Med Students Cite Importance of—and Obstacles to—Care Coordination
The 9th annual Epocrates Future Physicians of America Survey from athenahealth polled more than 1,400 medical students about clinical teamwork, among other topics. A whopping 96% of respondents said that collaborating with “extended care teams”—members of which might include nurses, PAs, and medical staff—is important or very important to the delivery of high-quality care. Forty-three percent cited fragmented care as the number-one risk factor for compromised patient safety, with cost of care and medication non-compliance coming in a distant second and third, respectively. And, apparently aware of the shift toward financial incentives for better outcomes arising from team-based care, 67% rated care coordination as important or very important for a physician’s financial success.
However, 57% of respondents cited inadequate cross-team communication as the number-one barrier to coordinated care, with a lack of interoperability among current EHR systems cited by 42% as the primary hurdle. On a more positive note, the survey found that 86% of respondents felt that their medical training prepared them for patient-centered care, a model that stresses patient and family involvement in shared decision-making.
The survey also asked students about their awareness of accountable care organizations (ACOs). According to the American College of Physicians, “the core purpose of an Accountable Care Organization is to provide accessible, effective, team-based integrated care.” Yet, according to the survey, 65% of medical students feel they don’t know enough about ACOs. That’s down from 72% in last year’s survey, but it’s still a sizable proportion. Another 39% admitted that they are unsure about the purpose or structure of ACOs.
In two miscellaneous findings that reveal ambivalence among medical students regarding the personal versus technological in medical practice, 99% of respondents said they would prefer a face-to-face office visit over a virtual encounter for an initial patient interaction, while at the same time 97% said they would encourage patients to use remote monitoring devices such as those now available for tracking weight, physical-activity levels, blood sugar, and vital signs.
Most Med Students to Sidestep Private Practice, but Ortho Residents Seek Independence
If you’re a physician in private practice, there may be very few doctors following in your footsteps, according to results from athenahealth’s 9th annual Epocrates Future Physicians of America Survey.
Among medical students who responded to the survey, 73% said they plan to seek employment through a hospital or large group practice; a mere 10% said they hope to join a private practice, down from 17% the previous year. One reason for the employed practice-setting preference: med students feel their training doesn’t prepare them for the challenges of running a business. Fifty-seven percent expressed dissatisfaction with their education in practice management, and 65% reported feeling unprepared for the exigencies of billing and coding.
When asked about their “top concerns,” 60% of respondents cited a desire for work-life balance as number one. That, along with an apparent aversion to the administrative hassles of private practice, helps explain this year’s findings.
However, when OrthoBuzz asked members of the JBJS Resident Advisory Board to comment on these findings, another side of the story emerged. Daniel Hatch, MD, a fifth-year resident at Penn State Hershey Orthopaedics, said, “I am a huge proponent of private-practice medicine and hope to join a private-practice group when I am done with training, but I too feel the pull toward employed positions with guaranteed high salaries for the first few years and large signing bonuses. But I am looking for more autonomy and control in the decision-making related to my practice.”
Orrin Franko, MD, a chief resident at UC San Diego, concurred: “Personally, I desire the independence of private practice and do not fear the inevitable challenges I will face by running a business—but I am in the small minority,” he said. “I have seen first-hand the personal satisfaction, financial success, and independence of private-practice surgeons, and I desire that for myself. I hope that more of my colleagues feel the same way. Otherwise, I feel we are at risk of losing control over our specialty to large hospital systems and payors.”
For Benjamin Service, MD, a resident at Orlando Health, the choice is “not simply academic versus private practice versus hospital employed…due to the variation in orthopedic practices.” Dr. Service agrees with the survey’s findings about subpar private-practice preparedness. “US medical schools are severely lacking in educating their students on debt management, finance, asset protection, and practice management,” he said. “It is obvious that many students would not initially consider private practice due to this gap in our education.”
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Mobile Medical Apps and the Orthopaedic Surgeon
Results from a new JBJS study, Mobile Technology/Social Media Usage Among Orthopaedic Surgeons, show orthopaedic surgeons are frequent users of mobile medical apps, with seven in ten orthopaedic surgeons having downloaded at least one app on their smartphone. Roughly 40% of 320 respondents to a JBJS email survey say they are using medical apps more than they did a year ago, and 41% of the respondents say they have downloaded an app offered by a supplier. The types of information surgeons most desire in an app include drug information, surgical techniques, journal articles, and patient information. The favorite medical app mentioned was Epocrates, an athenahealth app that provides point-of-care medical information to doctors. Other favorite apps include AO Surgery Reference an d Medscape.
The findings also show that orthopaedic surgeons are getting more comfortable using mobile devices for orthopaedic tasks such as referencing drug data, checking formulary schedules, reading journals, communicating with their patients, and seeking information about orthopaedic devices/products. (see charts). Finally, the findings reveal that although many surgeons are not using LinkedIn and Facebook, one in five believe that social media will have a positive impact on orthopaedic care in the future.
New JBJS survey shows that orthopaedic surgeons use medical apps frequently and that they’re getting more comfortable using mobile devices for communicating with patients.
Fracture Treatment App for Orthopaedic Surgeons
The AO Surgery Reference is a comprehensive portal of surgical knowledge that includes hundreds of surgical procedures and approaches, tools to help make surgical decisions, and access to hundreds of pages of previously published AO material. Developed by the AO Foundation, the reference is now available via iPhone, iPad, and Android apps. This app is a good starting point to access information about the treatment and management of traumatic fractures. According to a recent JBJS survey of orthopaedic surgeons, AO apps were mentioned second to Epocrates as a favorite medical mobile app.
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