From the Director
We had a great Doctoberfest! Thanks again to everyone for their Go Green efforts, their participation in our WE CARE WEDNESDAYS, answering the trivia questions and enjoying some food and fun with our residency family. Special thanks to all those who were on overnight on the “extra hour” longest night of the year. We started our recruitment on Friday with “Prelim Day”, and got a chance to meet some fantastic students. Categorical recruitment starts TODAY, and I hope that dinner was fun last night and look forward to an outstanding recruitment season. An early thank you to our stellar recruitment team of the chiefs, Erin Payne, Lynsey Michnowicz, Lauren Dincher, and Jen Averitt, as well as the APDs, advisors, attendings who interview, Dr. Klotman and, of course, our fabulous residency team who are the real reason that applicants want to become DUKE RESIDENTS!
Turkey bowl practice gets serious now, with the last of the combined practices happening on Sunday. Look out for memes pitting Ryan Schulties against Coach G and Krish Patel as the game day approaches.
Kudos this week go to Sam Lindner from the gen med nursing staff for outstanding communication on the floors, to Sarah Nelson from her VA Gen Med team for excellent professionalism, to Zach Wegermann for helping with paging on gen med, and to our residency council (especially Azalea Kim and Jenny Van Kirk) for planning a fantastic residency halloween party.
This week’s pubmed from the program goes to Jim Lefler for his 1st place presentation at the national Medicine Psychiatry meeting entitled “Shift Work”. Congratulations Jim!
Have a great week!
Aimee
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What Did I Read This Week?
Submitted by: Aaron Mitchell, MD
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Aaron Mitchell, MD[/caption]
James C. Robinson, PhD, MPH; Kelly Miller. Total Expenditures per Patient in Hospital-Owned and Physician-Owned Physician Organizations in California. JAMA 2014;312(16):1663-1669.
http://jama.jamanetwork.com/article.aspx?articleid=1917439
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Why did I read this: One of my biggest interests in health care policy is the high cost of care, and the factors that cause it to be so high. The role of hospital consolidation in contributing to this problem is something I have been following closely. I encountered this particular article in assembling my weekly email summary of health care policy articles. Let me know if you want to subscribe! Background: The United States has a serious problem with health care costs. We spend about 18% of our GDP on health care, compared to 9-12% for most other developed countries. As the Baby Boom generation ages and we docs continue to discover new and expensive treatments, the public financing of medical care is putting an increasing strain on federal coffers. One trend that seems to be contributing to the rise in costs is that of provider consolidation. Unlike most industries, where greater consolidation/integration leads to lower prices by producing economies of scale, the opposite seems to be true for health care. When one health system (typically a large, academic center) starts to buy up local hospitals and physician groups, prices tend to go up rather than down. This is likely because having a dominant market share puts the health system in a better bargaining position against insurers, allowing it to demand higher reimbursements. More research on this trend can be found in these sources: http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/06/the-impact-of-hospital-consolidation.html http://jama.jamanetwork.com/article.aspx?articleid=1769891 Results: The primary outcome measure was the annual per-capita health care spending in California, according to the type of health care system. The three models of care were physician-owned, local hospital-owned, and multihospital systems. After adjusting for severity of illness and other factors, the authors found that costs were significantly higher in multihospital systems – nearly 20% more than in physician-owned organizations.
Conclusions:
While it may be that larger systems are better able to coordinate care (more timely communication between providers, fewer repeated tests, etc.), the authors conclude that whatever cost benefits there may be from large health care organizations appear to be outweighed by other factors.
“For the hospital-owned organizations represented in this study, however, any resulting improvements in coordination were not associated with lower expenditures per patient…These findings are in contrast to the hope and expectation that organizational consolidation of physicians with hospitals would result in greater coordination, and hence lower expenditures.
In other words, big hospital systems = big costs. But what can be done to stop this trend and hold costs down? Other studies have shown that health outcomes are not noticeably better in large health systems. Would it help to link reimbursement more closely to care quality and outcomes? Maybe we will get a chance to see, as the ACA starts to head in that direction.
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From the Chief Residents
Grand Rounds
Fri., Nov. 7: Endocrine, Dr. Brittany Bohinc
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 11/3/14 | Interview Day | Lunch w/ applicants | 12:00/Room 2002 | Saladelia |
| 11/4/14 | MPeds Interview DayG Briefing Session | Lunch w/ applicantsDN 8277 | 12:00 | Saladelia |
| 11/5/14 | Ambulatory Town Hall | Ambulatory leadership | 12:15/Room 2002 | China King |
| 11/6/14 | SAR Emergency Series: Antibiotic Choices and Management | Matt Hitchcock | 12:00/Room 2001 | Dominos |
| 11/7/14 | Interview Day | Lunch w/ applicants | 12:00/MedRes Library |
From the Residency Office
Recruitment 2014!
Reminder to All Residents: Please email your recruitment buddies! This has such a large impact on their visit and is greatly appreciated!”Pin Station Re-located
The pin station is the MedRes library has been re-configured so that images can be projected on the large screen for report. If you need an individual pin station for work, please feel free to use the one in the front cubicle of the MedRes office, suite 8254.Open Enrollment for Benefits Begins 10/27/14!
Enrollment Period is from October 27th – November 7th 2014.
Open Enrollment is the only time of year when all Duke employees can enroll in or change their medical, dental, vision and reimbursement account benefit selections. If you have questions about Open Enrollment, please contact Jill Watkins at 684-2897.
Housestaff Healthcare, Dental and Vision Premiums 2015
If you take no action during Open Enrollment, the selections you made for 2014 for your medical, dental, and vision coverage will continue for 2015. However, to continue to use a reimbursement account, you must re-enroll for 2015.
Reminder: Your coverage term for benefits through Duke HR is one year. Changes in plan coverage can only be made outside of the Open Enrollment period for life changing events.
Qualifying events include, but are not limited to:
- Marriage, divorce, or legal separation,
- Birth or adoption (or placement of adoption) of a child,
- Death of a covered dependent,
- Loss or gain of eligibility for insurance coverage for you or a covered dependent (coverage must not be a student or individual policy),
- Change in spouse's employment status, and
- Change in health insurance eligibility due to a relocation of residence or work place.
- Change in your child's full-time student status(marriage, death, baby, job, etc).
Job changes within Duke (e.g. GME to Duke Faculty) are not considered a life changing event. Please keep this in mind when you finalize your enrollment.
Thanks for Another Amazing Doctoberfest!
Thank you for another amazing month of community building. Thanks to "We Care Wednesdays", donations will be made to the Lincoln Health Center and Durham Rescue Mission this week! We loved hearing about everyone "goes green" and enjoying some special treats and festivities. Many thanks to the residency council for a fabulous Halloween party! Now, on to Movember!
Register Now for BLS Blitz - November 10-14, 2014
Use the Swank system to register for BLS classes. If you do not have an account in Swank contact the DHTS Service Desk 919-684-2243 to establish an account. You may register for one session. Detailed Registration Instructions and Informational Flyer When you attend class, arrive 15 minutes before session begins and you must have your:- Class Registration Confirmation
- Duke ID Badge
- AHA BLS Healthcare Provider Manual 2010
Trent Center Colloquium Series
Please join us at the Trent Semans Center for Health Education, Room 4030 for this upcoming colloquium and forward to interested faculty, students, residents and fellows. Space is limited. RSVP by Wednesday, November 5: trent-center@duke.edu. The slow food movement has transformed the ways we think about eating. Could a ”slow medicine” movement transform the ways we think about illness and health? In this discussion of the work of the physician, historian, and writer, Victoria Sweet, we will consider what it means to renew the practice of medicine. Abraham Nussbaum, MD, MA directs the adult inpatient psychiatric service at Denver Health. His research interests include the history of psychiatry, medical professionalism, psychiatric diagnosis, and the treatment of people with schizophrenia. The Trent Center Colloquium Series explores interdisciplinary topics in ethics and the social and cultural aspects of medicine. It is an opportunity for interested faculty, students, residents and fellows to both engage with current scholarship and, through informal, lively conversation, find avenues for collaborative exchange. This talk is also part of the Theology, Culture and Medicine Seminar Series co-sponsored by the Duke Divinity School and the Trent Center.Ebola Virus Updates in MedHub
Given the rapidly changing national and international response to Ebola, Duke University and Duke Medicine have established a centralized information resource to provide ongoing updates to employees, students, patients and other members of the Duke community. The Ebola Resources website will be updated regularly with new information regarding Duke's Ebola preparations, plans and policies. The site features updates from Duke Medicine leadership, information session announcements, videos with Duke Medicine infectious disease experts sharing the latest information regarding the virus, and an overview of DUHS' infection control preparations. The link to Duke's Ebola Resources website as well as CDC Ebola information, NC Medical Society Ebola update and ACGME Ebola guidance statement will be listed in MedHub with the GME News stories for the duration of the active Ebola virus period.Partners In Health and BWH Hospitalist Program
PIH is currently seeking excellent physicians in Internal Medicine (or Internal Medicine/Pediatrics) to join our teams in Rwanda, Haiti, and Malawi for the 2015-2016 academic year . This full-time position provides an opportunity to serve as both a clinician educator at a PIH field site and as an academic hospitalist at Brigham & Women’s Hospital in Boston. Candidates interested in this exciting opportunity should submit an application at http://www.pih.org/pages/employment before December 1, 2014, or can contact Dr. Neil Gupta at ngupta@pih.org. Partners In Health and BWH Hospitalist Program Background: Partners In Health (PIH) is a health and social justice organization with a mission to build high quality, comprehensive public health systems around the world. PIH has partnered with local communities and governments over the past 25 years to provide high-quality health care to the poorest of the poor and train the next generation of physicians, nurses and public health professionals in countries around the world. General Description: We are currently seeking excellent physicians in Internal Medicine (or Internal Medicine/Pediatrics) with strong interest in global health and medical education to join our teams in Rwanda, Haiti, and Malawi. This full-time position provides an opportunity to serve as both a clinician educator at a PIH field site and as an academic hospitalist at Brigham & Women’s Hospital in Boston. Specific Responsibilities: Internists at PIH field sites serve as clinician educators, working with local medical staff and trainees on inpatient medical wards and outpatient clinics in rural districts hospitals and health centers as well as academic teaching centers. These clinician educators are faced with a vast diversity of diseases, including but not limited to, HIV, tuberculosis, malaria, non-communicable diseases, oncology, and other tropical infectious diseases. They also supervise international trainees and students rotating from Brigham & Women’s Hospital and other international institutions, engage in quality improvement and research activities, and help to develop and implement innovative programs to strengthen health delivery. Financial Support: The Brigham and Women’s/Faulkner hospitalist program provides hospitalist salary support and full benefits package, including malpractice insurance and health insurance. PIH provides international airfare as well as full accommodations while at PIH sites. Successful candidates will also have the opportunity for academic appointment at Brigham and Women’s Hospital and a diversity of professional development opportunities. Qualifications:- ABIM board-certification or board-eligibility in internal medicine or internal medicine / pediatrics; candidates with sub-specialty interests are welcome to apply
- Board-eligible graduating senior medical residents are eligible to apply
- A desire to gain experience with health care delivery in sub-Saharan Africa
- A talent for teaching and an interest in medical education and quality improvement
- Flexibility, humility, creativity and enthusiasm
- A two-year commitment is encouraged but not required
Information/Opportunities
Sign up to receive a complimentary e-subscription to The American Journal of Medicine in 2015! All you have to do is to complete the online form by December 8, 2014. The subscription starts in January. Career Fair-Chapel Hill Financial Planning Webinar for New Physicians - CST Des Moines IM Opportunities STL_NocturnistFlyer STL__GenInternalMedicineFlyer Internal Medicine opportunities http://www.merritthawkins.com/ www.mountainmedsearch.com www.nhpartners.comUpcoming Dates and Events
November 27, 2014 - Turkey Bowl
December 13, 2014 - DoM Holiday Party
Useful links
- https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
- http://duke.exitcareoncall.com/.
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response