Resident Guide to Preventive Medicine 2011
by Samuel Peik
Preventive Medicine 2011 had numerous sessions for residents to participate in, and initial feedback showed residents had a great time at the meeting. The sessions Great Careers in Preventive Medicine and Lifecycle of a PM Career featured experts from several different fields and provided career advice. Friday night was capped by the RPS/YPS/MSS Social Event with dinner at a nearby restaurant, and over 30 ACPM members attended.
The annual RPS Guest Lecture featured the esteemed speakers Drs. David Satcher, former Surgeon General and Kenneth Cooper, founder of Cooper Aerobics, who gave their career perspectives to an audience of young physicians, residents, and medical students. This was one of the most popular sessions of the meeting and both guests stayed well after the session to personally speak with residents.
PM 2011 was an amazing opportunity to learn more about the field of Preventive Medicine and network with leaders in the field and fellow colleagues. For more information on the meeting and to find out how to get involved next year, visit the most recent version of Headlines at http://www.acpm.org/.
Health Insurance in Canada
Part I: Background and Context
by Lawrence Loh, External Officer, NSSCM Resident Council
The vast majority of Canadians receive their health insurance through provincial-government administered plans. This was the result of a legacy of private insurance failures during the Great Depression, which led to government bailouts and restructuring of health insurance along provincial lines in the post-World War II era. During that time, Saskatchewan (one of Canada's prairie provinces) struggled with a physician shortage and created a municipal doctor program, which provided government subsidy for physician billings in order to attract physicians to communities suffering from shortages.
Together with "union hospitals", which were hospitals in those same communities whose costs were also subsidized by the government, the Saskatchewan government eventually passed the Saskatchewan Hospitalization Act, which guaranteed free access to hospital care for citizens of Saskatchewan.
This same model of funding for hospitals and physicians were taken up by other Canadian provinces through the 1950s. In 1957, the Canadian federal government passed the Hospital Insurance and Diagnostic Services Act. This committed the federal government to pay for 50% of provincial health care costs covered through a provincially funded Hospitalization Act. The provincial act would have to meet specific criteria, such as comprehensive coverage of basic services and universality for all provincial residents.
After adoption by all the provinces in 1961, the 1966 Medical Care Act replaced the 1957 Hospital Insurance and Diagnostic Services Act by adding physician services to the funding model. With further federal inputs to social services, a 1977 Federal act lumped health care funding together with post-secondary funding in what was termed a "social programs transfer." Finally, the Canada Health Act was passed in 1984, to combat physician extra-billing for insured services; it remains to this day the keystone of health insurance funding in Canada.
The five principles of the Canada Health Act are thus:
- Universality - all residents of a province or territory are entitled to health care benefits provided they have been in the jurisdiction for three months;
- Comprehensiveness - all "medically necessary services" (deemed so by the provincial government) provided by physicians, hospitals and dentists must be covered.
- Portability - provincial insurance covers covered services if sought in other jurisdictions of Canada
- Accessibility - no extra charges or user fees above the insured rate are permitted
- Public Administration - a public authority administers the plan on a non-profit basis
For the most part, there is uniformity in what is deemed "medically necessary" from province to province, though there are some notable differences. The result, however, is that most Canadians will receive their health care through provincial funding. Exceptions include the Canadian military, newcomers and refugees, and indigenous and Inuit citizens, who are all covered by the federal government directly.
In practice, services are funded either directly from the government (as in public hospitals), or through billing the provincial government plan upon presentation of a valid provincial health card to a private hospital or private physician/dental practitioner for an insured service.
As with any system, there exist benefits and concerns, and these will be addressed in the next part of this series.
Palliative Care: Preventive medicine for terminal patients
by Jordana Rothschild
Most of us think of palliative care as being on the opposite spectrum from preventive medicine - it is what happens when primary, secondary, and tertiary prevention all fail and a patient succumb to disease. My experiences with hospice, however, have taught me otherwise.
A study published last August in the New England Journal of Medicine showed that patients receiving early palliative care had less aggressive care at the end of life but longer survival. My rotation this year with my program's palliative care inpatient service confirmed that it is the ultimate preventive medicine: prevention of suffering, prevention of harmful medical procedures, and prevention of disease burden on patients and their families.
Although most PM physicians probably won't encounter terminal patients on a regular basis, there are three ways we can all practice palliative care. First is political support - we have to combat the misconception that a palliative care referral is equivalent to a "death panel". Second is education of health practitioners as well as patients. Many physicians still see palliative care as "giving up" or "withdrawing care." The NEJM study showed that patients will actually do better with this care than they would under aggressive, harmful "treatment." If physicians and patients are informed of all their options while they are healthy, we can prevent a lot of agony for them in the future.
The third and easiest way for us each to practice palliative medicine is by encouraging everyone we know, from patients to family members, to designate a health care agent. Only 25% of Americans have a health care proxy form. Even without having to decide difficult issues, patients can determine who will make decisions for them in the event that they lose capacity.
Study Finds Widening Pay Gap in Newly Trained Men and Women Physicians
by Clarence Lam
A study published in the February 2011 issue of Health Affairs1 found that women physicians who were beginning their careers immediately following residency training were earning $16,819 less on average than their male colleagues.
The study data was based on self-reported survey data collected from 8,233 graduating residents between 1999 and 2008 in New York State, which has the highest number of residents and residency programs than any other state.
Prior studies have theorized that gender differences in physician pay could be attributed to job productivity and the tendency for women to pursue primary care specialties. By examining survey data of residents exiting residency programs, this study controlled for specialty type, work hours, practice setting, immigration status, experience, and age.
According to data analyzed by the researchers, the gender differences in salaries is widening, from men receiving a statistically insignificant average of $3600 more than women in 1999 to a statistically significant difference of $16,819 in 2008. This is inconsistent with the findings of many earlier studies which concluded that the gender gap in pay was narrowing.
The study authors did not attribute the difference in pay to the role of marital and family status of residents or to discrimination. Instead, they pointed to possible reasons such as the possibility that women are more responsive to non-monetary benefits in job offers, such as greater flexibility in work schedule, that lead to lower pay as well as gender differences in social contexts and constraints during employment negotiations.
 Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Affairs. 2011 Feb;30(2):193-201.
Vote in the RPS Governing Council Election
by Samuel Peik
Voting for the new Governing Council is now open! Click to view the Statements of Interest and CVs of each candidate, as well as position descriptions.
RPS should have received an email with a personal Zoomerang link to vote. The RPS election will close at 5 PM ET on Monday March 21. Contact David Dauphinais at firstname.lastname@example.org with any questions.
by Samuel Peik
This section provides a brief overview of current clinical preventive recommendations, including the United States Preventive Services Task Force (USPSTF) as well as other pertinent national organizations. This month's topic is on screening for Diabetes Mellitus.
USPSTF (released 2008)
- Asymptomatic adults with sustained blood pressure (regardless of treatment) greater than 135/80 mm Hg: B (recommend)
- Asymptomatic adults with blood pressure 135/80 mm Hg or lower: I (insufficient evidence to assess)
American Academy of Family Physicians (released 2007)
- Recommends screening for type 2 diabetes in adults with hypertension and hyperlipidemia
- Insufficient evidence to recommend for or against screening adults at low risk for coronary vascular disease
American College of Obstetricians and Gynecologists
- Recommends fasting glucose testing for women beginning at age 45 every 3 years
American Diabetes Association (released 2007)
- Recommends consideration of screening to detect prediabetes or diabetes beginning at age 45
- Consider testing those under age 45 if overweight and have another risk factor for diabetes
For more on the USPSTF recommendations, visit their website at http://www.uspreventiveservicestaskforce.org/