March Matching Madness

This is SO last week, but I'm behind on posting to this blog. Recently, I posted about the residency "matching" process for myself and other 4th year medical students. And then school happened, and then I went to the AMSA national convention (more on this to come), and that's where I found out where I'm going for the next three years of my life, for family medicine training!

I'm going to Harbor-UCLA for family medicine! Yay! I've been in love with the program from the moment I found out about it -- I'll be receiving excellent clinical training in clinical medicine, working with seriously underserved populations, working at a county hospital system (that doesn't turn any patients away for lack of health insurance), working with seriously community-organizing-minded faculty and seriously inspiring and fun residents, and living in one of the most diverse communities in America. This is a place I'll be inspired by visionary people every day. The leadership of the program see the workings of health in a broad sense, and see family physicians naturally fitting into a new paradigm of dealing with health and the improvement of health -- a "thinking outside of the box" kinda paradigm. I'm sure i'll write so much more about this as I transition to the west coast and start my residency. It's coming up -- I graduate on the 25th of May and start residency in mid-June. Yikes! Anybody have housing tips for LA? Anyone have culture tips on LA? Good clubs? Any clubs want a drumnbass/hiphop dj? jk...

The only thing that's going to be a downer for me is that my parents won't be around, as they're in New Jersey. I'm hoping i'll see them relatively often, and I can't yet imagine what life's going to be like without them close by.

Ah, I forgot to mention -- my good friend Shipra (who goes to medical school with me) will be joining me at Harbor-UCLA for family medicine. She has a previous career in environmental justice organizing and keeps me on my toes in regards to walking the walk that I may otherwise just talk. I'm SO excited to be spending the next 3 years training with her, and hanging out with her and her awesome husband. AND... my good friend Casey Kirkhart, this year's Jack Rutledge Fellow for Universal Health Care and Eliminating Health Disparities at AMSA (the job I had last year) will ALSO be joining me at the program! Not only is HE kickass, but his wife April is so much fun and is a community organizer/social worker/yoga teacher! I'm doing the anju dance...

Update on county public hospital finances and politics.

I had the pleasure of attending my first Board of Regents Health Sciences Center sub committee meeting this past week and i learned some interesting truths there.

first off, for those not familiar with power politics, the board of regents is the highest level board at a university. in new mexico, all members are appointed by the governor. this subcommittee has the obligation to oversee all financial and mission aspects of the entire health sciences center, including the hopital and medical school.

after a few weeks of front page news stories about a $2.5 million deficit which was blamed on poor anduninsured people, the truth surfaced in a quiet but profound way. we are only about $100,000 behind budget. the real cause of some of the loss is not uncompensated care rising, it's that our outpatient surgical business is not running at predicted numbers and we lost two GI doctors last year which seriously decreased our specialty income at the hospital.

on top of that, for the first time ever, the hospital administrators finally published their data on how much uncompensated care we really give. let me take a moment to define some terms here. uncompensated care is care given by an institution or provider that has NO REIMBURSEMENT SOURCE. it breaks down into charity care (which is care given away without any effort to try to collect on it) and bad debt (which is care that is charged to patients, sent to collections and then eventually written off as uncollectable).

our hospital administrators were claiming almost $100 Million per year in uncompensated care. no one challenged this figure publicly until the community coalition came along and raised the issue in public meetings and with the board of the hospital. three years later we finally have a partial picture of the truth. out of the $100 Million estimated as uncompensated care about $86 Million has some source of compensation thru county or state taxes, and special reimbursements thru Medicare and Medicaid. The new total of uncompensated care is: $14 Million. not such a horrible number in a $600 Million institution. these are the hospital's figures, made public last week, not mine.

i would also subtract from this estimate all the tax breaks the hospital gets (no property tax, no gross receipts tax, less state and federal taxes for being a nonprofit). subtract the large donations of pharmaceuticals from big companies like pfizer easily totalling over $1Million per year. subtract a few million for having terrible same day access to urgent care forcing uninsured people to use the ER and get much larger bills. subtract all the CEO bonuses. subtract all the money spent on travel, food, vacations of the top execs. subtract all the price breaks the hospital gets on supplies and medicines thru special programs like 340B pricing.

what would the new total be? perhaps a few million? and yet we're made to think that the hospital is going broke because of uninsured people over-using the services. i'm glad that wiser heads than mine, and certainly wiser heads than the CEO are sitting on the board and asking some real questions now. i'll keep y'all updated as things progress.

aziwa

Hiphop for healthcare

Last fall, I represented the American Medical Student Association on a panel on "generation debt and healthcare" at the Campaign for a National Health Plan NOW's new york conference. I had the fortune of being on a panel with the kickass speaker and activist Adrienne Marie Brown and the wonderful L. James from a neat organization called the Grassroots Artists Movement, which partly serves to unionize independent hiphop and other musicians and help provide health care benefits to them. The organization is also building power to organize around health care for everyone. After the panel an impressive spoken word artist/rapper named Hasan Salaam dropped some INSANE raps full of political knowledge and beautiful rhythms. He's absolutely amazing, check out his site if you can.

Anyway, if you're in the NYC area in the next couple days, the following event is going to be pretty hot (I won't be able to make it because I'll be at the AMSA national convention -- perhaps blogging a bit from there).

I'd love to know how the event went, if you go -- so hit me up on the comments or email...

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"Hip-Hop for the Tsunami Victims & HealthCare" Benefit Concert
Organized by G.A.ME (Grassroots Artist MovEment) & HHAC (Hip Hop Advocates Club) Friday March 18th, 2005 7:30pm doors open wide New York City Hunter College Auditorium North building 1st fl., 69th St. btwn Park & Lexington Ave.
All Ages...No dress code...
$10.00
more info. 347-431-1826 contact@kickgame.com tix online www.kickgame.com
Event flyer http://www.kickgame.com/images/flyers/tsunami.html

PERFORMING LIVE:
G.A.ME artists:
Immortal Technique, Red Clay, Division X, Majesty, Ravage, DJ Kay Slay, Black Market Militia (Killah Priest, Tragedy Khadafi, Timbo King, Hell Razah) Keith Murray RA the Rugged Man Wu-Tang's DJ Mathematics Hosted by Amanda Diva

There will be a mtg. about organizing after this huge event March 22nd 7pm. G.A.ME is a Hip-Hop Union which provides free healthcare to artists & activists' families through the G.A.ME HealthCare Network. We also invest in strengthening youth leadership around the globe.

Yay! I matched!

Yay I matched! No, that doesn't mean i found my mate on an internet site, that means I found out today at noon (online, no less), that I will in fact be moving on to a family medicine residency next year, as a match means that at least one program said "hey kid, we like you, come on board...". On Thursday, I'll find out where I matched to, and that's a BINDING contract. Yup, I've ranked programs in California, Arizona, New Mexico, New York, Pennsylvania, Rhode Island, and Maryland, and on thursday I'll find out which wonderful state I'll be moving to for the next three years of my training. So back to the binding contract -- I ranked programs, 1 to 10. And they ranked applicants. A computer program runs through an algorithm and spits out the matches for residents and programs, and whatever I get on Thursday I've gotta stick with. I've signed a contract by entering into the match. Yes, it sounds incomprehensible because in most other professions you apply for jobs or schools and you have your pick after they tell you they like you. This year is the first year we even get to see our contract for the next three years (salary, benefits, other issues), while interviewing. Before this year, you would only see your contract AFTER matching (the American Medical Student Association pushed for that to happen, and it's good progress in this crazy world of matching and residency). I'm so nervous/excited for thursday!

In other news, my medical school has a new curriculum for the first and second year medical students, something that's taken a long time and a lot of thought to put together. One of the new pieces is a section called Physicians' Core -- with lectures and small group sessions on humanism, professionalism, advocacy, etc. As part of this, I've been invited to speak to the first years about Advocacy and Activism, specifically on universal health care and my experience as Jack Rutledge Fellow at AMSA last year. The other panelists are physicians, which is great but it's hard to send a message about the importance of "medical student" activism when there aren't other current med students on the panel (the two others who were invited are in other countries this month...though i know there are more than two other med students who are involved in activism). I'm probably going to talk about changes that med students have made in universal health care and related issues, and maybe even show a short clip of the Sea-Couver video we made with med students asking seattle citizens and vancouver citizens about their health care experiences and then discussing amongst themselves what positive changes they can make). But 15 minutes! That's such a short amount of time! There will be a Q&A session, so that's good. Any advice for the talk -- some motivational stuff for first year med students?

And lastly, the recent mentions of this blog have been fun to check out -- All About George (dope site, along with Negrophile) mentions Andru's post on running a clinic for the uninsured, Saurav (Dark Days Ahead) and Thinking Nurse heart us, and Nick mentions some 4th year bloggers who are matching this year! Doctor Disgruntled is disgruntled at the news of Andru's clinic for the uninsured, but Andru comes back with a one, two punch with this and that response.

Charity or Fair Prices?

A number of folks have mistaken this enterprise as charity care. I'd like to set the record spinning in the right direction. By labeling this as charity care, folks are able to rationalize their own financial situations as the necessary cost of education and business.

A Fair Priced Medical Practice isnt' charity, it's business. It's just not a predator model of business. There is an acceptance in our society that it is okay to prey upon other's vulnerabilities, injuries and fears. I can accept this in the selection of a car (seatbelts, airbags, SUV vs Pinto) although it still seems kinda rude. But imagine healthcare, people are at their worst moments of combined fear, illness and vulnerability. Now throw them a $1000-$100,000 bill and watch what happens...

It doesn't have to be this way, and it's not about doctors having to be poor. I have shared some of the math of this business endeavor in previous posts. And let me clarify again - this is for primary and urgent healthcare, not surgery, emergency or major organ failure / cancer medicine. Those efforts require a different economic and technical investment to achieve success. so back to primary/urgent care.

Let me share a vignette - miscarriage. For those new to the health scene, a miscarriage is when a woman loses her baby while it is still in the womb. For first trimester miscarriages there is no form of prevention, it happens in 10% of known pregnancies.

How much should it cost to diagnose, counsel and treat a woman having an early miscarriage? Take a PRICE IS RIGHT guess. $50... $1000... $2000...

Here's what's involved - you take a few moments and listen to the woman's symptoms. Vaginal bleeding, lower abdomenal cramping, perhaps passing some tissue. Then you do a speculum exam followed by a bimanual exam to feel with your finger if the cervical OS is open or closed. If you have access to an ultrasound machine you can use it so see if the fetus is alive and to make sure the pregnancy is in the uterus and not one of the tubes (ectopic), which could be life threatening. It would probably take about 30 minutes from start to finish.

Miscarriage is actually a fairly common and simple medical problem. The real problem is how the insurance and hospital systems perform. Women having a miscarriage often feel anxious, fearful, concerned that they caused it somehow and usually rush to their doctor to try to save the baby. All reasonable reactions. Uninsured women in my city have very few options and most wind up in the ER where they wait for 4-12 hours. Believe it or not, but miscarriage isn't a medical emergency. There isn't anything we can do to prevent it and unless the woman is unstable or in severe pain, she'll wait while the gun shot wounds and car accidents take priority.

Then she'll receive a bill for upwards of $1-2K for "services" rendered and sent home to see if the fetus passes on it's own. Occassionally a surgical procedure, D&C, is indicated which then ups the bill by a few thousand more.

A simple, yet scary problem with a complex and expensive solution for uninsured women. If primary healthcare functioned well in my city, this could be taken care of in an office setting for $35-100 with compassionate phone followup, something ER's have trouble doing for good reasons, it isn't their mission nor their job.

I appreciate debate and the flow of sharing experienced. Keep it coming.

A simple how-to guide for "starving the beast"

1. Cut taxes, claiming a scary budget surplus if taxes aren't cut.

2. Spend money unwisely, on unnecessary ventures (like wiping out people in another country, or like not allowing the government to negotiate on drug prices for a government drug program), line the pockets of corporations.

3. Create a striking budget deficit.

4. Employ "Bait-and-switch": Have your economic hit-man state in all his wisdom that reversing the tax cuts is NOT the smart way to fiscally smart budget-balancing, and have him present the better solution of cutting social programs such as social security, medicare and medicaid.

5. Present private social security accounts and health savings accounts as the answer to all Americans' problems.

6. Employ "divide and conquer" techniques: for example, encourage doctors, lawyers, and patients to fight amongst themselves about low medicaid reimbursements and tort reform.

Thanks to Paul Krugman's "Deficits and Deceit" for the clarity, and Tom Toles' cartoon from 03/04/05 (3, 4, 5!).

A child needs more than healthcare and food to make it in this world...

Last fall, I accompanied a family medicine doctor on several home visits to check up on a few patients in the town his clinic was based in. Each visit had such a profound impact on me -- not only could I finally see the patient in the context of his or her community (neighborhood, house/apt, family), but the limits of modern medicine were so apparent among all the societal factors that contribute to peoples' lives. I'd be both frustrated at the situation and happy to be connecting with patients in their home environments. So it was heartening to see another medical student ("dr. honeydew" over at Push Fluids) rant about society's priorities after a home visit:

...I accompanied a preventative services case worker whose job for the day was checking up on an 18 month-old and a 15 month-old to assess their developmental progress. Both children were happy, playful, and hilariously cute. On the surface, there was nothing abnormal about these kids. If I'd seen them in a clinic, they'd be just two more happy faces.

Yet, the 15-month old lives in a 3 bedroom apartment with 3 other familes. (Total = four families.) There were a few bicycles in the apartment and in the hallway - many of the fathers are working long hours as delivery men. You'd think that under these conditions, making ends meet would be possible. Think again though - the rent is too steep, and the mother we spoke to today said she was looking for a new place to live.

Add to this the fact that the mother and father of this child cannot speak English and cannot even write in Spanish - they never learned to read. Thus, they are unable to advocate for themselves, let alone for their 15 month-old son.

Is it really any wonder that so many urban youths are destined for future problems? People point their fingers at "schools" and "drugs" and "gangs" and "crime." Are these really the heart of the problem, or just symptoms?

Medical pathology abounds in neighborhoods like these - asthma, drug use, malnutrition, developmental delay, mental health issues, etc., etc. The deeper pathology is our society's willingness to allow people to live in our country under such egregiously inhospitable conditions.

Better schools and better social services are definately a step in the right direction, but until society stops exploiting these people, their children will never have a fair shot at the American Dream. It is really pathetic that the wealthiest of Americans are getting tax cuts, buying Picasso's and bequeathing fortunes to their alma maters, while children are being raised in poverty.

It is not easy to raise children under any circumstances. When our society accepts that the raising of certain children will be nearly impossible, it is, in my opinion, nothing short of a collective criminal act. Jacob Riis documented the lives of "The Other Half" more than one-hundred years ago. Granted, we've come pretty far since then, but a child needs more than health care and food to make it in the world. When are we going to get off of our collective asses and do something about this? (And can we please not vote for any more Republicans?!)