For Rural Practice
Small-town doctors throughout the U.S. say they are drawn to rural practice for the sense of community and personal connections with patients. Yet physician shortages have been a persistent problem in rural America for decades. About 10% of physicians practice in rural areas. Medical schools nationwide are trying to tackle the problem. … Some schools focus on identifying students from rural backgrounds through the admissions process or as early as high school, while some seek to give students a breadth of experience in rural medicine during medical school. Other schools are opening campuses in small towns and cities to immerse students in rural settings (Carolyne Krupa, 8/8).

The Atlantic: Home Remedy: A Small Town Solves Its Physician Shortage
For all of Albany's charm, trying to entice doctors and nurses to resettle there, an hour northeast of the nearest city, St. Joseph, has proved extremely difficult. … John W.Richmond, who retired last year as Northwest Medical Center's president and CEO … began speaking in local schools about the rewards of caring for family and neighbors. He orchestrated "pipeline" events, allowing kids to shadow medical staff on their rounds. He gave them paying jobs at Northwest Medical Center, even when there was no real work for them. And to those who showed potential, he awarded financial assistance to attend vocational or medical school, so long as they promised to return one day to work. … To date, at least 23 nurses, two medical technicians, and a certified registered nurse anesthetist have received financial assistance. So have two family-practice doctors who will soon finish their residency training and begin serving full-time on Northwest Medical Center's five-physician staff (David Freed, August, 2011). 

The Week: Walgreens' 'Unusual' Plan To Sell Health Insurance
Walgreens, the country's largest drugstore chain, is reportedly about to get in the business of health insurance ... making available a "variety of plans with different price ranges and coverage levels," says Chris Morran at The Consumerist. (Walgreens has yet to confirm the specifics of its plans.) What's behind this "unusual" initiative? … Beginning in 2014, the new health care reform law mandates that "health insurance exchanges" be created for the uninsured and the under-insured to buy state-approved and standardized affordable health plans — all in an effort to ensure that most Americans have health insurance. … Walgreens, which already has 7,700 locations nationwide, is likely getting involved because health insurance exchanges should prove to be a "lucrative market — estimated to be worth billions of dollars" (8/10).

The Weekly Standard: A Disaster Waiting To Happen
Sometime late this summer—the Friday before Labor Day if historical patterns hold—the Centers for Medicare and Medicaid Services (CMS) will announce the beginning of something called Medicare Round Two of "the Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies." Although it sounds obscure, this bidding process's manifest flaws could have serious consequences for just about every American who needs medical care. Shortages of vital devices could develop, medical supply companies could go out of business, medical innovation could slow, and, if things go as badly as some economists think they will, health care costs could skyrocket as the direct result of a program intended to control them (Eli Lehrer, 8/15).