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January 2012 News

  CME Mirrors Healthcare

There's a parallel between CME and patient care on the horizon: It's all about shortages. Scarcity. Bottlenecks. A recent Wall Street Journal headline summed it up:" Medical Schools can't keep up: As Ranks of Uninsured Expand, Nation Faces Shortage of 150,000 Doctors in 15 years."

Fewer budding doctors are choosing primary care. An estimated 30 million more patients are expected to be covered by health insurance. If you think waiting-room times are long now, imagine the triple whammy of more patients, fewer physicians, and continued efforts to squeeze expense budgets.

As in the care of patient care, we have stressed the CME system over the past decade and wring out some efficiencies. But without a serious commitment to CME's future, expect a negative impact on continuing education, physician proficiency, and patient health.

The ACCME's new Program Activity and Reporting System (PARS) is providing all stakeholders with a more detailed look at CME trends. That's the good news. The bad news is that it appears that CME grant funding may have declined even more from 2009 to 2010 than the numbers show.

The new PARS reports now require accredited providers to report "commercial support" for each CME activity. In the past, some providers simply reported the net industry grant funding they received after subtracting pass-through costs. Since some accredited providers under reported commercial support in the past, the decline in industry grant funding may actually be higher than we think.

The CME field is struggling to do more with less. With roughly the same total expenses and flat industry CME grant funding, CME activities still attracted 600,000 more physicians in 2010 than in 2009.

Between 2006 and 2010, the number of physician CME participants increased by 39 percent while average per-physician CME costs decreased 30 percent. The number of non-physicians participating in CME activities is growing at a rate nearly twice as high as the rate of growth for physician participants. This shouldn't be a surprise. After all, we all are in the business of opening minds through healthcare continuing education.

Now that the stakes for patient health are high, we would be wise to redouble out CME commitment.

1/13-15/2012 VAMC Winter Retreat, Hunt Lodge, McCall(Nancy Williams - 422-1325)

2/23-26/2012 Ada County Medical Society Winter Clinics, Shore Lodge, McCall (Don Bich - 336-2930)

2/16-17/2012 Perinatal Winter Conference, Nampa Civic Center, Nampa (Sarah Jacobson - 381-4174)

  Wednesday, 8:00 a.m. - Anderson Center
  Wednesday, 12:15 p.m. - Winter Room
  Friday, 8:00 a.m. - McCleary Auditorium

  Other Regularly Scheduled Conferences

  St Luke's RMC

Thoracic Tumor Board - 1st & 3rd Tuesday, 7:00 a.m
Tumor Board - Tuesday, 12:00 noon
Breast Tumor Board - Thursday, 7 a.m.
MSTI Pediatric Tumor Board - 2nd & 4th Wednesday, 12 noon
CHEERS (Children's Hospital Education Enrichment Review) - 1stThursday, 8 am
Anderson Center - Ada -2; MATCH 2nd Thursday, 8 am

 

  MEMBERSHIP:

No New Members this month:

  UPCOMING EVENTS:

February 23-26, 2012 ACMS 53rd Annual Winter Clinics, Shore Lodge, McCall

 

2012 Perspective

One hundred years ago

• The federal budget was 690 million.
• Unemployment was 6.9%.
• A first class stamp was $.02.
• the Chinese Republic over throws the Manchu Dynasty
• Italy defeats the Turks and takes over Libya.
• 91,872,000 U.S. population.
• Life expectance is 47 years.
• Automobile fuel was sold in drug stores.
• 90% of physicians had no formal education.
• Average physician income was $2500/year.
• Five leading causes of death were 1) pneumonia and influenza 2) tuberculosis 3) diarrhea 4) heart disease 5) stroke.
• Marijuana, heroin and morphine were all available over the counter at the drug store.
• 230 murders were reported for the whole country.
• The average wage was $.22 an hour.

My, what a long way we have come, or not.

  February 2012

 1 Management of Anticoagulation, David Hinchman, MD
 3 TBA
 8 Continuous Management of Acute Back Pain, Barbara Quattrone, MD
15 Drug Use in Pregnancy, Ira Chasnoff, MD
17 Topic TBA, Amy McIntyre, MD
22 Update on Ophthalmology, Mark Boerner, MD
24-27 ACMS Winter Clinics
24 NO CONFERENCE
29 Topic TBA, Stephanie Long, MD

Skepticism

Even though I'm not from Missouri, the show me state, I've always had a healthy amount of skepticism so necessary in the practice of medicine. Webster defines skepticism as "a doubting state of mind". The challenge is to not let it dominate ones thinking and everyday relationships.

As medical students we were taught to keep an open mind, not get locked in on one diagnosis but to consider other possibilities. Certainty wasn't always possible to obtain and physicians have difficulty dealing with uncertainty. If a laboratory test or imaging study didn't fit our preconceived diagnosis perhaps it was in error.

History taking though required more than a little skepticism. Patients have been known to embellish certain things such as how much exercise they get and to diminish other things such as alcohol consumption, caloric intake and medication compliance.

Osler was right when he said "Deal gently then with this deliciously credulous old human nature in which we work and restrain your indignation… if you discover accidentally a case of Warner's Safe Cure in the bedroom of your best patient."

Now with evidence based medicine I sometimes find my skepticism increasing. Even experts (can't agree on PSA testing, post-menopausal hormone use, proper antibiotic choice, or mammogram frequency). It reminds me of past truisms in medicine such as low fiber diets for diverticular disease, bland diets to treat ulcer disease or never to use beta-blockers in the presence of heart failure.

Listening to politicians only increases my skepticism; promises of energy independence, balanced budgets, lower Medicare spending, and lower taxes only create more doubt.

How then should we manage this dilemma? We should neither display a blind credulity nor an unreasonable skepticism. We should challenge existing dogma and keep our minds open to the possibility that what we're telling patients today may change in the future.

John J. Mohr, M.D.

 

January 2012 Conferences

  Anderson Center, St. Luke’s RMC, Wednesday 8:00 a.m.

 4 Epidemiology Update, Chris Hahn, MD
11 I don't know why… C. diff Recurrences , Birgitt Dau, MD
18 St. Luke's Children's Hospital, Grand Rounds, GI Case, Henry Thompson, MD
25 Breast Imaging, James Maxwell, MD

  Winter Room, Saint Alphonsus RMC - Nampa, Wednesday 12:15 p.m.

 4 Epidemiology Update, Chris Hahn, MD
11 I don't know why… C. diff Recurrences , Birgitt Dau, MD
18 Sepsis, Darin Lee, MD
25 Breast Imaging, James Maxwell, MD

  AW Horsley, VA Medical Center, Thursday 8:00 a.m.

 5 Teledermatology in VISN 20, Nic Compton, MD
12 NO CONFERENCE
19 Epidemiology Update, Chris Hahn, MD
26 Catheter Ablation of Atrial Fibrillation, Marcos Daccarett, MD

  McCleary Auditorium, Saint Alphonsus RMC, Friday 8:00 a.m.

 6 Epidemiology Update, Chris Hahn, MD
13 Update on Melanoma, Gregory Ausmus, MD
20 Hormone Replacement Therapy, Steve Moser, MD
27 Current Management of Pancreatic Cancer, Paul Hansen, MD

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