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Best Practices for Better Care—A Unique Focus on Quality and Patient Safety

May 31, 2011

The recent destructive storms in Missouri and Kansas are another reminder of this extraordinary spring with seemingly unprecedented natural disasters striking American communities. I saw it first hand while driving through North Carolina with my family for the kids' spring break when I realized I had no idea what to do about the dark funnel cloud my son spotted out the back window (and the debris flying in circles around our sunroof). After making it through that very frightening storm, we saw up close the devastation that had occurred across a large swath of counties surrounding I-95. Trees had been plucked like carrots from the wet ground, and the odds and ends from the lives of many families were plastered onto chain-link fences.

More tornadoes and floods have necessitated that many of our colleagues at academic medical centers across the country respond in ways that few others could. Over the last month or so, we've seen aggressive community responses in places like Alabama with UAB treating over 100 of those injured by widespread tornadoes. As flood waters from the Mississippi River started to crest, I was struck by this video that offers an aerial perspective of the University of Mississippi Medical Center's response in Yazoo City. While these events are thankfully rare, they do remind me of how we call on teaching hospitals and their faculty and staff to be there when disaster strikes, whether it's the treatment of burn victims after the explosion of an off-shore oil rig, the devastation caused by a hurricane, or the care for the unfortunate but common victims of gun violence or vehicular trauma. Major teaching hospitals are only 6 percent of all hospitals in the country but run 75 percent of the nation's burn units. In some states—New Mexico, Utah, Iowa, Maine, and Delaware—the sole trauma centers are run by AAMC-member teaching hospitals and staffed by their teaching physicians. The costs of these services are supported, in part, by Medicare's Indirect Medical Education payments, which recognize the importance of specialized services only available in teaching hospitals.

There are many ways to measure an institution's commitment to its neighbors or to society at large. Many of the nation's communities are served in ways that are almost silent until disaster strikes or are, unfortunately, part of what we have come to accept as system failures—like the over half billion dollars a year of uncompensated care delivered by the University of Texas System's medical schools and the similar charity care delivered all over the country by other medical faculty. When I asked a colleague whose medical center responded to one of the recent disasters why the institution responded so forcefully, he said, simply, "Because we give a damn."

More Challenges in Meeting Physician Workforce Needs

This month, the Massachusetts Medical Society released the results of its annual physician workforce survey, pointing out yet again that "insurance coverage doesn't equal access to care." Even in a state with among the highest numbers of physicians per capita, more than half of all primary care docs aren't taking new patients. Wait times for those practices that are accepting patients are as much as 48 days for general internists and over 40 days for specialists such as gastroenterologists and gynecologists. While the need for more primary care physicians is clear, physician workforce data shows growing problems across the board. With over 208,000 general internists and family physicians, there is one primary care physician for every 900 or so adults. Other specialties, whose patients include an aging subsection of America, are also in short supply with one nephrologist for every 40,000 potential patients and a neurosurgeon for every 60,000 patients… which doesn't seem like that few until you need a neurosurgeon. In Maryland, another state with relatively high numbers of physicians, patients continue to have difficulty accessing oncologists, psychiatrists, thoracic surgeons, and others.

The wait to see physicians is likely to worsen on every end of the age spectrum, with less than one geriatrician for every 2,500 or so older adults—a ratio that will soon be far worse. Pediatric subspecialists also are in short supply throughout the country, and yet the Children's Hospital Graduate Medical Education (CHGME) program will lose $48 million in funding this fiscal year. Children's hospitals in the CHGME program train over 40 percent of the nation's pediatric generalists and specialists, and it's likely that the current federal cuts will make access to care for the sickest children more difficult. Combined with investments in biomedical research, pediatric specialists have helped reduce mortality rates in kids with cancer by more than 40 percent. Thankfully, those children will grow to become adults but will then continue to have unique needs requiring specialized health care services.

These challenges come at a time when educators are trying to lessen the burden for a nation on the verge of a decreasing physician supply by increasing enrollment in medical schools and by trying to make the most effective use of professional teams. More than 230 medical schools and teaching hospitals are finding new ways to improve the quality of care today and over the course of the next generation through clinicians trained in evidence-based practices. Unless we commit to training enough health professionals to care for an aging and growing population, we will not be able to meet society's needs—even with the best prevention and chronic care. While we find ways to make care more efficient and effective, we need to be sure we don't shortchange our ability to provide that care to every community.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029