“Young doctor” could be considered a contradictory term because by the time physicians-to-be finish med school, residency, and a year of fellowship, they are not so young anymore. And they are saddled with debt.


To address those problems plus the physician shortage, some medical schools have eliminated the fourth year. Doing so will not only speed up the process but also, theoretically, increase the ranks of primary care physicians.

Those making this argument often cite an article in the March 21, 2012, issue of JAMA (http://jamanetwork.com/journals/jama/fullarticle/1105095) by Ezekiel J. Emanuel, MD, PhD, and Victor R. Fuchs, PhD. Emanuel and Fuchs write, “[T]here is substantial waste in the education and training of U.S. physicians. Years of training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.”

Paying off those enormous student loans might be one reason why aspiring doctors choose to be specialists, where they can make more money.

Not everybody likes this idea. Writing in the Sept. 19, 2013, issue of the New England Journal of Medicine (http://tinyurl.com/Goldfarb-piece), Stanley Goldfarb, MD, and Gail Morrison, MD, state that a similar effort was attempted in the 1970s for the same reasons: to reduce medical school costs and to increase the number of PCPs. It failed.

“The hope that students would opt for primary care careers was not consistently borne out,” they write. “Students enrolling in some accelerated BA–MD programs in community-based medical schools tended to enter careers in family medicine in higher numbers than did those from standard MD programs, but even those numbers were nowhere near the hoped-for 60% to 75%; and overall, these programs did not consistently boost the number of students choosing primary care careers.”

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.