E-DMN - January 18, 2010

January 18, 2010

Editor's Column: Critics No One Needs
WSU Seeks Support For Primary Care Development Grant
DWCHA Reports Solvency, Aggressive New Programs
Med Student Mission To Haiti In Limbo; Collections Continue
AMA TV Ad Asks Senate To Stop Medicare Crisis
Dr. Loeb Elected To Epilepsy Foundation Board
Henry Ford's GolFitness Program Offers Pre-Season Strength Training
2009 Children's Holiday Party Contributors

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Editor's Column: Critics No One Needs

By JOSEPH WEISS, MD
In the OP-ED page (A27) of the December 27 issue of the New York Times, in an article titled Doctors No One Needs, Shannon Brownlee and David Goodman indict America’s doctors.

The article starts with “…. more doctors has simply meant more doctors, not better access for patients, and not better results.” The article ends with the line: “[with more doctors] we’ll simply end up perpetuating a system in which too many doctors provide poor-quality care at too high a price.”

Between the opening salvo and the ending blast, the article repeats the mantra that the medical community needs no more residents, but rather should place all the doctors training now into family practice. Brownlee and Goodman also impose the requirement that: “Before adding residency slots, Congress should demand that academic medical centers come up with a plan to improve the disorganized, fragmented care that plagues the country.”

The article’s rant obscures a point: the way to reach a workable solution to medical care in this country is not by turning out an army’s worth of new doctors. As much as we look at enlarging medical manpower, we should look even more to reorganizing medical care.

Unfortunately, the approach of Brownlee and Goodman is deadly to the cause of change and the chance of reform. It does no good to demean doctors, bully legislators, or try to force medical school deans to do your bidding. Likely in the next 20 years American medicine will reorganize along lines of large groups built on basic care by physicians, nurse practitioners, medical assistants, and health care personnel. Specialists will be part of these groups, but not their leaders or money makers.

Harangues like that of Brownlee and Goodman will give way to the pressures coming from a nation with everyone insured, all needing some care, and all care restrained by cost. Physicians should ignore the rant of Brownlee and Goodman and their like, and concentrate instead on the changes that coverage, technology, the aging population and increasing cost will bring to our working environment.

DR. SUSAN ADELMAN’S COMMENTS
I am not sure we are wise to ignore these attacks. Many of them are designed to denigrate doctors and build the foundation for replacing doctors with nurses and PAs. The argument will be that the medical profession is being obdurate in not insisting that young doctors go into primary care instead of specialties. Thus, the argument will continue, other health care professionals must be prepared to go where doctors are too greedy to go. The most effective thing the medical profession could do is fight for fair reimbursement for primary care and think of other profit-sharing methods to encourage residents to go into primary care.

Of course, there once was a way to share the profits. It once was called fee-splitting. Now that is the norm in larger systems.

DR. VICTOR BLOOM’S COMMENTS
Dr. Weiss’ rejoinder to the op-ed (Doctors No One Needs) is intelligent, rational and articulate. I think the extremism of the article needs some deeper understanding. What are Brownlee and Goodman worried about? What are they reacting to? It would seem they are reacting to, in part, the sheer growth of the health care industry, working its way toward a fifth of the GDP. Easy for us to say, "so what?" Health care is good, it employs many people; it is an industry. Why try to limit it? One way to limit it is to restrict the number of new doctors. They claim there are already too many doctors dispensing poor quality care at too high a price. What is their evidence for this? Certainly, it is true in part, in some areas, geographic and demographic; but in many other places there are not enough doctors. What is needed to fix these irregularities are better inducements for doctors to come to out of the way and rural areas, and fewer inducements for doctors to go into already crowded areas. But if the government decides these inducements, it will be accused of socialism and compared with communist Russia and China, where doctors are sent by the government and paid by the government and regulated by the government, resulting up in “barefoot doctors.” We certainly don't want that, but we did have inducements for young doctors to spend time in public health and Indian reservations.

When we see what the beef is, maybe then we can decide how to deal with the hamburger we have been offered. We certainly don't have to swallow it.

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WSU Seeks Support For Primary Care Development Grant

By PAUL NATINSKY
The Wayne State University School of Medicine is trying to give primary care in Michigan a long-term boost and bring the state in line with 46 others.

WSUSOM is rallying support for its application for an Area Health Education Centers (AHEC) grant from the federal government. The grants provide seed money to set up clinics offering primary care services and to jumpstart recruitment and retention of future health care providers from area schools.

The WSU proposal would use partners working as subcontractors to set up clinics and health professional development efforts in four regions: Southeast Michigan, West Michigan, Central Michigan and the Upper Peninsula, said Doug Skryniarz, senior director of external affairs for the medical school. Skryniarz said the grant would garner about $500 per year in matching funds for a commitment of the same amount by the university. WSU is seeking contributions from other entities to offset some of the cost and make up for the fact that Michigan’s state budget, unlike past cases in other states, won’t be able to contribute any money. The university has received several letters of support from area health care and community organizations and Skryniarz asked the WCMSSM Public Health Committee for a letter of support from the medical society.

The AHEC grant would match applicants’ contributions for five years at 100 percent and drop to 50 percent in year six. Ultimately, the programs are intended to become self-funding. The clinical side is expected to find sources of revenue and the university hopes the recruitment side results in an increased number of health professions, physicians and non-physicians, enrolling in its programs in future years. Skryniarz said the university does not expect the program to return as much money as is spent on the recruitment side, but that the intent is to stimulate access to primary care services rather than focus on dollar-for-dollar return on the investment.

“Many states, particularly North Carolina, have been able to link their AHECS with improved health outcomes,” said Skryniarz.

Employees of the AHEC report to its board and not to the university.

Skryniarz said the University of Michigan has also submitted an application and that WSU and UM originally intended to submit jointly. Several states have two AHEC programs, typically divided geographically, but the applications aren’t constructed that way in the Michigan applications.

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DWCHA Reports Solvency, Aggressive New Programs

By PAUL NATINSKY
The Detroit Wayne County Health Authority just finished reviewing its books this year with what Executive Director/CEO Chris Allen described as the organization’s “fourth straight clean audit.”

Allen highlighted some of the DWCHA’s recent activities, particularly with its hospital partners. He said DWCHA worked with Oakwood Health System on an outreach program to enroll 4,000 Medicaid eligible patients, bringing $10.5 million in revenue for Oakwood.

Allen also discussed the Health Authority’s Web-based program in which it works with area hospitals to help determine patient eligibility for Medicaid, Medicare, housing and food assistance as soon as the patient comes into contact with the hospital and health system. Allen said the Health Authority is working to make the system accessible to private physician practices.

DWCHA is working with six major hospital systems in Southeast Michigan to find ways to reduce $650 million annually in uncompensated hospital care and put the dollars saved into expanding primary care services. The workgroup met several times last year and has made commitments to continue its work into 2010. Allen spotlighted a program at St. John Health System, called Doctors Who Care, in which 400 physicians provide no-cost services.

Other current DWCHA initiatives include an expanded search for grants as the state Medicaid allocation dwindles. The Authority is “recruiting a full-time professional to manage fund development and implement a new primary care development corporation.”

DWCHA is also working with Detroit Public Television to create programming targeted toward newly unemployed people, connecting them with resources. Allen said the program’s content can be used in multiple settings and outlets once it is developed.

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Med Student Mission To Haiti In Limbo; Collections Continue

Wayne State University School of Medicine students are eager to get to Haiti to provide medical assistance, but the devastation caused by Tuesday’s earthquake in the small island country has put the mission in limbo.

While the students may not make it to Haiti for their scheduled week, they are determined to help survivors by continuing to collect medical supplies and monetary donations to send in relief packages.

“If it turns out that we can’t go because conditions are still too bad or we’d just be in the way, we’ll make certain that our funding and the supplies that we collect are shipped to Haiti,” said second-year medical student Rossitza Iordanova, coordinator of the student group planning the mission to Haiti.

The 20 students, members of the WSU chapter of the World Health Student Organization, were scheduled to travel to Haiti the week of Feb. 25. The student-run organization brings drugs, medical equipment and health care to rural areas that do not have regular access to health care in Central and South America.

This is the fifth year of WHSO medical missions. This year, student groups from the School of Medicine traveled to Nicaragua (Dec. 17-Dec. 24), and were scheduled to fly to Belize (Feb. 28-March 7), Costa Rica (Feb. 25-March 7), Haiti (Feb. 25-March 7) and Ecuador (March 20-28).

The magnitude-7 quake that devastated one of the world’s poorest nations has left the students to sort through contingency plans and develop efforts to step up contributions.

At a group meeting Jan. 14, a number of the students said they would donate their $350 airfare to relief efforts if the trip is cancelled. The students pay for their own travel.

“We don’t have much solid information,” said Iordanova, who last year was a member of the mission to Honduras. “We’re still waiting to hear from Rays of Hope for Haiti, but they haven’t had any communication from their people in Haiti."

Based in Grand Rapids, the Rays of Hope for Haiti ministry assists organizations and individuals in sending supplies to partner projects or family members in Haiti. The organization would send the supplies and funds raised by the students if the trip is cancelled.

Kevin Taliaferro, a first-year medical student, said people appear more eager to help and donate since news of the devastation. “People are a lot more willing now,” said Taliaferro, who placed a box for donations of bandages and other supplies in his apartment building. “People have been filling it up when they go shopping.”

Additional collection efforts will be announced as they are formalized.

The students are scheduled to serve on the island of Gonave, located northwest of the capital of Port au Prince. They were to fly into the capital, drive to the coast, and then take a boat to the island, which has limited food supplies and scant access to clean drinking water. The students don’t know how badly the quake hit the island. Their trip, however, could be cancelled by damage to the Port au Prince airport, which is now closed to commercial flights.

Doug Porritt, a representative of Rays of Hope for Haiti, said he left the country a few hours before the quake struck. “Most of my work has been to try to reach our staff in Haiti,” he said. “Right now, as you can imagine, things have turned upside down."

Porritt said Gonave Island was untouched by the earthquake, but transportation to the island is hindered by the damage. However, there is a greater need, he said, for a mission team to serve in Croix des Bouquettes, a community outside of Port au Prince. Porritt said he is attempting to contact the deputy minister of that community to determine whether the area could support a clinic if the location were switched for the WSU students.

About 90 students in all will take part in the medical missions. Each trip is generally staffed by 20 first- and second-year students, two fourth-year students and a physician. The groups serve for seven to 10 days in remote areas where the population has no or very limited access to primary medical.

Tax-deductible monetary donations will assist the group in purchasing additional supplies and equipment, and can be made at http://www.waynewhso.org/page31/page31.html.

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AMA TV Ad Asks Senate To Stop Medicare Crisis

With less than two months to go until steep Medicare cuts to physicians begin, the American Medical Association kicked off an intensified Medicare campaign with a brand-new TV ad Jan. 15 calling on the Senate to take permanent action and preserve seniors’ access and choice of physician. The ads are airing in 10 states and started Saturday through the end of January. They can be viewed at http://www.ama-assn.org/go/repeal-sgr.

“Time is running out for the Senate to act on this important issue for seniors, military families and physicians,” said AMA President J. James Rohack, MD “Our new TV ad expresses the urgency of the issue, as physicians will be forced to make tough practice decisions if Congress does not fix the issue once and for all before March 1.”

The ad features seniors and military as both groups will be hurt by cuts to physicians and says, “Physicians who care for Medicare and TRICARE patients face a 21 percent cut, and seniors and military families will pay the price with fewer doctors and less access to the care they’ve earned.”

“This ad is the opening salvo in our two-month campaign to urge the Senate to take immediate action to repeal the current Medicare physician payment formula and replace it with one that reflects the cost of providing care,” said Dr. Rohack. “Congress can no longer put a band-aid on the problem by passing yet another short-term fix that creates instability in the system for seniors and their physicians. A permanent fix is crucial to building a solid foundation for health reform.”

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Dr. Loeb Elected To Epilepsy Foundation Board

Jeffrey Loeb, MD, PhD, associate professor of the Wayne State University School of Medicine’s Department of Neurology and associate director of the Center of Molecular Medicine and Genetics, has been elected to the Epilepsy Foundation’s Professional Advisory Board.

Dr. Loeb was nominated for the four-year term by the Epilepsy Foundation of Michigan.

“I look forward to helping the Epilepsy Foundation carry out its mission to support both patients with epilepsy as well as the research mission of reducing the burden or eliminating seizures from our patients,” said Loeb, who also serves the Hiller ALS Center at the School of Medicine.

The board provides professional guidance and expertise in implementing policies and programs revolving around research and advocacy for the Epilepsy Foundation. Members ensure that medical and scientific aspects of foundation activities are “at the forefront of current knowledge and professional standards,” according to the organization.

In addition to Dr. Loeb’s election, Brien Smith, MD, of the Henry Ford Health System, was named vice chair of the board. Jack Parent, MD, of the University of Michigan, also serves on the 49-member board, bringing the state’s contingent to three members.

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Henry Ford's GolFitness Program Offers Pre-Season Strength Training

Golfers can get ready for a great season with a GolFitness group pre-season training session, sponsored by Henry Ford Hospital's Center for Athletic Medicine.

Stretching routines designed specifically for golfers are known to have positively impacted the games of many professionals and can play a major role in helping GolFitness participants achieve consistent results on the course.

Henry Ford's team of sports medicine professionals will perform a brief biomechanical assessment of each golfer's swing and provide a customized program to help increase strength and flexibility.

Through GolFitness, participants learn pre-game warm-up, core strengthening and home flexibility exercises to help develop an effective swing.

Spring 2010 sessions will be held from 7 - 8:30 p.m. at five Henry Ford locations including:

Feb. 10: Wyandotte Rehabilitation Orthopedic Center, 3rd floor, 3200 Biddle Ave., Wyandotte

Feb. 24: Henry Ford's Columbus Center Athletic Medicine & Physical Therapy, 39450 12 Mile Rd, Novi

March 10: Henry Ford Cottage Hospital Athletic Medicine & Physical Therapy, 159 Kercheval Ave., Grosse Pointe

March 24: Lowell Park Athletic Medicine & Physical Therapy, 44800 Delco Boulevard, Sterling Heights

April 7: William Clay Ford Center for Athletic Medicine, P.T., 6525 Second Ave., Detroit

Each participant will receive a GolFitness exercise booklet. Sessions cost $40. Call (313) 972-4167 to register.

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2009 Children's Holiday Party Contributors

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children that took place Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

Clarence H. Schultz, MD

Dr. Stephen Lemos

Robert G. Borchak, MD

Dr. & Mrs. William J. Cosgrove, Jr.

Dr. and Mrs. Mark A. Kelley

Steven A. & Deborah L. Portney

Hassan Amirikia, MD

Sheryl Wissman, MD

Dr. Adnan Munkarah

Paul & Debbie Natinsky

Dr. & Mrs. Mark Tuthill

Dr. Orlando S. Sison

Guat and Dionisia Sy, MD's

Giovanni A. Morreale, MD and Lisa J. Morreale

Dr. & Mrs. Theodore B. Jones

Dragos M. Galusca, MD

Julius V. Combs, MD

Dr. and Mrs. Charles Barone

Melvin L. Hollowell, MD

James Sunstrum, MD

Aaron Lupovitch, MD

Catherine A. Nordby, MD

Claus Petermann, MD

Dr. Amorn Manadee

Michael F. Schaldenbrand, MD

Richard J. Pollard, MD

Mary Beth Hardwicke, MD

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