Posts Tagged ‘physicians’

China’s doctor shortage prompts rush for AI health care — Man’s inability to care for mankind?

September 20, 2018

Qu Jianguo, 64, had a futuristic medical visit in Shanghai as he put his wrist through an automated pulse-taking machine and received the result within two minutes on a mobile phone — without a doctor present.

The small device, which has a half-open clasp that records the heartbeat, is one of the technologies developed by hi-tech firms aiming to help China offset its shortage of physicians by combining big data and artificial intelligence (AI).

The machine made by Ping An Good Doctor was shown off at the 2018 World AI Expo in Shanghai at a time when Chinese policymakers are making a major push to turn the country into a global tech leader.

© AFP/File | China has less than 12 million health workers, prompting a drive for AI technology in the country of almost 1.4 billion people

“I came here to see how Chinese-style medical treatment could be done without a doctor. That would be really convenient,” said Qu, a retired IT worker attending the expo.

China had less than 12 million health workers in 2017 in a population of almost 1.4 billion, according to the National Health Commission.

Image result for Ping An Good Doctor, photos

Ping An Good Doctor, which recently listed in Hong Kong, has one of China’s largest online healthcare platforms with 228 million registered patients.

Bi Ge, a company spokesman, said the company receives 500,000 online consultation requests daily.

The pulse-taking machine is part of Ping An Good Doctor’s AI-assisted medical consultation system, which allows patients to do quick preliminary checks and get prescriptions without having to go to the hospital or pharmacy.

Ping An’s services include a mobile app in which patients enter their personal data, medical history and describe their symptoms to an AI-assisted “receptionist” that transfers the information to a real-life doctor for a diagnosis.

“It can definitely ease China’s doctor shortage problem… With the assistance of AI, it can relieve doctors from doing the mundane, simple, and repetitive work,” said Liu Kang, a former doctor at Peking Union Medical College Hospital.

“But China’s overall AI development in medical fields is still at the catching-up phase,” Liu added.

– ‘Still need real doctor’ –

US and European companies, startups and researchers have also been harnessing AI to apply the technology to various health care needs.

Chinese companies have been learning from other countries to develop and implement AI-assisted care such as medical imaging diagnosis, robot surgical systems, and drug research and development.

Good doctors in China are highly sought-after, but the supply is low and not equally distributed.

Less than 10 percent of China’s hospitals are considered high-level facilities, but they treat half of the country’s patients, according to a 2017 State Information Center report.

Big data and AI-assisted services and remote communication offered by companies such as Ping An allow patients from second- and third-tier cities to access professional advice from qualified doctors based in big cities.

“We are imitating and duplicating the skills of qualified doctors, the ones from tertiary-level (highest-level) hospitals, and spread it to smaller cities and local counties,” said Fang Qu, CTO of Proxima, a health care technology company focusing on AI-assisted medical imaging diagnosis.

Traditional Chinese methods of medical assessment — including pulse taking, which Qu experienced at the AI expo — are still popular among the elderly, although some might prefer a more human touch.

“It doesn’t feel the same as a doctor yet. I also don’t understand what the result means,” said Qu. “I’d still need a real doctor.”




Although we’re running low on doctors, the solution may not be more doctors

September 13, 2018
Less than 5 percent of OB-GYNs practicing in Sacramento, Calif., are under age 40. West Texas can’t recruit enough psychiatrists to meet the region’s needs. All but two of Alabama’s rural counties need more primary care physicians.

For most Americans, the physician shortage feels familiar: months to get an appointment, hours in the waiting room, and a visit so quick you barely scratch the surface. But it’s only going to get worse.

The Association of American Medical Colleges (AAMC) suggests that the country could see a shortage of up to 120,000 physicians by 2030. It’s already begun: The federal Health Resources and Services Administration calculated that 29 states already had shortages of primary care physicians in 2013.


SEPTEMBER 12, 2018

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Some argue that there are plenty of doctors, but they are just poorly distributed throughout the country. Although this may be true, the end result is the same: reduced access to care.

Rural areas will likely bear the brunt of reduced access. Rural populations tend to be sicker and in higher need of medical care. But that care is often unavailable because medical centers and health care providers are concentrated in urban areas. Fewer providers overall will only exacerbate the disparity.

Related: Not enough doctors? Nurses fill the gap after earning online degrees
What’s odd about the shortage is that the number of students graduating from medical school keeps increasing. It’s up 27.5 percent from 2002 to 2016. But the number of available residency slots isn’t keeping up, increasing only 8 percent in the same period. If new medical school graduates can’t place into residencies, they can’t practice, offering no relief to the shortage.

The number of non-physician providers has been growing steadily. For example, almost 28,000 nurse practitioners graduated in 2017 alone. But the potential of non-physician providers to deliver care is hindered by laws that limit their ability to diagnose and treat patients on their own.

Reforming graduate medical education

After medical school, all new doctors are required to complete several years of post-graduate training before they can practice independently. This includes residency, sometimes called graduate medical education. Hospitals receive funds for providing this education based on the number of residents they train.

Most of the money comes mainly from the federal government, which spends somewhere between $14 billion and $16 billion per year on graduate medical education, mostly through Medicare. Many states contribute funds as well. Hospitals are paid through two distinct financing streams, and funding caps were implemented in 1996.

The AAMC supports increased funding for graduate medical education, saying it will result in more resident physicians. But as Amitabh Chandra and co-authors have argued in the New England Journal of Medicine, graduate medical education may not be the most effective way to train new physicians. Previous funding cuts, for example, didn’t negatively affect residency training: salaries for residents weren’t reduced and the number of residency slots still increased. This suggests funding changes may not be the best way to reform the current program.

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Further, economists like Chandra argue that residents pay for their own training anyway. They accept lower wages regardless of how much funding for graduate medical education their training hospital receives.

While the impact of funding for graduate medical education on the capacity for physician training is murky, it is still central to sustaining training programs in hospitals. Thus, several medical associations recommend the evaluation of current policies in an effort to move toward a performance-based system. They argue that the current cost of training needs to be determined — per-resident funding is still based on 1980s data — and the two funding streams need to be consolidated into one. Then the system should be structured to respond to physician workforce demands, including specialty-specific shortages, and payments should be tied to its ability to do exactly that.

Reforming graduate medical education will likely have minimal effect on alleviating the physician shortage and thus access to care. The data suggest that other interventions, such as utilizing nurse practitioners and other non-physician providers, may be more effective. But at the very least, such reform will modernize a system that is rife with inefficiency and complexity.

Effective utilization of nurse practitioners

While the effect of reforming graduate medical education on the physician shortage is still theoretical, using non-physician providers more effectively already shows considerable promise. To be clear, all types of non-physician providers — nurse practitioners, physician assistants, and the like — have the potential to mitigate the impact of a physician shortage on access to care. For the sake of brevity, we focus here on nurse practitioners.

These clinicians have master’s and/or doctoral degrees and are licensed to provide direct patient care and case management, usually with physician supervision or collaboration. Both the quality and effectiveness of the care provided by nurse practitioners are on par with physician care, often at lower cost.

Even so, allowing nurse practitioners to work independently is met with resistance in America’s physician-dominated system. But doing just that, along with standardizing scope of practice laws nationwide, could increase access to care in the midst of a physician shortage.

Scope of practice laws fall into three categories: full practice, reduced practice, and restricted practice. Full practice laws, which allow nurse practitioners to independently care for patients without supervision by or collaboration with a physician, are recommended by multiple medical organizations. Yet only half of U.S. states have them.

Related: Military medics and corpsmen could help fill the shortage of primary care providers

The use of nurse practitioners is increasing nationwide, and has been for years, but license restrictions diminish the true potential of their care. As expected, states with the least-restrictive scope of practice laws have the highest utilization of nurse practitioners. State-by-state variations in these laws lead some nurse practitioners to leave more restrictive states in favor of full-practice states, which likely worsens existing provider shortages.

The Brookings Institution argues that restrictive scope of practice laws are used as anticompetitive barriers, legally separating physicians from non-physician providers. The end result is reduced efficiency, productivity, and access to care. Independent nurse practitioners offer the opposite: cost savings and increased access to quality care.

When the AAMC predicted the physician shortage, it also looked at how various policy interventions could alleviate the impact. Maximum use of non-physician providers was the only intervention for which predicted provider supply was greater than demand, most significantly for primary care. Effectively employing non-physician providers could mitigate the effects of a physician shortage on provider accessibility.

The U.S. has the best health care in the world but access to it is fading fast. Reforming graduate medical education may be needed to prepare for future workforce demands, but independent practice for non-physician practitioners is likely at the crux of an immediate solution.

Elsa Pearson, M.P.H, is a policy analyst at Boston University School of Public Health. Austin Frakt, Ph.D., is the director of the Partnered Evidence-Based Policy Resource Center at VA Boston Healthcare System; an associate professor at Boston University School of Public Health; and an adjunct associate professor at Harvard T.H. Chan School of Public Health.


American health-care workers are committing suicide in unprecedented numbers

May 31, 2018

As America focuses on one epidemic — the opioid crisis — another goes entirely ignored. American health-care workers are dying by suicide in unprecedented numbers. Earlier this month, a medical student and a resident at NYU medical school completed suicide less than a week apart.

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My junior colleague took her life just 11 days before her 35th birthday. I had supervised her as she transitioned into practice from fellowship. She said that the way I said her name foretold if the conversation pointed to a weakness or a strength in her patient assessment. My last sight of her was as she drove off to her new job. Less than six months later, she made a life-ending choice.


A scan of her suicide note, asking that I be notified, was emailed to me. I did not show it to anyone. The news of her suicide was announced by an email in the department. We all went about our business, as if suicide by a young colleague is usual. And perhaps, in a way it is.

After all, physician suicide — and more broadly health-care worker suicide — is a huge issue in the U.S. In my own experience, I have lost six colleagues to suicide — five physicians and one physician assistant. That does not include the suicides that I have heard about through the whisper network at work.

My junior colleague was among an estimated 400 physicians who took their lives in 2016. Many physicians know more doctors than patients who have taken their lives. Physicians and nurses complete suicide more often than do average Americans; rates are even higher for women in both professions. Respect, fear and love for our colleagues often leads us to list the cause of death differently on death certificates. We frequently self-medicate, so suicides may instead be listed as accidental. Phrases to describe the scope like “an entire medical school class a year” or “a doctor a day” have particularly ominous meanings for physicians.

All of the physicians that I knew who took their lives were American medical graduates, a worrisome statistic if it reflects the general trend. A full 24 percent of physicians in the U.S. are international medical graduates; my specialty, pathology, is about 40 percent international graduates.

Although a recent report of suicides among residents does not suggest differential suicide rates among international and American medical graduates, the data may be limited by the nature of the study. The number for nurse or other health-care worker suicide is unknown, since we do not even track these numbers. Earlier this year, the National Academy of Medicine released a paper to raise awareness of nurse suicide, calling for a closer look at another facet of this epidemic. The high suicide rates correlate with the high rates of depression among physicians and nurses.

Why physicians and health-care workers are more likely to complete suicide is unknown. It perhaps has to do with a work-related mental health syndrome called disengagement and burnout, which has reached epidemic proportions in health-care providers and nurses. Excessive pressures and expectations at work, paired with seemingly unattainable goals for quality and productivity as well as societal loss of trust in physicians, has led to a loss of meaning of work and of self for physicians. This is not the norm that physicians or nurses expected when we answered the call to be care-providers.

Regardless of why medical workers tend to die by suicide, there needs to be a call to arms to do something about it. Health-care organizations need to more proactively report suicide in their workforce, so we can begin to understand the drivers for suicide in health-care workers. The information needs to be granular enough to identify risks by specialty and work-type.

More immediately, institutions need to develop procedures and processes for grief recovery support for colleagues of the deceased. Many institutions shy away from even mentioning suicide at the workplace. There is concern for suicide contagion, an increased tendency toward suicide in the already predisposed upon hearing of a suicide. There is stigma to talking about suicide among leaders, and fear that it will cast a shadow on them or their organization.

But, that is the wrong response. Colleagues suffer when one of their own is lost to suicide. One spends a third of one’s life at work. Sustained relationships at work are particularly important in an environment that is so stressful. The responsibility for another’s well-being and the ever-present risk for potential harm to another from a misjudgment extracts a heavy emotional toll on health-care providers.

We perhaps even blame ourselves more when we lose a colleague to suicide. Why did I not see it? Could I have done something to prevent it? One wonders about one’s self worth and one’s ability to care for patients when one fails a colleague and friend. One institution at least, UCSD, has heard this call to action and created the Healer Education and Assessment Referral program, which promotes self-assessment for depression and provides support for all health-care workers in the setting of a coworker’s suicide. But more needs to be done — at a department level, at an institutional level and at a national level.

Postvention programs to provide support for survivors of a co-worker suicide need to be developed in the profession. Structured prevention strategies to reduce suicide need to be developed as has been done for the police and military — two other at-risk professions for suicide. Leaders need to be trained to give support to their providers, so providers can heal and continue in their job of caring for their patients, after one of theirs is lost to suicide.

Vinita Parkash M.D. is an associate professor of pathology at the Yale School of Medicine. She is a Public Voices fellow with the OpEd Project, which is an organization that focuses on increasing the number of women thought leaders contributing to key commentary forums and media outlets.




The opioid crisis is draining America’s workforce

February 23, 2018

“The job search has not been going good,” said Harsanyi, a baby-faced 27-year-old with tattoos poking out of his collar. “I think when you’re a drug addict in sobriety with a felony on your record, they look at you different, like you’re going to rob their store.”

Jobs are plentiful in Maryland’s Anne Arundel County, which boasts an unemployment rate of 3.1%. But after doing time for an armed robbery committed while he was high in 2015, Harsanyi has so far been turned down for jobs at Valvoline and Jiffy Lube, and is only able to pick up occasional work as a tile setter for another recovering addict he met through his 12-Step program.

Harsanyi’s experience isn’t just hard on him. The opioid crisis is turning into a real problem for employers, who are having trouble finding workers in the midst of one of the tightest labor markets in decades.

There are nearly 6 million job openings in the U.S. and the unemployment rate, at 4.1%, is at a 17-year low. But the share of people working or looking for work still hasn’t recovered from before the recession. Part of the problem: The rise in abuse of prescription painkillers, partially responsible for the 64,000 drug overdose deaths in 2016, has incapacitated thousands of working-age people whom employers would otherwise be eager to hire.

And it’s concerning officials at the highest levels of government. “Curbing the opioid crisis is of critical importance for ensuring a stable or growing employment rate among prime-age workers,” wrote President Trump’s Council of Economic Advisors, in its annual economic report.

Related: How the opioid crisis is crippling America’s labor force

Last fall, Princeton economist Alan Krueger found that the increase in prescribing rates can account for between 20% and 25% of the approximately five-point drop in labor force participation that occurred between 1999 and 2015.

“Other countries had severe recessions worse, in many cases, than the U.S.,” Krueger said. “Yet they don’t face nearly the type of opioid crisis that the U.S. is facing. So I think this is at the moment a uniquely American problem.”

A map in Krueger’s study showing the intersection of opioid prescription rates and declines in labor force participation colors in large dark swaths over much of Appalachia and the Rust Belt. Those economically depressed places have become synonymous with the narrative of opioid addiction as a disease of the downtrodden, fueled by joblessness and despair.

opioid crisis

But the map also has dark spots in economically healthier areas, like coastal Washington state, northwest Arkansas and central Maryland, where unemployment rates are low and businesses increasingly complain that they can’t find enough workers.

Recent research by University of Virginia economist Christopher Ruhm suggests that while joblessness may have created fertile conditions for opioid addiction, the epidemic’s spread was fueled more by the availability of prescription drugs. Overprescribing has stricken communities on every rung of the economic ladder, and it’s now becoming a particular problem for places with more jobs than able-bodied workers.

“It’s coming out of areas where there’s a lot of money,” said Angel Traynor, who started a sober house for women in Annapolis, Maryland, in 2012 and now runs three of them. Many drug users can work for a while, but things usually fall apart when their habit becomes too expensive, which brings on crippling withdrawal spells. “Towards the end of anybody’s addiction, they’re not capable of holding a job,” Traynor said.

Related: Ohio blames drugmakers for fueling opioid crisis

Maryland saw a 70% increase in opioid-related deaths in 2016, when 1,856 people died. Although local law enforcement agencies often track overdoses, few governments have comprehensive data on the number of people in treatment for addiction at any one time. Anecdotal evidence, however, suggests that population has grown quickly.

As a result, some employers that typically screen drug users out through testing are starting to become less picky, according to Central Maryland Chamber of Commerce president Raj Kudchadkar.

“There’s definitely a direct impact on the business ecosystem,” said Kudchadkar, who has noticed changes primarily in the restaurant and retail sectors. “People have expressed fear about screening, because it might impact their ability to fill positions.”

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Deena Bradbury (right) at Grump’s Cafe with employee, Mehgan Degere.

Deena Bradbury, co-owner of neighborhood favorite Grump’s Cafe in Annapolis, said it would be hard to fully staff her two locations if she hired based on drug test results. One of her largest sources of labor are nearby sober houses, where residents are required to find a job, and usually don’t have a vehicle to travel far afield.

Bradbury will hire the people who list those telltale addresses on their applications, but she has to take extra precautions.

“Once we realized that there was a lot of folks with this set of circumstances, we changed how we dealt with it,” said Bradbury. For example, she makes sure that recovering addicts are honest about any past criminal records, and doesn’t assign more than one at a time to the same shift, to make sure they don’t negatively influence each other.

Related: Walmart is giving away free opioid disposal kits

It doesn’t always work out. Some employees relapse and disappear. But those who stay, Bradbury said, can be even better workers than those who’ve never popped a pill in their lives. “I think they tend to put forth more effort,” Bradbury said. “They don’t feel like a job is owed them. They tend to earn it.”

Such tolerance is not an option for all employers. Jobs that involve working with children typically bar people with criminal records. Construction companies, too, are less likely to take the risk of hiring someone who might come to work high and make a fatal mistake while on a ladder or using heavy equipment. In Annapolis, where a lot of construction work happens on government property, those rules are more commonly enforced.

But people in the treatment community emphasize that getting former addicts back to work is an essential part of recovery, and want more employers to give them a chance. For Mike Harsanyi, it’s another reason to stay on the wagon.

“When you’re not thinking about yourself, and you’re thinking about your job, and wanting to do better, and getting money, you just forget about you and your problems,” he said. “I really feel that addicts and alcoholics, once you get sober and once you get an opportunity, you flourish. But getting that opportunity is the problem.”

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Trump Says He Will Focus On Opioid Law Enforcement, Not Treatment — Slashing treatment budgets — No signs of developing a comprehensive national strategy to address the opioid epidemic

February 8, 2018

“It’s like closing a fire station in the middle of a wildfire.”

By Greg Allen


February 7, 2018 

More than three months after President Trump declared the nation’s opioid crisis a public health emergency, activists and healthcare providers say they’re still waiting for some other action.

The Trump administration quietly renewed the declaration recently. But it’s given no signs it’s developing a comprehensive strategy to address an epidemic that claims more than 115 lives every day. The President now says to combat opioids he’s focused on enforcement, not treatment.

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Trump spent just over a minute of his 80-minute State of the Union address talking about opioids. In a speech this week in Cincinnati, he had a few more comments. The opioid epidemic, he said, “has never been worse. People form blue ribbon committees. They do everything they can. And frankly, I have a different take on it. My take is you have to get really, really tough, really mean with the drug pushers and the drug dealers.”

The President’s mention of “blue ribbon committees” sounds like a slam on one he convened last year, chaired by former New Jersey Governor Chris Christie — the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The commission issued more than 50 recommendations. The administration has so far followed up on just a few of those recommendations.

Some officials and care providers who work on the frontlines of the opioid crisis, however, are scathing about what they see as a lack of action from the White House. Former Congressman Patrick Kennedy, who served on the White House opioid commission, says he’s “incredulous” that, after declaring a public health emergency in October, the President still hasn’t requested any money from Congress to combat the epidemic.

“I mean this is just a mental health crisis of the first order,” Kennedy says, “and this administration has done nothing.”

Here’s what the administration has done so far:

  • President Trump declared a public health emergency in October to deal with the opioid epidemic. The declaration brought no new money to fund the federal response.
  • In November, President Trump announced he’s donating his third-quarter salary — about $100,000 — to help the Department of Health and Human Services fight opioids.
  • The Centers for Medicare and Medicaid Services announced a policy change in November that allows states to apply for waivers allowing them to use Medicaid to pay for residential drug treatment at facilities that have more than 16 beds. Some states are already taking advantage of that policy change.
  • President Trump signed the INTERDICT Act in January giving federal agents additional tools for detecting fentanyl and other synthetic opioids at the border.
  • Also this month, Attorney General Jeff Sessions announced an operation using medical data to crack down on pharmacies and doctors that dispense suspicious amounts of opioids.

Here are things critics point out the administration hasn’t done:

  • There is still no head of the Office of National Drug Control Policy. In October, Trump’s nominee to the position, Rep. Tom Marino, R-Pa., withdrew his name after reports linked him with a bill that limited the DEA’s ability to investigate abuses by opioid manufacturers and distributors.
  • President Trump still hasn’t nominated anyone to head the Drug Enforcement Agency.
  • The administration hasn’t asked Congress for any new funding to address the opioid epidemic.

Roughly 64,000 people died from drug overdoses in 2016, and data from the CDC indicates deaths are rising. Kennedy says what’s needed is a coordinated federal response similar to the one in the mid-1990s — when the U.S. spent $24 billion a year to address the HIV/AIDS crisis.

“We’re talking about a major league crisis and they’re taking credit for little things, while the whole country is burning down,” Kennedy says.

Instead of a big boost in funding, the Trump administration is focused, in many cases, on cutting spending.

In the 2018 budget, the President recommended cutting the Office of National Drug Control Policy budget by 95 percent, and may do so again this year.

“It’s very hard to make sense of,” says Keith Humphreys, a professor of psychiatry at Stanford and former policy adviser to the drug czar’s office in the Obama administration. “I mean, it’s like closing a fire station in the middle of a wildfire.”

A law signed by President Obama that designated a billion dollars to help states combat opioids runs out of money this year. Humphreys has seen no sign President Trump intends to ask Congress to renew that funding.

“The 2018 budget had a $400 million cut to the Substance Abuse and Mental Health Services Administration which is the lead agency that funds treatment in the United States,” Humphreys says. “So, the administration’s impulse seems to be not to spend more — in fact to spend less.”

The White House is preparing to act on one of the recommendations of its opioid commission—that it launch a campaign to educate the public, especially young people, on the dangers of opioids. The campaign is being developed not by the Office of National Drug Control Policy, but by a team in the White House led by Kellyanne Conway.

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The U.S. Opioid Crisis: How Can We Remedy? — U.S. has five percent of the world’s population but uses 50 percent of the world’s opioids

January 5, 2018



This post was contributed by Gerald McKenna, MD, a board member of the Physicians Foundation and the CEO and Medical Director of his private practice in Addiction Medicine, McKenna Recovery Center.

(Photo credit: Shutterstock)

The United States is in the midst of an opioid crisis unlike anything we have seen in medicine since the HIV epidemic in the 1990s. Imagine, the U.S. has five percent of the world’s population but uses 50 percent of the world’s opioid analgesics. In 2017 alone, an opioid overdose was the cause of more than 60,000 deaths—quadruple the number of deaths since 1999. This death rate continues to increase and shows no signs of slowing.

In order to understand the origins of this opioid epidemic, we need to go back to the early 1990s. New guidelines on analgesic treatment and quality assurance issued by the U. S. government (1995), the American Pain Society (1995), and the World Health Organization (1996) tell the story.

There was a movement to treat pain more adequately than what had been done in prior decades. Pain was to be labeled as the fifth vital sign in medicine, in addition to blood pressure, pulse, respirations, and temperature. As a result, physicians were ordered to adequately evaluate and address pain in their patients. As part of this order, there was a requirement in California to obtain at least ten Continuing Medical Education (CME) credits per year to ensure that all physicians with a California license adhered to the new policy. Physicians who did not comply or who had complaints against them for inadequate pain control were sometimes referred to peer-review committees to have their noncompliance evaluated.

The new recommendations appeared successful and were quickly adopted nationwide.  It was not unreasonable to expect that a trained physician would be able to determine the origins of pain and provide adequate treatment for it. Thus, the production and sale of short-acting opioids increased dramatically.

Unfortunately, the CME courses that were offered to physicians attempted to address the proper prescribing of opioids, but did not necessarily emphasize the use of non-opioid approaches to treating chronic pain.

As the opioid crisis has reached a climax, physicians have been forced to look carefully at their prescribing habits. Physicians’ continuing medical education programs are now deemphasizing the use of opioids in all but acute pain, such as for postsurgical analgesia.

A corollary to this reeducation and reconsideration by physicians is the challenge to help reduce opioid use for patients who have been placed on very high levels of opioid analgesics for years. This is an incredibly important task – to reverse the alarming opioid crisis we find ourselves in today as a country.

The Physicians Foundation, of which I am a board member, was established to aid physicians in dealing with serious emerging problems in our healthcare system. The opioid crisis is an issue the Foundation recognizes as a critical one that must be addressed. That begins with properly educating our physicians, then treating patients using effective and safe means.

There are a series of actions that need to be taken if we are going to affect the opioid crisis.

  • Educate physicians, nurses, pharmacists, medical students, residents and the public on the treatment of acute and chronic pain.
  • Pharmaceutical companies need to recognize their role in creating this crisis and work with the medical profession to address it.
  • Educate patients regarding treatment approaches to both acute and chronic pain.
  • Implement a group model for patients who present to primary pain clinics with complaints of chronic pain. This model is well suited to educate patients regarding the clinic’s approach to the use of opioid analgesics, central and peripheral mechanisms involved in pain, non-medication approaches to pain and empowerment to support each other in dealing with chronic medical conditions involving pain.
  • Encourage physicians to take the online training in the use of buprenorphine, an often lifesaving medication.

In a similar vein, addictionists have come to understand that the physical and emotional reaction to chronic drugs can easily lead to a chemical use disorder, the term used to describe the chronic medical conditions formerly called addiction or drug dependence. There has traditionally been inadequate training in medical schools and residencies regarding the diagnosis and treatment of chemical use disorders, but the American Society of Addiction Medicine has provided many educational opportunities online and in courses around the country to train physicians in the recognition, early treatment, and referral for further intervention of these chronic medical illnesses.

Physicians need to be trained in the early signs and symptoms of chemical use disorders, including drug-seeking behavior, physician manipulation, seeking prescription from multiple physicians, and using emergency rooms and urgent care clinics to obtain opioid analgesics for non-existing or minor injuries.

Our health care system needs to be revamped to provide this equal recognition. Without these changes, chemical use and psychiatric disorders will always be sidelined and will not be recognized as chronic medical problems in need of equal treatment.

The opioid epidemic is vast and increasing. We have the tools at hand to be able to successfully intervene in this serious medical problem. It will take congress and the will of the people in pressuring our congressional leaders to support the readily available solutions to this deadly problem.

U.S. hospitals feeling the pain of physician burnout

November 21, 2017


By Julie Steenhuysen


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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.

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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.


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.


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.”


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)

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.


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


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.


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.




Doctors are not prescribing a drug to treat opioid addiction because they don’t want to be flooded with patient requests for it, study says

August 4, 2017

Suboxone buprenorphine/naloxone tablets 8mg 2mg

  • Doctors are hesitant to prescribe a drug that treats opioid addiction  
  • Buprenorphine can treat addiction if a doctor has a waiver to prescribe it
  • It is the less severe of only two drugs approved by the FDA to treat addiction
  • In the past few years there has been an uptick in opioid use in the United States
  • Doctors said they were hesitant to prescribe it because they don’t want a flood of new patients
  • Those that do prescribe it have said they don’t want to prescribe more because they can’t handle more patients 

Doctors are hesitant to prescribe a drug that treats opioid addiction and withdrawal, a new survey revealed.

One of the two drugs that treats opioid addiction is being under-prescribed, especially when taking into account the spike in numbers addicted.

Most doctors said they don’t want to prescribe the drug because they don’t want to be flooded with new patient requests according to the study at Johns Hopkins School of Medicine in Maryland.

And among the doctors that can prescribe it, a number didn’t want to give it to new people because they don’t feel they can take on new patients.

Doctors are hesitant to prescribe a drug that treats opioid addiction and withdrawal, a new survey revealed (stock image) 

Doctors are hesitant to prescribe a drug that treats opioid addiction and withdrawal, a new survey revealed (stock image)


‘Though it was widely believed that allowing physicians to prescribe this drug in a primary care setting would increase the number of patients receiving treatment, the number of physicians adopting this therapy has not kept pace with the magnitude of the opioid epidemic,’ lead author Dr Andrew Huhn explained.

In the past few years there has been an uptick in opioid addiction, with the most common being heroin and the powerful contaminant fetanyl.

Paul Wright shows a picture of himself in the hospital after a near fatal overdose in 2015, Thursday, June 15, 2017, at the Neil Kennedy Recovery Clinic in Youngstown, Ohio. (AP Photo/David Dermer)

Fentanyl, the drug responsible for the death of musician Prince last year, is a man-made opioid 100 times more powerful than morphine.

Opioid addiction impacts million of Americans, and withdrawal symptoms can be severe if a sufferer stops taking them.

Withdrawal can cause intense sweating, nausea, chills, diarrhea, shaking, depression, fatigue and severe pain.


Figures released in June by the New York Times revealed drug overdoses are now the leading cause of death in American adults under 50.

The data, published in a special report by the Times’ Josh Katz, lays bare the bleak state of America’s opioid addiction crisis fueled by deadly manufactured drugs like fentanyl.

The figures are based on preliminary data, which will form part of an official report by the CDC later this year.

Experts warn a key factor of the surge in deaths is fentanyl, which can be 50 times more powerful than heroin.

The Times said its data showed between 59,000 and 65,000 people could have died from overdoses in 2016, up from 52,404 in 2015, and double the death rate a decade ago.

In the past few years there has been an uptick in opioid addiction, with the most common being heroin and the powerful contaminant fetanyl.

Fentanyl, the drug responsible for the death of musician Prince last year, is a man-made opioid 100 times more powerful than morphine.

The two opioid replacement methods currently used to treat addiction are:

  • Methadone, which under federal law must be dispensed from authorized clinics
  • Buprenorphine can used to treat addiction in the privacy of a physician’s office so long as he or she has proper waivers to prescribe it

Buprenorphine was approved for treatment of opioid use disorder in 2002, but in order to prescribe it physicians must apply for a waiver from the Substance Abuse and Mental Health Services Administration.

It works similarly to methadone, but is less intense and therefore not as likely to be abused.

Both suppress addiction withdrawal symptoms with daily doses of the drug.

A physician who has a waiver to prescribe buprenorphine is allowed to treat up to 30 patients in the first year and 275 in each year following.

The team of researchers surveyed 558 English-speaking physicians in the United States over email during the spring and summer of 2016.

Each participant was asked a series of questions addressing drawbacks associating with prescribing the drug, possible resources that would make doctors more likely to get the waiver, and resources that would make those with the waiver accept new patients.

Only 74 said they did not have the waivers required to prescribe the drug. Of them, one-third said nothing would make them more willing to get a waiver.

The most common reasons for not having the waiver were not wanting to be inundated with new patient requests for the drug and concerns about people reselling it.

More than half of the people who said they had waivers and were not prescribing to capacity said nothing would make them more willing to prescribe at that level.

The most common reason for not prescribing at the maximum capacity were lack of time for new patients and insufficient reimbursement.

Participants in general said they would be more willing to either obtain the waivers or increase their number of patients if they received information about local counseling resources, were paired with an experienced provider and if there was more access to medical education courses on opioid use disorder.

An estimated 1.27 million people were hospitalized or went to the emergency room for opioid related issues in 2014. This was a 64 percent increase for in-patient care and a 99 percent increase for emergency room visits compared with 2005.

‘I think the two biggest takeaways from our research are that there are not enough physicians prescribing buprenorphine to meet patient demand, and access to counseling services for patients and mentoring services for physicians would make physicians more likely to take on new patients with opioid use disorder,’ Dr Huhn said.

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Doctors Leaving Venezuela During Unrest

June 13, 2017

Country’s loss of medical and other professional personnel is gain for places like remote Chilean island

Doctors Flee Desperate Venezuela to Work in Safer Places

© Juan Barreto, AFP | Opposition activists clash with the police during a demo in Caracas on June 7, 2017.


June 12, 2017 5:39 p.m. ET

ANCUD, Chile—On a recent day in this remote island town, Dr. Jhomar Yansen rushed to operate on a man who had been kicked in the gut by a sheep and was suffering severe internal bleeding.

The surgeon worked in his native Venezuela saving patients with gunshot and knife wounds until last year, when he fled the chaotic, impoverished country like thousands of other professionals. Now he finds himself as part of a cluster of Venezuelan physicians looking after fishermen and shepherds here on a green archipelago in the frigid Southern Pacific.

“This isn’t exactly where I thought I’d work,” said Dr. Yansen, who lives here with his wife, also a doctor, and their infant daughter. “But thank God I’m here. I didn’t want my daughter to grow up in such a hostile environment.”

Venezuelan physicians Eiko Desirée Urquiza  and Jhomar Yansen at the hospital where they work in Ancud, Chile.
Venezuelan physicians Eiko Desirée Urquiza and Jhomar Yansen at the hospital where they work in Ancud, Chile. PHOTO: RYAN DUBE/THE WALL STREET JOURNAL

Nearly 2 million Venezuelans have fled their country since the late strongman Hugo Chávez took office in 1999 and put his country on the path to socialist revolution, according to Tomás Páez, a sociologist at Venezuela’s Central University who wrote a book on the diaspora.

The numbers have accelerated since President Nicolás Maduro took over in 2013, Mr. Páez said, with businessmen, university professors, farmers and oil workers abandoning a country riven by authoritarian rule and protests. Venezuelans are flooding particularly into neighboring Colombia and Brazil. They have boarded boats bound for Caribbean islands. In the U.S., their asylum requests have surged, while the sight of them selling cornmeal cakes known as arepas has become a commonplace in the Peruvian capital, Lima.

The exodus of doctors is exacerbating the already serious strain on Venezuela’s once-vaunted public-health system, which has been crippled by dilapidated hospitals and shortages of medicine, supplies and equipment. Figures released last month by the country’s health ministry showed maternal mortality there increased by 66% last year; infant mortality, which rose by 30% last year, is now higher in Venezuela than in war-torn Syria. Malaria and diphtheria rates are soaring amid shortages of insect repellents, vaccinations, and public-health funding.

Fellow activists help an injured opposition demonstrator during clashes with riot police last month in Caracas.
Fellow activists help an injured opposition demonstrator during clashes with riot police last month in Caracas. PHOTO: FEDERICO PARRA/AGENCE FRANCE-PRESSE/GETTY IMAGES

The Venezuelan Federation of Doctors estimates that some 16,000 doctors have left in 12 years, moving as far away as Spain and Australia.

“If this wave of migration of doctors to other countries continues, a moment is going to arrive…when they aren’t going to have enough capacity to run hospitals,” said Juan Correa, the federation’s vice president. Calls to Venezuelan health authorities seeking comment weren’t returned.

Venezuela’s loss is helping places like Ancud on Chiloé, a tranquil island of green rolling hills, Humboldt penguins and wooden churches located 760 miles south of Santiago—and a world away from Venezuela’s strife.

“We’ve had, I would say, a blessing with doctors of such good technical quality,” said Luis Hernán Vallejos, a Chilean physician who runs the Ancud hospital’s emergency unit.

Venezuelans have arrived to Chile in droves, attracted to the political stability in Latin America’s most developed nation. Last year, nearly 23,000 Venezuelans received visas, up from 439 in 2006, with recent arrivals including many young, well-educated professionals, according to the head of Chile’s immigration office, Rodrigo Sandoval.

“Chile is kind of this California of the south,” said Cristián Doña, an immigration expert at the Diego Portales University in Santiago, referring to this country’s appeal to South American migrants.

Last year, 1,313 Venezuela-educated physicians, more than any other foreign group, took a test to work in Chile’s public-health system, up from just 16 in 2011, according to exam administrators. Most took jobs in areas that have an acute shortage of physicians, said Juan Carlos Riera, a urologist who created an association of Venezuelan doctors in Chile.

Many more could arrive. In 2016, 88% of medical students in their final year at four Venezuelan universities said they hoped to emigrate after graduation, according to research by Iván de la Vega, a Venezuelan sociologist.

The town of Ancud in southern Chile has become home for a cluster of Venezuelan doctors escaping their native country's crisis.
The town of Ancud in southern Chile has become home for a cluster of Venezuelan doctors escaping their native country’s crisis. PHOTO: RYAN DUBE/THE WALL STREET JOURNAL

Mario Castro, the first Venezuelan physician to settle in Ancud, fled with his family in late 2015 after a friend was kidnapped and a neighbor’s car was stolen with her baby in the back seat.

“In no way did I want my son to grow up in an environment with so much violence,” the fertility expert said.

In the last 18 months, about a dozen other Venezuelan doctors—including surgeons, gynecologists, and anesthesiologists—have found work in Ancud’s small 72-bed hospital.

The physicians recently saved a baby through an emergency caesarean section and operated on a man’s deeply cut forearm and wrist to avoid amputation. Angélica Velásquez, a 25-year-old woman Dr. Castro treated for difficulties conceiving a child, recently gave birth to twins.

“I’ve had an excellent experience,” she said. “His knowledge can help a lot of women like me.”

These Venezuelan exiles from a Caribbean climate have adjusted to the Chilean island’s cold nights by learning to split firewood to heat their houses. They have been rattled by powerful earthquakes and had to start thinking of where to flee in the case of a tsunami.

Venezuelan doctors Karina Castilla and Eduardo Arteaga at their home outside Ancud, Chile.
Venezuelan doctors Karina Castilla and Eduardo Arteaga at their home outside Ancud, Chile. PHOTO: RYAN DUBE/THE WALL STREET JOURNAL

Sometimes, they listen to Venezuela’s folk music, recalling memories of home.

“At times you want to cry,” said Karina Castilla, a gynecologist from Caracas. “You’re in a country that has welcomed you, but it isn’t your country and it will never be.”

Still, they don’t see a future back in Venezuela. Here there are no food shortages. Some doctors have opened businesses, and many are able to send remittances and medicines to family back home.

“I have no problem living here,” emergency-room physician Daniel Arocha said as he watched his daughter play in a park. “We found what we were looking for.”

Write to Ryan Dube at