Noteworthy: Smokers Need not Apply; Navel Gazers

July 1, 2011

Noteworthy items from Physicians Practice

Smokers Need not Apply

The national health insurance firm Humana says it plans to stop hiring smokers wherever the law permits it. The company, which has about 35,000 employees nationwide, already declines to hire smokers in some places, and CEO Michael McCallister told the Dow Jones Newswire that it intends to expand the policy everywhere, except states that have laws protecting smokers from workplace discrimination. "We want to begin a long transition to an environment where it's not something people do," he said.

Many workers' rights advocates and some in the public health field argue that laws protecting the public from secondhand smoke are one thing. But employment discrimination against groups of people based on legal activities conducted privately goes too far.

"I don't think that employers should be engaging in discrimination, whether it's legal or not," Michael Siegel, professor in the department of community health sciences at Boston University's School of Public Health, told Dow Jones. He argues that the same logic used to justify smoker bans could be applied to, say, obese workers.

Is There an App for That!!?

A Chinese teenager made international news in June when it was learned that he'd sold one of his kidneys for about $3,000. The 17-year-old saw an ad online, he said, and after haggling a bit over the price, he hopped on a bus to the hospital, had the organ removed, and was discharged after three days. That's when his mother found out.

But none of that is newsworthy. People sell organs in China all the time, fueling a thriving black market where about 10,000 organs become available annually to the 1 million people in need of a transplant. Reports of foreigners traveling to China to receive a black market organ are common.

What made this story news is what the young man said when he was asked why he would do such a drastic thing: "I wanted to buy an iPad2, but I didn't have the money."

The End of Private Practice?

Evidence that the era of independent practice may be fading away continues to mount.

One study, commissioned by national physician search firm Merritt Hawkins, found that the majority of physician jobs available are now based in hospitals.

Another study, commissioned by consulting firm Accenture Health, found that more physicians are choosing to leave their practices to join larger healthcare systems.

During a one-year period beginning in April 2010, 56 percent of physician job searches conducted by Merritt Hawkins were for jobs based in hospitals. Five years ago, fewer than one in four Merritt-conducted searches were for hospital jobs.

"Doctors today are more likely to be employees working for increasingly large health systems or medical groups" than working in private practice, explained Travis Singleton, senior vice president of Merritt Hawkins, in a statement.

Hospital recruitment of primary-care physicians - partly driven by Medicare's shift toward team-based "accountable care organizations" and partly by hospitals' own desire to control their referral base - is one factor in the shift. Another is a change in the mindset of independent practitioners, who once eschewed institutional employment but are now warming up to the idea, according to research by Accenture.

In fact, by 2013, less than 33 percent of physician employment will occur in private practice, according to Accenture. That's a significant drop from 57 percent in 2000.

Income stability, more predictable hours, relief from administrative responsibilities, and greater access to healthcare IT tools is being seen by many doctors as more important than independence from a corporate master, according to Accenture.

Cancer Deaths Higher in U.K.

Why are British prostate cancer patients more likely than their American counterparts to die of the disease?

Medical policy leaders in both countries are faced with that question after U.K. research, released in June, revealed significantly higher death rates from prostate cancer in the U.K. Researchers say the British findings challenge the notion that prostate cancer is a disease that men die "with" rather than "from." Researchers followed more than 50,000 prostate cancer patients from the Thames Cancer Registry between 1996 and 2007, and found that about half of those who died during that period died of prostate cancer, which researchers said was "an important cause of death in all subgroups, including those treated with curative intent and older men."

About 20,000 men in the cohort died during the study period. That works out to a prostate cancer death rate of about 20 percent, which is actually lower than the 27 percent death rate based on 2008 Cancer Research U.K. data. Either number is considerably higher than the 15 percent prostate cancer death rate in the United States, as reported by the American Cancer Society. Experts cited the higher rate of PSA testing of asymptomatic men in the United States than in the U.K. as the key reason for the death rate difference.

"I would rather have the potential - and I emphasize the potential - for overtreating than swing the other way and lose all of these patients to a disease that is curable," Brantley Thrasher, a urologist in Kansas City and a spokesman for American Urological Association told Medscape Medical News.

Navel Gazers

Have you ever wondered what's going on in your belly button, on a microbiological level? Well, your wait may soon be over: Researchers at publicly funded universities are at last being set loose to study the mysteries of the human belly button. The Belly Button Biodiversity Project at North Carolina State University has begun examining microbial ecosystems of our navels. "Each person's microbial jungle is so rich, colorful, and dynamic that in all likelihood your body hosts species that no scientist has ever studied," says the Belly Button Biodiversity Project. "Your navel may well be one of the last biological frontiers." If you're wondering what weird stuff they've already discovered growing on people, check www.wildlifeofyourbody.org.

Stat

Median 2010 income:

$205,379: Internists
$189,402: Family Physicians
$192,148: Pediatricians

Source: Medical Group Management Association

Quotable

"It's like they own a car, but they're stuck in first gear. They have good intentions but then they buy [an EHR] and get frustrated."

Marion Jenkins, healthcare IT consultant

"Health systems such as ours have all of a sudden realized that we want to get involved with primary-care physicians, which is new."

Gaurov Dayal, chief medical officer for Adventist HealthCare, a hospital system in suburban Washington, D.C., on the trend of health systems employing more primary-care doctors, in The Washington Post.

This article originally appeared in the July/August 2011 issue of Physicians Practice.