The Baseball Lover’s Presidential Politics Edition of Health Wonk Review

cubs

In this week’s health policy roundup, Brad Wright posts Health Wonk Review: The Game 7 of Politics Edition  at Wright on Health. His post skillfully ties two of America’s favorite and most contentious pastimes together: sports and politics. Something here for everyone.

 

And next Tuesday, don’t forget to “Play Ball!”  

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Posted in biotechnology, electronic patient records, health economics, health insurance, health IT, health policy, health reform, healthcare marketing, pharmaceutical marketing | Leave a comment

Healthcare Devices and the Internet of Things – Promise, Peril and Distributed-Denial-of-Service Attacks

Last Friday, widely used websites like PayPal, Netflix and Twitter were unavailable due to a distributed denial of service (DDOS) attack . Hackers got into those systems through technical holes in hundreds of thousands of personal wifi-enabled devices like baby monitors and personal devices to bring down a website host, Dyn. For people in healthcare who are concerned about security, it brought a system vulnerability into sharp relief.

I am not a computer expert (disclaimer), but as I understand it, many of the consumer and even medical personal devices that we use to monitor our health and deliver data to the electronic patient record are pre-set with default passwords. Users don’t usually reset them to a private password so most of these IoT devices remain set with the factory default. Apparently, any hacker can guess the default passwords, hijack the devices and get them to log into a web host system like Dyn all at once which overloads the system with requests and causes it to fail.

Vulnerabilities to Healthcare Organizations and Individual Patients

These kinds of vulnerabilities pose risks to individual patients and healthcare systems.

Healthcare organizations have already sustained several debilitating attacks that have occurred in this way. In 2014, Boston Children’s Hospital was offline for several days after a DDOS attack by the group Anonymous that was protesting its treatment of a patient; other hospitals have sustained similar attacks. Computer experts say there are measures that hospitals and health systems can institute to prevent such attacks. This article broadly describes some of those precautions.

Concerns regarding the safety of individual patient devices such as heart monitors and insulin pumps fall into two broad categories 1) diverting data thus compromising patient privacy and 2) resetting dosing parameters thus endangering patient lives. The FDA, which regulates medical devices, is interested in the issue and has studied it, but so far has decided not to regulate the IoT of medical devices for several reasons. It is technically difficult to do, technology and security advance more quickly than threats, and the threat to individual patient health and safety is more theoretical than actual. A hacker could hack into an individual patient’s medical device to reset it, but that is very unlikely. It doesn’t mean that patients with consumer or medical devices cannot or should not take steps to protect themselves. Patients can reset default passwords. This article from TechTarget describes the pros and cons of patient access to device passwords in more detail.

Due Diligence

The attack last week wasn’t a state-sponsored attack from Russia as originally postulated, but came from non-state-sponsored vulnerabilities out of China .DDOS No matter where it came from, last week’s incident reminds everyone, including those in healthcare, that a damaging hack attack is not that hard to do. In fact, attacks like this occur all the time, all over the globe. For a little fun – or for a wake-up call – check out this website where you can watch cyberattacks in real time. There is usually a lot of activity into and out of the U.S., Russia and China.

The challenge for IT specialists in health care is to make sure these attacks aren’t perpetrated on your patients or your organization. This article from Modern Healthcare  describes Athenahealth and Allscripts outages that occurred during the DDOS attack last week. A Medical Group Management Association health information expert reminded individual physicians’ offices that their data, too, can be taken offline during an attack and he recommends backup plans that involve having a technician on speed dial.

An article out of the 2014 Black Hat hackers conference  explains that all attacks –even those not directly targeted at healthcare – should be of concern to health IT professionals.

All hacks and cyberattacks can expose your patients and organizations. The Dyn DDOS attack is a reminder to do your due diligence.

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Posted in consumer health apps, electronic patient records, health IT, health IT training | 1 Comment

Health Wonk Review Election Edition – Mama Says Eat Your Peas and Don’t Forget to Vote

kid eats peasVoting this presidential year feels a little like being forced to eat your peas; it’s the right thing to do but you have to hold your nose.

An educated populace is the bedrock of a sober and productive small “d” democratic society. Our Health Wonk Review contributors are doing their part to keep democracy alive. Let’s start by reading this positive post by our friends at Health Affairs about  opportunities for continued progress in the U.S. health care system that are not necessarily dependent on the outcome of the election.

Health Affairs Blog this week discusses What Bipartisan Opportunities Will the Next Congress and President Have to Improve Health Policy? by Anand Parekh, Ashley Ridlon, Katherine Hayes, Janet Marchibroda, Lisel Loy and William Hoagland of the Bipartisan Policy Center. In it, we learn that while larger ideological questions divide the two major parties regarding whether the Affordable Care Act should stand and how payments for programs should be structured, voters across party lines may still look forward to progress on issues that directly affect the quality of patient care such as the move to value-based care, the steady advance of technology, and the emergence of care coordination. The article’s introduction tells us that “there will be several potential opportunities for bipartisan agreement to further advance the health of the American public” and concludes, “Whether the political will exists to reach across the aisle and work together remains to be seen. If so, bipartisanship may very well contribute to having a positive impact on the nation’s health.”

Technology: The Promise and the Dark Side

Julie Ferguson at Workers Comp Insider also brings some heartening news on the potential for catastrophically injured workers to be enabled with new functionality via exciting new assistive technologies. See her post Cyborgs and Workers Comp where she defines the term “cyborg” to orient her readers to the promise of technology: A cyborg (short for “cybernetic organism”) is a being with both organic and biomechatronic body parts.

More on the promise of technology as David Williams asks Is Radiology Doomed? In this article, David explains that captured radiologic images may be delivered directly to the patient record completely bypassing a human radiologist. That prediction begs the question: Is machine learning going to replace radiologists? He says, “Eventually yes, unless radiologists figure out how to be diagnostic quarterbacks.”

Next, Roy Poses tells us that not all wonder drugs are all that wonderful. In his entry at Health Care Renewal, Not So Wondrous Drugs: New Warnings about Severe Adverse Effects of New, Heavily Marketed Drugs for Hepatitis C, Roy digs down into the clinical trial data of recently approved Hepatitis C cures. Roy discusses whether trial results really support claims for pricey and highly-touted Sovaldi. He concludes saying, “The skepticism [evidence-based medicine] should engender could lead to health care that is more about patients and their outcomes, and less about hype ideology, hype, and hucksterism. If only such skepticism were easier to find.”

Speaking of Evidence-Based Medicine

Another blogger this week is also questioning the evidence, or lack of same, from another quarter, and that is the legitimacy of a 30-day readmission rate as a quality benchmark for hospitals. In The Hospital Leader, Brad Flansbaum shows us data that reveals a hospital’s influence on a patient’s post-discharge condition falls off a cliff after about a week, at which point the readmission rate is influenced far more by factors outside the hospital’s control. Read more as The Hospital Leader considers ways this issue can be handled to the advantage of patient outcomes and a hospital’s liability for them.

Paying for Care – Proven and Unproven

You’ll never know whether a treatment works if you can’t pay for it. Several bloggers this week turn their attention to whether the nation’s Affordable Care Act is, indeed, affordable.

Hank Stern at Insure Blog submitted a blog written by his colleague Patrick Paule that looks at a shell game where taxpayers funded a non-profit health plan to participate as an Obamacare co-op in the state health exchange to the tune of $65 million under the condition that it remain a non-profit. However, as one of the few co-ops that have remained standing – albeit on wobbly legs – it just announced its acquisition by a private equity group and conversion to a for-profit entity – moves that create a dilemma for the Obama administration. Read details here about this political sticky wicket that catches 38,000 patients in its grip.

Another blogging HWR regular, Louise Norris, also digs into a detail of the ACA that snags another small subset of patients. In this two-part series at Healthinsurance.org , Louise analyzes the data on who is actually impacted by rising insurance rates. She concludes that while rates are going up, only a small sliver of the U.S. population are “being crushed by rate increases”. For those who are part of the non-subsidized, median-income crushed, she offers advice for dealing with premium hikes.

In a separate blog at Health Insurance Colorado , Louise Norris tells readers that while Colorado rates are rising an average of 20 percent for the combined subsidized and unsubsidized individual markets, the people of Colorado will be getting more for their Obamacare premiums. Specifically, benchmark plans for 2017 will include chiropractic care, bariatric surgery and fertility treatments.

Back to the Voting Booth

We will wrap up this edition of Health Wonk Review by revisiting the voting booth. Our contributor, Shalvi Prasad, writes for Health Access: California’s Health Consumer Advocacy Coalition asking readers in California to push the lever for Proposition 56 that would add $2 to each pack of cigarettes to fund smoking cessation programs and boost funding for Medi-Cal. Find details on Prop 56 in Health Advocates Protest Big Tobacco’s Lies at Health Access.

And don’t forget to eat your peas!

 

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Posted in biotechnology, electronic patient records, health economics, health insurance, health IT, health policy, health reform, healthcare marketing, pharmaceutical marketing, pharmaceutical sales | 6 Comments

Pre-election Punditry with Joe Paduda at Health Wonk Review

tumblr_inline_nuh71x0O4I1r565cw_1280If you think the Black Death was fun, you’ll just adore this election season!

So join Joe Paduda this week for Pre-election Pundit Ponderings! at Managed Care Matters for some pre-game festivities.

 

I am excited to announce that I will be hosting the last pre-election Health Wonk Review blog confab before the main event here at Health System Ed in two weeks. After Joe’s edition, what’s left to be said? Stay tuned…

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Peering into the Future of Health Insurance: Real-time Data and a Whole New Way to Look at Actuarial Science

crow'snest

“At Lemonade…their hope is to remake insurance as a social good, rather than a necessary evil.” – Dr. Peter H. Diamandis

The structure of ObamaCare® requires people who don’t have health insurance to purchase it; if you can’t afford it, the government will subsidize your payments. If you don’t sign up, you pay a penalty. If you wait until you are sick, you can sign up and your bills get paid. This system turns traditional actuarial science on its head because the insurer can’t reject applicants – all comers are in – so the insurer has no control over its insured pool.

Insurance of all sorts is based on predictive analytics derived from retrospective data. Experience would suggest that if you have run a bunch of red lights and have a drawer full of speeding tickets, that you are a higher risk to insure for a car accident than someone who drives the speed limit and obeys all the laws. Based on retrospective data, the car insurance company can make predictions about your future behavior and the amount of risk that it is assuming by issuing you a policy.

But what if a car insurer – or health insurer – could track your behavior in real time, perform some predictive analytics based on the collected data, and generate a premium based on that real-time data?

Ah, the Joy of Data

Our man at Singularity University  and Human Longevity Inc., Peter H. Diamandis, MD, is exploring what he describes as the “demonetization of insurance.” In an email last week, he described a new insurance model that is already in practice in homeowner’s insurance and the effect it will have on health insurance in the future.

The future of healthcare is about real-time data collection, analysis and informed action.  His concept takes the value of informed decision making to its logical conclusion.

Where Health System Ed imagined just a few years ago that the collection of health data from the universal set of all patients – and the resultant best practice clinical protocols – would reside in a big electronic patient record database to determine the best course of action during a single encounter, technology galloped ahead of that concept. The proliferation of personalized health information and tracking devices appears to allow patients to go straight to self-management of disease. It also goes straight to self-determining your health insurance risk to create your own risk pool.

Whaaattt???

Here are excerpts from Dr. Diamandis’ September 26 email where he describes Lemonade Insurance Company   in New York State – a peer-to-peer homeowners’ insurance company that is making the traditional insurance model obsolete. Lemonade isn’t just an insurance company; it is a non-profit organization with a humanitarian mission.  It’s worth reading through his description of the homeowners’ and car insurance concepts because when you get to the upshot, the application to health insurance will be obvious.

Dr. Diamandis:

…I have been advising and am a proud board member of a new company called Lemonade Insurance Company that is rebuilding the insurance model from the bottom up — it is the world’s first “peer-to-peer” (P2P) insurance company.

Imagine just 90 seconds to get insured, 3 minutes to get paid. Zero paperwork.

P2P reverses the traditional insurance model. They treat the premiums you pay as if it’s your money. With P2P, everything becomes simple and transparent. Lemonade takes a flat fee, pays claims really fast, and gives back what’s left to causes you care about.

This week Lemonade launched their service and announced that they’ve been licensed as a full-stack insurance carrier by New York State for homeowner and renter’s insurance…

Fraud consumes as much as 38% of all the money in the traditional insurance system, inflating premiums by $1,300 and making the claims process protracted and unpleasant.

This happens because there is a lack of transparency in a largely analog (rather than digital) system with many humans in the loop.

If you could digitize the entire process – from signing up to submitting a claim – and give the insured individual full transparency over the status of their request, adding in automation and machine learning, you can dramatically reduce processing time and costs.

This is what Lemonade does at its core. “Technology drives everything at Lemonade,” said Shai Wininger, president and cofounder. “From signing up to submitting a claim, the entire experience is mobile, simple and remarkably fast. What used to take weeks or months now happens in minutes or seconds. It’s what you get when you replace brokers and paperwork with bots and machine learning. Zero paperwork and instant everything. . .

Imagine finding a group of peers, who you trust and can vouch for, and coming together as a group to self-insure.

You skip the centralized, expensive middleman insurance carrier – instead, a technology stack (app, database, AI-bot) manages a decentralized network of people who pay premiums and file claims that the group approves.

This takes out an enormous percentage of the cost structure of traditional insurance. Instead of paying fees and insurance company salaries, your peer group will be able to decide what to do with the extra cash that wasn’t paid out.

At Lemonade, you actually have the option to donate underwriting profits to nonprofit organizations of your choosing. Their hope is to remake insurance as a social good, rather than a necessary evil. . .

When talking about life insurance, it’s going to be difficult to ignore genomic data. Your DNA is your medical future. It’s predictive of what’s likely to inflict or kill you…It’s in their best interest to do so. [Click here to see Health System Ed blog on Human Longevity Inc.] You’ll be able to upload your genomics data and find others in your peer group that have similar or better risk profiles than you do…

For life insurance companies, I believe there is a beautiful alignment of incentives coming soon. These life insurance companies will use genomics information to help their clients stay alive longer.

Why? Because the longer they are alive, the more premiums they can pay…

Sensors will allow insurance policies to be based on actual data (e.g. usage, health), rather than general heuristics and rules. As an analogy, check out Progressive Insurance’s SNAPSHOT Automotive Sensor package – it’s a sensor you put in your car that tracks how well you drive. (Do you brake hard? Speed? Take high-speed turns?)

When your insurance policy is based on how you actually drive, rather than just your age, gender and what kind of car you own, safer drivers win.

Sensors will have the biggest impact on health insurance, as hundreds of new health sensors are coming to market in the next 5-10 years.

Sensors tracking healthy behavior such as how much you exercise and what you eat, will get you low insurance costs…

In the near future, with the peer-to-peer model, you’ll soon upload everything from what you eat to the number of steps you take per day, and find a group with similar health profiles and self-insure.

Thus spake Dr. Diamandis. The pace of innovation just may outrun our problems.

What do you think?

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Posted in biotechnology, consumer health apps, electronic patient records, health economics, health insurance, health IT, health policy, health reform, healthcare change management, healthcare marketing | Leave a comment

Health Wonk Review – Colorado Health Insurance Insider Celebrates 10 Blogging Years

number candlesLouise and Jay Norris mark Colorado Health Insurance Insider’s 10 year blogging anniversary – congratulations!! – with a rousing edition of Health Wonk Review. She notes that there’s a little something for everyone, and highlights the fact that healthcare reform is still very much a work in progress.

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If I could choose only one healthcare topic two months before the election, it would be…

…difficult to choose.

  1. The escalating cost of drugs is an election year favorite
  2. Then there are several reports this week that electronic health records are a PITA to doctors, and I don’t mean the kind wrapped in flatbread
  3. Let’s not forget the fact that the Affordable Care Act is anything but – for patients who have to pay the rates (as opposed to those who get government subsidies) and for the health insurance companies trying to provide them

I thought about posting a request for a vote and then expound on the most popular topic. Each one, however, is so rich with possibility. Let’s not let any of them lie fallow.

The Escalating Cost of Drugs

Pharmaceutical companies are under public scrutiny for raising prices. We’ve had the Shkreli scandal and now another company is in the news for increases from about $100 to $600 over the course of about 8 years, give or take. Ouch. If you are a patient paying full price out of pocket, or even some copay that amounts to about 25% of the full cost, you feel that. Not seen in this diagram, however, is that much of this product finds its way into schools for free to save the lives of children.

After the public outcry, this particular manufacturer immediately cut the cost of its drug by half, then introduced a generic version.

There is the potential for a trend here. If the manufacturer releases its own generic, it wins whether it’s playing on the swings or the sliding board. And I am sure that this manufacturer’s price hike will remain political fodder for the next few months because hating on the pharmaceutical industry is such an easy win for a politician pandering to public opinion.

Beware the legislation that arises from this controversy.

Electronic Health Records

I would say it myself, except this writer said it so much better:

Electronic health records slow doctors down and distract them from meaningful face time caring for patients.

That is the sad but unsurprising finding of a time and motion study published in Tuesday’s Annals of Internal Medicine. A team of researchers determined that physicians are spending almost half of their time in the office on electronic health records (EHRs) and desk work and just 27 percent on face time with patients — which is what the vast majority of doctors went into medicine to do. Once they get home, they average another one to two hours completing EHRs…

…This is a shared problem with more than enough culpability to go around. Vendors like my company, athenahealth, and others have been required to develop EHRs that satisfy government regulations rather than the needs of providers and patients.

With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.

Motivated by more than $30 billion in incentives, vendors have lined up happily to ride the wave, building EHRs that satisfy government requirements but make it increasingly difficult and less rewarding to care for patients.

[end of excerpt]

I’ve been saying this for years, but writer Jonathan Bush just boiled it down so nicely. We’ve made progress on implementing electronic patient records throughout the system, certainly, and will continue to do so. However, so much greater progress will be made with physicians, patients and computer programmers working together in harmony rather than working against the constraints and deadlines of government regulations wending their way through a serpentine lawmaking process that can’t keep up with the pace of technological progress.

Technology should make our lives easier, don’t you think?

About the Cost of the ACA and Aetna’s Problem

I wrote about this when the ACA first passed, and it continues to be an obvious issue. The Affordable Care Act defies actuarial science. Under the ACA, rates are not set according to mortality charts, but are government-subsidized and the products are structured under regulations. In a rational health insurance scheme, healthy people pay into the plan and help fund sick people. Health insurance companies structure benefits considering the amount of risk they are willing to take on an individual given the amount of care the patient/member chooses to insure when they select a plan. Since the ACA, this concept is out the window. If someone shows up at the hospital without health insurance, the patient applies for health insurance and, at least in theory, the bill gets paid. Aetna is losing so much money on its ACA products that it is pulling out of most health exchanges.

If you are a provider, the ACA works because health insurance pays your invoice whether the patient was insured or not when they walked in the door. In fact, one hospital came up with the bright idea that they would even pay the premium of uninsured patients to make sure the bill got paid. That little scheme looks like it won’t pass court scrutiny.

Democrats need the ObamaCare plan to appear to work, even when the evidence is glaringly against it. Again, this New York Times writer was much more eloquent and succinct on this issue:

Premiums in many areas are expected to go up by double digits and some insurers are bailing out or scaling back after having lost hundreds of millions of dollars. Going into their fourth year, the law’s health insurance markets don’t seem to be on a stable footing yet. But they are also unlikely to implode, because subsidies will cushion the impact of premium increases for most customers.

[end of excerpt]

In election years, the cost and availability of healthcare have become perennially favorite scapegoats. If I were a politician, I’d promise free drugs, free health insurance, free exams, free everything because, after all, the government can just print more money and pay the bills.

What could possibly go wrong?

Nota bene: The opinions expressed are my own and reflect disillusionment with the politically-motivated solutions to our healthcare crisis. My opinions do not reflect lack of care for those who can’t afford to see a doctor or pay for a drug. Quite the opposite. My opinions reflect frustration, and I join with others looking for reasonable, rational, workable, affordable answers so people can get the healthcare they need, when they need it with the promise of technology providing part of the answer.

 

 

 

 

 

 

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Posted in biotechnology, electronic patient records, health economics, health insurance, health IT, health policy, health reform, pharmaceutical sales | Leave a comment

Blogging to Aid the Pelican State and Flooding’s Affect on Hospital Workers

Source: U.S. Department of Defense - http://www.defense.gov/Media/Essay-View/CollectionId/15653

 

Insure Blog’s Hank Stern, best known in this space as a constant contributor to Health Wonk Review, rallied an effort to send some love – and money – to flood victims in the U.S. Gulf Coast region, particularly Louisiana. Ironman at Political Calculations answered Hank’s call for help and assembled a collection of charities in this post, “Aid Across Acadiana”. Click here for Ironman’s post to learn how you can help.

For a little news on how the flooding is affecting healthcare workers, here is an article from HealthLeaders Media John Commins today, “Louisiana Hospital Workers Struggle with Flood Recovery“.

Thanks to Hank Stern, Ironman, and all the people in the blogosphere calling much-needed attention to this tragedy. And don’t forget to click here and learn what you can do to help the flood victims, if you are so inclined.

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Jason Shafrin’s Health Wonk Review: Short and Sweet Edition at Healthcare Economist

Jason Shafrin has posted Health Wonk Review: Short and Sweet Edition at Healthcare Economist.  

Jason offers an easy-reading digest format of an eclectic mix of topics. You can find a link to the post to our single August edition here .

Thanks for hosting an great edition, Jason – much appreciated!

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The Little Black Doctor Bag Circa 2016 and the Physician Gender Pay Gap

Last week was a truly memorable occasion in our family. My daughter entered medical school. The White Coat ceremony was lovely, joyful and dignified. I don’t often write about my personal life, but this one triggered a few thoughts that I would like to share, if you can indulge me.

So155358003_-university-little-rock-black-leather-nurse-doctor-metime in 2009, I began blogging about the promise of electronic patient records – all info, all the time, where you need it, when you need it at the point of care. What is most memorable about those early essays was developing the character Health System Ed, a little blue doctor holding an iPad.

In Ed’s first incarnation, he was holding a clipboard. And that just seemed so wrong. It was everything Ed was not about – static paper records stuck in a manila folder in a wall of files. So I went to an artist and we revised Ed and gave him an iPad. And yes, even though I wanted Ed to look gender, ethnically and racially neutral, I needed to give him a name, and “Ed” represented Health System Education.

Today, the iPad is an essential piece of medical equipment. Remember the little black doctor bag? Today, the little black doctor bag is a stylish black leather tote emblazoned with my daughter’s initials, just big enough to hold a MacAir and an iPad. With those tools, she’ll be able to know a lot about her patients, their labs, their vitals, their activity level. So I was just moved to see that we have come this far this fast, and that the little black doctor bag actually looks good with a little black dress, if necessary.

About Doctors in Little Black Dresses

Which leads me to my next point. We all know about the gender pay gap. Women have been railing about it for decades. Turns out that the gender pay gap is just as prevalent among physicians. This article today in FierceHealthcare states:

Reports of pay discrepancies based on physician gender have rolled in for years, as previously reported by FiercePracticeManagement. While the reason for the pay gap has long been in question, hard evidence has been virtually nonexistent, according to the current study. Researchers sought to adjust reimbursement data to account for the three primary theories accounting for the difference in pay: female physicians undervaluing their services, spending less time on the job or being less productive than their male counterparts.

As a basis for its report, the study used Medicare Fee-for-Service Provider Utilization and Payment Data Physician and Other Supplier Public Use File (PUF) data covering 13 specialties, which yielded an average pay gap of $34,125.68. Adjusting for hours worked, productivity and years of experience narrowed the gap to $18,677.23. While female physicians earned less across all specialties, two (hematology and medical oncology) showed statistically insignificant differentials. The largest gap occurred among nephrologists, at $16,688.96.

Cost and Passion is the Same for Women and Men

The cost of medical school is the same for men and women. The hard years of study, practice, relentless dedication to patients and the art of the science of medicine are the same for both sexes. If women can expect a 5 to 10 percent reduction in pay, that does not mean they will get a break on the high cost of pursuing their passion.

So with this little soapbox I’ve built over the years, let me add to the laundry list of policy issues this very critical issue of gender pay equality for physicians.

When that medical school tuition bill comes due, her bill will look the same as the next guy’s. It is both our hopes that her paycheck will look the same, too.

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Posted in electronic patient records, health economics, health IT, health policy, health reform | 1 Comment