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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

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    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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Medical School Ethics versus Business School Ethics

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Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA]

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In the evolutionary shifts in models for medical care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.

While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.”

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[Medicine versus Business]

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Assessment

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.

Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

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Anatomy of a Doctor

Risks versus Rewards [A Changing Calculus]

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Some laymen enjoy helping others, but don’t seriously consider medical school. Hard work does pay off, but only if you’re good at biology in this case. One problem has always been the crazy amount of names to learn.

The thought of SAT exams, medical school and MCAT tests already raise stress levels. It’s no surprise that a large percent of doctors feel stressed. Today, only half of them recommend their career to others. It seemed like a fun career once all the classes and training was done. And, many doctors seemed to be happy by the way they carried themselves.

Not so today! The higher than average salaries probably helped to boost their attitude before the ACA. But, perhaps not so much, today!

So; not everyone is cut out to be a doctor. Although it sounds really cool and we can dream about it as a child, becoming a doctor is not always practical. It is a high-intensity job but with decreasing stature and pay, likely going forward.

Assessment

But, the joys of helping others and saving lives are always worth it; aren’t they?

Conclusion 

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Understanding the Modern Challenges of Student Doctors

An Evolving Educational Model

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By Cyndi Laurenti

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Medical education could be driving potential doctors away and damaging those who do go on to practice with long hours, high debt, inconsistent training, and lack of emotional support. Research indicates the current structure of residency programs produces resident physicians who are stressed, sleep-deprived, and prone to medical errors.

Medical Residents

Medical school graduates who’ve begun their on-the-job training are called residents varying in length from three to seven years, depending on the specializations doctors pursue. Most programs utilize experienced physicians called preceptors to teach the new doctors how to practice their particular branches of medicine. Another common practice is to pair second- or third-year residents with one or more first-year residents, so the senior students take on some of the teaching and supervision roles.

Duties

Residents admit patients to the hospital, obtain medical histories, perform examinations, and administer treatments or do procedures under the guidance of the senior resident or preceptor.

The hours in a residency program are long. Despite recommendations from the Institutes of Medicine intended to decrease long shifts and work hours, 80-hour weeks are common in residency programs and 30-hour shifts with five-hour sleep periods are the norm. Moreover, those 80-hour work weeks represent the average over a four-week period, so a resident might actually work considerably longer in a single week.

Work Shifts

Rotating shifts, in which residents work at different times of the day or night, are also common. Sleep deprivation is the norm: a 2004 survey of over 3,000 residents reported 66 percent slept less than six hours a night, and 20 percent slept less than five. Of even more concern, those who slept less than five hours a night reported they had used alcohol, resorted to stimulants to stay awake, had serious accidents or injuries, had conflicts with other professional staff, or made serious medical errors.

Financial Stress

Many residents also face financial or family stressors as well. Debt is common in medical school: the New England Journal of Medicine reports one fourth of graduating residents have debt exceeding $200,000. Some residents use their limited free time to moonlight for additional income as the average medical resident salary is about $45,000 per year.

Age

Medical residents are often in their late twenties or early thirties, a time when many people look to starting families. The lack of income may drive them to work extra hours in an already crowded schedule, which prevents them from spending time with children or a spouse, if indeed they manage to have either. Research from as far back as 1986 indicated over 40 percent of medical residents experience problems with their spouses during residency. Respondents often feel the working conditions of residency contribute to family problems, which in turn affect their hospital work as a result. On a positive note, researchers have found stress can be moderated by family relationships and social contact, and recommended social support systems be fostered in residency programs.

Stress

Emotional stress related to patient care is another aspect of the issues with residency. Over 70 percent of residents in one study reported hospital activities such as cardiopulmonary resuscitation were extremely stressful and the lack of a debriefing session afterward increased the impact of that stress, particularly when the resident felt the resuscitation was inappropriate.

Recipe for Disaster?

The combination of stress and sleep deprivation is a recipe for disaster. A study at HarvardUniversityfound residents who worked extended shifts or long hours were involved in 300 percent more fatal errors than when they did not work excessive hours. These same physicians reported they were likely to fall asleep during surgery, patient examinations, hospital rounds or lectures, and that their medical errors induced guilt, anger, humiliation, and decreased compassion for the patients they treated.

To add to these stresses, as recently as October 2011 almost half of graduate physicians in one survey reported they had been harassed, intimidated or discriminated against while residents. These behaviors took the form of verbal abuse and being assigned extra work as punishment. The sources of inappropriate behavior were primarily specialty physicians, but specialty residents, hospital nurses, and patients also participated in the harassment.

The Changing Paradigm

Some residency programs have made changes to improve the quality of life for residents. These include strategies such as decreasing patient load, senior residents supervising a single resident instead of two or more, and decreasing hand-offs, the transfer of patients from one group of residents to another. Other recommendations include debriefing sessions for stressful situations such as cardiopulmonary resuscitation, ethics committees to which residents can take complicated problems, and increased emotional support.

I.O.M

Other possible strategies include a decreased shift length, or simply adherence to the Institutes of Medicine’s guidelines for residency training programs. Social networks for residents’ spouses and families would provide a forum to air concerns and obtain emotional support from those in similar circumstances.

Additional efforts to relieve medical student debt would also make a considerable positive impact. A program currently exists in theUnited Statesfor physicians to obtain loan forgiveness: the National Health Service Corps pays off medical student debt if the physician practices full-time at a NHSC-approved site, usually a federally-qualified health center, rural or Indian Health service clinics, or prison. If a physician serves full-time for six or more years, the entire debt may be repaid by the NHSC.

Assessment

Most residency programs in other parts of the world are similar to those in theUnited States, although there may be different laws that affect work hours or salaries. There is clear evidence that overstressed and sleep-deprived residents are more likely to make serious or even fatal medical errors and lose their sense of compassion for patients. The current residency system is expensive, emotionally stressful, and puts the lives of patients at risk. America (and likely other nations as well) would benefit from making even more changes in residency programs to provide adequate time for sleep, family or social interaction, and emotional support for fledgling doctors.

About the Author

While she figures out her next career move, Cyndi Laurenti works as an online writer and editor. Her primary interests are education, technology, and how to combine them. She enjoys the trees and beaches of thePacific Northwest, and looking things up on other people’s iPhones.

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Nathaniel Potter MD and Touring with Dr. Marcinko [Part VI]

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About Nathaniel Potter, MD

By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: Baltimore MarylandNathaniel Potter MD

While in Washington DC on the second portion of our recent ME-P book “signing and opining” tour, I had the good fortune to visit the gravesite of the noted physician Nathaniel Potter, MD. Dr. Potter was born in Carolina county Maryland in 1770 and died in Baltimore on 2 January, 1843. He graduated from the University of Pennsylvania in 1796, and settled in Baltimore, where he practiced medicine until his death. In 1807, he associated with Dr. John B. Davidge in founding the University of Maryland, School of Medicine where he ultimately served as professor and dean. He died penniless.

THINK Potter’s field!

About Green Mount Cemetery

Green Mount Cemetery is located in Baltimore, MD. Established in 1839, it is noted for the large number of historical figures that have been interred in its grounds as well as a large number of prominent Baltimore-area families. It retained the name Green Mount when the land was purchased from the heirs of Baltimore merchant Robert Oliver. Green Mount is also a treasury of precious works of art, including striking works by major sculptors like William Rinehart and Hans Schuler. The cemetery was listed in the National Register of Historic Places in 1980.

Assessment

In as much as Dr. Potter was a well know figure to me, I was most pleased at the impromptu visit to his grave. You see, although I attended Temple University because of my future specialty, my first medical school choice would have been at University of Maryland if post-graduate education opportunities had been different at the time. And, I passed the medical school, and the imposing Greek themed Davidge Hall Dome, daily for four years as I rode the number 8 public transportation bus to my undergraduate studies at nearby Loyola University, in Townson Maryland. Of course, the fact that Potter was educated at the University of Pennsylvania School of Medicine, the first in the nation, did not elude me when I worked in its ER as a young medical student in Philadelphia, back in-the-day. University of Maryland was the fifth such medical school in the country.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries; as well as interest in our online www.CertifiedMedicalPlanner.org  program.

Part V: https://healthcarefinancials.wordpress.com/2009/08/21/off-road-touring-with-dr-marcinko-part-v/

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Consultants and Hospital Employment Statistics

Economic Conditions Better than Other Major Industries

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horizontal-nurses1According to Richard Pizzi, on March 9th, Healthcare Finance Newsweek reported that employment at US hospitals climbed 0.14 percent in February to a seasonally adjusted 4,719,300 people.

Bureau of Labor Statistics

Responding to just issued BLS data, the number employed was 6,800 more than in January and 131,800 more than in February 2008. Without seasonal adjustments, which remove the effects of fluctuations due to seasonal events, hospitals employed 4,703,700 people in February 2009, 2,200 more than in January and 130,100 more than a year ago.

Impact on Healthcare Consultants

This was good news for financial advisors, insurance agents and accountants; medical management consultants and health economists; HIT suppliers and related DME vendors, etc.

Assessment

The news was not so good in other areas of the American economy, however, as the national unemployment rate rose from 7.6 percent to 8.1 percent. The US economy shed an additional 651,000 jobs in February 2009. But, according to Rachel Pentin-Maki; RN, MHA of www.MedicalBusinessAdvisors.com

“Employment continues to be strong in almost all aspects of the healthcare industrial complex. This includes professionals, technicians, nurses and para-professionals, as well. However, in the long-term, we believe that medicine will not attract the best and brightest young minds in the future. The economic, political and competitive demographics are just not favorable.” 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is healthcare really a recession proof industry? What about those bright young minds; where will they go for professional careers, instead?

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