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<ul class="summary-list"><li>A doctor shortage is projected to hit 86,000 by 2036. Rural communities already feel the impact.</li><li>Educational initiatives and congressional bills aim to combat issues like limited appointment slots.</li></ul>Every three to four months, Mellisa Case drives three and a half hours from her small town of Prineville, Oregon, to Portland to see her orthopedist for help with arthritis, a condition she believes she could have avoided at this stage in her life.In 2021, Case had surgery for a meniscus tear at an orthopedic center in Bend, an hour away from her home. However, she couldn't schedule appointments for follow-up care, which doctors consider necessary for proper recovery. For several months after her meniscus surgery, Case kept calling the center for an appointment with no success while her knee deteriorated.Now Case takes time off from work and spends up to $125 round trip on gas while traveling to Portland for arthritis care. Case said that symptoms like stiffness, swelling, and discomfort — which resulted from a lack of postsurgical medical support — could interfere with her sleep, gait, and ability to enjoy her hobbies like hiking and gardening."Until you've experienced not being able to see a doctor, you don't really realize how frustrating it is," Case, who is 53, told Business Insider. Eventually, she will need surgery for a <a target="_blank" class="" href="https://www.businessinsider.com/nc-woman-plans-finally-getting-knee-surgery-after-winning-lottery-2023-1">full knee replacement</a>.Case said that she remains concerned that the overall lack of medical care in her community, as she's observed doctors retiring or leaving her area.Some of her family members and friends also struggle to find physicians close to home, Case said, so they have to drive long distances or wait for appointments.A March report from the Association of American Medical Colleges projected that the US would face a <a target="_blank" class="" href="https://www.businessinsider.com/why-hospital-wait-times-are-bad-physician-shortage-low-pay-2024-4">physician shortage</a> of up to 86,000 specialists and primary-care doctors by 2036.Michael Dill, the organization's director of workforce studies, said this estimate was conservative."The country needs hundreds of thousands of doctors to provide an equal amount of care to everyone, including minorities, those without medical insurance, and people living in rural areas," he told BI.An aging population, physician retirement, and the administrative challenges of running a practice contribute to the shortage and disproportionally affect vulnerable populations such as older people, those lacking transportation options, and people with disabilities, public-health advocates told BI.Two solutions could be increasing medical-training programs in rural communities and passing legislation to retain and <a target="_blank" class="" href="https://www.businessinsider.com/best-high-paying-jobs-hiring-doctors-construction-accounting-2024-4">bolster the physician workforce</a>.<h2 id="0a289233-786f-4ff1-969a-24da2c3ab5eb">An aging population and provider burnout are contributing to a worsening doctor shortage</h2>The effects of a doctor shortage are already here, Dr. Bruce Scott, the president of the American Medical Association, said.Scott practices in Louisville, Kentucky, and said that in addition to patients in rural areas driving hours to appointments, they're waiting months to see a doctor.Various factors, including an aging population, play a part in the situation, Dill said.In 2020, 55.8 million Americans, or 16.8% of the population, were 65 or older, and by 2030, all baby boomers will have reached age 65, according to a <a target="_blank" class="" href="https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html ">US Census report.</a> As people age, they require more physician services, such as cardiologic or neurological care, and at the same time, doctors are aging and retiring, adding to the shortage, Dill said.<a target="_blank" class="" href="https://www.businessinsider.com/labor-shortage-hospital-beds-empty-nurses-doctors-staff-covid-vaccine-2021-10">Physician burnout</a> further exacerbates the problem, Scott said. In one survey that was part of AMA Organizational Biopsy report, of over 12,400 doctors, 48% of respondents said they were burned out. In another survey from the same report, one in three respondents said they planned to retire or reduce hours within two years.One AMA survey found some doctors were leaving their practices because they were being paid less to handle more <a target="_blank" class="" href="https://www.businessinsider.com/electric-health-records-causing-doctor-burnout-2018-12">administrative burdens</a>, such as spending 12 hours a week filling out prior-authorization requests. "Medicare is paying us nearly 30% less in 2024 than it did in 2001, when adjusted for inflation," Scott said, citing further data compiled by the AMA.<h2 id="1d068686-c4d6-4ee0-81d9-f17918ad516a">Strategies to alleviate the shortage</h2>To help alleviate the physician shortage in rural areas, medical students need to receive training there, said Molly Fox, the vice president of institutional advancement at Kansas Health Science University."We engage students with the rural community because we know that people tend to practice where they feel connected," Fox said.At KHSU's Kansas College of Osteopathic Medicine, for example, third- and fourth-year students can complete clinical rotations at St. Catherine Hospital in Garden City, four hours from Wichita, where the university is.Chase Hearn, a third-year student, said he'd seen doctors at the hospital who have worked 26-hour shifts to meet patient needs."I've also heard patients say they can't take a day off work to travel 200 miles to see their OB-GYN," Hearn said. He added that his training had strengthened his resolve to practice in a rural community but that he anticipated challenges, like burnout and working with patients who lack consistent access to care.<a target="_blank" class="" href="https://www.businessinsider.com/how-el-paso-trying-solve-us-physician-shortage-2023-7">Rural residency programs</a> are also needed to address the shortage, Dill said. Only 2% of residency training occurs in rural areas, the US Government Accountability Office says.A residency program through Oregon Health &amp; Sciences University aims to alleviate the doctor shortage in three central-Oregon counties, including Crook County, where Case lives. The program is training physicians in primary care, family birthing, emergency medicine, behavioral health, and hospital medicine.According to the Rural Medical Training Collaborative, 133 rural residencies in family medicine and 69 rural-track programs are recruiting for 2025 enrollment, along with 30 internal-medicine residencies and 16 psychiatry residencies.Several pieces of legislation have also been introduced to Congress to address the doctor shortage. Scott said bills to adjust Medicare payments for doctors — no matter where they practice — to the annual rate of inflation and rules to reduce the need for prior authorization could help ease administrative burdens.Some legislation, if passed, would specifically influence rural areas.For example, HR 7855, the Association of American Medical Colleges-endorsed Rural Residency Planning and Development Act of 2024, would codify the Rural Residency Planning and Development Program, which funds the startup costs of residency training in rural areas, Dill said. From 2019 to 2024, the program has enabled the launch of 46 accredited rural residency programs across 38 states and Puerto Rico.Hollie Davis Frick, an immigration lawyer for Wintersteen Patel Law Group, said congressional action could easily incentivize doctors born abroad and who receive advanced medical training in the US to remain here and practice in rural areas."Many doctors who come here for residencies and fellowships return abroad because of our ineffective immigration policies," Davis Frick said.If passed, S 665, the Conrad State 30 and Physician Access Reauthorization Act, would allow state health departments to sponsor additional visa waivers for foreign-born doctors who agree to practice in underserved areas within those states.While Case remains skeptical that doctor-training initiatives and legislation will directly affect her community anytime soon, she considers herself fortunate, she said."I have the ability to drive, afford travel expenses, and pay for out-of-network doctors," Case said. "Not everybody does."

Medical schools and legislation aim to address a worsening doctor shortage that's already hitting rural communities 

<ul class="summary-list"><li>Dr. Jennifer J. Bryan used to work an extra 10 to 20 hours a week, note-taking for her job. </li><li>Last fall, she began using an AI assistant to create notes and says it's alleviated her stress.</li></ul>This as-told-to essay is based on a transcribed conversation with Dr. Jennifer J. Bryan, 47, about using an AI voice assistant in the medical field. The following has been edited for length and clarity.I work in family medicine, treating newborns up to patients in their 90s.I graduated from my residency in family medicine in 2006. I've been practicing in Mississippi for 18 years and joined the Hattiesburg Clinic a year ago.I work at my clinic 40 hours a week, but I used to spend a lot of my time documenting patient notes outside those hours. Documentation admin would take an extra 10 to 20 hours a week.Last fall, I started using <a target="_blank" href="https://www.businessinsider.com/suki-medical-assistant-for-doctors-2018-4">Suki AI</a>, an AI-powered voice assistant, to help me make notes from patient interactions. I now use it all the time.It reminded me of the old days of <a target="_blank" href="https://www.businessinsider.com/how-neurosurgeon-mom-demanding-job-parenting-2024-6">practicing medicine</a> when I wasn't constantly typing notes into a computer. It's provided a more organic way for me to interact with patients and alleviated a lot of stress about note-taking.I'm in favor of <a target="_blank" href="https://www.businessinsider.com/how-use-ai-same-time-work-chatgpt-claude-jasper-2024-9#psychiatrists-1">using AI for notetaking</a>, but do have hesitations about using it for other purposes in the medical field.<h2 id="0e3448a1-1ff6-41da-ab17-340d27917a5e">I used to type my notes or use a dictation software</h2>When I first started practicing medicine in 2006, I took handwritten notes. I'd get hand cramps sometimes, but I could get my notes done during consultations.When <a target="_blank" href="https://www.businessinsider.com/electronic-health-records-benefits-challenges">electronic health records</a> came into effect, doctors could type notes, but typing while interacting with patients was distracting. So, most typing would happen over a lunch break or at home on the couch. This is when the time I spent documenting notes increased significantly, and it also caused <a target="_blank" href="https://www.businessinsider.com/doctor-burnout-ai-assistant-help-paperwork-administrative-tasks-2023-8">burnout for a lot of physicians</a> around the country.As the president of the Mississippi State Medical Association, I speak to a lot of physicians. They say button-clicking and typing adds extra strain to their lives. Personally, I never burned out, but I was often stressed and looked to alleviate it.I started using dictation software around six years ago. I would speak into a handheld microphone, and it would type my words out. It was a good product, but verbally recreating each visit took a long time, and it misspelled and misheard some words.A fellow physician at my clinic encouraged us to try using an <a target="_blank" href="https://www.businessinsider.com/openai-personal-assistant-ai-age-chatgpt-2024-2">AI assistant</a> for note-taking. I signed up to trial Suki AI, which I heard the <a target="_blank" href="https://www.fiercehealthcare.com/practices/physicians-group-testing-out-ai-tools-to-combat-pain-points-for-doctors">American Academy of Family Physicians endorsed</a>, and a competitor product. I preferred Suki, and it's the product I still use today.(Editor's note: A spokesperson for Suki AI told BI that the company has no financial partnership with either Hattiesburg Clinic or the AAFP, and the listing price for the technology is $399 a month per provider.)<h2 id="f93c9ca3-2f16-44ba-b52a-4c311e5da2ec">How the AI assistant works</h2>Suki is <a target="_blank" href="https://www.businessinsider.com/generative-ai-smartphones-mwc-artificial-intelligence-assistants-apps-2024-2">an AI assistant</a> app on my phone that I use for notes. When I walk into a room with a patient, I ask my patients for consent to use the software. I'll hit record and my phone will listen to the conversation with the patient. I'll walk out of the room and stop recording.Unlike the dictation software I used before, which couldn't produce summaries of what I said to it, Suki generates a summarizing note from the appointment, which I send to my computer.If my phone dies or I don't have it on me, I can speak directly to Suki about the appointment. It creates a solid note as if it were listening to the exam room interaction, but I think it's more accurate when I have it in the room with the patient.At the end of the day, I'll spend 15 minutes going through my notes on my computer, making sure <a target="_blank" href="https://www.businessinsider.com/ai-down-rounds-rise-valuations-investors-2024-9">the AI</a> spelled the drugs correctly, and cleaning things up. It's a huge contrast from the 10 hours a week I used to spend on notetaking.I'm very legal-minded, and one of my first questions about Suki was how long it stores patient information. I learned that the audio and transcript from patient interactions are erased from Suki after seven days, so I felt comfortable with how it handles privacy. Before the notes are erased from Suki, I send them to my computer, and they're permanently stored in my electronic records.<h2 id="390a5732-407e-48d8-9ff6-68fd25bc4a68">Using AI at work has reduced my stress, but the technology isn't perfect</h2>I use Suki all the time now. I pay for the service, which is deducted from my paycheck.It's made my workflow easier. I'm more able to accommodate patients into my schedule. Patients have also noticed that I don't have to type anymore and can keep eye contact without looking over a computer.It's alleviated stress in my personal life. I'd never miss family events for work because family is my priority, but I did overload myself and would have to stay up late to finish notes. Now, when I'm home, my family and I are watching movies or doing homework, and I don't have to type notes for work on my laptop.The technology isn't perfect. Sometimes, when it generated notes, there were two paragraphs that almost said the same thing, so I'd cut one out when editing. Every now and then, it will misunderstand a medicine I say and put in something else.I don't see this as a problem. There are plenty of errors with scribbly doctor's handwriting and some with other dictation software. As physicians, we're responsible for reviewing notes for accuracy. With any technology, there will be an acceptable degree of edits that need to be made.<h2 id="994fc1a5-2b7a-4345-9a6e-73e00286e83f">I'm in favor of using AI for transcription and cautiously welcome it in other medical areas</h2><a target="_blank" href="https://www.businessinsider.com/ai-deals-growing-faster-healthcare-tech-svb-venture-capital-2024-6">AI has been part of medical care</a> for quite some time now, particularly in <a target="_blank" href="https://www.sciencedirect.com/science/article/abs/pii/S0720048X18302250">radiology</a> and <a target="_blank" href="https://www.imperial.ac.uk/news/200673/application-artificial-intelligence-ai-surgery/">surgery</a>.When it comes to medical transcript and scribe work, I see AI as a welcome relief from typing for physicians, who were trained to diagnose and treat, not to type.I don't see <a target="_blank" href="https://www.businessinsider.com/ai-chatbots-tech-doctors-medicine-healthcare-system-empathy-quality-email-2023-6">AI ever replacing the physician</a>, but I can see it chipping away at the medical scribe career. Scribes sit in exam rooms and type for doctors, but they're very expensive to have on board.I cautiously welcome AI in the medical field. There are <a target="_blank" href="https://www.businessinsider.com/ai-healthcare-doctors-drugs-treatments-patients-2023-12">definitely benefits that can help humans practice medicine</a>, such as using it to <a target="_blank" href="https://www.imperial.ac.uk/news/249573/new-ai-tool-detects-13-more/">detect breast cancer</a>. However I am cautious about errors from AI when it comes to patient lives and patient safety. In medicine, you can never underestimate the value of human interaction and understanding pain and feelings.I'm all in when it comes to using AI for transcription and summing up visits, but we have to make sure we have appropriate guardrails when going beyond that.Do you have a personal story about AI in the workplace you want to share with Business Insider? Email ccheong@businessinsider.com

I use an AI assistant as a doctor and cut hours off my workload. But, I'm still cautious about AI's future.

<ul class="summary-list"><li>Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.</li><li>Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.</li></ul>Independent doctors are almost a thing of the past.UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. The same month, the powerful healthcare conglomerate, which owns the nation's largest <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">health insurer</a>, got the green light to take over a decades-old independent Oregon <a target="_blank" href="https://www.oregonlive.com/business/2024/03/oregon-health-officials-give-emergency-ok-to-corvallis-clinics-acquisition-by-insurance-giant-unitedhealth-group.html">medical practice</a>, adding another 100 healthcare providers to its roster. It picked up a 400-doctor <a target="_blank" href="https://www.fiercehealthcare.com/payers/unitedhealth-quietly-scoops-new-york-physician-group-crystal-run">group</a> in New York about a year before.These are just the purchases we know about; there could be many more. Physician practice deals often go unannounced and get little attention from regulators, but they add up. Near the end of 2023, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth's Optum</a>, the business unit housing its clinics and surgery centers, said it employed or was affiliated with 90,000 doctors. That's a whopping 10% of all doctors in the US.Though it's the hungriest, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth</a> is just one buyer in the market for physicians. Little by little, big businesses have taken over healthcare in the US. Hospitals have been scooping up medical practices for decades to create giant health systems. Insurance companies fought back with their own clinic purchases. Private equity firms increasingly staked claims to nursing homes and groups of specialists such as emergency physicians and dermatologists.And in the last few years, tech companies and retailers like Amazon, CVS Health, and Walgreens added thousands of doctors to their payrolls when they bought <a target="_blank" href="https://www.businessinsider.com/cvs-walgreens-amazon-primary-care-acquisition-strategy-2024-3">primary-care chains</a>.Nearly 78% of US doctors are employed by hospitals or other corporate entities, such as insurers and PE firms, according to <a target="_blank" href="https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Study-on-Physician-Employment-Practice-Ownership-Trends-2019-2023">research</a> from consultancy Avalere and the Physicians Advocacy Institute. For the first time, more medical practices were owned by corporate entities (30%) than hospitals (28%) as of January 2024, the research found.There's mounting evidence that this trend toward corporatization could harm patients. Research has found that prices go up when hospitals and private-equity firms buy medical groups. Sometimes, care gets <a target="_blank" href="https://www.nber.org/papers/w30928">worse</a>, but there's still much unknown about how corporate ownership affects medical care, especially when it's a giant like UnitedHealth or CVS doing the buying.Some doctors and experts in the industry fear corporate owners could prioritize their investors and profits ahead of patients, and doctors could lose the ability to make their own decisions about what's best for a patient."The big guys aren't cheaper. They don't deliver better customer service, they aren't more timely, none of that. They're just able to negotiate higher prices," said Farzad Mostashari, the CEO of Aledade, a company that aims to help primary care practices stay independent.The federal government is starting to pay attention. In March, it <a target="_blank" href="https://www.ftc.gov/news-events/news/press-releases/2024/03/federal-trade-commission-department-justice-department-health-human-services-launch-cross-government">launched</a> an inquiry into PE firms and other corporate owners' "increasing control over healthcare" and how this might threaten patients' access to affordable and quality care.The feds also zeroed in on UnitedHealth, <a target="_blank" href="https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2">reportedly</a> facing an antitrust investigation by the US Justice Department into how its medical group acquisitions affect consumers and competitors. News of the probe surfaced before a <a target="_blank" href="https://www.businessinsider.com/change-healthcare-cyberattack-small-mental-health-practices-payments-money-2024-3">cyberattack on UnitedHealth's</a> technology business, Change Healthcare, caused hospitals and clinics nationwide to forgo billions in payments — raising more questions about UnitedHealth's chokehold on the healthcare industry.<h2>Doctors are hot commodities</h2>It's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. But, in essence, they're all hiring doctors for their relationships with patients, who bring opportunities for more profits. <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">US healthcare spending</a> reached $4.5 trillion in 2022, representing almost a fifth of the national GDP.Hospitals rely on doctors — especially those who provide primary care — to refer patients for lucrative procedures or surgeries. <a target="_blank" href="https://www.businessinsider.com/unitedhealth-stock-exec-medical-costs-rising-2023-6">Insurers like UnitedHealthcare</a> and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Still, they can pocket more of those premiums by sending patients to clinics they own.Pharmacies hope that buying medical practices will give more prescriptions to fill and get more customers to buy over-the-counter products at the front of the store."They all realize that patients will follow what their doctors tell them to do or where their doctors tell them to go," said Chas Roades, a longtime healthcare consultant. "So it allows them to both drive traffic to a downstream profit model that they're interested in growing, and I think it also is a way to get consumers to trust them."Meanwhile, independent doctors have a tough time going it alone. Reimbursement is shrinking, and small practices don't have the ability to <a target="_blank" href="https://www.ama-assn.org/system/files/2022-prp-practice-arrangement.pdf">negotiate higher rates</a> as big hospital systems do. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. <a target="_blank" href="https://www.businessinsider.com/ai-chatbots-tech-doctors-medicine-healthcare-system-empathy-quality-email-2023-6">The pandemic</a> made things even more challenging, spurring many doctors to sell their private practices.<h2>The quiet takeover of physician practices</h2>Much of the takeover of physician practices has slid under the radar. That's because acquisitions valued below <a target="_blank" href="https://www.ftc.gov/enforcement/competition-matters/2024/02/new-hsr-thresholds-filing-fees-2024">$119.5 million</a> don't have to be reported to federal regulators, and many practice purchases don't meet that threshold. Publicly traded UnitedHealth, for instance, rarely announces its purchases of medical groups and surgery centers."We're really flying blind here with respect to understanding how many acquisitions by which entities and what geographies and what specialties," said Yashaswini Singh, an assistant professor at Brown University who studies healthcare consolidation.This lack of disclosure has made consolidating doctor practices difficult to study. Research into private equity's effects on healthcare is just emerging, and there's little to no academic, peer-reviewed research on how other corporate owners' acquisitions affect healthcare prices and quality, Singh said.Studies, including Singh's <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946">research</a>, have shown, however, that PE ownership leads to steeper prices and more utilization, meaning patients may have more frequent doctor's appointments. Together, that drives healthcare costs higher. Research also suggests that PE ownership of nursing homes and hospitals <a target="_blank" href="https://jamanetwork.com/journals/jama/article-abstract/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=122623">worsens the quality</a> of care. One <a target="_blank" href="https://www.nber.org/system/files/working_papers/w28474/w28474.pdf">paper</a> found that patients who went to nursing homes owned by private equity firms had a 10% greater chance of dying.And yet, private equity companies are rapidly expanding their presence in healthcare. A 2023 <a target="_blank" href="https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf">study</a> found that one private equity firm owned 30% of the market share for physician practices in over a quarter of metropolitan areas across the US. A single PE firm owned over half the market share in some areas.<h2>'An unsatisfying way of practicing medicine'</h2>Acquisitions by other corporate giants might not produce the same outcomes as PE firms, said Zirui Song, an associate professor of healthcare policy and medicine at Harvard Medical School who studies private equity in healthcare. PE firms are unique in holding on to their acquisitions for only a few years and saddling their acquired companies with debt and fees. Owners who hang on to their medical groups might be more motivated to improve services, he said.Anecdotally, though, many doctors don't like working for corporate overlords, Roades said. Older physicians who own equity in their medical practice get a nice payday when they sell, but the younger ones left behind are closely managed and measured in terms of cost and productivity, he added.It's "an unsatisfying way of practicing medicine. We're seeing a growing number of disgruntled early and mid-career physicians in these groups who find themselves suddenly working for large corporations, and this is not what they wanted to do with their lives," he said.After a few years working at Optum-owned Oregon Medical Group, Dr. Nick Jones opened a <a target="_blank" href="https://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3">direct primary care practice</a>, a type of clinic that charges a monthly fee instead of billing insurance. He said there's a sense of powerlessness for primary-care doctors in the traditional healthcare system — whether they're employed by Optum, a large hospital system, a private-equity firm, or a nonprofit clinic.With thousands of patients to treat, they face a mountain of administrative paperwork and have no control over their schedules. These problems stem from the fact that primary-care doctors are <a target="_blank" href="https://kffhealthnews.org/news/article/compensation-pay-primary-care-shortage-solution/">underpaid</a> in the traditional "<a target="_blank" href="https://www.commonwealthfund.org/publications/newsletter-article/moving-health-care-system-away-fee-service">fee-for-service</a>" healthcare system, in which doctors are paid for every visit, he said.While he felt supported at his previous Optum-owned clinic because of his office manager, "the financial underpinnings and the economics of medicine" made it unsustainable and stressful, Jones said. "There was a three or four month wait for patients to see me. There was still too much on our plate to do, and [during the pandemic] there weren't enough medical assistants or case managers or nutritionists or other support to make 20 patients a day feel like the right thing to do."<h2>Doctors worry corporate giants put profits over patients</h2>The insurers and retailers say care is better and cheaper when integrated under one roof, connected to the health plan, pharmacy, or other provider organizations.For its part, Optum says it wants to improve the health and well-being of people and lower the cost of care with integrated care teams and better technology. It says it's helping clinics transition to providing <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">"value-based"</a> or "accountable" care, which means that its doctors get paid fixed fees upfront that, in theory, encourages them to keep patients healthy and order fewer unnecessary tests.Optum said in a statement it continues "to focus on supporting physicians, advance practice clinicians, and nurses in closing gaps in care and helping the health system perform better for everyone."A spokesperson pointed to a <a target="_blank" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376">study</a> by Optum published in JAMA Network Open in December 2022 that found seniors in value-based care arrangements were less likely than seniors in traditional payment models to visit the emergency room, or be admitted at the hospital for COPD, asthma, stroke, or heart attack.But there are potential dangers. Patients may end up with fewer choices as bigger companies edge out competitors.California health system Emanate Health sued Optum in 2023 for anticompetitive behavior. It alleged that Optum canceled its contracts with Emanate hospitals and steered patients away after Emanate refused to agree to certain terms. Among the terms: Emanate primary-care doctors would serve only Optum patients, and Optum would get first dibs if Emanate decided to sell its primary-care practices.Care might also feel less personal. Some <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">One Medical patients</a> complained that since the chain folded into Amazon, their appointments were shortened, and certain features for seniors, like having health coaches available during patient visits, went away, according to a report from <a target="_blank" href="https://www.washingtonpost.com/technology/2024/02/28/amazon-health-one-medical/">The Washington Post</a>.<h2>Patients could end up spending less time with doctors and face higher costs</h2>Dr. Mitch Li, an emergency physician who started Take Medicine Back, a group that opposes corporate owners pushing into healthcare, said patients will spend less time with their doctors and potentially face higher costs from predatory billing practices."The corporate practice of medicine is the reason why <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">healthcare costs</a> are out of control," Li said.Above all, some doctors fear having to make decisions that benefit the owner's bottom line, even though they may not be the best option for a patient.Dr. Michelle Cooke, a primary-care physician, previously practiced at an Atlanta clinic owned by a hospital system. Though the system was not-for-profit, it didn't operate like that, and over time, the job became unbearable, she said.She had more than 3,000 patients assigned to her care — <a target="_blank" href="https://www.jabfm.org/content/jabfp/29/4/496.full.pdf">far more</a> than typical — and appointments were too short, especially for the chronically ill, she said. The hospital system would prioritize lucrative physicals for <a target="_blank" href="https://www.businessinsider.com/cigna-selling-medicare-advantage-business-insurers-higher-costs-slower-growth-2024-2">Medicare patients</a> rather than seeing patients with an urgent need."It really got to the point where I feel like I was working to feed the corporation," Cooke said. "It really wasn't incentivizing what the patients needed."Cooke has since opened a direct primary care practice, where she sees just a few hundred patients and can spend more time with them. She said she's found that she prescribes less medication now because she has time to educate patients on lifestyle habits and nutrition.<h2>The federal government and states are dialing up the scrutiny</h2>The Federal Trade Commission, the US Department of Justice, and the Department of Health and Human Services are <a target="_blank" href="https://www.wsj.com/articles/federal-agencies-probe-private-equity-profiteering-in-healthcare-2ba4c23a">stepping up scrutiny</a> of healthcare deals, particularly those backed by private-equity firms. The agencies also signaled that they want to look at smaller deals that typically wouldn't trigger an antitrust review.Several states have also increased their oversight of local healthcare consolidation. Some state lawmakers are also trying to strengthen <a target="_blank" href="https://www.nejm.org/doi/full/10.1056/NEJMp2306904#f1">laws prohibiting</a> corporations from practicing medicine. Most states have these bans on the books, but companies have found various ways around them.It's unclear if any of these efforts will meaningfully slow the corporatization of healthcare. And, to be sure, some physician practices may not have survived without an infusion of capital from a corporate buyer.A bill introduced by Oregon State Rep. Ben Bowman would have closed certain <a target="_blank" href="https://www.opb.org/article/2024/02/22/oregon-lawmakers-could-limit-corporate-ownership-of-medical-practices/">loopholes</a> and put more distance between corporate entities and their medical practices. Bowman told Business Insider he wanted to prevent big businesses from eroding doctors' autonomy."A physician who went to medical school who took an oath — their highest ethical duty is to care for their patients. Whether it's a private equity firm or a large corporation, their highest ethical duty is to generate a return on investment for their shareholders. Those two incentives are fundamentally at odds," Bowman said.The bill, opposed by Amazon and CVS, died in March, but Bowman said he plans to reintroduce it in 2025.Around the same time the bill died, UnitedHealth's Optum and The Corvallis Clinic — the small Oregon medical practice that Optum struck a deal to buy — requested that their tie-up receive an emergency exemption from state review because of the Oregon clinic's deteriorating finances.The proposed acquisition, first announced in December, had received plenty of pushback from state residents. The request also came as hospitals and clinics nationwide faced cash shortfalls because of the cyberattack on UnitedHealth's Change Healthcare.A week later, Oregon's health authority approved the request.

Big corporations are quietly taking over your medical practice. Some doctors and experts say it's ruining healthcare.

<ul class="summary-list"><li>Stroke is the fifth leading cause of death in the United States, but is preventable.</li><li>Black people are two times more likely to have a stroke than any other racial group.</li></ul>Having a good doctor can turn a visit to a doctor's office from a dreaded affair into a tolerable one, and maybe even make it enjoyable. Attentive care can also lead to improved health long-term, including reducing risk of stroke.Stroke is the <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.stroke.org/en/about-stroke">fifth cause of death</a> in the United States, and affects more than <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.cdc.gov/stroke/facts.htm">795,000 people each year</a>. Black adults are two times more likely to have a stroke than white adults, and Black people have the <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.stroke.org/-/media/Stroke-Files/Lets-Talk-About-Stroke/Prevention/Lets-Talk-About-Black-Americans-and-Stroke-Sheet.pdf">highest death rate from stroke</a> than any other racial group, per the CDC.There is no simple solution. Systemic racism impacts the health of Black Americans in myriad ways, from poor food access to worse medical care, as a group of leading doctors reported in an <a target="_blank" rel="noopener noreferrer nofollow" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781103">editorial</a> for JAMA.But there are some concrete steps doctors can take to reduce stroke risk, according to <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.ahajournals.org/doi/0.1161/STROKEAHA.122.042055">new research</a> published August 3 in the journal, Stroke."There is a lot of disparity in the healthcare system in general," Dr. Eyad Almallouhi, a neurointerventionalist at Sarasota Memorial Hospital in Sarasota, Florida, and one of the study's lead authors, told Insider. "So what's important to know is, how can we minimize this disparity?"Researchers looked at outcomes of Black patients compared to non-Black patients who participated in a study from 2008 to 2011, and found that attentive medical care not only reduced disparities, but prevented stroke going forward.Here are three things doctors should be doing, according to Almallouhi and Dr. Ashley Nelson, co-author of the study and neurology resident at the Medical University of South Carolina in Charleston.<h2>Design a personalized exercise and diet routine that patients can stick to</h2>A stroke occurs when <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.insider.com/guides/health/conditions-symptoms/what-is-a-stroke">blood stops flowing</a> to a part of the brain, leading to a lack of oxygen. Strokes can be fatal, or can lead to a permanent disability.Patients in this study had "intensive lifestyle modification coaching, medication management, and had routine access to follow up," said Nelson, collectively known as "medical management." <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.nejm.org/doi/full/10.1056/nejmoa1105335">The original study</a> found that medical management was more effective than <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.insider.com/guides/health/how-to-prepare-for-stent">a stent</a> — a medical device that opens up narrowed arteries — at preventing future strokes.At the start of the study, Black patients were less physically active than non-Black patients, and were more likely to have type 2 diabetes, high cholesterol and high blood pressure — also known as hypertension — all risk factors for stroke.But that shifted after one year of medical management, and key stroke risk disparities between Black patients and all other patients had largely disappeared.Specifically, medical management eliminated differences in patients' <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.insider.com/guides/health/conditions-symptoms/how-to-control-high-blood-pressure">diastolic blood pressure</a>, which is a <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.eurekalert.org/news-releases/997143">good marker of cardiovascular health</a>, and significantly increased physical activity.Ultimately, the researchers said medical management also eliminated disparities in future stroke or death for Black patients.<h2>More frequent follow-up visits for Black patients at risk of stroke</h2>One "helpful" feature of the study, Almallouhi said, was "having close follow-ups with patients to be able to monitor and make sure their risk factors are under good control."Over the course of this study, patients had more frequent check-ups than most Americans, per <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2019-namcs-web-tables-508.pdf">CDC data</a> — five doctor's visits during the course of a year. That included their initial visit, and a 30-day, four-month, eight-month and 12-month follow-up visit.The frequency of visits allowed doctors to see how well each patient's treatment plan was working. If a patient's blood pressure was still high, for example, at a follow-up visit, doctors could adjust their medication to help bring it into a healthy range. They also provided lifestyle coaching, to help patients improve their physical fitness.<h2>Build a trustworthy environment</h2>Almallouhi said that Black patients often face more barriers to accessing medical care than white patients, which can lead to disparities in health outcomes.But there's also a question of trust. The American Heart Association (AHA) issued a "<a target="_blank" rel="noopener noreferrer nofollow" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000936#d1e1105">call to action</a>" in 2020, acknowledging that "misdeeds conducted in the United States in the name of science and clinical care," have led to "mistrust and poor relationships" between people of color, including Black people, and the healthcare system.It came shortly after an AHA study found that Black patients were <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.031121">less likely to seek medical help for stroke</a> during the COVID-19 pandemic. For Almallouhi, it's clear that the onus is on healthcare professionals to rebuild that trust if they are to provide equal care.Start by creating a safe and trustworthy environment for patients, Almallouni said.<a target="_blank" rel="noopener noreferrer nofollow" href="https://www.insider.com/doctor-who-has-been-gaslighted-shares-advice-for-patients-2022-8"> Good listening and communication skills</a> will go a long way to help a doctor truly understand their patient's <a target="_blank" rel="noopener noreferrer nofollow" href="https://www.insider.com/doctors-dismissed-young-peoples-strokes-as-drugs-alcohol-migraines-2022-11">concerns</a>. Doctors should make sure their patients understand why they are ordering certain tests, or prescribing a particular treatment."I think we have a long way to go to be able to achieve equal access for everyone," said Almallouni, but "highlighting the disparities and what we can do about them is very important to be able to move past these obstacles."

3 things doctors can do to prevent strokes in Black patients, who have double the risk 

The <keyword id="6354977" type="ORGANIZATION" weightage="20" keywordseo="Supreme-Court">Supreme Court</keyword> Thursday refused to entertain a contempt plea filed by <keyword id="6365835" type="ORGANIZATION" weightage="20" keywordseo="indian-medical-association">Indian Medical Association</keyword> (IMA) against the Delhi Chief Secretary for alleged <keyword id="961315" type="PERSON" weightage="20" keywordseo="non-payment-of-salaries">non-payment of salaries</keyword> to doctors and asked it to approach the high court which is dealing with the issue. A bench of Justices Ashok Bhushan, R Subhash Reddy and M R Shah said the issue was being dealt with by the <keyword id="6355014" type="UNKNOWN" weightage="20" keywordseo="delhi-high-court">Delhi High Court</keyword> and there is no point in entertaining this plea in the apex court. Senior advocate Maninder Singh, appearing for IMA, said the salary for April and May was paid after the high court's intervention but no salary was paid again from June to October. The bench said the high court had already passed its order on July 29 and it is monitoring the issue. Singh submitted that doctors are termed as frontline warriors and they have to be paid salary on time but there was no substantial hearing in the high court. He said that after the contempt application was filed in the top court, salaries for the months of June to October were paid to the doctors. Singh contended that doctors should be paid their salary on time to which the bench said that there is no doubt that salary has to be paid and Union of India has already passed an order in this regard. On July 29, the Delhi High Court had told the AAP government to release to the North Delhi Municipal Corporation (NrDMC) the funds it requires to pay the stipends of the resident doctors in the six hospitals run by the civic body. The high court had asked the Delhi government to release within 15 days an amount of Rs 8 crore, as was done by it earlier, to NrDMC without waiting for completion of paperwork so that the resident doctors can be paid. It had observed that the resident doctors do not get a regular salary and instead they are only given stipends or emoluments which ought not to be denied to them. It had made it clear that the amount being released was meant solely for the purpose of paying the stipends or emoluments of the resident doctors in the six hospitals of NrDMC. It had also directed the corporation to complete all the paperwork in relation to the Rs 8 crore that would be released by the Delhi government and warned that failure to complete the formalities would lead to action against the officials concerned. The high court order had come while hearing a PIL initiated by it based on news reports that doctors of Kasturba Gandhi Hospital have threatened to resign as they have not been paid salaries since March this year. The news reports have also stated that recently the doctors of North MCD-run Hindu Rao hospital had written to Prime Minister Narendra Modi over non-payment of their salaries for the months of March, April and May. In its status report, filed in response to the plea, the corporation has said that salaries up to May of all resident doctors in hospitals run by the civic body have been paid. The corporation has also said in its report that the salary upto April of all of its regular doctors have also been paid. SEE ALSO: <a href="https://www.businessinsider.in/finance/banks/news/rbi-directs-hdfc-bank-to-suspend-its-digital-business-and-new-credit-cards-amid-rising-incidents-of-outages/articleshow/79542055.cms">RBI tells HDFC Bank to stop new digital launches and selling new credit cards after recent outages of online banking</a> <a href="https://www.businessinsider.in/tech/news/india-may-reportedly-block-wikipedia-if-the-site-doesnt-delete-the-map-showing-aksai-chin-as-a-part-of-china/articleshow/79541391.cms">India may reportedly block Wikipedia if the site doesn't delete the map showing Aksai Chin as a part of China</a> <a href="https://www.businessinsider.in/science/environment/news/geo-tagged-bottles-in-the-ganges-river-show-how-plastic-pollution-can-travel-thousands-of-kilometres-in-just-a-few-months/articleshow/79540173.cms">Geo-tagged bottles in the Ganges river show how plastic pollution can travel thousands of kilometres in just a few months</a>

Supreme Court refuses to entertain contempt plea over non-payment of salaries to doctors

The agitating resident doctors on Friday called off their 14-day long nationwide agitation over the delay in NEET-PG counselling and alleged manhandling of doctors by the police. The doctors will resume work from 12 p.m. The strike was called after a meeting between the members of the Federation of Resident Doctors' Association (FORDA) and Joint Commissioner of <keyword id="6358992" type="General" weightage="50" keywordseo="delhi-police" source="Orion">Delhi Police</keyword>. "Last evening we met the Joint CP of <keyword id="66" type="General" weightage="100" keywordseo="delhi" source="Orion">Delhi</keyword>. The Delhi Police have initiated the process of quashing the FIR," said Dr Manish Nigam, president of FORDA. Joint CP has sent a video message to rebuild the trust between the doctors and the police, he said. In a statement, FORDRA said that a series of meetings of FORDA Representatives was held with multiple Delhi Police officials. It was highlighted by the Delhi Police that they have the highest regard for doctors. They are well aware of the hardships of Doctors and as earlier, they are willing to cooperate with the <keyword id="42518" type="General" weightage="20" keywordseo="medical" source="Orion">Medical</keyword> fraternity for any issue at any time. "A virtual meeting of FORDA with all RDA Representatives was convened late in the evening whereby all the proceedings were conveyed and all concerning points were discussed in detail. It was unanimously decided to call off the agitation on 31st December, 2021, 12.00 p.m., considering various factors including patient care," said FORDRA. However, the doctors association has said that a national meeting with all the RDA representatives will be convened by FORDA on January 6. As the health ministry is supposed to submit the Committee Report to the <keyword id="6354977" type="General" weightage="20" keywordseo="supreme-court" source="Orion">Supreme Court</keyword> before January 6, 2022 and will publish the NEET-PG 2021 Counselling schedule following the Court hearing, the association said. The resident doctors had called for a total shutdown of medical services in the hospitals after the police action during their march towards the apex court on December 27. SEE ALSO: <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/business/startups/news/indian-startups-added-44-unicorns-and-9-went-for-ipo/slidelist/88611418.cms">44 unicorns, 9 IPOs — the high points of the Indian startup ecosystem in 2021</a> <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/science/health/news/serum-institute-applies-to-indian-authorities-for-full-market-authorisation-of-covishield/articleshow/88611779.cms">Serum Institute applies to Indian authorities for full market authorisation of Covishield</a>

Delhi resident doctors call off their 14-day long nationwide strike over NEET-PG counselling

Taking a dim view of abusive behaviour towards healthcare professionals amid the nationwide lockdown, the Indian Medical Association (<keyword id="8507" type="ORGANIZATION" weightage="20" keywordseo="IMA">IMA</keyword>) has called for observance of a 'White Day' on Wednesday and a nationwide 'Black Day' protest on Thursday. The IMA wrote a letter on Monday to all its current and past office-bearers to issue directions to different hospitals and health workers to light candles on hospital premises as a symbol of protest and vigil on Wednesday. "Let not our white become red," the IMA warned, and demanded enactment of a central law through an ordinance for the protection of healthcare professionals and guarantee for a safe workplace. "If the government fails to enact a central law on violence against doctors and hospitals even after a white alert, the IMA will observe a 'Black Day' on Thursday," it said. The association said that all doctors in the country will sport black badges on Thursday as a mark of protest. "A decision on the further course of action will be taken if suitable steps are not taken by the government even after 'Black Day'. The 'White Alert' is only a warning," said the association. the IMA said that it had so far observed the utmost restraint and patience in spite of extreme provocations. "Doctors have been abused, beaten up, denied entry to their residences. Obstruction in cremation is the last straw that the IMA can bear," Dr Rajan Sharma, IMA President, said in the letter. "If dignity is denied even in death, our patience and restraint lose their value. We demand a special central law against violence against doctors, nurses, healthcare workers and hospitals through an ordinance," Dr RV Asokan, Honorary Secretary General of the IMA, added. See also: <a href="https://www.businessinsider.in/india/news/resident-doctors-of-aiims-write-to-union-minister-over-harassment-of-colleague-who-attempted-suicide/articleshow/75237665.cms">Resident doctors of AIIMS write to Union minister over harassment of colleague who attempted suicide</a> <a href="https://www.businessinsider.in/india/news/coronavirus-hits-mumbais-jaslok-hospital-31-nurses-5-doctors-test-positive/articleshow/75229762.cms">Coronavirus hits Mumbai's Jaslok hospital, 31 nurses, 5 doctors test positive</a> <a href="https://www.businessinsider.in/india/news/an-mp-doctor-who-looks-after-covid-19-gets-infected/articleshow/75242024.cms">An MP doctor who looks after Covid-19 gets infected</a>

Top medial association wants to observe white day and black day to protest abuse

New Delhi, May 22 () A mess worker at AIIMS-Delhi has died of COVID-19, the Resident Doctors Association said on Friday, alleging he died because the hostel administration did not take precautionary measures as demanded by it more than a month ago. The association also alleged the hostel superintendent tried to present the death as a "possible cardiac event" and demanded his and the senior warden's resignation. "A mess worker from RPC canteen died of COVID-19 because the hostel section refused to take precautionary measures as demanded by RDA more than a month ago," the RDA said in a letter to the AIIMS Director. The association had demanded regular screening and other safety measures like provision of thermal scanner, sanitizer, masks etc. to ensure mess workers are able to work safely. "These demands have fallen on deaf ears and hence the fatal outcome," it said, requesting the AIIMS administration to provide compensation to the family of the mess worker who was "serving" them during the pandemic. "Hostel superintendent tried to present the death as probable cardiac event in the morning review meeting. RDA AIIMS demands resignation of both Hostel Superintendent and Sr. Warden taking moral responsibility of the same," the letter signed by RDA President Adarsh Pratap Singh and General Secretary Srinivas Rajkumar T read. They also demanded testing of all mess workers and resident by diligent contact tracing and ensuring such incidence don't repeat. They also sought appointment of a more receptive and resident friendly hostel superintendent and senior warden. "The RDA, AIIMS request the AIIMS administration to provide compensation to the grieving family of the mess worker who was serving us during the pandemic," they said. PLB ABH ABH

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Big corporations are quietly taking over your medical practice. Some doctors and experts say it's ruining healthcare.

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3 things doctors can do to prevent strokes in Black patients, who have double the risk

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Supreme Court refuses to entertain contempt plea over non-payment of salaries to doctors

PTI

Delhi resident doctors call off their 14-day long nationwide strike over NEET-PG counselling

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Top medial association wants to observe white day and black day to protest abuse

IANS

AIIMS mess worker dies of COVID-19: Resident doctors

PTI

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