AMA Says Physician Shortage Increasing, Announces Initiatives

Several prominent medical associations, including the American Medical Association (AMA), are officially acknowledging a likely shortage of physicians in some areas of the United States, with the expectation that the problem will continue to worsen.

The AMA adopted a policy at its interim meeting in December that shifted its policy from recognizing a physician surplus to noting that various factors are actually contributing to an imminent lack of physicians.  In addition, the Accreditation Council on Graduate Medical Education has similarly reversed its stance on the issue, calling for an expansion of medical school spaces and residency slots.

"While the ACR cannot speak for all of medicine, there is unquestionably a shortage of both physicians and technologists in radiology," says ACR general counsel and assistant executive director Bill Shields.

To add fuel to the fire, a study by Richard Cooper, MD, director of the Health Policy Institute at the Medical College of Wisconsin, Milwaukee, published in the December 10 edition of the Journal of the American Medical Association, suggests that physician shortages are having a negative impact on medical education and patient care. In a survey of allopathic medical school deans and state medical society executives, 89% of deans and 82% of executives reported physician shortages in at least one specialty, while 80% of deans said shortages were creating problems with faculty recruitment and retention and with clinical education. According to the survey, shortages were most pronounced in radiology and anesthesiology.

At its interim meeting, the AMA noted that the following trends pointed to an undersupply: the growing, older population requiring more medical care; physicians opting to work part-time or on a temporary basis; the difficulty international medical graduates are having getting visas, creating problems for underserved areas that rely on these doctors; the liability crisis that many states are experiencing, which is influencing where some doctors choose to  set up and creating shortages in some areas; and debt, which is influencing which specialties medical students are choosing to enter.

"Our Manpower Task Force has been working on the problem for over 2 years, looking at such approaches as asking the government to raise the ceiling on radiology residencies; coordinating with the American Society of Radiologic Technologists (ASRT)  to create the radiologist assistant to help relieve radiologists of some work that calls for a higher level of expertise, but does not require a physician; and reengineering workflow to gain manpower efficiencies," says ACR's Shields.

For its part, the AMA announced that it would be undertaking the following initiatives in an attempt to help resolve the shortage: working to minimize visa delays for international medical graduates; supporting funding of the Public Health Service Act, Title VII, Section 747, to increase the number of primary care physicians working with underserved populations; working to ease medical student debt; encouraging and conducting national and regional research on physician supply and distribution; collaborating with public and private sectors to ensure adequate physician supply in all specialties; developing recommendations for adequate reimbursement of primary care physicians and improved recruitment; publicizing the need to enhance underrepresented minority groups in medical schools and in the physician workforce; and developing a national consensus on physician workforce policy in conjunction with state and specialty societies.

A Superior Predictor of Future Cardiac Events?

A study published in the Journal of the American Medical Association has shown that a high coronary artery calcium score (CACS) can modify predicted risk obtained from a patient's Framingham score (FRS).

The study, led by researchers from the Departments of Preventative Medicine and Medicine at the Feinberg School of Medicine, Northwestern University, Chicago, was conducted to determine whether CACS assessment plus FRS in asymptomatic adults gives a prognosis that is superior to either method alone, and whether this combined approach is more accurate in guiding primary preventive strategies in patients with coronary heart disease (CHD) risk factors.

The research team studied 1,461 adults with coronary risk factors. Those with at least one risk factor received a CT examination, underwent screening from 1990 to 1992, were contacted yearly for up to 8.5 years after the CT scan, and were assessed for CHD. During a follow-up median of 7 years, 84 patients experienced myocardial infarction (MI) or CHD death, while 70 patients died of other causes; 28% of the study participants had an FRS of more than 20%, and 21% had a CACS of more than 300. Compared with an FRS of less than 10%, an FRS of more than 20% predicted the risk of MI or CHD death. In addition, compared with a CACS of zero, a CACS of more than 300 was predictive. Moreover, across categories of FRS, CACS was predictive of risk among patients with an FRS higher than 10% but not with an FRS less than 10%.

According to the researchers, the data supported their hypothesis that high CACS can modify predicted risk obtained from FRS alone, particularly among patients in the intermediate-risk category in whom clinical decision-making is uncertain.

Virtual MRI Autopsy Is Reliable, Say Researchers

Although the idea of performing an autopsy without making a single incision on a corpse might seem like science fiction, a Swiss research team says the concept could soon be standard procedure.

The researchers, from the University of Berne, Switzerland, recently reported success in employing CT scans and MRIs to produce 3D images of corpses, noting that such "virtual" autopsies often produce better results than the traditional method, according to a December 4 article in The Wall Street Journal.

A corpse undergoing the virtual autopsy typically receives a 10-minute CT scan followed by a much longer MRI. Physicians use a "virtual knife" to then scan parts of the body and head for details about the deceased person's soft tissue, muscles, and organs. Such scans could eventually be used in the court system to eliminate the potential of destroying evidence in the course of cutting up a body.

Although the procedure is rare, some US forensic pathologists are already reportedly using MRIs to find the cause of death in shaken babies and to estimate level of force in a car accident.

However, at an estimated cost of $4,000, the virtual autopsy is unlikely to gain wide acceptance anytime soon. And despite the Swiss researchers' work, some pathologists have pointed out that the virtual method has certain scientific shortcomings, such as inability to determine color of the organs, detect bacteria, or stimulate circulation of the blood. More likely, says the Journal article, both the virtual and traditional autopsy methods would be used together in the future.

CMS: 2002 Health Care Tab Was $1.6 Trillion

According to a newly released report by the Centers for Medicare and Medicaid Services (CMS), health care spending in the United States reached $1.6 trillion in 2002, growing at 9.3%, or more than twice the rate of growth in the gross domestic product (GDP). The figure adds up to about $5,440 per covered person.

The study also says that physicians are receiving smaller amounts of new spending while prescription drugs are receiving a larger piece of the growth pie. As a result of the recent growth, health care added a total of 1.6 percentage points to its share of the GDP between 2000 and 2002, increasing it to 14.9% of the GDP in 2002. It had stayed around 13.3% throughout the 1990s, according to CMS.

Spending growth on physician services was $339.7 billion in 2002, at a slightly lower growth rate than the previous year. That spending represented 22% of overall health care spending in 2002. In addition, hospital spending was $486.5 billion in 2002, representing the biggest piece of health care spending and accounting for almost one third of the total health care spending increase for 2002.

Over the past three decades, per enrollee spending for a common benefit package has grown at a slightly slower than average rate for Medicare than for private health insurance, with more pronounced growth differences recently reflecting legislated Medicare reimbursement changes and consumer demands for more loosely managed care.

Electronic Records Grant Program Targets Small Towns

The Agency for Healthcare Research and Quality (AHRQ) has announced plans for a $41 million planning and implementation grant program that could potentially bring electronic health record technology to smaller, rural areas of the country.

The agency's grants, part of a larger program, include $14 million in new implementation grants earmarked for small community and rural hospital settings, $7 million in planning grants to provide communities and organizations with the funds for developing health IT infrastructures, and $10 million in grants to demonstrate the clinical, organizational, and financial value of health IT.

Erratum: In the December StatRead, a bar graph showing demographic influence on imaging volume by modality depicted the wrong bar colors corresponding to modality. Below is the corrected chart.

The remaining funds, according to the AHRQ, will be used in part for the creation of a Health Information Technology Resource Center to aid grantees by providing technical assistance, a focus for collaboration, a repository for best practices, and disseminating needed tools, and to fund other related activities.

"We're really excited about this," says Tom Leary, director of federal affairs for the Healthcare Information and Management Systems Society (HIMSS). "This would bring electronic health record solutions to areas that desperately need them. We're trying to encourage big and small facilities to work together more, and this is one avenue through which to do that."

Leary says HIMSS worked closely with the AHRQ on developing the grants, which target small areas throughout the country. "This will be a big push, particularly in rural communities," he says. HIMSS is also working with the National Rural Health Association to "get the word out," he adds.

In addition, according to Leary, there is currently an optimistic attitude at HIMSS regarding electronic health records in general. For example, President Bush touted the computerizing of health records in his recent State of the Union address, pointing out that the process would lead to the avoidance of medical mistakes, reduction of costs, and improved care.

"That was the first time a US President addressed the need for effectively utilizing information and management systems," says Leary. "It really elevates the level of awareness and importance to this issue for our industry."

Research resulting from the grants, according to the AHRQ, will inform providers, patients, payors, policy makers, and the public about how community-wide health information technology can be successfully implemented in diverse health care settings. Final applications for grants are due to the AHRQ by April 22. Information can be found at www.AHRQ.gov.