Quick Hits

Being an MD ain’t ‘beanbag’

Physician stress increases, but ophthalmology is among happiest.

By René Luthe, Senior Editor

Physician burnout is on the rise, according to a recent survey of nearly 20,000 U.S. doctors by online medical news site Medscape. Defining burnout as “loss of enthusiasm for work, feelings of cynicism and a low sense of personal achievement,” the Medscape Physician Lifestyle Report 2015 showed 46% characterized themselves as burned out, compared to 39.8% in the 2013 report. The specialties at the “frontline” of medical care, unsurprisingly, reported the highest rates of burnout — 52% for emergency medicine and 53% for critical care. As for ophthalmology, the specialty is relatively content, at 41%, with dermatology in last place at 37%.

Causes of the growing angst? Respondents cited the top five sources:

1. Too many bureaucratic tasks

2. Spending too many hours at work

3. Insufficient remuneration

4. Increasing computerization of practice

5. Impact of the Affordable Care Act

BREAKING IT DOWN

A closer look at demographics revealed that age seems to affect burnout rates, with the lowest reported among physicians at both ends of the spectrum — 44% for those 35 and under, and a mere 22% for those 65 and older. The “hot spot” for stress was the 45-to-55 age group, at 53%. Those 36 to 45 were a close second, at 51%, and the 56-to-65 group, 46%.

As for gender, 51% of female physicians report burnout vs. 43% for their male counterparts. Those findings accord with other national surveys on the subject, Medscape notes. Both genders reported higher rates than in the 2013 report, when it was 45% for women and 37% for men.

LIFESTYLE ISSUES

Medscape also asked participants to rate their physical health on a scale from “poor” to “excellent.” While the majority of both burned-out and not burned-out rated their health as very good to excellent (54% to 70%, respectively), those who self-reported as burned out tended to rate their health as poorer: 30% reported good health vs. 24% for the not burned-out, and 16% rated their health as poor to fair, as compared to only 6% for the not burned-out.

Regarding alcohol use, Medscape found no difference between the habits of the burned out and their less-stressed colleagues; participants reported very light to moderate drinking habits.

Living status also played a role in a physician’s likelihood of feeling burned out: the highest rates were for those never married or living alone, clocking in at 57%. Those who were widowed came in last at 37%, while married physicians came in at approximately 45% for burnout.

A bright spot for ophthalmologists: the specialty reports the second highest scores on the question of happiness at work, coming in second only to dermatologists. For more information on Medscape’s survey, go to http://www.medscape.com/features/slideshow/lifestyle/2015/public/overview#1.

Meeting the MRSA threat

ASCRS committee considers medicine’s armamentarium.

By René Luthe, Senior Editor

The findings of a recent study conducted by the Cornea Clinical Committee of the American Society of Cataract and Refractive Surgery warn that the incidence of methicillin-resistant Staphylococcus aureus infections (MRSA) is increasing in all realms of medicine, including ophthalmology, and that more research is needed to develop better methods of identifying, preventing and treating them.¹

“The changing patterns from almost exclusively hospital-based facilities harboring MRSA pathogens to the current scene of expanding its base to the community and infecting healthy individuals is disturbing and extremely challenging to both the medical community and the drug manufacturers,” says Thomas John, MD, a study co-author.

Key points of the study, published in the Journal of Cataract and Refractive Surgery, include the following:

• Community-acquired MRSA is geographically widespread and has been reported in many regions of the United States. A growing number of MRSA cases have been reported in patients who had no known risk factors for MRSA colonization (such as admission to a hospital, surgery, intravenous drug use or previous antibiotic exposure).

• Screening for MRSA did not reduce the risk of postoperative ocular infections, including endophthalmitis, according to the committee’s survey of recent research in the United Kingdom and United States. “Not only is screening an inefficient use of healthcare dollars since there are so many people that need to be screened to identify those patients who are potentially colonized by MRSA, but it’s not effective in the primary purpose of the screening, which is to reduce MRSA postoperative infections,” co-author Francis S. Mah, MD, explains.

• Dr. Mah pointed out a bright spot. “Although MRSA infections are increasing and although it’s a significant pathogen … in ophthalmology, we are able to treat it a little better than in the systemic world, because our dosing is so much higher and so much more frequent that we are able to overcome mild to even moderate levels of resistance.”

The committee recommends surgeons be informed of local MRSA rates, and be suspicious if they see no improvement in infected patients.

To win the war against MRSA, Dr. John concludes, “It is essential for continued research, newer antibiotic development, high clinical suspicion in potentially susceptible individuals scheduled for ocular surgery and optimal, intensive, clinical treatment of MRSA ocular infections that present to the eye clinic.”

REFERENCE:

Glaucoma rates rise with higher life expectancy

Longer life spans in Africa, Asia bring eye disease challenges.

Researchers from Singapore Eye Research Institute and Johns Hopkins’ Wilmer Ophthalmological Institute have projected — after culling through more than 3,000 reports and choosing 50 for their work — that the number of worldwide glaucoma patients will soar by 74% between 2013 and 2040: 64.3 million to 111.8 million. The main reason, say the authors, is that glaucoma will affect those living in Asia and Africa in a disproportionate fashion, not only because people there are aging, but because their life expectancy is increasing. The authors controlled for the disease’s risk factors, including age, gender, rural vs. urban living area and ancestry.¹

The authors found that the prevalence of primary open-angle glaucoma (POAG) was highest among those living in Africa, but primary angle-closure glaucoma (PACG) could be found the most among those living in Asia. In general, men are more inclined to have POAG (36%), as are urban dwellers (58%).

The authors, who published in Ophthalmology, concluded that health officials needed to pay attention to their findings so officials could determine the “designs of glaucoma screening, treatment and related public health strategies.”¹

REFERENCE:

Read the full article online at:

http://www.aaojournal.org/article/S01616420(14)00433-3/fulltext

New law aims to keep tabs on drugmakers and dispensers

Eases apprehension about drug safety and effectiveness.

By Zackary Tertel, Senior Editor

On Jan. 1, the FDA’s Drug Supply Chain Security Act went into effect. The new law aims to prevent counterfeit, stolen or contaminated medication from entering the nation’s drug supply chain.

The new law requires manufacturers, wholesale drug distributors, repackagers and many dispensers who feed the supply chain to provide information about those medications, including those who handled them, each time they are passed along to another link in the chain.

To comply with the act, manufacturers, distributors, and so on are required to:

• Respond to verification requests about a suspect product

• Quarantine and investigate a suspect product to determine if it is illegitimate

• Notify trading partners and the FDA about an illegitimate product

• Respond to notifications of an illegitimate product

• Keep records.

According to FDA spokesperson Stephen King, the law’s product tracing and verification requirements will assist with the government’s efforts to detect and recover suspect drugs.

“If a counterfeit or other harmful drug is discovered in the supply chain, we can immediately notify patients, health-care professionals, hospitals and others about the public health risk,” Mr. King says.

He explains that the FDA hopes the new law will alleviate ophthalmologists’ and patients’ concerns regarding drug legitimacy or lack of efficacy.

“Provisions of this law will enhance FDA’s ability to help protect consumers from exposure to [harmful] drugs … through improved detection and removal of potentially dangerous drugs from the drug supply chain,” Mr. King says. “U.S. consumers deserve safe, effective and high-quality medications.”

According to Mr. King, the following is what is covered, and not covered, under the new law.

WHAT IS COVERED:

• Prescription drugs in finished dosage form for administration to a patient without further manufacturing (such as capsules, tablets, lyophilized products before reconstitution).

WHAT IS NOT:

• Blood or blood components intended for transfusion

• Radioactive drugs or biologics

• Imaging drugs

• Certain IV products

• Medical gas

• Homeopathic drugs

• Compounded drugs.