The President’s Podium: Unhappy Doctors?

Posted in Health Reform, Leadership, Medicine on August 12th, 2013 by MMS Communications – 1 Comment

by Ronald Dunlap, M.D., President, Massachusetts Medical Society 

The headline shouted the news – 60% of Docs Wouldn’t Recommend Their Profession as a Career – recounting the sentiments of a nationwide survey of nearly 3,500 physicians. And while we may parse the responses – Is it a generational thing? Does specialty matter? – it’s likely most physicians aren’t surprised at the result. Changes to our profession have been fast and extensive in recent years, and we’re constantly adjusting to new demands.

When six out of ten doctors, however, suggest they’re unhappy, it prompts some key questions. What might patients think of this? Are discontented doctors affecting the physician-patient relationship? Or are survey respondents just blowing off steam out of frustration?  I think that it’s an important issue. Here’s my take on the reasons behind the survey results:

Mounting administrative and mandated requirements. Prior authorizations, certifications, complex billing, and the myriad of administrative tasks before us all steal time from the thing we most love to do: engagement in patient care. Ever-expanding oversight (though some, we’ll agree, is good and necessary) through more and more rules and mandates from insurers, legislators, and regulators, some duplicating the others, steal more time, and chip away at the control we have over how we practice medicine.

The imposition of information technology. Advocates say IT will lead to better quality care, but for many physicians, it’s been more of a disruption than an improvement to medical practice. Big investments of money and time, without appreciable return, along with lack of interoperability among systems, have soured many on computers, despite financial incentives. Computers have provided some benefits and may yet prove to improve health care, but the evidence so far is limited, and the transition is not complete.

The cost of educating physicians. Many young doctors avoid primary care or public health positions in favor of higher-paying specialties that may offer a more flexible lifestyle. It’s easy to understand why, when they’re coming out of medical school with hundreds of thousands of dollars in debt. The extraordinary cost and years of training are raising questions about the return on their investment of time and money.

Other issues weigh on our perspective. These include declining and changing reimbursements, the specter of liability, the uncertainty of reform, and imperfect rating systems from a host of sources telling us how well (or not) we practice medicine.

These are legitimate concerns. I suggest, however, that our discontent is not with the practice of medicine, but rather with the business of medicine – a fact borne out by the survey that prompted this post. I suspect, as those who conducted the survey do, that the disenchantment was prompted in part by colleagues letting off steam.

As my fellow MMS members and I work to fix what’s wrong, I remind myself that “physician” remains at the top of every poll ever taken of most admired professions and that, in the words of Dr. William Osler, we are distinguished from all other vocations by our unique ability to do good. I hope my patients feel the same way.

The President’s Podium is a new feature that will appear regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   



July Physician Focus: Weight-Loss Surgery

Posted in Health, Medicine, Physician Focus, Public Health on July 1st, 2013 by MMS Communications – 1 Comment

Obesity continues to be prevalent throughout America, with 36 percent of adults and 17 percent of children and adolescents now considered obese, according to the U.S. Centers for Disease Control and Prevention. This epidemic has fueled an increasing patient demand for weight-loss surgery; about 220,000 operations now occur each year, and the number is likely to rise.

While this kind of surgery has been successful in shedding excess pounds, as well as reducing such accompanying conditions as diabetes, hypertension, and sleep apnea, it is far from a quick fix for being excessively overweight. Indeed, according to physicians Rick Buckley Jr., M.D. (center, photo) and Mitchell Gitkind, M.D. (right, photo), weight-loss surgery is just one tool physicians have to treat excessive obesity and one step in a lifelong process for patients.

Dr. Buckley, former chief of bariatric surgery at North Shore Medical Center, and Dr. Gitkind, medical director of the UMass Memorial Weight Center, join program host Bruce Karlin, M.D.  (left, photo) in the July edition of Physician Focus – Weight-Loss Surgery: Myths and Realities – to outline the basic facts and fallacies of this fast-growing surgical treatment.

The program serves as a primer on the topic, discussing who is eligible for this surgery, the three most common kinds of surgery, the multi-disciplinary approach taken to weight loss through surgery, what is expected of the patient before and after surgery to maintain the best outcome, and the rewards the patient can realize with surgery and subsequent lifestyle changes.

Physician Focus is available on public access stations throughout Massachusetts, online at ,, and


Physicians Take Notice: Suicide Rates are Increasing Dramatically

Posted in behavioral health, Medicine, mental health, Steve Adelman on May 23rd, 2013 by MMS – Comments Off on Physicians Take Notice: Suicide Rates are Increasing Dramatically

By Steve Adelman, MD

Earlier this month, the CDC’s Morbidity and Mortality Weekly Report (MMWR) presented alarming data comparing age-adjusted suicide rates between 1999 and 2010.

Historically, the two major causes of death of younger people have been motor vehicle accidents and suicide. As motor vehicle accident deaths have gone down, suicides have gone up: 2009 was the first year in which the number of people who put an end to their lives themselves was greater than the number who lost their lives in car accidents.

Overall, the suicide rate jumped by 28.4% among persons aged 35-64. The rate of increase was even greater for whites, American Indian/Alaska Natives, older women (60-64), and people living in the West. As usual, in most successful suicides the cause of death is firearms.

To put the numbers in perspective, let’s think about a busy, multispecialty ambulatory adult primary care practice that employs a group of 4 internists, 2 nurse practitioners and a physician assistant. In the course of a year, perhaps 12,000 unique patients are seen in the office. A practice of this sort in Massachusetts, New York or New Jersey is likely to see one patient die by suicide per year. In Midwestern practices of this size, a second patient suicide would be predicted.

Suicide, not murder, is the most prevalent form of firearm death in this country. What is the role of primary care physicians in addressing this worrisome, growing public health problem?

Provide an opening: Give patients in the office enough time and space to talk about the things that worry them and weigh on them. A question like, “Is there anything else going on that you’d like to share with me? “ may give permission for a suicidal person to open up. A comment like, “Sometimes the most important stuff is the hardest to talk about….I’m all ears,” followed by enough time for the patient to think and open up, can make a difference.

Know your patient’s psychiatric history: Many elements in a patient’s history elevate the risk of suicide: a history of previous suicide attempts, a known mood disorder, a history of a substance use disorder, recent losses, and family history of suicide. Take the time to know your patients, and get help from mental professionals, as appropriate.

Clarify access to firearms: As firearms are the commonest proximate cause of violent deaths, physicians should understand whether or not their patients have access to firearms. It is appropriate to be worrying about high-risk patients with access to firearms, and to address this risk factor with the help of the patient’s family, mental health professionals, and, in some cases, the police.

Let patients know that the channels of communication are always open: People who know that they can always call and reach a health care professional have a place to turn when all else fails. Make sure that your practice has accessible 24/7 coverage, and that those covering know what to do when somebody suicidal calls for help.

In my next  post, I plan to discuss an important related topic: physician suicide. We have always been a high risk group, and this is especially worrisome in view of the recent overall increase in suicide.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.


April Physician Focus: Checkups and Screenings: What Do You Need?

Posted in Health, Health Policy, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on April 1st, 2013 by MMS Communications – 1 Comment

The annual physical exam and other periodic screenings have for years been considered key elements to sound medical health, offering prevention against disease and illness. Yet recent studies have called into question the value of these exams, saying such testing has had no effect on reducing disease or death and in some cases causes harm.

The April episode of Physician Focus, Checkups and Screenings: What do you need?, offers an in-depth discussion of this issue with Michael Barry, M.D., president of the Informed Medical Decisions Foundation in Boston and medical director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital. Hosting the show is primary care physician Mavis Jaworski, M.D.

Among the topics of conversation are the pros and cons of medical tests and treatments, how to decide which ones to have, why patients should have a greater voice in their health care decisions, and the concept of shared decision-making – physicians and patients working together so that, in Dr. Barry’s words, “good medical decisions are made with the full participation of an informed patient.”

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at and on iTunes at


MMS Ethics Forum: Cost-Conscious Medicine

Posted in Ethics Forum, Health Policy, Health Reform, Interim Meeting 2012, Medicine on November 30th, 2012 by MMS Communications – 1 Comment

The overriding refrain in medical care over the last several years has been persistent if nothing else:  “the continuing cost of medical care is unsustainable.”  The subsequent calls for “cost-conscious medicine” have been ringing louder and more frequently.  The trend is inevitable, as governments at all levels, businesses of all sizes, and individuals who buy coverage struggle with strained budgets and rising costs.

The efforts for cost control in the Commonwealth culminated this year with Chapter 224, the cost-containment law passed earlier this year by the legislature.

So what might be the impact on physicians? How should physicians react? And what could it mean for patient care?

Some answers came from the 2012 Interim Meeting’s Ethics Forum, Serving Two Masters – What Practicing Cost-Conscious Medicine Means for Patient Care and the Public Trust.

Presenters included James E. Sabin, M.D., Clinical Professor in the Departments of Population Medicine and Psychiatry at Harvard Medical School and Director of the Harvard Pilgrim Health Care Ethics Program, and Martin Samuels, M.D., Professor of Neurology at Harvard Medical School and Neurologist-in-Chief and Chairman of the Department of Neurology at Brigham and Women’s Hospital and Co-Chair of Partners Neurology.

Over nearly two hours, the physicians offered their perspectives on the issue and the direction that physicians might take in today’s practice environment of ever-increasing fiscal constraints. Some excerpts from their presentations:

Dr. Sabin – “Implementing cost-conscious medicine will take time and will not be easy…the biggest impediment is more emotional than intellectual…We must involve patients and the public in our deliberations and policy-making…They will only trust the concept of cost-conscious medicine if they believe the quality of care is preserved and the savings will be used for good purpose.Physicians are the crucial players in this endeavor, we can be spoilers or leaders….It is our responsibility to make it work.”

Dr. Samuels – “The important question is which master do we serve? … Simultaneously considering the interests of society and the individual patient represents an irresolvable conflict of interest… Overutilization is expensive and dangerous….Errors are unavoidable, despite our best efforts, and without errors, we have no progress…Believe in the concept that physicians are required to do everything that they believe may benefit each patient, without regard to costs or the societal considerations…because the best individual care is cost effective.”


October Physician Focus: 100th Show, Medicine’s Greatest Achievements, Features NEJM Editors

Posted in Medicine, NEJM, Physician Focus, Uncategorized on October 1st, 2012 by MMS Communications – Comments Off on October Physician Focus: 100th Show, Medicine’s Greatest Achievements, Features NEJM Editors

The October edition of Physician Focus marks the 100th production of cthe program and steps back from the show’s usual fare of medical conditions to examine some of medicine’s greatest accomplishments and what they mean for patients today. The milestone show also takes occasion to pay tribute to the New England Journal of Medicine, as it celebrates its 200th year of publication this year.

Medicine’s Greatest Achievements features two distinguished NEJM editors: Jeffrey Drazen, M.D., Editor-in-Chief (photo, right), and Julie Ingelfinger, M.D., Deputy Editor (center). Hosting the program is primary care physician Bruce Karlin, M.D. (left)

The physicians discuss such landmark developments as the stethoscope, anesthesia, aseptic surgery, antibiotics, and vaccines and how these have improved the lives of millions of people around the world. Also in the conversation: the early days of the New England Journal of Medicine and its importance today in communicating medical knowledge to health care professionals throughout the world.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. To view online, visit The program is also available on iTunes at




Consumer Reports Rates Mass. Physicians

Posted in Health, Health Policy, Medicine, Primary Care, Uncategorized on May 31st, 2012 by MMS Communications – Comments Off on Consumer Reports Rates Mass. Physicians

Richard V. Aghababian, MDFrom magazines featuring “top doctors” to multiple websites of state agencies, nonprofit organizations, and commercial enterprises, physicians have been graded and rated on a host of criteria, in the interests of increasing transparency and improving care. But few offer comprehensive  or scientifically-based data.

Consumer Reports magazine, perhaps the biggest and most widely known judge of all, in creating its own Health Ratings Center, has set out to change that. In April, CR published ratings on heart surgeons in collaboration with the Society of Thoracic Surgeons.

Now, in concert with Massachusetts Health Quality Partners, CR has focused on the Bay State, delivering a special 24-page report in its July issue for its Massachusetts readers rating the state’s primary care physician practices.

The ratings are based on MHQP’s patient experience survey, which asked questions of more than 47,000 adults and 16,000 parents about their experiences with their physicians.  Nearly 500 physician practices with three or more doctors are ranked.

Among the areas examined were how well physicians communicate with their patients, coordinate care, and know their patients, as well as the patient’s experience with other staff in the practice. In publishing the ratings, CR recognized the difficulty in rating an area like healthcare:  “…medical care is complex, and patient experience is only one measure of quality” but the magazine suggests that patient experience can affect clinical measures like managing conditions such as arthritis, high blood pressure, or high cholesterol.

So how did Massachusetts primary care doctors rate?

“Most practices in the state earn one of the top two ratings across multiple measures in the survey,” CR wrote. “But nearly every practice has room for improvement.  Overall, scores for physician practices in Massachusetts have been on the upswing since the first patient experience survey in 2005” [the year MHQP began its patient experience surveys].

In reacting to the report, MMS President Richard Aghababian (photo, right) told the Associated Press that patient experience can be valuable as one piece of information for patients to use in selecting a physician.  But he echoed CR’s caveat — that patients should consider many other factors, such as recommendations from family or friends, treatment outcomes, doctor safety, and a doctor’s access to particular hospitals.

“It might be helpful to scan what other people have thought about this physician,” Dr. Aghababian said, “but it’s a very personal thing.  It’s not like you’re rating a motor vehicle. It’s a little bit hard to analyze human interaction.”

Dr. Aghababian also agreed with Consumer Reports that such ratings can be helpful to physicians. “If we can glean information from data like this, along with all the new data that’s flowing from medical research, if that will lead to better patient care, then we should take advantage of the information.”

To review the ratings, visit Massachusetts Health Quality Partners at

2011 MMS Oration: Powerful Messages on Physicians and Health Care

Posted in Health, Health Policy, Health Reform, Interim Meeting 2011, Medicine, MMS Oration on December 2nd, 2011 by MMS Communications – 1 Comment

“Within my lifetime, our profession has changed profoundly.  The practice of  medicine is exciting but extremely complicated – scientifically, technologically, financially and academically.  And we are at a breaking point.”

So began the 200th Annual Oration of the Massachusetts Medical Society, delivered by Sean Palfrey, M.D., professor of pediatrics and public health at the Boston University School of Medicine and a practicing pediatrician at Boston Medical Center, at the MMS 2011 Interim Meeting on Friday, December 2.

His presentation carried some powerful messages, not only for his physician colleagues in attendance, but also for other leaders in health care.

Encouraging a renewal of the human touch along with a “necessary discipline” to use modern technology appropriately, Dr. Palfrey said “We are at a very difficult juncture, a point where we have an embarrassment of scientific and technological riches that we need to learn to use optimally, yet we provide health care outcomes that compare poorly with the rest of the world.  So this is a moment of huge opportunity as well as serious crisis.”

Dr. Palfrey’s Oration expanded on his viewpoint of how physicians should practice medicine today, first brought forward in a Perspective article, Daring to Practice Low-Cost Medicine in a High-Tech Era, published in the New England Journal of Medicine in March.

Above all, Dr. Palfrey has a dual message for physicians.  First, doctors should reconsider how they treat every patient and think about the cost and value of what they do.  “Despite huge reservoirs of human warmth and dedication,” he says, “doctors are distancing themselves from their patients. Our ability to heal our patients depends both on our clinical skills and on our understanding of science and technology.  Our patients are not simply the sum of their data, as vast as that might be, they don’t really exist inside a computer, and we need to keep reminding ourselves that it is our cognitive skills as physicians that really make us good healers.”

Second, physicians must advocate for what’s right for their patients and their practices and work collaboratively with others to improve the health care system.  “We all need each other and should not see ourselves as competitors.  Just as we should be partnering with lawyers to solve the huge malpractice challenges, we need to work with nursing and many other health professional administrations to solve the country’s massive staffing and personnel shortages. We should be welcoming and eager to partner with them so that each of us can be using our knowledge and training most effectively and be more satisfied in our clinical roles.  This is not simply an issue of efficiency or financial resources or the national economy. It’s the future of quality health care.”

Dr. Palfrey’s perspective is worth the read. You may find the text of his Oration here.

July Physician Focus: Medicines and Medication Safety

Posted in Medicine, Physician Focus on July 4th, 2011 by MMS Communications – Comments Off on July Physician Focus: Medicines and Medication Safety

American medicine seems blessed with a plethora of antidotes for a multitude of ills. Physicians’ Desk Reference lists more than 1,100 of the more commonly-prescribed prescription medications, and pharmacy shelves contain scores of over-the-counter remedies in different dosages and formulations for adults and children. Add a growing list of supplements – vitamins, herbals, and other ‘natural’ medicines – and you have a lengthy list indeed.

Throw in the increasing number of medicines (prescription and otherwise) taken by individual patients, new medicines reaching the market, and the hit-or-miss levels of patient understanding and compliance in using medicines.

All those factors combined present quite a challenge.  And raise the risk for error.

“Medication errors are among the highest number of errors we encounter in medicine, in the hospital and in the home,” says Mary Anna Sullivan, M.D., President of the Massachusetts Coalition for the Prevention of Medical Errors.

Dr. Sullivan, who is also Chair of the Department of Psychiatry and Chief Quality and Safety Officer at Lahey Clinic in Burlington, discusses the critical issue of medication safety in the July edition of Physician Focus, MMS’s monthly patient education television program, with program host Bruce Karlin, M.D.

Among the topics of conversation: what physicians take into account when prescribing medications for patients; considerations for giving medicines to children; the role of electronic prescribing; steps patients can take to increase medication safety; relationships among physician, patient, and pharmacist; and how to obtain free materials on medication safety from the Massachusetts Coalition for the Prevention of Medical Errors.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. To view online and comment, visit

Hefty Numbers: The Economic Impact of Physician Practices

Posted in Medicine, workforce on March 24th, 2011 by MMS Communications – Comments Off on Hefty Numbers: The Economic Impact of Physician Practices

Here’s a different, but important, look at the impact of physician practices: Massachusetts office-based physicians contribute $31.7 billion in economic output to the state and support 112,000 jobs. Those were some of the findings from a first-of-its-kind analysis done for the American Medical Association by The Lewin Group, a national healthcare policy research and management consulting group based in Virginia. The study reported on the economic impact of nearly 20,000 office-based physicians in the Commonwealth for the year 2009.

The study also found that Massachusetts office-based physicians support $23.5 billion in total wages and benefits and generate $1.5 billion in total state and local tax revenues.  

Reacting to the findings, MMS President Alice Coombs, M.D. said the report clearly shows the economic significance of the physician workforce as part of the state’s number one industry, as well as the critical need to improve the physician practice environment in the state, which, according to MMS annual evaluations, has been in a continual state of decline.

“A good physician practice environment produces many benefits,” Dr. Coombs said. “Patients will have more and better access to care, the state will have a stronger economy, and we will be better able to recruit and retain physicians to enhance our health care delivery.”

Additional key findings from The Lewin Group’s research: in comparison to other industries, office-based physicians almost always contribute more to local economies than the hospital, legal, nursing home, home health, or legal industries, and physicians provided an estimated $24.4 billion in charity care nationwide in 2008.

The complete report on Massachusetts is available here. AMA commissioned a national report, as well as individual reports for each state, and those are available from the AMA’s website.