Clinician executives who want to relieve stressed-out physicians, and perhaps help stave off doctors leaving the profession, can start by encouraging the recruitment of nurses, physician assistants, nurse practitioners and other ancillary caregivers, according to a survey by Cejka Search and Physician Wellness Services (PWS), a company that helps doctors manage stress.

“Physicians surveyed indicated that of the organization-supported services which they felt might help them more effectively deal with stress and burnout, the top choice by far was ‘ancillary support,’ by 63 percent,” says the “Physician Stress and Burnout Survey.” Such support can help doctors “deal with their top three work-related stress factors: paperwork and administrative tasks (39.8 percent), too many hours of work (33.3 percent), and on-call schedules and expectations (26.2 percent). In addition, it frees them up to provide more time with and to see more patients.”

Lori Schutte, Cejka Search president, says that “the survey underscores the need for organizations to recognize physicians’ stress and take action to improve retention.”

Perhaps help is on the way. A recent study in Health Affairs says that the number of young registered nurses increased 62 percent from 102,000 in 2002 to 165,000 in 2009, the highest growth rate since the 1970s.

Sixty-three percent of respondents in the study by Cejka and PWS say that their stress increased moderately or dramatically in the past three years.

There is something else clinician executives should be mindful of. “Since 2005, the part-time physician workforce has grown by 62 percent,” says the survey. “This trend tracks with the change in profile in today’s medical workforce, in which the two fastest-growing segments are female physicians entering practice and male physicians approaching retirement.”

The survey was conducted in September 2011. More than 2,000 physicians throughout the nation participated.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.