From the Director
Hi everyone!
Glad you all survived the great snowstorm of 2013. It was pretty crazy out there, according to our favorite Wisconsin native,
Ryan Schulties. And then the sun came out, providing some much needed bright light therapy!
Lots going on in the program now - kudos from
Kathy Andolsek to Steve Sumner (yes, you can be in Africa and get kudos) for going the extra mile to protect patient confidentiality. Also a big thanks to many who have given tours during interview season - this week,
Nilesh Patel, Callie Coombs, Sajal Tanna and Bonike Oloruntoba were spotted leading groups of suits around.
Many more deserve a big thanks as well. Also to
Kathleen Kiernan, Ivan Harnden, Sahar Koubar and Nilesh Patel for great SAR talks. And we got to see pics of Savannah.
Abby Vann was spotted on the 8th floor as well - thanks Lisa for stopping by!
Hope people enjoyed the liver rounds. See the bottom of updates for more "save the dates". Congrats to all whose posters were accepted to NC ACP. Look for the details in next weeks pubmed from the program.
We will be offering a second MKSAP order - details to follow in the coming weeks. Bill and I will be holding "fellowship info sessions" during the first few weeks of February. This is for JARs, any SARs who are applying for July 2014 and any interns interested in the clinician investigator pathway. We will offer a couple dates so that you can be there.
GME month is coming up - great talks as well as treats from the "big" GME office. Details to follow.
Congrats to our office! The MedRes Office has formed a team – the
Med RESolutions – and joined the
Get Moving Challenge, part of Duke’s Live for Life Program. It runs from
January 14 – March 24th. As a team, we are tracking our steps per day via pedometer, and some are tracking daily exercise and weight loss. The team is:
Randy Heffelfinger – team captain
Jen Averitt, Lauren Dincher, Laura Kujawski, Sheila Gainey, Erin Payne.
Be sure to ask them how it's going!
This week's pubmed from the program goes to
Jon Menachem (mentor
Chet Patel) for his International Society for Heart and Lung Transplantation abstract...congrats Jon
“Right Atrial to Pulmonary Capillary Wedge Pressure Ratio Is Not Associated with Failure of Optimal Medical Management in the INTERMACS 4-5 Population"
Have a great week!
Aimee
What Did I Read This Week (by Aaron Mitchell, MD)
[box]Reimbursement policy and androgen-deprivation therapy for prostate cancer. Shahinian VB, Kuo YF, Gilbert SM. N Engl J Med. 2010 Nov 4;363(19):1822-32. http://www.ncbi.nlm.nih.gov/pubmed/21047226 [/box]
Why did I read this? I am currently taking Clinical Epidemiology, and one of my research questions has been whether physicians’ financial incentives influence clinical practice. I found this paper in my literature review for prior work that has been done on this subject.
Background: As we all know, we docs do not get paid for the medicines that we prescribe. However, we DO get paid for the medicines we ADMINISTER; this is particularly relevant to the field of oncology, in which many chemotherapeutics are given in IV formulation during treatment sessions.
In the old days (before 2003), some loopholes in the Medicare fee schedule allowed for oncologists to receive huge markups (500% or more) on some of the chemotherapies they administered. This was recognized as a problem, and with the Medicare Prescription Drug and Modernization Act of 2003, the loophole was closed and reimbursement for physician-administered drugs was set at 106% of whatever the physician bought it for. So, we still make a little bit (6%) on what we give, but significantly less than before.
After this change went into effect on January 1, 2005, the incentives for oncologists to administer IV medications in their offices shifted dramatically. The authors of this paper were trying to detect any resultant changes on usage of these medications, in the specific context of IV GnRH agonists used for treating prostate cancer.
What they did: They used SEER Medicare data on men age 65 or older with new diagnosis of prostate cancer between 1994 and 2005 to compare the likelihood that these men received GnRH agonists before and after the payment reforms that went into effect on January 1, 2005. They further stratified this cohort by tumor characteristics, into “appropriate use” (men with a clear, evidenced based indication for GnRH agonists) and “inappropriate use” (men for whom GnRH agonists would not be expected to produce a benefit) groups.
What they found: As payment reforms went into effect, there was no change in the rates of “appropriate use” of GnRH agonists in those men for whom this drug was clearly indicated (apprx 80-90% of men in this group received the drug). However, there WAS a significant decrease in the “inappropriate use” of GnRH agonists for men who did not need the drug (usage in this group fell from 39.0% before to 22.5% after payment reform).
What this means: When prostate cancer patients clearly needed a drug, they got it, regardless of the amount the physician could expect to be reimbursed. However, these findings are also consistent with the hypothesis that we (physicians) will give MORE care than is necessary, at least we expect to profit personally from that extra care. Findings such as these contribute strongly to the case for payment model reform, away from our current fee-for-service model that presents incentives to provide unnecessary care.
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From the Chief Residents
Grand Rounds
| Date |
Division |
Speaker |
Title |
| 25-Jan-13 |
Gastroenterology |
Dr. Jane Onken |
Inflammatory Bowel Disease |
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
| Monday |
1/21 |
MLK Day--no noon conference |
|
|
|
| Tuesday |
1/22 |
MED PEDS SAR TALK |
Dolgner, Livingston |
12:00 |
Sushi |
| Wednesday |
1/23 |
Communicating with Radiology |
Lexie Riofrio |
12:00 |
Moe's |
| Thursday |
1/24 |
Celiac Disease/malabsorption |
Nancy McGreal |
12:00 |
Domino's |
| Friday |
1/25 |
INTERVIEW |
|
12:00 |
saladelia |
Annual Charity Auction !!!
Save the Date!
2013 Charity Auction
benefiting Durham Senior PharmAssist
& The DOC Clinic Fund
hosted by the Internal Medicine Residents
Friday – February 15, 2013
Durham Arts Council Building
120 Morris Street, Durham, NC
Sympathy Cards 8100 and 8300 Patients
Sympathy cards for patients and their families have been placed visibly in the 8100 and 8300 workrooms. These cards are available on a PRN basis and made possible through the generosity of the Duke Hospitalist Service. I know that many of us have commented over the years that it would be nice to express our condolences to a family in a meaningful way. Hopefully, the cards are a good, efficient means to achieving this end.
On Behalf of the Orgain Stead Society,
Laura, Manesh Patel, Cecily Peterson
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From the Residency Office
Our office will be closed on Monday, January 21st, in observance of the Martin Luther King Holiday
MLPR - PLEASE NOTE CHANGE IN DATE!
The Management and Leadership Pathway for Residents (MLPR ) will hold an information session for interested residents on
Monday, January 28 (originally scheduled on
Thursday, January 24th) from 5:30 – 6:30 in the Faculty Center (in the Library, just off the walkway between the Hospital and Clinics). Dr. William Fulkerson, Chief Executive Officer, Duke University Hospital and MLPR Program Director, and current residents and faculty will be available to answer questions about the program.
MLPR is designed for residents who hold advanced management degrees (MBA, MPH, MPP) or a minimum of two years management experience who are interested in future careers as physician executives.”
Invitation to Participate in Study - East Carolina University
"I am inviting you to participate in a study, in which researchers will seek to better understand medical residents’ thoughts and beliefs surrounding medically unexplained symptoms and medically unexplained illnesses. Your participation in this research study will help me better understand this topic and may assist in the future development of educational opportunities and resources to better assist medical providers in effectively and confidently providing care to patients with these medical difficulties.
Participation will involve an interview conducted via Skype, an online videoconferencing program, at a time that is convenient for you. The interview will take approximately 30 minutes to complete. Your responses to interview questions will be kept confidential and a pseudonym will be used to protect your identity. You are also able to terminate participation at any time without any negative repercussions. As a token of appreciation for your participation, a $20 gift card will be provided. The information gained from your interview and those of other participants will be used to complete my dissertation and will contribute to the growing body of knowledge on medical providers’ views of medically unexplained symptoms and medically unexplained illness.
If you have any questions about this study, please contact me at
harshj10@students.ecu.edu or (808) 778-7253. You may also feel free to contact my research supervisor Jennifer Hodgson, PhD, LMFT, at
Hodgsonj@ecu.edu or (252) 328-1349."
Thank you for your time,
Jennifer Harsh, MA; PhD Candidate
East Carolina University, Primary Investigator
Jennifer Hodgson, PhD, LMFT
Professor, East Carolina University
Durham Again Recognized As a "HOT SPOT"
Check out this NYTimes article to see what you might be missing in your own back yard. What will you find? An itinerary of great venues to share with your friends who might be visiting for the weekend.
http://travel.nytimes.com/2013/01/20/travel/36-hours-in-durham-nc.html?pagewanted=all&_r=3&
Recruiting Dinners and Tour Guide - Final Opportunities
PLEASE sign up for a Recruitment Dinner and/or to be a Tour Guide on a Recruitment day!
http://www.signupgenius.com/go/60B084FAEAE2CA13-january1
http://www.signupgenius.com/go/60B084FAEAE2CA13-december
Contact Information/Opportunities
Panama City Florida Internal Medicine
North Carolina Hospitalist
Harker Heights Internal Medicine
Indiana Regional Medical Center Adult Medicine
New Jersey- Westwood IM
Upcoming Dates and Events
February 1: CELEBRATE THE END OF RECRUITMENT!! ( IM Residents and staff)
February 8: ACP Meeting /Poster Session, Washington Duke
February 13: Duke/ UNC Game at Motorco
February 15: Annual Charity Auction, 7 PM at the Durham Arts Center
March 15: MATCH DAY CELEBRATION at Dr. Klotman’s!
April 28: 2nd Annual Stead Tread
June 4: Resident Research Conference, Searle Center
June 8: SAR Dinner, Hope Valley Country Club
Useful links
