Close to 50% of physicians age 50 and older plan to leave medicine in the next 1 to 3 years, according to a survey by Merritt, Hawkins & Associates, a national healthcare staffing firm based in Dallas. The survey also found that an additional 28% of older physicians plan to close their practices to new patients, significantly reduce their patient loads or work on a temporary basis.
CEO Joseph Hawkins said an exodus of older doctors from medicine would have a dramatic effect on healthcare delivery and create the potential for acute provider shortages in some specialties. "These are throwback, workhorse physicians in their 50s or 60s, the kind who are used to working long hours and seeing many patients," Hawkins said. "Their loss would not only create service gaps for some communities, but it would also create gaps in knowledge and experience that would be hard to fill."
Fifty-six percent of physicians surveyed cited managed care as first on their list of professional frustrations. Medicare/Medicaid regulations were a distant second at 15%. Other findings included:
- Only 18% of older physicians plan to continue in their current style of practice.
- Only 50% of physicians surveyed would choose medicine as a career if they were starting out today.
- Only 42% would encourage their children to pursue careers
in medicine.
For a copy of the Merritt, Hawkins & Associates survey, call (800) 876-0500 or visit www.merritthawkins.com.
What Your Patients are Reading
Books Aim to Educate Public on LASIK.
In addition to the reams of refractive surgery information available to your patients on the World Wide Web, new books aimed at them continue to be published at a steady pace. Recent titles, most from this year, include:
- LASIK Vision Correction (Med World Publishing) by Kristin Pisacano, M.D., medical director of refractive surgery at New York Eye Surgery Center in the Bronx
- The Laser Vision Breakthrough (Prima) by Corrine Kuypers-Denlinger, Stephen F. Brint, M.D., and Dennis Kennedy, O.D., in association with TLC Laser Eye Centers
- LASIK Vision Correction (Med World Publishing) by surgeons Robert K. Maloney, M.D., and Jonathan M. Davidorf, M.D.
- LASIK Vision Correction (Med World Publishing) by Stephen S. Dudley, M.D., F.A.C.S.
- How to See Like a Hawk When You're Blind as a Bat (Doctors Advice) by Matthew Ehrlich, M.D.
House Passes Campbell Bill
No Senate Bill is in Motion Yet.
With a 276-to-136 vote that the American Medical Association termed a "milestone victory for physicians' rights," the U.S. House approved the Quality Health Care Coalition Act. The bill, sponsored by Reps. Tom Campbell, (R-CA) and John Conyers (D-MI), would allow independent physicians to collectively bargain with health plans over fees and contract terms.
The bill faced ferocious opposition. The American Association of Health Plans said the bill is "all about income protection for providers" and one of the most anti-consumer proposals ever approved by any Congress.
Other opponents claimed the bill would lead to higher healthcare costs for patients and employers. Anti-trust officials said the legislation would allow doctors to fix prices and increase fees.
No companion bill exists in the Senate, so the American Academy of Ophthalmology is working with Rep. Campbell and the AMA to identify a senator to champion the cause in that chamber. This is a pressing task because the second session of the 106th Congress is scheduled to adjourn on Oct. 6.
HMO Penetration
Numbers Rose, But May Have Peaked.
California continues to lead the nation in HMO enrollment; 55% of the state's population participates in an HMO plan. And two-thirds of the 50 states have experienced increases in enrollment levels, according to the 2000 edition of the Health Maintenance Organization Penetration Rate survey conducted by Medical Data International, Inc. (MDI).
Data from this survey, MDI's seventh annual, also showed:
- In 80% of U.S. major population centers, at least one-third of residents are now enrolled in HMO plans.
- Among the states, Pennsylvania reported the biggest 1-year enrollment gain, which was 15%.
- Arizona's enrollment rose to 32% from 27%, and New Mexico jumped to 37% from 26%.
- Alaska has no HMO enrollees
- Wyoming and South Dakota have 3% each.
Other rates were:
- Hawaii 45%
- Nevada 25%
- Mississippi 4%
- Georgia 18%
- S. Carolina 12%
- Florida 33%.
In addition to state enrollment, the survey examined data from 65 large Metropolitan Statistical Areas (MSAs). Sacramento has the highest MSA enrollment at 82% penetration. San Francisco follows at 72%. MSAs in the South and Midwest had the lowest enrollment. The nationwide penetration rate for 1998 was 30.5%, up from 27.5% in 1997.
MDI managed care analyst Michael Casey explained in a report on the data that the overall HMO growth rate in 1998 was smaller than in previous years, and that enrollment may have peaked. "Most major insurers were keeping their premiums low because of the escalating number of competitors moving into highly populated markets. In some instances, that strategy backfired . . .," Casey wrote.
Casey said it wasn't until 1999 that premium increases for most major employers would jump by as much as 10% or by numbers in the high teens for self-insured individuals.
As premiums rose, employers began to consider such tactics as freezing enrollment or contracting directly with healthcare providers. Furthermore, he explained, HMOs didn't realize the full effects of the Balanced Budget Act of 1997 right away and so didn't abandon markets that had become unprofitable. And "Pressure from providers for higher rates and from consumers for more freedom and fewer restrictions helped undercut the price and utilization controls that had kept healthcare costs in check throughout most of the 1990s."
Looking ahead, Casey said, "As their frustrations with HMOs mount, employers may begin to re-examine the usefulness of preferred provider organizations, which offer more choice at a slightly higher cost, or direct contracting with physicians for their employees' health care."
FDA Approvals
Laser Cataract Removal Now an Option.
Laser Corp.'s Dodick Laser PhotoLysis System is the first laser device to be approved in the United States for cataract removal. According to Laser Corp., the Dodick System uses an Nd:YAG laser with a patented, disposable handpiece that doesn't expose the eye to the laser light.
The new technology offers surgeons an alternative to ultrasound phacoemulsification. Laser Corp. says the laser technology has many advantages over ultrasound, including removal through a smaller incision, lower cost per procedure, no thermal damage and a much shorter learning curve.
Delivery of units will begin immediately. The system is marketed and sold through a subsidiary, A.R.C. Corp.
LTK Gets the Go-Ahead.
Sunrise Technologies has received FDA approval for its Hyperion LTK (laser thermal keratoplasty) System for the temporary reduction of hyperopia in patients with +0.75D to +2.50D of manifest refraction spherical equivalent with up to +/- 0.75D of astigmatism.
Laser time for the LTK procedure is approximately 3 seconds per eye. It involves no cutting or removal of corneal tissue. Instead, the Hyperion gently heats tissue outside the center of the cornea, which causes it to steepen, reducing hyperopia.
One of the clinical investigators, Sandra Belmont, M.D., F.A.C.S., said of the approval: "We needed a good, safe, quick procedure for farsighted patients, and now we have it."
NEI Director Steps Down
Dr. Kupfer Held the Position for 30 Years.
Carl Kupfer, M.D., the only person to ever serve as director of the National Eye Institute (NEI), is stepping down.
In 1968, Congress established the NEI, part of the National Institutes of Health (NIH). In 1970, Dr. Kupfer was appointed the agency's first director. He witnessed the growth of the NEI budget from $24 million then to more than $450 million today.
His accomplishments, too numerous to list here, included:
- an emphasis on the individual research grant, as opposed to large, umbrella-type project grants, which resulted in the first of many 5-year strategic plans that accelerated the progress of vision research in the United States and ultimately became a model for other NIH institutes.
- launch of the landmark Diabetic Retinopathy Study, setting a standard for modern clinical trials in vision research
- establishment of an Office of Biometry and Epidemiology and lab programs in molecular biology, immunology, neuroscience and molecular genetics.
"His leadership has made the NEI, today, the largest and most comprehensive vision research center in the world," said NIH acting director, Ruth Kirschstein, M.D.
IN THE NEWS
- Merger proceeds
REFRACTIVE SURGERY UPDATEREFRACTIVE
SURGERY UPDATE
- AMD.
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