Obama Aides Promote Health Care Plan

Fact check: Obama, Cruz distort health exchange facts

AP Health Care Budget Fact Check

Sent! A link has been sent to your friend’s email address. 154 To find out more about Facebook commenting please read the Conversation Guidelines and FAQs Obama aides promote health care plan David Jackson, USA TODAY 9:31 a.m. EDT September 30, 2013 President Obama (Photo: Evan Vucci, AP) SHARE 468 CONNECT 57 TWEET 154 COMMENTEMAILMORE One day before the opening of new health care exchanges, the Obama administration is using a variety of techniques to encourage people to sign up. And they’ll need all of them, if a new poll is any guide. A survey by the Kaiser Family Foundation and NBC News says that “Americans remain deeply divided on the Affordable Care Act, with half confused about how it works or worried about how much it will cost them.” The poll found “an anemic level of enthusiasm from people about the program, with splits among party lines.” The Obama administration is trying to fight these perceptions in a variety of ways, including op-eds, special events, and even animation. All are tied to Tuesday’s start of sign-ups for new health care exchanges, designed to finance the plan to fulfill its goal of insuring nearly every American. The White House has launched a new “animated graphic” designed to explain how to apply for health insurance through the new marketplaces. “With one application, you’ll be able to compare all your coverage options side-by-side, learn if you can get lower costs based on your income, and enroll in a plan that fits your needs and your budget,” says the graphic posted on the White House website . Meanwhile, Vice President Biden and Health and Human Services Secretary Kathleen Sebelius have authored op-eds that will appear in at least newspapers, explaining how to sign up for the exchanges. Biden’s column in particular is “designed to directly reach young Americans and states with high pockets of uninsured Americans” and that “break down the benefits of the law in plain English,” says the White House. Also on Monday, White House officials will host a summit to explain the law to military families, part of first lady Michelle Obama’s “Joining Forces” program. The Obama administration is likely to draw more support from Democrats than Republicans. The Kaiser/NBC poll indicated that most Democrats back the new health care law, while the vast majority of Republicans oppose it. “Among those surveyed, 29% said they were angry about the (law), compared to just 24% who described themselves as enthusiastic,” the poll said. “And while a quarter of Democrats say they are worried, the poll shows that three-fourths of Republicans fret.” SHARE 468 CONNECT 57 TWEET 154 COMMENTEMAILMORE USA NOW

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Shutdown nearing, GOP seeks health care delay

20, 2013. (Photo: Orlin Wagner, AP) Health insurance exchanges open Oct. 1 Obama says the law will make health insurance affordable Republicans say the law will prove too expensive SHARE 661 CONNECT 72 TWEET 80 COMMENTEMAILMORE Both sides in the great Obamacare debate are distorting the facts about premium rates on the soon-to-open health exchanges to make their case for or against the law: President Obama gave false comparisons, saying that average premiums for the exchange in Illinois were 25% lower than current individual market rates. Illinois officials compared exchange rates with what the federal government had predicted the exchange premiums would be not with current individual market pricing. Obama said the average decrease in California was 33%. But officials said premiums were up to 29% lower compared with small-employer plans not individual plans. Sen. Ted Cruz claimed that the Ohio Department of Insurance announced an 88% average increase for the individual market. It didn’t. The department estimated a 41% increase on average in a press release that called for the law’s repeal. INTERACTIVE: What the health care law means for you Much has been made of what Americans can expect to pay for insurance on the state-based and federal exchanges created by the Affordable Care Act and set to launch on Oct. 1. Republicans and critics of the law have claimed the rates will be too expensive, while Obama and the White House have said they’ll be affordable for those needing to buy their own coverage. In his sit-down talk with former President Bill Clinton at the Clinton Global Initiative Health Care Forum on Sept.

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Health Canada presides over birth of billion-dollar free market in marijuana

Acknowledging as much, Rep. Trent Franks, R-Ariz., said that as a conservative he had often found during Obama’s presidency that his choice was “between something bad or (something) horrible.” Reid pushes House to approve bill with Obamacare funding GOP aides said that under the legislation headed toward a vote, most portions of the health law that already have gone into effect would remain unchanged. That includes requirements for insurance companies to guarantee coverage for pre-existing conditions and to require children to be covered on their parents’ plans until age 26. It would not change a part of the law that reduces costs for seniors with high prescription drug expenses. One exception would give insurers or others the right not to provide abortion coverage, based on religious or moral objections. The measure would delay implementation of a requirement for all individuals to purchase coverage or face a penalty, and of a separate feature of the law that will create marketplaces where individuals can shop for coverage from private insurers. By repealing the medical device tax, the GOP measure also would raise deficits – an irony for a party that won the House majority in 2010 by pledging to get the nation’s finances under control. Issa snaps at reporter who predicts budget bill failure For a moment at least, the revised House proposal papered over a simmering dispute between Speaker John Boehner and the rest of the leadership, and tea party conservatives who have been more militant about abolishing the health law that all Republican lawmakers oppose. It was unclear whether members of the rank and file had consulted with Texas Sen. Ted Cruz, who has become the face of the “Defund Obamacare” campaign that tea party organizations are promoting and using as a fundraising tool. In debate on the House floor, Republicans adamantly rejected charges that they seek a government shutdown, and said their goal is to spare the nation from the effects of a law they said would cost jobs and reduce the quality of care. The law is an “attack and an assault on the free enterprise and the free economy,” said Rep. Pete Sessions of Texas. Democrats disagreed vociferously. “House Republicans are shutting down the government. They’re doing it intentionally.

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“There’s a real need,” he said in an interview. “You see what this medicine does to them.” Tweed Inc. proposes to produce at least 20 strains to start, and will reserve 10 per cent of production for compassionate, low-cost prescriptions for impoverished patients, he says. Patients often use several grams a day to alleviate a wide range of symptoms, including cancer-related pain and nausea. They’ll no longer be allowed to grow it for themselves under the new rules. Revenues for the burgeoning new industry are expected to hit $1.3 billion a year by 2024, according to federal projections. And operators would be favourably positioned were marijuana ever legalized for recreational use, as it has been in two American states. Eric Nash of Island Harvest in Duncan, B.C., has applied for one of the new licences, banking on his experience as a licensed grower since 2002 in the current system. “The opportunity in the industry is significant,” he said in an interview. “We’ll see a lot of moving and shaking within the industry, with companies positioning. And I think we’ll see some mergers and acquisitions, strategic alliances formed.” “It’ll definitely yield benefits to the consumers and certainly for the economy and society in general.” Veterans Affairs Canada currently pays for medical marijuana for some patients, even though the product lacks official drug status. Some provinces are also being pressed to cover costs, as many users are too sick to work and rely on welfare.

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Franciscan Alliance Acquires Medical Specialists

Greedy medical specialists refuse to treat most children with serious health problems if they have public insurance

Dr. Alexander Stemer said he will remain president of what will now be called Franciscan Medical Specialists. The group’s employees will remain, and they will maintain all of their benefits, Stemer said. Aside from the new name, patients will not notice much change. The offices will maintain the same services. “There will be no apparent difference from the standpoint of the patient,” Stemer said. Gene Diamond, CEO of Franciscan Alliances Northern Indiana Region, said the physicians group is a good match for Franciscan. We’ve been chatting with these folks for years, he said. The reason we have persisted is because Alex (Stemer) himself and, obviously, the group he has led have established a pretty obvious excellent reputation for high quality. Given Alex’s abilities and his vision, it was pretty clear to us that this would be a good match. Stemer said Franciscan Medical Specialists will serve as a specialty arm in the northern region, recruiting and placing university-qualified physicians where they are most in need. The land beneath our feet in health care is shifting, he said. We’ll be looking for physicians looking to join larger organizations. Aside from his role as president, Stemer will work in strategic planning in the northern region. Diamond said Stemer already is beginning to work with Franciscan on its accountable care organization in the northern region. Medical Specialists was established in 1978 and has 12 locations in Lake, Porter and LaPorte counties. Its team consists of 55 physicians and surgeons, 11 nurse practitioners and two physician assistants.

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Putting a price tag on contacting your medical specialist

But if youngsters with identical health problems and symptoms had the higher paying private insurance, they were turned away by doctors only 11 percent of the time. “We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance — even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children,” senior author Karin V. Rhodes, MD, MS, director of Emergency Care Policy Research in Penn’s Department of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, said in a media statement. What’s more, the study also uncovered facts indicating that some specialists apparently think they can thumb their noses at federal law which is supposed to require that Medicaid recipients have the same access to medical care as the general population in their community. Bottom line: the researchers found that Medicaid and Children’s Health Insurance Program (CHIP)-insured children who were able to even get an appointment with a specialist had to wait far longer to be seen than kids with private insurance. It almost sounds like the specialists are inflicting a kind of punishment on kids who have the “wrong” kind of public insurance that doesn’t pay the doctors as much in reimbursements as private insurance. Sick kids with Medicaid or CHIP had to wait over a month, about 44 days, for help. But privately-insured children with similar urgent conditions were seen in less than three weeks. For the study, research assistants compiled facts by working undercover — they posed as moms of children with seven common medical that affect large numbers of children and are serious enough to need timely specialty care: severe body rashes, obstructed breathing during sleep, Type 1 diabetes, uncontrolled asthma, severe depression, new onset seizures and a fracture that could affect bone growth. The researchers, pretending to be mothers, placed calls to a random sample of 273 clinics representing eight medical specialties in Cook County, Pennsylvania. Each of the investigators placed two calls, separated by one month, to each clinic using a script that varied only by insurance status. Only 34 percent of callers with Medicaid-insured children were told they could even get an appointment with the specialist. But if the researchers-posing-as-moms claimed they were calling about a child with Blue Cross Blue Shield PPO insurance, 89 percent were given appointments. It was obvious that how the doctor was going to get paid — whether by higher paying private insurance or by lesser paying public insurance — was of far more importance to the specialists’ offices than the severity of the child’s reported symptoms.

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The institute’s Select level costs an extra $500 a year. For that sum, patients will receive “priority appointments” for certain treatments, such as pacemaker maintenance, and “prompt notification of non-urgent test results.” Presumably, if you don’t pay the extra money, you’ll get your pacemaker adjusted at their convenience, and word of your test results will arrive in a less-than-timely manner. For $1,800 a year, institute patients can enjoy Premier status, which buys them everything Select patients receive plus “priority scheduling of diagnostic tests” and “direct email and phone communication with your personal cardiologist.” I’m sorry, but for people with a heart problem , you’d think every diagnostic test is a priority. Moreover, since when is it considered a premium service to be able to reach your doctor by email, especially if you have a chronic condition? The institute’s top-drawer Concierge service runs $7,500 a year and provides everything the other levels offer, as well as 24-hour pager, email and cellphone access to your doctor and “emergency night and weekend availability of your personal cardiologist.” I spoke with Oppenheim’s cardiologist, Dr. Richard Wright, who acknowledged that a doctor at his practice will always be available if a patient has an emergency. “But if you want me, and it’s my weekend off, that’s now purchasable,” he said. “What we’re telling patients is that if you want additional access, that’s an option.” From a purely dollars-and-cents perspective, Wright makes a case for premium levels of healthcare. Many of his patients are covered by Medicare, he said, and the federal insurance program has lower reimbursement rates than many private insurance plans. It’s not economically feasible, Wright said, for him and other doctors at his practice to take every patient call or respond to every email. In many cases, he said, nurses or nurse practitioners can just as easily handle these communications. But if a patient wants to pay extra for a higher level of access, Wright said, then that possibility should be available. “This is a mechanism for the doctor-patient relationship to survive,” he said.

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Justice Department Reaches Settlement Over Medical Care Issues At Piedmont Regional Jail In Va

Keeping Up with Progress in Mobile Medical Apps

The Justice Department says it has reached a settlement to ensure prisoners at the Piedmont Regional Jail in Farmville receive appropriate medical and mental health care. Officials say the department launched an investigation in March 2011 into allegations that the jail was not providing prisoners with constitutionally adequate medical care. Friday’s Photos of the day The department says its investigation found deficiencies in medical and mental health care at the jail exposed prisoners to an unreasonable risk of serious harm. Among the findings were inadequate staffing, insufficient procedures to screen and assess medical and mental health problems, and the absence of a chronic care program to treat conditions such as seizures, heart diseases and high blood pressure, the department said. The agreement announced Friday requires the jail to employ adequate medical and mental health personnel, perform timely screening and appropriate health assessments and establish a chronic care program, among other things. Jail officials also must track the performance of medical and mental health improvement efforts. It also must work with an independent monitor to implement the changes described in the agreement and to evaluate the jails success in effecting meaningful reform. Piedmont Regional Jail is a minimum to high-security facility that serves Amelia, Buckingham, Cumberland, Lunenburg, Nottoway and Prince Edward counties. It houses more than 700 male and female inmates. Officials with the jail did not immediately return a phone message seeking comment on Saturday. Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Heavy smoke rises from the Westgate Mall in Nairobi Kenya Monday Sept. 23 2013. Multiple large blasts have rocked the mall where a hostage siege is in its third day. Associated Press reporters on the scene heard multiple blasts and a barrage of gunfire. Security forces have been attempting to rescue an unknown number of hostages inside the mall held by al-Qaida-linked terrorists.  (AP Photo/ Jerome Delay)

The draft guidance for mobile medical apps, published in July 2011, elicited more than 130 public comments that the FDA reviewed and considered when writing the final guidance. “Most were positive; people generally liked the draft proposal and understood which types of mobile medical apps we would regulate,” says Bakul Patel, M.S., MBA, senior policy advisor to the director of FDA’s Center for Devices and Radiological Health. However, some who commented asked for more examples of what would not fall within the focus of FDA’s regulatory oversighta suggestion incorporated in the final guidance just issued. Patel explained, for example, that FDA would regulate a mobile medical app that helps measure blood pressure by controlling the inflation and deflation of a blood pressure cuff (a blood pressure monitor), just as it regulates traditional devices that measure blood pressure. A false reading by either blood pressure device would deliver a false diagnosis and perhaps even lead to treatment that could endanger patients. However, although a mobile app that doctors or patients use to log and track trends with their blood pressure is a medical device, as explained in the final mobile medical app guidance, such mobile apps would not fall within the current focus of FDA’s regulatory oversight. Similarly, mobile medical apps that recommend calorie or carbohydrate intakes to people who track what they eat also are not within the current focus of FDA’s regulatory oversight. While such mobile apps may have health implications, FDA believes the risks posed by these devices are low and such apps can empower patients to be more engaged in their health care. In the final mobile medical apps guidance, FDA clarifies that its mobile medical apps policy does not apply to the use of smartphones or tablets themselves. Providers of mobile medical apps, such as the iTunes app store, would not be treated as medical device manufacturers. back to top A Growing Trend The mobile app market is anticipated to grow 25 percent annually for some time, according to the market research firm Kalorama Information; companies are investing record amounts in developing new health apps. Consumers will be finding more and more options from which to choose. FDA intends to stay current with the expertise needed to evaluate mobile medical apps for which safe use and accuracy are critical to public health by hiring additional skilled engineers, including software engineers, and medical officers with device expertise. FDA also works closely with experts in academia and is now reviewing its current practices involved in evaluating software used in mobile medical apps.

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Australia Needs Physician Assistants. So Why Aren’t We Getting Them?

It would be good to hear your responses to the pro-PA arguments that have been made. Meanwhile, Professor Peter Brooks, director of the Australian Health Workforce Institute, explains below why he believes that Australia needs PAs. (Incidentally, he is also due to speak at at a University of Sydney seminar on May 3 titled Are we training too many doctors?.) Professional self-interest is blocking introducton of physician assistants Peter Brooks writes: Well done Croakey for running these stories on Physician Assistants (PAs). The opposition to the introduction of these health workers mirrors very much what happened in the US some 40 years ago. Strident cries from the American Medical Association that their introduction would end life as we know it. But interestingly it didnt! Why the nurses are so actively against it is interesting but one would have to ask all opposing groups are they interested in opposing for oppositions sake, are they interested in providing health services to patients who currently find it difficult to access them because the workforce is not there, or are they interested in preserving the status quo with siloed health professional practice? The health service and its constituent parts is a very complex organism but every part of it should work together to improve patient care and not work only in the interests of the health professional or have I got that wrong ? The health and social welfare workforce is currently the largest in Australia 1.4 million and like the rest of the population, it is ageing. We will need to recruit about half a million new workers at least to this sector over the next decade a significant challenge that policy makers and politicians do not seem to be fully accepting at present. Where are these new workers to come from? Current recruitment will not achieve these targets so perhaps some innovation is required. Trials of new models of care have been carried out by Queensland Health and the South Australian Health Commission in respect to PAs. These trials, albeit small, did suggest that these new health professionals would be useful across a variety of health care situations.

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Uk Tv Show ‘doctor Who’ Is Setting A Us Fashion Trend

You might now be at the point of wondering why you should care, so maybe this will grab your attention: According to Sriraman, Doctor Who has become the second most requested brand behind Star Wars, beating out science-fiction favorites like Star Trek and Battlestar Galactica. That’s big news for the sci-fi geeks in your life, and should be surprising to you, since those other franchises have resulted in blockbuster successes. Lisa Granshaw/TODAY.com / Three “Doctor Who” cosplayers at New York Comic-Con 2011 dressed as the tenth Doctor, a Dalek, and the eleventh Doctor. Her Universe , a company dedicated to creating clothing for the female science-fiction fan, ThinkGeek ,a website with products for “technophiles and geeks,” and Hot Topic have all seen more consumers asking for “Doctor Who” items. Actress Ashley Eckstein, founder of Her Universe, has been surprised by the interest. I never thought I would see it grow this much, the 30-year-old entrepreneur told TODAY.com. Girls would come up to me saying they wanted Doctor Who shirts and I didnt know how I could make it work logistically with the BBC in London. Luckily, Eckstein didnt have to cross the pond to try to get the rights to make Doctor Who-themed T-shirts, because the BBC approached her. Ashley was a natural choice. She has a pulse on this demographic and on knowing what girls want, Sriraman said. We knew from our research that Doctor Who was drawing in a lot more women. Her Universe / This T-shirt was inspired by a painting that appears in the season 5 episode “The Pandorica Opens” ($28 at Her Universe). When Her Universe started selling Doctor Who-themed T-shirts, they completely sold out the first day. And theyre not the only ones seeing a huge response from fans: Doctor Who is one of ThinkGeeks top brands, and the only one where items are bought by just as many women as men, according to the website’s press manager, Steve Zimmerman. Zimmerman believes aBritish influence on U.S. pop culture and products is not new, citing examples like the The IT Crowd and The Office. ThinkGeek / The best-selling “Doctor Who” apparel items at ThinkGeek are their collection of bathrobes ($69.99). As it states on the site, “Because even a Time Lord needs a break.” Either we’re enjoying the British version of the shows or are remaking it in our own way; the influence is still there, he said. The fact that a show like Doctor Who, which has such a long legacy, is doing well here is great for helping to increase exposure to science-fiction as a whole. With the premiere of season 7 on BBC America this Saturday, Doctor Who fever is sweeping the nation. At the New York City premiere screening at the Ziegfeld Theater last week, many fans were dressed like the Doctor or his companions, and even more sported T-shirts with sayings from the show.

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Doctor Who 50th anniversary schedule revealed by BBC

Matt Smith, David Tennant and John Hurt

Smith said: “Hope you all enjoy. There’s lots more coming your way.” Other highlights include a BBC Two lecture by Professor Brian Cox on the science behind the hit show and the drama An Adventure In Space and Time, written by Mark Gatiss. The one-off programme stars David Bradley – known to millions for his role as Filch in the Harry Potter films – as William Hartnell, who played the first Doctor in 1963. BBC Four will introduce new audiences to Hartnell, with a re-run of the first ever story. The four episodes are being shown in a restored format, not previously broadcast in the UK. BBC Two’s flagship arts programme The Culture Show is to present Me, You and Doctor Who, with lifelong fan Matthew Sweet exploring the cultural significance of the BBC’s longest running TV drama. A 90-minute documentary on BBC Radio 2 will ask “Who Is The Doctor?” – using newly-recorded interviews and exclusive archive material to find an answer. For those less familiar with the show, Doctor Who: The Ultimate Guide will provide a handy primer. Danny Cohen, BBC director of television, said: “It’s an astonishing achievement for a drama to reach its 50th anniversary. “I’d like to thank every person – on both sides of the camera – who has been involved with its creative journey over so many years.” The anniversary episode, which also stars Jenna Coleman and Billie Piper, sees the return of the Daleks Smith has already started filming his final scenes as the Doctor, which are due to air in this year’s Christmas episode. His replacement, Scots actor Peter Capaldi, was announced in August. Steven Moffat, lead writer and executive producer on Doctor Who, said: “50 years has turned Doctor Who from a television show into a cultural landmark. Personally I can’t wait to see what it becomes after a hundred.” CBBC will broadcast a show, 12 Again, bringing together stars to share their memories of Doctor Who. They include the seventh Doctor, Sylvester McCoy, Tommy Knight, who played Luke Smith in The Sarah Jane Adventures, Warwick Davis, who played Porridge in a Doctor Who episode and Louise Jameson, who was the fourth Doctor Tom Baker’s companion Leela. Blue Peter is launching a competition giving viewers aged between six and 14 the opportunity to design a new gadget that will become part of the series and Matt Smith will appear on the Blue Peter sofa to answer viewers’ questions.

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General Medical Council to test UK doctors’ English proficiency

8 (ANI): British medical council is being given new powers to check the English-language skills of all doctors working in the UK. The General Medical Council at present only makes language checks on doctors from outside Europe. The government is carrying out a 12-week consultation on the changes. According to the BBC, in April, the government created a national list of doctors who can treat NHS patients. The report said that it also appointed senior doctors who have a legal duty to ensure all doctors in their local area can speak the necessary level of English to perform their job in a safe and competent manner. Health Minister Dr Dan Poulter said that overseas doctors make a hugely valuable contribution to the NHS, but it is clear that tougher checks are needed, the report said. He added that they have already strengthened the way doctors’ language skills are checked at a local level. He said that these new powers are an important step in making the system even stronger by allowing the GMC to carry out checks on a national level before they start work in the UK. Poulter said the move would prevent doctors who do not have the necessary knowledge of English from treating patients, the report added. (ANI)

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Canadian Doctors To Tackle Unnecessary Medical Tests

Access granted! barriers endure: determinants of difficulties accessing specialist care when required in Ontario, Canada

Among the common practices called into question south of the border are routine diagnostic imaging for headaches and short-term lower back pain, prescription of antibiotics for sinusitis, annual electrocardiograms (commonly called EKGs) for low-risk, symptom-free patients and annual Pap tests. Antibiotics arent effective against viruses the most common cause of illness and even bacterial ear and sinus infections frequently clear up on their own, avoiding risks of side effects and superbugs. While diagnostic imaging can provide helpful information in some cases, it also exposes patients to radiation, which can itself cause cancer, or leads to invasive tests that carry other risks. An unnecessary test is often worse than no test because it can lead to even more tests and procedures, some of which are invasive and carry their own risks, said Dr. Scott Wooder, president of the Ontario Medical Association . And testing opens the doors to false positives, causing anxiety on the part of patients. False positives are a kind of harm. It can be harm psychologically, and physically, said Dr. Wendy Levinson, a professor of medicine at the University of Toronto who worked on the Choosing Wisely campaign in the U.S. Levinson, who chairs Choosing Wisely Canada, said society has built an underlying belief that more is better. But when you talk about not ordering a test . . . Canadians can think this is about rationing, said Levinson.

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Demand high but medical specialists not finding work in Canada

MacLean. It is expected that most of the jobless doctors will get work eventually, but the delay could mean a year or two of not applying highly-sophisticated abilities, though numerous studies have shown that the competency of surgeons, especially, improves as they perform more of a particular procedure. If youre not practising once youve been taught, your skills get a little rusty, said Dr. Geoff Johnston, an orthopedic surgeon in Saskatoon and a spokesman for his specialtys national association. Its important that one can promptly employ these people. While the situation varies from region to region and specialty to specialty, there is relatively little debate that Canada needs more doctors. In 2008, it ranked 26th of 32 Organization for Economic Cooperation and Development (OECD) countries on that front, with 2.3 physicians per 1,000 population, compared to the average of 3.2, and 2.4 in the U.S. In response to outcry over long wait lists, provinces have in recent years significantly boosted medical school enrollment and the number of on-the-job training positions: two-year family-medicine residencies and five-year residencies in a specialty. Once trained, family doctors and many other primary-care physicians, like pediatricians or psychiatrists, can simply hang out a shingle and start billing for their services. Surgeons and others who require expensive infrastructure like operating rooms to do their jobs, are often hired by hospitals or health regions. A cardiac surgeon, for instance, costs a hospital $1.5 million a year, though the doctors income is only part of that, said Ms. Frechette. Physicians say the job market has been tightened in part because the expected wave of retirements has yet to materialize, with many older doctors deciding to keep working after investment losses. Sometimes, as well, the jobs are out there, but might require a new specialist to relocate across the country, not always easy if they have working spouses and children, said Mr. MacLean. Yet in areas where demand for doctors is still high, budget-constrained health institutions are often not hiring the additional specialists recently churned out, medical leaders say.

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Low income in this study was defined by having a household income adjusted by household and community size to in the province of Ontarios lowest quintile. Highest level of education was recoded to less than secondary school, secondary school only, and post-secondary education (e.g. University education, College education and higher). Statistics Canada uses the 35 health regions in Ontario as the primary sampling frame for the CCHS, and these were conceptualized as being enabling characteristics. Health regions were grouped into three categories: Urban, Rural, and the City of Toronto. The City of Toronto was separated from the other urban health regions because it is the largest metropolitan centre in Ontario, and the main centre for secondary and tertiary health care in the province. Urban areas were those that satisfied one of two criteria: (1) per guidelines proposed by the Organization for Economic Co-operation and Development [OECD] the health region had more than 150 people per km2 [ 25 ], or (2) the health region contained a Census Metropolitan Area that represented at least 85% of the population of the region. Census Metropolitan Areas in Canada are municipalities, or clusters of municipalities around a central core, with a total population over 100,000 people of which 50,000 live in the central core [ 26 ]. There is no universal definition of urban or rural in the Canadian context at the health region level, thus the addition of the second criteria. Eighty-five percent of a regions population living in a CMA was used as the cut-off point, as the most recent statistics show that 85% of the population of Ontario lives in urban areas versus rural areas [ 27 ]. Data used to calculate the proportion of the health region living in a CMA were available from the 2006 Canadian Census community profiles. The use and usefulness of this procedure for defining health regions as urban versus rural will be discussed further in the limitations section of the paper. The CCHS collects data on a range of chronic conditions used to create the variable measuring health need. These chronic conditions include: asthma, fibromyalgia, arthritis, back problems, high blood pressure, migraine headaches, chronic obstructed pulmonary disorder (COPD), diabetes, heart disease, cancer, stomach or intestinal ulcers, effects of a stroke, urinary incontinence, bowel disorders, chronic fatigue syndrome, multiple chemical sensitivities, mood disorders, and anxiety disorders. A total number of chronic conditions were tallied for each respondent, and coded as No chronic conditions, 1-3 chronic conditions, and 4 or more chronic conditions. Analysis All univariate and multivariate analyses are weighted to population weights provided by Statistics Canada in the public use microdata file for the 2010 CCHS.

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New Report Analyses Numbers Going Into Medical Specialist Training – And Where


The report contains an overall analysis of numbers going into medical specialist training and identifies which medical specialties are at risk of over-supply as well as identifying the geographical balance. This report is the first of a number of reports looking at the shape and size of the overall workforce needed for the NHS of the future.As one of the first pieces of work carried out by the CfWI in its current form, and within a constricted time span, the underpinning research is necessarily limited, but the report makes recommendations and identifies emerging messages. NHS Employers has welcomed the final recommendations on medical training numbers for 2011 outlined in the CfWIs report published today. Bill McMillan, head of medical pay and workforce at NHS Employers, said: “We support the CfWIs programme of work to increase understanding of the shape of the future medical workforce and the numbers going into training. “It is critical that the correct number of doctors are trained in the specialities and geographical areas where they are most needed to avoid the risk of either a shortage or significant over-supply, both of which can be expensive, demoralising for doctors and affect patient care. “NHS organisations have a central role to play in medical training in the UK and are ultimately answerable to the public and patients for ensuring they have the right people in place with the correct skills, knowledge and commitment. Planning for the next generation of qualified doctors is central to this and todays report will help inform their decisions.” NHS Employers believes it is also important that employers are able to influence the number and geographical location of trainees to make sure that the balance between training and service is appropriate as doctors progress through their training programmes. Shifts in the numbers of trainees at each level of training can have a profound impact on service delivery and the costs of that service. This impact may well extend beyond the medical workforce and encompass reconfigurations of service and different ways of delivering services. NHS Employers believes that NHS organisations are best placed to influence these aspects of the discussions and planning. Together with demand and supply issues there is also a question of cost.

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Specialist nurses as good as doctors in managing rheumatoid arthritis patients

The results of the multi-centre trial at the University of Leeds, funded by Arthritis Research UK, showed that there may be some clinical benefit to people with rheumatoid arthritis, whose condition is managed in clinics run by rheumatology clinical nurse specialists, especially with respect to their disease activity, pain control, physical function and general satisfaction with their care. Rheumatoid arthritis is a chronic inflammatory disease , which if untreated may lead to severe disability or death. However, the management of the disease has changed significantly over the past ten years due to better understanding of the disease process, an emphasis on early diagnosis, intensive treatment and the use of more efficacious drug therapies . The nation-wide trial was led by Dr Mwidimi Ndosi, of the University’s Institute of Rheumatic and Musculoskeletal Medicine, and former University academic Dr Jackie Hill. It compared the outcomes of 180 people with rheumatoid arthritis in 10 out-patient clinics around the UK, half run by clinical nurse specialists, and the other by rheumatologists. In both groups the nurse or doctor took a patient history, carried out a physical examination, discussed pain control, change of drugs or dose (including steroid injections ) and offered patient education and psychosocial support. The nurse-led clinics’ appointment times were on average longer than the consultants’ (20 vs 15 minutes). The results of the study, published in the Annals of the Rheumatic Diseases, found that although the nurses made fewer changes to a patient’s medication and ordered fewer x-rays and steroid injections, their patients saw greater improvement in disease activity than those under rheumatologists’ care. Nurses also provided patient education and psychosocial support more frequently than rheumatologists, and their patients also had fewer unplanned hospital admissions or visits to accident and emergency units. “The results of this study show that clinics run by rheumatology clinical nurse specialists can manage many people with rheumatoid arthritis without any reduction in the quality of care and treatment,” said Dr Ndosi. In addition to better improvements in the disease activity, nurse-led clinics had overall lower healthcare costs, representing a cost-effective service. The economic evaluation took into account healthcare resource use, including consultation costs, investigations, hospital admissions and treatments including over-the-counter medications. Interestingly, throughout the 12-month follow-up period, the proportion of patients receiving expensive biologic drug treatment remained more or less constant in the nurse-led clinics, while that of rheumatologist-led clinics doubled. “The development of the role of clinical nurse specialist in rheumatology has resulted in great improvements in rheumatology service, providing a high quality, accessible and person-centred care to people with rheumatoid arthritis ,” said Dr Hill. “The results of this research are encouraging, demonstrating that this model of care is effective, safe, and associated with more patient satisfaction. At a time when deficiencies have come to light in some areas of the NHS, it’s good to know that in rheumatology there are high levels of satisfaction with the care we provide.” Professor Alan Silman, medical director of Arthritis Research UK commented: “Rheumatoid arthritis is, despite modern treatment, a chronic condition requiring long-term expert professional care to help patients manage their symptoms and control disease.

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‘that Terrifies Us’: Canadian Doctors Get Virtually No Training On Handling A Patient’s Desire To Die

Doctors debate physician-assisted suicide

Librach. Sometimes the appeal comes from the relative of a deeply suffering patient. They say If my dad were a dog, you would just put him down. Why cant you do something? said Dr. Harlos. The situation can be challenging even for those trained to deal with such issues, said Dr. Robin Fainsinger, a palliative-care physician at the University of Alberta. Its never going to be an easy conversation, he said. The reasons behind the requests vary, with untreated pain being just one of many possible motives, said palliative specialists. Sometimes the sentiment stems from a loss of control not knowing when or how the end will come or a worry about burdening family members, said Dr. Harlos. When he did die, he died in agony: We couldnt get enough medication into him In one of the Winnipeg physicians terminal cases, a highly successful businessman and all-round alpha male felt he essentially had nothing left to live for as he lay incapacitated in a hospital bed and wanted help to die prematurely. I said, Youre used to accomplishing things and the biggest task ahead of you is to show your family how this is done, said Dr. Harlos. It inspired him to the point where he completely turned around [psychologically]. He and Dr. Fainsinger said the vast majority of patients can be mollified by the right kind of medical help and counseling.

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Canada needs better programs that allow patients to die comfortably at home and more palliative care training for young physicians, said panellist Dr. Eric Wasylenko, a Calgary family physician specializing in palliative care. Proper end-of-life care strives to help patients live as well as they can before they die, he said. aMy personal view is it is not within the role of the physician or the practice of medicine to actually deliberately cause someoneas death, even if theyave asked for it,a said Wasylenko, in an interview following the panel discussion. aThe role of physicians and medical care is to support people in their life until their natural death, not to kill them artificially or in advance of their natural death.a The debate has taken on growing urgency in Canada after Quebec introduced contentious right-to-die legislation this year. Earlier Monday, Canadaas health minister Rona Ambrose said the federal government isnat planning to reopen the debate on euthanasia. aThis is an issue that is very emotional for a lot of people a not just regular Canadians, but also physicians,a she told reporters. aParliament voted in 2010 to not change its position on this issue. At this time, we donat have any intention of changing our position.a As the Quebec parliamentary commission begins hearings next month on the issue, Canadian physicians should be prepared to face a growing public discussion around the issue, said CMA president Dr. Anna Reid. aAlthough physicians are grappling with these issues, they require a broader societal discussion,a she said. aWe feel as physicians we need to actually start to find out what our members feel and actually tease out the nuances, actually start to understand the definitions, understand the terminology of what weare all talking about.a Dr.

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