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A New Generation of Doctors Forgoes a Solo Practice
Changes in medicine make working for someone else more appealing, says retired physician Young doctors have lost interest in going solo. A recent survey of doctors-in-training in their final year of residency showed that just 2 percent want a go-it-alone practice. Instead, their goal is to seek balance between their private and […]
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Changes in medicine make working for someone else more appealing, says retired physician
Young doctors have lost interest in going solo.
A recent survey of doctors-in-training in their final year of residency showed that just 2 percent want a go-it-alone practice.
Instead, their goal is to seek balance between their private and professional lives by working for someone else, such as a hospital, clinic, or large group practice.
That’s according to a survey by MerrittHawkins, a physician staffing firm and subsidiary of AMN Healthcare, which say it is the largest health-care staffing company in the U.S.
A mixture of technological advances, health-insurance payment models, corporate-business models, and other factors have brought drastic changes to the medical profession, that have been building for decades.
People of my vintage went into medicine for what seemed to be all the right reasons. We expected to work long hours, to be at the call of someone in distress, to sacrifice youth to gain knowledge and experience, and to sacrifice time with family to alleviate the suffering of others.
That selfless philosophy makes it all the more puzzling why [my] generation of doctors allowed health care to evolve into an industry more concerned about profits and quarterly earnings than patient care.
I think the trend probably began in the early 1960s when physicians declined the opportunity to take an active role in the management of hospitals and health care. Instead, they hired administrators to do that work and did not pay close attention to the results. That was just the beginning of the shift, though. Over time, the groundwork was laid for the practice of medicine to be controlled by the reimbursement polices of insurance companies and corporate business practices.
Physicians lost control of the health-care system and became managers of therapeutic teams.
Today, there is a decreasing emphasis on self-sacrifice and individualism, and an increase in group practice or organizational medicine where hours are predictable. You can’t necessarily blame young doctors for the decisions they are making. It’s just been the natural progression of things.
Until the profit motive is purged from medicine, any talk and action to improve the health-care system will be of little or no benefit. There are barriers to those needed changes happening, though, including:
*Health care as an industry comprises 18 percent of GDP. No one will tamper with it for fear of uncomfortable or egregious economic fallout. It could have been done during the formation of the Affordable Care Act, but it was not.
*There are far too many stakeholders in the current system to consider shutting it down or even to make large changes. Many industries support health-care organizations with day-to-day services and supplies. Other industries create, provide, and manage the increasingly complex technology used in health care. Entire educational systems, from medical schools to community colleges that train lower-level technical and nursing staff, are engaged in supporting the system. The insurance industry that manages payments is an enormous employer that is itself responsible for driving up the cost of care. Finally, the individuals employed in all of the above are dependent upon the continued functioning of this “out-of-control creation” for their livelihoods.
Not all is pessimistic in the world of medicine, though. Technological advances have helped both patients and doctors by providing the tools and knowledge to diagnose disease more accurately and treat it more efficiently.
So, while some of the human touch in the doctor/patient relationship is gone, the importance of better patient outcomes shouldn’t be dismissed.
Although I find a personal health-care visit to be a sterile interaction, I cannot deny it is more efficient and more effective than the medicine we practiced. Our model has gone, and another has taken its place.
J. Joseph Marr, M.D. is a retired academic physician and pharmaceutical and biotechnology executive who lives near Denver. Dr. Marr is the author of more than 200 academic publications, and has authored and edited six books, including “Fall From Grace: A Physician’s Retrospective on the Past Fifty Years of Medicine and the Impact of Social Change.”
CNY to host AHL all-star game for a second year in 2016
SYRACUSE — The American Hockey League (AHL) will hold its all-star game in Central New York for a second consecutive season in 2016. AHL CEO David Andrews on May 18 announced that the minor league’s board of governors had “unanimously” approved the Syracuse Crunch to host the next all-star game, according to a news
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SYRACUSE — The American Hockey League (AHL) will hold its all-star game in Central New York for a second consecutive season in 2016.
AHL CEO David Andrews on May 18 announced that the minor league’s board of governors had “unanimously” approved the Syracuse Crunch to host the next all-star game, according to a news release posted on the Crunch website.
Andrews repeated the announcement for a local audience at a news conference at the Onondaga County War Memorial on May 27.
The Utica Comets hosted this past season’s all-star game at the Utica Memorial Auditorium on Jan. 26.
The league, which features a number of players that go on to play in the National Hockey League (NHL), contends the War Memorial will provide a “perfect backdrop” to “celebrate our past while showcasing the brightest young stars in hockey,” according to the May 18 news release.
CNYBJ asked Andrews if it’s unusual to hold the game in the same region in back-to-back years.
“I think we will take a little criticism from fans around the league for that. We haven’t been out west in a long time,” Andrews acknowledged, as he spoke with reporters following the May 27 local announcement.
Syracuse served as a charter member city in the AHL in 1936. So the league “saw the fit” between a league charter-member city and the 80th anniversary, says Andrews. [Syracuse Crunch owner] Howard [Dolgon] and his staff “very clearly” have the ability to deliver a “first-class, special event.”
“For us, it’s a no-brainer to put those two things together to celebrate our 80th anniversary,” says Andrews.
The Crunch will enter their 22nd season as members of the AHL in 2015-16, but the city’s history in the league traces back to the Syracuse Stars, which won the very first Calder Cup championship in 1936-37, according to the news release.
“In my mind, we will definitely have a heritage feel to the event … we want to make certain that we really celebrate our 80th in a great way,” Andrews said in speaking with reporters after the presentation.
In operation since 1936, the AHL serves as the “top” development league for all 30 teams in the NHL.
CNYBJ also asked Andrews about the economic impact the AHL all-star game can have on a region.
He didn’t provide a specific dollar figure but estimates the event will attract about 1,000 out-of-town fans from places such as Utica, Albany, Rochester, Hershey, and the Wilkes Barre–Scranton area.
“There’s going to be a lot of demand for tickets for folks coming in from those areas,” says Andrews.
Minor-league hockey fans have purchased about one-third of the seats at the War Memorial for the all-star game, Megan Cahill, public & media-relations manager for the Syracuse Crunch, said in response to an email inquiry from CNYBJ.
Requesting Syracuse
When Andrews approached Dolgon about hosting the all-star game, the Crunch owner requested time to think about it, considering his staff had just organized the Frozen Dome Classic in the Carrier Dome in November, something Dolgon called an “undertaking.”
“So, once the staff embraced [it] and [Onondaga County] embraced it, it became easier to say … it makes sense for us to move ahead for all the right reasons,” says Dolgon.
The challenge for the Syracuse Crunch staff members is how they can make this all-star game presentation “an event,” says Dolgon.
The Crunch owner is aiming for an atmosphere similar to what a National Football League city does when it hosts the Super Bowl.
“I want that same feel of when the All-Star Game comes here,” says Dolgon.
The all-star game also provides additional ticket sales and sponsorship opportunities for the Syracuse Crunch, he adds.
“It extends our brand on a national level, which we always think about doing,” says Dolgon.
Continued Controversy Surrounding the New York-SAFE Act
Very often, legislative bodies pass ill-advised laws in response to tragedies in hopes that the new laws will work to prevent similar tragedies from happening in the future. I used to work for a judge who would say bad facts make bad law. This is true in the legislative process and no truer is the
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Very often, legislative bodies pass ill-advised laws in response to tragedies in hopes that the new laws will work to prevent similar tragedies from happening in the future. I used to work for a judge who would say bad facts make bad law. This is true in the legislative process and no truer is the case with the NY-SAFE Act, which passed in January 2014, shortly following the Newtown, Connecticut school-shooting tragedy. Since its passage, law-enforcement officials, 2nd amendment advocates, outdoor enthusiasts, and others have panned the law. The general criticisms of the law, which I agree with, are: (1) that its drafters had a limited knowledge of firearms, (2) the law will not do much to prevent another Newtown tragedy, and (3) it infringes on law-abiding citizens’ 2nd Amendment rights.
Since its passage, there have been numerous attempts to repeal the SAFE Act, or at the very least amend the law to remove some of its more egregious provisions.
Unfortunately, because the New York Assembly is controlled by New York City Democrats who generally favor any gun-control measures, legislative efforts have failed. Furthermore, even if the New York Legislature voted to repeal the act, or make significant changes to it, that legislation would likely be vetoed by Governor Andrew Cuomo. The governor after all drafted the legislation and was its biggest champion.
It is the governor’s continued, unwavering advocacy for gun control and the SAFE Act that makes the latest news regarding the legislation a head-scratcher. On July 10, Jim Malatras, the governor’s director of state operations, and Senate Majority Leader John Flanagan entered into a memorandum of understanding (MOU) that was first reported to be an agreement to, among other things, scrap the requirement that background checks be performed on purchasers of ammunition. However, after pushback, especially from supporters of the SAFE Act, the governor’s counsel clarified the intent of the MOU was not to permanently scrap the background-check requirement but rather postpone its implementation until technology is developed to perform these background checks. Turns out this was much ado about nothing because most people who understand the provisions of the SAFE Act already knew that the background-check provisions were unworkable.
I understand the Senate majority leader’s willingness to enter into an MOU. After all, he and his conference, which is made up of mostly suburban and upstate legislators, have advocated for amendments to the SAFE Act (even full repeal) and presumably, they would be happy to get those changes whether by legislation or otherwise. However, I am troubled by the use of the MOU. The governor’s use of an MOU, even though it didn’t amount to much in this case, illustrates Cuomo’s willingness to bypass the legislative process. Why should the governor and a leader of a legislative conference be able to enter into an agreement that would, if it did what it was initially reported to do, bypass enacted legislation? This circumvents the democratic process. While I agree that the ammunition background-checks provision of the SAFE Act should be repealed, if this can be done by use of an MOU with one leader of the legislature, why couldn’t other policies be implemented or ignored by the same means?
We, unfortunately, have seen this in other areas and most recently with the governor empaneling a wage board that will presumably raise the minimum wage for fast-food workers to $15 an hour. The governor couldn’t get the legislature to increase the minimum wage so he decides to do it on his own and target the fast-food industry. Many can understand that the governor wants to enact his agenda and that, at times, he is frustrated with his inability to get the state legislature to agree to pass his agenda. Frustration, however, is not a valid reason to bypass the democratic process. If he can’t convince legislators to support his proposed policies, maybe he should be a stronger advocate. Or, maybe his policies simply aren’t worth supporting.
William (Will) A. Barclay is the Republican representative of the 120th New York Assembly District, which encompasses most of Oswego County, including the cities of Oswego and Fulton, as well as the town of Lysander in Onondaga County and town of Ellisburg in Jefferson County. Contact him at barclaw@assembly.state.ny.us, or (315) 598-5185.
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