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WEEKLY NEWS BRIEFS FOR HOSPITALISTS |
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PHYSICIAN COMPENSATION |
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1. Who are the big earners among specialties?
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It's no surprise, but orthopedists headed up the list of specialties in Medscape's 2016 physician compensation report with an annual income of $443,000, followed by cardiologists with $410,000. Internal medicine weighed in at $222,000 while family medicine was $207,000 and pediatrics was $204,000. The report is based on surveys of more than 19,000 doctors in close to 30 specialties. According to the report, compensation for internal medicine rose 12% over the previous year's, while that of pulmonology declined 5%. Family and internal medicine also led the pack in the number of physicians reporting that they would choose medicine again, at 73% and 71%. Meanwhile, results of the Merritt Hawkins 2016 survey indicated that while orthopedists generate about 5.5 times their annual compensation in hospital revenue, family physicians generate 7.5 times the value of their compensatinon. Read more from Medscape. |
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| STROKE RISK |
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2. Aggressive TIA evaluation sharply cuts stroke risk |
| Studies conducted in 1997-2003 put a patient's risk of stroke or acute coronary syndrome in the first three months after a TIA or minor stroke at between 12% and 20%. However, a new study looked at 2009-11 registry data for close to 4,800 TIA or minor stroke patients in 21 countries. Researchers found that risk of stroke, acute coronary syndrome or death from cardiovascular causes after TIA or minor stroke had fallen to 3.7% at 90 days and to 6.2% at one year. The authors credited urgent, fast-track evaluation of TIA patients for that improvement, as well as better and quicker implementation of stroke prevention strategies including medications and revascularization. The authors also looked at the association between patients' ABCD2 scores and their one-year risk of recurrent stroke. Read more in NEJM. |
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| ADVANCE CARE PLANNING |
| 3. Few doctors are billing for EOL discussions |
| Doctors applauded when the CMS this year introduced two new codes they could use to bill for advance care planning services. But a survey of more than 700 physicians finds that only 14% have billed for those services, even though virtually all of them (99%) felt that advance care planning is important. Sponosored by several national health foundations, the survey targeted specialists who treat Medicare patients with high mortality, including oncologists, pulmonologists and cardiologists. While 75% of those surveyed noted that the new Medicare benefit makes it more likely that they will conduct advanced care planning discussions, only 29% said their health care system has a formal procedure in place to discuss end-of-life planning, and only 29% reported having any formal training in end-of-life discussions. Surveyed doctors also pointed to technological barriers: One-third noted that they have no place in their EHR to record whether patients have an advanced care plan. Read more from the John A. Hartford Foundation. |
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| THROMBECTOMY |
| 4. Revascularization: the faster, the better |
| Stroke patients are much better off presenting to a medical center that provides endovascular therapy, rather than being referred to one. That's because, according to a new industry-sponsored study, rapid reperfusion with stent retriever therapy makes a big difference in patients' functional recovery. Patients who presented to an endovascular center waited about three hours between symptom onset and procedure vs. more than six hours if they were transferred. The study looked at close to 200 patients who were randomized to tPA with or without stent retrieval. Patients with stent retriever therapy had a 91% chance of functional independence if they were reperfused within 150 minutes of symptom onset. Those odds fell 10% over the next hour and 20% each subsequent hour of delay. Read more in Radiology. |
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PATIENT SAFETY |
| 5. Are you cleaning your hands all wrong? |
| Researchers testing the microbiologic effectiveness of WHO's six-step hand hygiene technique vs. the CDC's three-step process have declared the WHO's method to be the winner. Their research found that the WHO technique reduced the bacterial count on providers' hands more effectively, from 3.28 CFU/mL to 2.58 CFU/mL (vs. from 3.08 to 2.88 for the three step method). However, the WHO process took more time: 42.5 seconds vs. 35, and only 65% of clinicians using the WHO technique completed the entire process, even though they were being observed for the study. While research was conducted using alcohol-based handrub, New York Times coverage, which provides details of both methods, pointed out that the same techniques should be used when washing hands with soap and water. Read more in Infection Control & Hospital Epidemiology. |
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