Posts Tagged ‘doctor shortage’

Boris Johnson warns Theresa May she must commit to giving NHS extra £100m a week to defeat Jeremy Corbyn

January 17, 2018

Image result for nhs, a&e, photos

By 

Boris Johnson has warned Theresa May that the Government must make a public commitment to giving the NHS an extra £100million a week after Brexit if the Tories are to beat Jeremy Corbyn at the next election.

The Foreign Secretary believes that the Government must adopt the flagship Vote Leave pledge and spend £5.2billion a year that would have been paid into Brussels on the health service instead.

His intervention comes as hospitals struggle to cope with the winter flu crisis amid an ongoing row between the Government and NHS England over funding.

Mr Corbyn, the Labour leader, has put the issue at the forefront of his campaigning. Mr Johnson is likely to have the support of Michael Gove, the Environment Secretary and leading Leave campaigner, alongside senior Eurosceptic Tory MPs as he makes his case for the commitment.

Read more (Paywall):

http://www.telegraph.co.uk/politics/2018/01/16/exclusive-boris-johnson-warns-theresa-may-must-commit-52bn-brexit/

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Boris Johnson suggests Brexit could fund NHS

Boris Johnson said Vote Leave had underestimated the amount that Britain gives to Brussels each week
Boris Johnson said Vote Leave had underestimated the amount that Britain gives to Brussels each weekMATT CARDY/GETTY IMAGES

Boris Johnson has suggested that additional NHS funding should come from the Brexit dividend rather than a new tax.

The foreign secretary joined the heated debate among senior Conservatives about how much to put into the NHS after the funding settlement runs out in 2020 and how to pay for it.

Jeremy Hunt, the health secretary, is prepared to look at a new tax among other options, The Times revealed yesterday. Nick Boles, the Tory MP for Grantham & Stamford, has backed an additional levy, as has Nick Macpherson, former permanent secretary to the Treasury.

However, Mr Johnson told The Guardian that the cash should come from funds now paid to Brussels that may be available after Brexit, depending on how much the UK continues…

 

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Britain’s National Health Service Crisis: NHS crisis fuelled by closure of 1,000 care homes housing more than 30,000 pensioners

January 13, 2018

NHS figures show the worst Accident & Emergency crisis on record CREDIT: CHRIS J. RATCLIFF

By 

The growing NHS crisis has been fuelled by the closure of almost 1,000 care homes housing more than 30,000 pensioners, research suggests.

It comes as NHS figures show the worst Accident & Emergency crisis on record, amid a 37 per cent rise in the numbers stuck in hospital for want of social care, since 2010.

Experts said hospitals were being overwhelmed by the spread of flubecause they had almost no spare capacity to cope with surges in demand.

The report by industry analysts shows that in the last decade, 929 care homes housing 31,201 pensioners have closed, at a time when the population is ageing rapidly.

The research from LaingBuisson show care homes going out of business at an ever increasing rate, with 224 care homes closed between March 2016 and March 2017, amounting to more than 2,000 beds.

The research from LaingBuisson show care homes going out of business at an ever increasing rate
The research from LaingBuisson show care homes going out of business at an ever increasing rateCREDIT: JEFF J MITCHELL

Britain’s National Health Service (NHS): ‘No longer able to meet standards in its constitution’

January 13, 2018

‘Rising numbers of flu cases and more respiratory illness have placed intolerable pressures on staff’

By Samuel OsborneAlex Matthews-King

The Independent Online

The National Health Service is at a “watershed moment” and cannot deliver care to the standards required by its constitution with the funding it receives, Jeremy Hunt has been told.

Chris Hopson, chief executive of NHS Providers, which acts as as bridge between trusts and the Department of Health, has written to the Secretary of State for Health and Social Care to call for extra investment on a long-term basis to address the “fragility of the wider NHS”.

The three-page letter calls for the Government to commit to increasing the NHS budget to £153bn by 2022/23 – a sum the Office for Budget Responsibility said was needed, given projected increased demand for services.

But Mr Hopson has warned that, due to the current state of NHS finances, “substantial progress” must be made before the Autumn Budget this year.

Mr Hopson said: “Despite planning for winter more thoroughly and extensively than before, it hasn’t been sufficient. Rising numbers of flu cases and more respiratory illness have placed intolerable pressures on staff.

“The NHS is no longer able to deliver the constitutional standards to which it is committed. We need to be realistic about what we can provide on the funding available.

“If we continue to run the NHS at close to 100 per cent capacity day in, day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a high, but entirely predictable, spike in demand.”

Warning that failure to act would lead to targets moving further out of reach, he said: “There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the Government’s court.”

The letter follows the Health Secretary’s admission on Wednesday that the NHS will need substantially increased funding in future, which should be delivered across a 10-year spending period.

The letter adds: “The Government now needs to set out how it will create the sustainable, long-term health and care funding settlement you have rightly called for.”

NHS Providers has said the Government must commit to review this year’s winter preparations, which Prime Minister Theresa May has repeatedly said are “the best ever”, despite hospitals relying on a last-minute allocation of £335m in the Budget.

The Government has also guaranteed hospitals will be protected against further funding squeezes if they fail to hit increasingly remote financial targets.

The cancellation of non-urgent care, as advised by the NHS last week, will mean trusts, which are paid on a fee-for-service basis, miss out on income from these operations.

Jeremy Hunt apologises to patients as thousands of operations delayed

This will also make it harder to hit strict savings and performance targets and unlock the associated funding for delivering them.

NHS Providers’s intervention comes on the day after a leaked memo revealed Oxford’s Churchill Hospital was having to consider cutting back chemotherapy services for cancer patients because of staff shortages.

A letter from the hospital’s head of chemotherapy, Dr Andrew Weaver, said nurse numbers were down 40 per cent, and chemotherapy start dates may have to be pushed back or the number of cycles reduced.

Norman Lamb, a former Liberal Democrat minister, said the country had been “honest” about how to give the NHS more funding.

His party has called for adding a penny in the pound on income tax.

“The clear message from NHS leaders is that the Government must drop its sticking-plaster approach to the health service,” he said.

“The gap between demand and resources in the NHS is growing each year, with tragic human consequences across the country.

“The stark reality is that the current winter crisis is just a taster of what is to come unless ministers get to grips with the long-term funding shortfall facing the health service.”

A Department of Health and Social Care spokesman said: “The NHS was given top priority in the recent Budget with an extra £2.8bn allocated over the next two years, and was recently ranked as the best and safest healthcare system in the world.

“We know there is a great deal of pressure in A&E departments and that flu rates are going up, and we are grateful to all NHS staff for their incredible work in challenging circumstances.

“That’s why we recently announced the largest single increase in doctor training places in the history of the NHS – a 25 per cent expansion.”

Additional reporting by Press Association

http://www.independent.co.uk/news/health/nhs-constitution-standards-crisis-jeremy-hunt-beds-hospitals-privatisation-latest-a8152836.html

Britain’s Unavoidable Health-Care Choice

January 9, 2018

Bloomberg Editorial

Low taxes or free, high-quality medical services: Pick one.
.
The NHS needs more than emergency treatment. Photographer: Jack Taylor/Getty Images

Can a relatively low-tax country run a high-quality, taxpayer-funded health service that’s free to all? Britain’s National Health Service suggests the answer is no.

The NHS is good at some things but bad, bordering on disastrous, at others. Its great virtue is truly universal coverage, no questions asked — and by international standards, the system is also cheap to run. As a result, though, it’s perpetually short of money, and the service is erratic. Today the NHS is yet again dealing with a financial crisis and a surge of complaints about standards.

Prime Minister Theresa May has had to apologize to patients for a winter breakdown that has seen operations postponed and emergency-room waiting times rise well over the promised four-hour maximum. That comes a year after the British Red Cross declared the service was on the verge of a “humanitarian crisis.”

The NHS’s problems — too many patients and not enough staff — aren’t seasonal. Britain’s population is growing and getting older, and as medicine advances, treatments become more sophisticated and expensive.

Many years of meager funding are taking their toll. In relation to population, the U.K. has fewer doctors, CT scanners and MRI units per capita than most other EU countries, and ranks toward to the bottom of the league on infant mortality. Other universal-coverage systems score better on avoidable deaths, cancer survival, innovation, consistency of service, and other measures. Long waiting times for some non-urgent treatments are leading more patients, many suffering chronic pain, to tap savings or borrow for private treatment.

Granted, more money by itself won’t cure the system. One former head of the Treasury called the NHS a “bottomless pit.” Even so, bearing in mind how little the NHS costs, more money is surely part of the answer, as long as it’s combined with further efforts to run the system more efficiently. For instance, social care for the elderly and other groups hasn’t kept pace with what’s required, placing an added burden on more costly medical professionals. Fixing that kind of misallocation would improve the system’s value for money.

The public’s devotion to the principle underlying the NHS is undiminished: The British see health care as a right. Increasingly, though, they are also demanding higher standards of care, and those come at a price. Taxpayers must either dig deeper to maintain the current service — deeper still to improve it — or else accept that the NHS will continue to disappoint.

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

https://www.bloomberg.com/view/articles/2018-01-09/britain-s-unavoidable-health-care-choice

British PM May apologizes as overwhelmed British hospitals cancel non-emergency operations

January 4, 2018

Reuters

LONDON (Reuters) – Britain’s Prime Minister Theresa May apologized on Thursday to tens of thousands of patients whose operations were canceled to free up staff and beds to deal with emergency patients.

Earlier this week, officials at the National Health Service (NHS) in England recommended that hospitals cancel all non-urgent appointments and operations until next month.

Officials say this means about 50,000 operations may be postponed.

Hospitals are so full that they are reaching “dangerous levels” and staff are struggling to maintain the safety and quality of patients' care, claims a new report.

Emergency care in hospitals is still open

“I know it is difficult, I know it is frustrating, I know it is disappointing for people and I apologize,” May told Sky News after visiting a hospital outside London.

A flu outbreak, colder weather and high levels of respiratory illnesses have put hospitals in England under strain with many operating at or near full capacity, with long waits for treatment in emergency rooms.

The issue is potentially damaging for May, already weakened after losing a parliamentary majority in last year’s election and struggling to pacify her deeply divided party as she navigates the final year of Brexit negotiations.

The NHS, which delivers free care for all and accounts for a third of government spending on public services, is typically one of the most important issues for voters during elections and one which is often regarded as a weakness for May’s Conservative party.

UK: NHS hospitals ordered to cancel all routine operations — A&E crisis — services overwhelmed — “Things are terrible now, but I am fearful the next few weeks will be horrendous.”

January 3, 2018

The instructions will result in 50,000 operations such as cataract, hip and knee surgery being cancelled  CREDIT: PA 

By Henry Bodkin

Every hospital in the country has been ordered to cancel all non-urgent surgery until at least February in an unprecedented step by NHS officials.

The instructions on Tuesday night – which will see result in around 50,000 operations being axed – followed claims by senior doctors that patients were being treated in “third world” conditions, as hospital chief executives warned of the worst winter crisis for three decades.

Hospitals are reporting growing chaos, with a spike in winter fluleaving frail patients facing 12-hour waits, and some units running out of corridor space.

Sir Bruce Keogh, NHS medical director, on Tuesday ordered NHS trusts to stop taking all but the most urgent cases, closing outpatients clinics for weeks as well as cancelling around 50,000 planned operations.

Trusts have also been told they can abandon efforts to house male and female patients in separate wards, in an effort to protect basic safety, as services become overwhelmed.

The chaos follows a rise in flu cases when many hospitals were already close to capacity, with high numbers of frail patients stuck on wards for want of social care.

By Tuesday night 12 NHS trusts – including two ambulance services covering almost nine million people – had declared they had reached the maximum state of emergency.

One ambulance trust resorted to taxis to ferry patients to hospital, while another asked patients to find a family member to get them to hospital, with paramedics stuck outside A&E units in record numbers.

Health officials said pressures on the NHS were expected to continue to rise, with flu levels surging.

Sir Bruce Keogh
Sir Bruce Keogh, NHS medical director, said more action needed to be taken to tackle waiting listsCREDIT: CHRISTOPHER JONES

Sir Bruce said: “I want to thank NHS staff who have worked incredibly hard under sustained pressure to take care of patients over the Christmas. We expect these pressures to continue and there are early signs of increased flu prevalence.

“The NHS needs to take further action to increase capacity and minimise disruptive last-minute cancellations.”

Successive governments have banned mixed-sex wards, in a bid to protect patients’ dignity.

The decision to relax the rules was last night seen as a desperate measure, as pressures mount.

In Staffordshire, one senior consultant said vulnerable patients were now being treated in “third world conditions” amid mass overcrowding.

Dr Richard Fawcett, a consultant in emergency medicine at Royal Stoke hospital, said it broke his heart to see elderly and frail people lining NHS corridors.

The Army doctor, who has done three tours of Afghanistan commanding a field hospital, tweeted a personal apology to patients:

As an A&E consultant @UHNM_NHS I personally apologise to the people of stoke for the 3rd world conditions of the dept due to  pic.twitter.com/HW5JR8PSJ2

North East Ambulance Service is among trusts declaring the highest state of alert, warning that its “response standards to potentially life-threatening calls have deteriorated”.

The trust said it had received 19,000 calls to 999 in the week which just ended – one quarter more than the same time last year – while coping with 40 per cent more 111 calls.

Some patients who would normally be sent an ambulance were now being asked if they could make their own way to hospital, with help from relatives, the trust said.

East of England Ambulance Service, also at maximum capacity, said some patients were being sent taxis to get them to hospital, with paramedics stuck in ambulances queuing at hospitals for more than 500 hours in the last four days.

‘Black alerts’

In addition, 10 hospital trusts said they were at the highest level of pressure – better known as a “black alert” – under a four-point scale of “Operational Pressures Escalation Levels” used to bring emergency plans into motion, when patient safety is at risk.

Among those admitting they had now reached this level of pressure were:

  • Dartford and Gravesham NHS Trust
  • Royal Cornwall Hospitals
  • Portsmouth Hospitals NHS
  • Maidstone and Tunbridge Wells
  • Medway NHS Foundation Trust
  • University Hospitals Of Leicester
  • Epsom and St Helier University Hospitals
  • Taunton & Somerset Foundation Trust
  • Yeovil District Hospital Foundation Trust
  • Royal United Hospitals Bath

Many more trusts refused to provide information about pressure levels, with several saying NHS England no longer allowed them to divulge the information, which used to be published in previous winters.  Officials have also stopped weekly updates of data showing how A&E units are performing against the four-hour target.

However, an audit by the Royal College of Emergency Medicine (RCEM) suggests that ahead of Christmas, less than 81 per cent of patients were being seen within four hours – against a target of 95 per cent. The figure is the worst recorded since the college began tracking A&E units three years ago.

The RCEM audit of more than 50 hospitals also revealed thousand of operations cancelled during Christmas week, with 70 per cent more cancellations this year compared with last.

A number of NHS trust chief executives described the pressure as “relentless” with several on Tuesday saying they had never seen such pressure during 30 years in the health service.

Dr Nick Scriven, president of the Society for Acute Medicine, said: “The position at the moment is as bad as I’ve ever known. We are simply not coping, we were at full capacity before the sorts of pressures that we should be able to manage – like a rise in flu – is pushing us over the edge.

“Things are terrible now, but I am fearful the next few weeks will be horrendous.”

http://www.telegraph.co.uk/news/2018/01/02/nhs-hospitals-ordered-cancel-routine-operations-january/

U.S. hospitals feeling the pain of physician burnout

November 21, 2017

Reuters

By Julie Steenhuysen

,

Reuters
1 / 17

Dr. Brian Halloran. a vascular surgeon at Saint Joseph Mercy Ann Arbor, shows the canned vegetables from his garden across from Saint Joseph Mercy hospital

Dr. Brian Halloran. a vascular surgeon at Saint Joseph Mercy Ann Arbor, shows the canned vegetables from his garden across from Saint Joseph Mercy hospital in Ypsilanti, Michigan, U.S., August 23, 2017. REUTERS/Rebecca Cook

By Julie Steenhuysen

ANN ARBOR, Mich. (Reuters) – Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan.

His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients.

“You really have to find the balance to put it a little more in perspective,” he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected.

Some leading healthcare executives now say the way medicine is practiced in the United States is to blame, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

What’s more, burnout is not just bad for doctors; it’s bad for patients and bad for business, according to interviews with more than 20 healthcare executives, doctors and burnout experts.

“This really isn’t just about exercise and getting enough sleep and having a life outside the hospital,” said Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September.

“It has at least as much or more to do with the environment in which these folks are practicing,” he said.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors and leads doctors to leave a profession they once loved.

For a graphic, click http://tmsnrt.rs/2zMlmuy

Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

“Burnout decreases productivity and increases errors. It’s a big deal,” said Cleveland Clinic Chief Executive Dr. Toby Cosgrove, one of 10 U.S. healthcare CEOs who earlier this year declared physician burnout a public health crisis.

WHAT TO DO?

Hospitals are just beginning to recognize the toll of burnout on their operations.

Experts estimate, for example, that it can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

But no broad calculation of burnout costs exists, Shanafelt said. Stanford, Harvard Business School, Mayo and the American Medical Association are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

In July, the National Academy of Medicine (NAM) called on researchers to identify interventions that ease burnout. Meanwhile, some hospitals and health insurers are already trying to lighten the load.

Cleveland Clinic last year increased the number of nurse practitioners and other highly trained providers by 25 percent to 1,600 to handle more routine tasks for its 3,600 physicians. It hired eight pharmacists to help with prescription refills.

Atrius Health, Massachusetts’ largest independent physicians group, is diverting unnecessary email traffic away from doctors to other staffers and simplifying medical records, aiming to cut 1.5 million mouse “clicks” per year.

Insurer UnitedHealth Group, which operates physician practices for more than 20,000 doctors through its Optum subsidiary, launched a program to help doctors quickly determine whether drugs are covered by a patient’s insurance plan during the patient visit. It is also running a pilot program for Medicare plans in eight states to shrink the number of procedures that require prior authorization.

Similarly, Aetna Inc this year began a behavioral health program that eliminates prior authorization requirements for admission to some high-performing hospitals.

DOCTOR OVERLOAD

Experts define burnout as a syndrome marked by emotional exhaustion, cynicism and decreased effectiveness. Many burned out doctors cut back their hours to cope, and a disturbing number commit suicide.

A landmark 2015 Mayo Clinic study found that more than 7 percent of nearly 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers. About 400 a year go through with it.

Driving the burnout symptoms is the burden of data entry on clumsy electronic medical records systems that doctors must use to prove the quality of their care, said Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

Sinsky recently conducted an experiment in her own internal medicine practice in Dubuque, Iowa. She asked a staff member how many mouse clicks it takes to order and record a single patient’s flu shot in their electronic medical record. The answer: 32.

She has visited some practices where a doctor had to record flu shots for more than 1,000 patients because only the doctor was allowed to enter the order.

Such mandates reflect an overly strict interpretation of federal health reforms designed to encourage doctors to use electronic medical records, such as the 2009 Health Information Technology for Economic and Clinical Health Act that required doctors to demonstrate “meaningful use” of the systems.

“We have to recognize the exacting toll that the first generation of electronic health records have had on physicians,” Sinsky said. “I would identify it as one of the most important drivers of physician burnout.”

Pre-approval requirements from health insurers for many services and quality metrics built into Obamacare have added to doctors’ administrative duties.

“We’ve got this measurement mania. We’ve got to back off of that,” said Dr. Paul Harkaway, chief accountable care officer for Michigan’s St. Joseph Mercy Health System, a part of Trinity Health, a national not-for-profit Catholic healthcare system.

As a result of these requirements, primary care physicians spend more than half of their 11.4 hour workday performing data entry and other tasks, according to a September AMA/University of Wisconsin study published in the Annals of Family Medicine.

To manage, doctors often finish work at home in the evening, a part of the day known as “pajama time.”

COSTS TO THE HEALTHCARE SYSTEM

Doctors’ suffering can take a direct toll on patients. In a 2010 study, Shanafelt and colleagues found that the more burned out a surgeon was, the more likely he or she was to report a major medical error. Other studies have shown that burnout drives up rates of unnecessary testing, referrals to specialists and hospital admissions.

When doctors quit, it costs an estimated $800,000 to $1.3 million in recruitment, training and productivity costs, depending on the specialty.

Even when physicians don’t leave, they can contribute thousands of dollars in costs each year “just as a matter of inefficient functioning,” said Dr. Colin West of the Mayo Clinic.

The trend has medical malpractice experts concerned. CRICO, the malpractice carrier for Harvard University’s two dozen affiliated hospitals, recently had to settle a handful of cases because doctors were too burned out to fight, even though CRICO believed it could win.

“The clinician just wanted it to go away,” said Dr. Luke Sato, CRICO’s chief medical officer. Sato estimates that an average breast or colorectal cancer malpractice case might cost $750,000 to $1 million to settle.

The crisis has Harkaway worried for his colleagues in Michigan, and for his profession.

“Working with doctors every day, you see it,” he said. “They are just beat down.”

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Editing by Edward Tobin)

U.S. Trying to Find More Doctors to Send to Disaster Areas

October 14, 2017

Hurricane Maria left Puerto Rico’s hospitals in bad shape

Volunteer doctors organize medical supplies during a visit to a shelter to check refugees in the aftermath of Hurricane Maria in Humacao, Puerto Rico, on Oct. 2.
Volunteer doctors organize medical supplies during a visit to a shelter to check refugees in the aftermath of Hurricane Maria in Humacao, Puerto Rico, on Oct. 2. PHOTO: RICARDO ARDUENGO/AGENCE FRANCE-PRESSE/GETTY IMAGES

A U.S. government program that sends doctors and nurses to disaster zones says it needs more health-care workers, as relief efforts during this hurricane season are near the end of a second month with no end in sight in Puerto Rico and the U.S. Virgin Islands.

The National Disaster Medical System, which recently wrapped up big deployments to hurricane-ravaged areas in Texas and Florida, says it will start recruiting more medical professionals in the next few weeks.

“We’re far from the recovery stage of this event,” Robert Kadlec, a U.S. Department of Health and Human Services assistant secretary, said Thursday of Hurricane Maria’s devastation. The storm largely destroyed Puerto Rico’s power grid, leaving half the local hospitals without power, and downed its communications network. The federal health agency oversees the program that temporarily hires health-care workers for what are typically two-week rotations.

The U.S. teams, which set up temporary hospitals and clinics, are helping relieve the strain on Puerto Rican hospitals. Nearly half of the local hospitals are depending on sometimes unreliable generators for power. Generator failures have forced recent evacuations at two hospitals. And others suffered storm damage that crippled operations, said Jaime Pla Cortes, executive president of the Puerto Rico Hospital Association, in an interview.

“Everybody has to improvise,” Mr. Pla Cortes said. “The nurses and the doctors are tired, they are working full time.”

The National Disaster Medical System entered the hurricane season understaffed, system director Ron Miller said, adding that the U.S. Office of Personnel Management recently authorized expedited hiring.

Since Hurricane Harvey hit Texas in late August, the federal system has deployed more than 40 36-person teams to Texas, Florida and Puerto Rico, plus several smaller teams, including some with logistics personnel, veterinarians and morticians. The system has also dispatched one team to California in response to the state’s wildfires.

The prolonged response is a “huge anomaly” for the system, Mr. Miller said. Two-week rotations have occasionally stretched into a month, he said.

The program has enough teams to deploy through mid-November, he said. The U.S. program set up a temporary hospital in San Juan and dispatched teams to hubs around Puerto Rico, Dr. Kadlec said.

To fill open positions, the system has relied on medical staff from the Department of Defense and Department of Veterans Affairs, the latter of which has 73 staffers helping in Manati, Puerto Rico.

Other American health-care workers are traveling to Puerto Rico as volunteers, coordinating efforts with HHS. About 80 nurses and doctors from New York-area hospitals flew to Puerto Rico Thursday.

Demand for volunteers is strong, said Jenna Mandel-Ricci, an executive with the Greater New York Hospital Association, which helped organize the trip with HHS and New York state officials. The federal agency “is saying they are taxed,” and volunteers left without knowing where they would be working during a two-week stay, she said. “That’s how fluid things are on the ground.”

Write to Melanie Evans at Melanie.Evans@wsj.com

Doctor Shortage? — Overwork taking a toll on Malaysian doctors — Public healthcare — Rising cost of living drives patients to seek cheaper treatment

August 20, 2017

Image may contain: 1 person, sitting and crowd

Klinik Kesihatan Kuala Lumpur, one of KL’s largest government clinics, which can treat up to 1,000 patients a day.PHOTO: BERNAMA

Public hospitals stretched as rising cost of living drives patients to seek cheaper treatment

As a paediatrician in training, Dr Nurul Huda Ahmad dreamed of making healthcare fun for children.

But her dream will never come true. The 33-year-old from Kuala Terengganu was driving home after working for 33 hours straight, with little rest, when she died in an accident on May 9.

In July last year, another young doctor, anaesthesiologist Afifah Mohd Ghazi, also died in similar tragic circumstances.

Worn out after a long shift, Dr Afifah lost control of her car and crashed into a tree, resulting in fatal injuries to her chest and brain. She was only 27.

Post-call fatigue is nothing new in the medical world, especially for doctors in the public health sector.

But the situation is worsening as more Malaysians switch to public hospitals to cope with the rising cost of living in recent years, especially since the 6 per cent goods and services tax (GST) was introduced on April 1, 2015.

The influx has added to doctors’ workloads and, in many instances, led to deadly consequences, according to anecdotal accounts from physicians and surveys by medical associations.

Dr Nurul Huda Ahmad also died in a crash after completing a 33-hour shift.
  • 55% Percentage of accidents that occurred after respondents had worked for 25 to 36 hours, according to a 2015 survey of 440 healthcare professionals.65% Percentage of respondents who admitted they suffered from post-accident psychological trauma.

SO MUCH TO DO

We (doctors) are happy to be of service but I believe it is slowly taking a toll on us. A doctor at a public hospital sometimes has to take care of up to 500 patients. Imagine the exhaustion.

DR KUAN, on how the workloads of public hospital doctors have become heavier in recent years

JUST AS GOOD

Cost is definitely a factor because the prices of goods and services are steadily increasing. But another reason is that the waiting time (at public hospitals) is almost the same as at private hospitals.

MR MUHAMMAD NAJMI ABDULLAH, 36, an engineer, on how public hospitals are just as efficient as private ones.

WHY IT’S A PROBLEM

When you have more people seeking treatment at public hospitals… it will also affect the doctors attending to them – they get overworked.

DR AZLAN HELMY ABD SAMAT, from the Islamic Medical Association of Malaysia, on how the rising cost of living has resulted in a higher number of patients going to public

Dr Rozaimi (not his real name), a 35-year-old doctor at a public hospital in Selangor, told The Straits Times that he and his peers suffer from chronic fatigue and high levels of stress. “There is no job without stress and fatigue, but I’ve lost count of how many times I’ve accidentally fallen asleep behind the wheel post-call,” said Dr Rozaimi.

“One incident will always stand out – I had just completed a 35-hour shift and was driving to my home in Shah Alam. I accidentally swerved into the fast lane when a car was already speeding along it. The loud honks (from the driver) saved me, I managed to swerve back into my lane.”

Dr Kuan (not his real name), 32, has also had his share of near-miss post-call experiences.

He said: “Although most of us (doctors) have adjusted to our hectic schedules, I can never forget an incident several years ago when I almost lost my life. I crashed into a divider and my car ended up in a drain. My injuries were minor but I could have drowned.

“After transferring to a research department two years ago, I no longer work more than 24 hours at a stretch. My quality of life has improved tremendously and I have not fallen asleep behind the wheel any more.

“We have all been guilty of falling asleep post-call while driving.”

Both Dr Rozaimi and Dr Kuan say their workloads have become heavier in recent years due to more patients going to public hospitals.

Dr Kuan said: “The number of patients has definitely doubled compared with several years ago. Most of the patients I have attended to have cited the higher cost of living as the reason they’re seeking treatment at public hospitals.

“We (doctors) are happy to be of service but I believe it is slowly taking a toll on us. A doctor at a public hospital sometimes has to take care of up to 500 patients. Imagine the exhaustion.”

In 2015, a survey of 440 healthcare professionals on the topic of post-call motor vehicle accidents was published by the Islamic Medical Association of Malaysia (Imam) and Pertubuhan Amal Perubatan Ibnu Sina Malaysia, a non-profit organisation.

Some 55 per cent of the accidents the respondents had been involved in occurred after they had worked for 25 to 36 hours.

Nearly 65 per cent of respondents also admitted they suffered from post-accident psychological trauma.

Imam’s Dr Munawwar Salim said that at the time, the survey highlighted the need for further investigations into the correlation between motor vehicle accidents and the preceding hours of duty.

After serving the standard 24 hours, most doctors have to work for a further four to 10 hours just to clear the backlog of work.

Sleep deprivation is one of the recognised factors contributing to motor vehicle accidents.

Research has shown that drivers who are suffering from fatigue are as cognitively impaired as drivers who are intoxicated.

The high cost of living has been cited as the top reason that more Malaysians are seeking treatment at public hospitals.

Last year, public hospitals saw 20 per cent more patients compared with the year before, according to the Health Ministry’s deputy director-general, Dr Jeyaindran Sinnadurai. He noted that even before 2016, the number had been increasing.

Restaurateur Rita Liyana Rahmat, 41, said she started going to government-funded hospitals and clinics after the GST kicked in.

“It’s already hard to cope with daily expenses these days. Forking out money for medical treatments at private medical institutions just doesn’t make sense to me,” she told The Straits Times.

Engineer Muhammad Najmi Abdullah, 36, said he prefers going to public hospitals, which he said are just as efficient as private ones.

“Cost is definitely a factor because the prices of goods and services are steadily increasing. But another reason is that the waiting time (at public hospitals) is almost the same as at private hospitals,” said Mr Najmi.

“Instead of using up my deposit – which always happens at private hospitals after I get discharged – I would rather get treated at or admitted to government hospitals.”

Dr Azlan Helmy Abd Samat from the medical association Imam said there is a definite link between the rising cost of living and the rising number of patients opting for public hospitals.

“When you have more people seeking treatment at public hospitals… it will also affect the doctors attending to them – they get overworked,” he said.

This shift also means that private outfits have seen a drop – of almost 30 per cent – in patient numbers, according to Association of Private Hospitals of Malaysia president Jacob Thomas.

He told The Malaysian Insight news site last month that patients are turning to public hospitals asthese hospitals are exempt from GST and treatment is almost fully subsidised by the government.

Dr Jacob urged the Health Ministry to collaborate with the private sector to reduce long waiting times for procedures such as magnetic resonance imaging, computerised tomography and positron emission tomography scans.

At some private hospitals, patients who have been referred by public hospitals are offered these services at reduced prices, he noted.

“We understand that 25 per cent of patients at public hospitals have access to private healthcare insurance. We can manage them in our private hospitals,” Dr Jacob was quoted as saying.

In May, government representatives from the Road Safety Department and the Health Ministry’s Occupational Health and Safety Unit, as well as medical associations, held a meeting to discuss ways to prevent doctors from getting into road accidents after exhausting shifts.

The meeting was held in response to concerns aired by a group of medical non-governmental organisations (NGOs) on May 13 about the number of medical professionals who were involved in road accidents after working long hours.

“Until today, we do not have data on this subject. This is the reason why we need to have our own research on this,” Dr Munawwar from Imam told The Straits Times.

For now, the NGOs are working to raise awareness of the problem through campaigns and engagements, he added.

They will also launch a discounted ride-hailing service for post-call doctors in collaboration with GrabMalaysia on Sept 16.

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U.S. Faces Looming Shortage Of Primary Care Physicians — A Growing Problem ObamaCare Never Tried to Address — Its now a global problem

August 3, 2017
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NEW YORK (CBSNewYork) – America will soon face a shortage of as many as 90,000 doctors.

CBS2’s Dr. Max Gomez reports a combination of retiring doctors and increasing demand will lead to a significant need for primary care physicians. But some medical schools are working to ease the problem.

Dr. Katelyn Norman just started her internal medicine residency at Waterbury Hospital in Connecticut. It’s one of the final steps to achieving her lifelong dream of becoming a doctor.

“The work you do has such consequences for people and their lives and their health,” she said.

The U.S. is in need of more primary care doctors, partly because many older physicians are retiring, citing increased paperwork and decreased time with patients.

Norman is part of the first graduating class at Quinnipiac University’s new medical school that is tackling the shortage in internal medicine, OBGYN, pediatrics and psychiatry.

The school’s dean, Dr. Bruce Koeppen, says primary care applicants are put at the top of the admissions list.

“Your primary care physician is your navigator through the healthcare system,” he said. “They see you for every particular problem you have, they can refer you to specialists if that’s the case, but they’re the ones who know you the best.”

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By 2025 there could be a shortage of up to 35,000 primary care physicians. Koeppen says money plays a role.

“If you’re graduating from medical school with several hundred thousand dollars in debt, you may choose a sub-specialty where your earning potential is greater,” he said.

Still, Norman said she made the right choice about the kind of doctor she wants to be.

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“If you’re able to control their pain, if you’re able to explain their risk factors when they’re afraid of inheriting something from family… It’s equally beautiful and rewarding,” she said.

Another reason for the looming doctor shortage is that as our population grows older, we are all going to need more health care. And most of that can and should be handled by primary care physicians, Dr. Max reported.

Other medical schools like the Touro College of Osteopathic Medicine are also prioritizing primary care applicants.

Includes video:

U.S. Faces Looming Shortage Of Primary Care Physicians

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