Jeff Bendix

 in health care among low-income Americans. But results of a 

 suggest that goal has not been met, especially when it comes to primary care.

The study looks at Medicaid services use among nearly two million Black and white Medicaid enrollees in three states in 2016. It found that after adjusting for factors such as age, gender, health status and usual source of care, average annual spending on adult Black enrollees was $317, or 6% less than for whites. Among children (18 years and under) the difference was $94, or 14%.

The authors found similar differences in use of 

 services. After adjusting for demographic characteristics and health status, Black adults had 17.3, or 4%, fewer annual primary care visits per 100 enrollees compared to whites. Among children the gaps were larger, with Black children having 111.8, or 28% fewer primary care visits per 100 enrollees per year than whites.

The same patterns emerged for use of prescription drugs. After adjusting for demographic characteristics and health status, adult Black enrollees filled 16% fewer prescriptions per 100 enrollees annually than White adults. Black enrollees also were less likely to fill prescriptions for asthma medication, diabetes medication, and statins. However, adult Black enrollees filled more prescriptions for antihypertensives than white enrollees.

Black children enrolled in Medicaid also filled fewer prescription drugs compared with whites, and those with asthma or diabetes filled fewer prescriptions for managing those conditions.

The only medical service included in the study used more by Black enrollees than whites was the emergency department, where Black adults had 14% more visits, and children 8% more than did whites.

The study also revealed that despite Black enrollees lower use of medical services and less primary care, they had higher rates of HEDIS preventive care screenings after adjusting for demographic characteristics and health status. For example, compared with adult White enrollees, adult Black enrollees were 17% more likely to receive a breast cancer screening, 21% more likely to receive a cervical cancer screening, and 29% more likely to get screened for chlamydia. Rates of HEDIS preventive care measures were also higher among Black children than White children enrolled in Medicaid.

The authors say that despite the greater access to care made possible by Medicaid expansion in most states, “the results of this study suggest that coverage alone does not eliminate racial disparities.” They note that Black and white enrollees initiated care at similar rates, which implies that race-based differences in care utilization tended to emerge after care began.

That finding, in turn, “may be consistent with evidence that even when access barriers are overcome, Black patients receive worse care and experience the health care system as a result of medical racism…and differences in how physicians perceive them.”

The study, “Disparities in Health Care Spending and Utilization Among Black and White Medicaid Enrollees,” was published online June 10 in 

This article originally appeared on Medical Economics®. 

Articles

Black enrollees receive lower spending, have fewer primary care visits than white enrollees. 

Medicaid expansion hasn’t lessened race-based care disparities, study finds

In a trend that may spell yet more trouble for the availability of primary care, a new study finds that doctors who once provided both inpatient and outpatient care increasingly are choosing to work only as outpatient practitioners.

 looks at career choices among board-certified general internists over the last three decades. It found that from 2008 to 2018 the percentage of “mixed-practice” physicians—those in outpatient practices who also care for their patients who are hospitalized—dropped dramatically, with most of those who left mixed practices migrating to outpatient-only practices.

At the same time, the number of younger internists becoming full-time 

 has grown steadily, so that by 2018 more than 70% of newly-certified internists were practicing as hospitalists, compared with only 8% in outpatient-only practices.

The authors note that, in the short term, the shift of older internists to outpatient-only practices has compensated somewhat for the lack of younger doctors choosing that type of practice as a career. But at the same time, “workforce projection(s) may be underestimating the outpatient primary care shortage because most new physicians are focusing on hospital medicine and the flow from mixed practice to outpatient-only practice may be near its limits.”

The researchers conducted their study by linking Medicare evaluation and management (E&M) codes for inpatient and outpatient visits made between 2008 and 2017 to about 68,000 board-certified general internists who certified between 1990 and 2017. They identified physicians with fewer than 5% E&M outpatient visits as full-time hospitalists, those with 100% outpatient E&M visits as outpatient-only, and those with at least 5% but fewer than 100% as mixed-practice physicians.

They found that between 2008 and 2018, full-time hospitalists increased from 25% to 40% as a percentage of all general internists, while those in outpatient-only settings increased from 23% to 38%, and those in mixed practices declining from 52% to 23%. Most of those who left mixed practice migrated to outpatient-only practice.

The authors say their results also suggest that hospital medicine is a career decision rather than a temporary choice. They cite the finding that 86% of those classified as hospitalists in 2013 retained that classification five years later.

The study, “Evolving Practice Choices by Newly Certified and More Senior General Internists” was published online May 17.

Most younger doctors now going into hospital medicine, study finds. 

Internists career choices point to more primary care availability woes

 vaccine (BNT162b2) prevented about 110,000 deaths and 700,000 hospitalizations in the U.S. and saved more than $70 billion in health care costs and lost productivity in 2021, a 

The vaccine, which first became available in December 2020, was the only one with FDA approval in 2021. The Centers for Disease Control and Prevention estimates that fifty-seven percent of fully vaccinated individuals in 2021 received the 

, the highest proportion of the vaccinated population.

The study’s authors all received funding from Pfizer, either as employees, consultants or employed of companies paid by Pfizer. To carry out the study, the authors first developed a combined Markov and decision tree model. Then they entered both real-world and trial data into the model to estimate the one-year public health impact of the Pfizer-BioNTech vaccine compared with no vaccine.

The data they used included the number of vaccines administered, and the vaccine’s efficacy in different age groups, as well as the probability of catching COVID-19, developing symptoms and being hospitalized. They also accounted for the effects of 

 and the number of working days likely to have been lost due to short-term illness and the economic cost of premature deaths.

They found that compared to no vaccination, the two-dose series of the Pfizer-BioNTech vaccine prevented almost 8.7 million symptomatic cases of the disease, averted approximately 690,000 hospitalizations, and saved over 110,000 lives.

In addition, the reductions in COVID-19 symptomatic cases were associated with $43.7 billion in productivity gains. Around 36% of the gain came from preventing productivity loss due to early death, with the remainder due to avoiding workdays lost to illness.

The authors note their findings didn’t include the vaccine’s potential to reduce transmission of COVID-19 or its severity, and thus may underestimate the full impact of the vaccine.

“The analyses show that the Pfizer-BioNTech COVID-19 vaccine contributed substantial public health impact in the U.S. in 2021, and had a deep effect on the trajectory of the pandemic,” Manuela Di Fusco, senior director, health economics and outcomes research at Pfizer and one of the study’s authors, said in an accompanying press release. She added that the results “highlight the opportunity to continue widespread vaccination uptake to prevent COVID-19 related disease and generate societal benefits.”

The study, “Public health impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States,” appears in the 

Nearly 9 million symptomatic cases also avoided.

Pfizer-BioNTech vaccine prevented more than 100,000 US deaths in 2021

 among clinicians? Results of a recently-released survey suggest that it might.

In 2020 health IT consulting firm KLAS Research began asking members of its ARCH collaborative—a group of healthcare organizations working to improve the EHR experience through surveys and benchmarking—how likely they were to leave their employer in the next two years. The goal was to identify which clinicians were most likely to leave and what health care organizations could do to improve clinician retention.

The survey found that feelings of burnout, and the intensity of those feelings, correlated most closely with plans to leave their job. Sixty percent of respondents who reported feeling “completely burned out” said they were likely to leave, compared with only 9% who reported no feelings of burnout and 12% who said they felt “under stress.”

Those citing burnout as the reason for wanting to leave point to a wide variety of factors contributing to their feelings of burnout. Chief among these were “chaotic work environment” (47%), “too much time spent on bureaucratic tasks” (46%), “lack of effective 

 in my organization” (38%) and “no personal control over workload” (37%). “The common attribute of these contributors, along with several other leading responses, is that they can all be influenced by the organization’s governance structure,” the authors note.

After burnout, EHR-related factors were most closely associated with intent to quit. Fifty-six percent of respondents who were “very dissatisfied” or “dissatisfied” with their EHR said they planned to leave, versus 29% of those were “satisfied” or “very satisfied.”

The takeaway here, according to the study’s authors, is that “when clinicians feel the EHR is a help rather than a hindrance, they are more likely to want to stay at their organization,” therefore “health care leaders should focus on improving the areas of EHR satisfaction with the most room to improve.”

One of those areas for improvement, according to the survey, is time spent in after-hours charting.About one in four survey respondents who spent more than 25 hours per week charting after hours said they planned to leave their job in the next two years, compared with 16% of those who spent from zero to five hours charting after work hours.

Another effective EHR-related strategy for improving retention is to tailor EHR training to a clinician’s role in the workflow. Thirty-one percent of clinicians who strongly disagreed that their training was specific to their workflow planned to leave their jobs, compared with 14% who strongly agreed that they received training customized to their role in the organization’s workflow.

This article was originally published on Medical Economics®. 

Dissatisfaction with EHRs also tied to clinician turnover.

Reducing burnout could also improve staff retention, survey finds

This video was originally published on Medical Economics®. 

Bob White, COO of The Doctors Company, says most lawsuits occur due to patient frustration with not getting answers to their questions regarding an unexpected outcome.

Why patients sue their doctors

The number of medical students matching to family and internal medicine residency programs declined this year, according to results of the 

2022 National Resident Matching Program Main Residency (NRMP)

 results from the American Academy of Family Physicians (AAFP) shows the number of medical students and graduates matching to family medicine residencies fell from 4,493 in 2021 to 4,470, despite 91 more positions being offered.

The number of primary care positions offered in internal medicine declined to 429, of which 424 were filled, according to an American College of Physicians 

. Categorical position offerings rose from 9,024 in 2021 to a record 9,380, of which 8,915, or 95%, were filled.

“The continual annual increases in the number of offered and matched internal medicine positions demonstrates national recognition for the value provided by internal medicine physicians in our health care system,” Davoren Chick, MD, FACP, the College’s chief learning officer, said in the announcement.

“Primary care is more important than ever, and we commend every student who has chosen to practice in this profession,” AAFP President Sterling Ransone, MD, said in 

The AAFP analysis found that of the 4,470 students and graduates matching to family medicine resident programs, 1,555 were U.S. allopathic seniors and 1,496 were DO seniors. The rest were U.S. international medical graduates, graduates of foreign medical schools, and previous graduates of U.S. medical schools.

The analysis notes that while this year’s family medicine residency match is the second-highest in the specialty’s history, its fill rate of 90.6% was the lowest since 2007. Among U.S. MD seniors the rate was 31.5%, the lowest ever. “The trend for U.S. MD seniors is deeply concerning, and calls for U.S. MD medical schools, especially, to recruit and graduate more students who are likely to enter primary care specialties and practice in underserved areas,” the document says.

In contrast, the number of DO seniors matching to family medicine was a record, representing what the analysis calls “the strong and rising contribution to the family medicine workforce from DO students and graduates.” It adds that while the percentage of family medicine matching DOs has declined in recent years, it has been more than offset by the growing number of osteopathic medical schools and the resulting increase in all graduates, including those entering family medicine. And despite DO seniors making up only 19.6% of applicants who matched to all specialties, the number of DO students applying in family medicine already is greater than the number of U.S. MD students applying.

Decrease comes despite rise in number of positions offered. 