Physician Income
I knew this, but the data confirm it. Specialties see higher pay; primary care not so much
AMGA’s latest Medical Group Compensation & Productivity Survey reports that median physician compensation rose most steeply for diagnostic radiologists, dermatologists and anesthesiologists, all up more than 9%.
Interventional diagnostic radiology led the survey with a $356,000 median and topped the chart with a 16.3% increase from $306,000.
The survey is based on data from 242 medical groups representing 31,000 physicians. AMGA’s members tend to be from large physician groups.
The big increases in compensation for those specialties are driven by supply and demand, said Shawn Schwartz, manager at Minneapolis-based RSM McGladrey Inc., the consulting firm that conducted the survey for AGMA.
What specialties do you think medical students are choosing?
The dangers of walking
Magnets and arthritis
They do not work! This entertaining article discusses the scam – Once Upon A Magnetic Mattress. Whether you care about magnets and arthritis or not, you probably will enjoy the clever way the author makes a point.
On heart failure
Read this very nice piece from the Sunday Times (London) about heart failure and its treament (note that in the US the tradename for carvedilol is Coreg) – Kick-start the heart. The article covers known ground, but discusses some important new data.
The treatment of chronic heart failure was one of the principal points of interest in the Berlin conference. This interest had been excited by the presentation of the results of Carmen, a trans-European trial involving patients from 65 heart units in 13 countries. Carmen was designed to evaluate and compare the effects of the use of an Ace inhibitor, Innovace enalapril, and/or a sophisticated beta blocker, Eucardic carvedilol, manufactured by Roche, in the treatment of heart failure.
Eucardic, unlike most beta blockers, not only blocks the beta 1 andrenergic receptors but also comprehensively blocks the beta 2 and alpha 1 adrenergic receptors. Blocking the alpha 1 receptors gives Eucardic a vasodilatory effect of benefit in the control of heart failure, ischaemic (coronary) heart disease and high blood pressure.
There was a time when doctors did not prescribe beta blockers in the presence of heart failure. Now beta blockers such as Eucardic have been confirmed as being an important part of the trinity of drugs — Ace inhibitors, appropriate beta blocker and, when there is fluid retention a diuretic such as bendrofluazide — which should be the standard regime for those with heart failure. Evidence from an earlier trial showed that patients taking Eucardic demonstrated a 35 per cent reduction in mortality, and with it an accompanying improvement in the quality of life.
Carmen has shown the value of combining an Ace inhibitor with Eucardic — most patients were already receiving diuretics. The research also demonstrated that the combination of Eucardic with an Ace inhibitor resulted in reversal of the changes in the heart’s shape and structure that are characteristic of heart failure.
The article does not mention that we really do not know whether carvedilol works better than metoprolol or other beta blockers. “The Carvedilol or Metoprolol European Trial (COMET) is comparing the use of carvedilol or metoprolol in heart failure patients and the effects of the therapies on all-cause mortality.” Until we get the results of the COMET study, I am using metoprolol (FDA approved) for my heart failure patients (much lower cost). When the patient has class III or IV CHF, I often start with carvedilol for the first few low doses (carvedilol’s marketing includes very low dose pills for gradual titration). Once I get to 12.5 mg b.i.d. of carvedilol, I then switch to 25 mg b.i.d. of metoprolol (those are equivalent doses), and continue titrating upwards. The data for beta blockers are clear and compelling. If you feel uncomfortable using beta blockers in CHF patients, please find a consultant to help you care for the first few patients.
Avoiding some cancers
Report outlines diet-cancer link: Experts offer bottom line from decades of confusing research
Wading through 30 years of confusing and sometimes contradictory studies on cancer and diet, experts have summarized the state of scientific knowledge: alcohol is bad, obesity is bad and lots of fruits and vegetables are good.
Well that introduction provided no surprises. One can read the original article here – The effect of diet on risk of cancer (Lancet – free but registration required).
Riboli said emerging evidence suggests many of the factors that contribute to heart disease are also involved in cancer, such as lack of exercise, being even moderately overweight and problems with insulin, the hormone that goes wrong in diabetes.
“I think it’s possible that we will realize that some of the benefits which were in the past attributed to the diet in itself should actually be attributed to the global balance between how we eat, how we move and our body shape, where we are actually pointing more to the energy balance,” Riboli said.
…
Experts are also starting to advocate a tougher strategy. “The individual awareness approach has been shown repeatedly to have failed,” experts said in a report presented Wednesday at a European Union summit on obesity.
In its report, the International Obesity Task Force called for European restrictions on the advertising of junk food.
Other measures mentioned in the report were: redesigning roads to accommodate networks of bicycle tracks, removing junk food vending machines from schools, reintroducing cooking skills into the school curriculum and the establishment of a new medical specialty that takes a comprehensive approach to obesity.
We likely will continue to hear more and more pressure on diet control. While I am empathetic towards the problems, and I try to work with patients, colleagues and friends to eat more intelligently, I am against too much intrusion here. If I eat too much aspirin, I could die. One baby aspirin a day likely will decrease my chances of a cardiac event. Many vitamins are like that. I like the occasional junk food. We need to proactively provide diet options. We should beat the bad diet options in the marketplace. But please do not give us more regulations.
I love the idea of providing for more bike trails (and running trail are also good). We need more side walks in the suburbs – they encourage walking at least. We should sponsor exercise training in schools. Those are positive ideas.
