I posted a previous note about how general surgery is becoming a less attractive specialty for new medical school graduates (see: General Surgeons as the Primary Care Docs of the Operating Room). The article quoted drew a parallel between general surgeons and primary care physicians. The reason that general surgery is becoming less attractive is that these specialists often shoulder a heavy burden of the call schedule in hospitals and also end up referring many of the interesting cases to the surgical subspecialists. In that note, I addressed the on-call issue in the following way:

For me, the on-call issue is a distraction that can be solved relatively easily. The hospitals can hire their own surgicalists about which I have previously blogged (see: The Emergence of the Surgicalist) and taking a fair amount of call will be a condition of their employment by the health system. In terms of referral patterns and with a shortage of general surgeons, I envision that the PCPs will refer to the surgical subspecialists. But what happens if there is a shortage of PCPs?

Now comes a new article in the Washington Post that discusses how the shortage of general surgeons  is having a negative effect on healthcare delivery in rural areas (see: Shortage of General Surgeons Endangers Rural Americans). Below is an excerpt from the article with boldface emphasis mine:

Many young physicians are opting for non-surgical specialties, such as radiology or cardiology, in which they can earn as much money as a surgeon with less grueling and unpredictable hours. Many young surgeons, in turn, choose to concentrate in fields such as transplant surgery or plastic surgery, in which they can make more money and don't have to face (usually alone) the wide range of problems a generalist faces. "The shortage of general surgeons is at crisis dimensions," said George F. Sheldon, director of the American College of Surgery's Health Policy Institute. If the trend continues, he said, "the quality of health care will suffer, as the services of a surgeon are unique." In 1980, 945 newly trained general surgeons were certified in the United States. In 2008, the number was essentially the same -- 972 -- even though the population has increased by 79 million. In 1994, there were 7.1 general surgeons per 100,000 people. Today there are five per 100,000.

It occurs to me that a new breed of surgicalist could be developed to provide general surgery services in rural areas of the country. Multiple rural hospitals could join together and hire a salaried surgicalist(s) (i.e., a regional surgicalist) who would be an employee of the hospital network. In order to address the on-call burden, it would probably be necessary to hire two or more of them for any individual network. In addition, it would also be useful to establish telemedicine links across the participating hospitals so that a referring PCP or internist could rapidly obtain a teleconsultation with the regional surgicalist to determine whether surgery was necessary for a particular patient and where the surgery would be performed.

Despite the fact that a hospital surgicalist (or regional surgicalist) is becoming more of a generalist, these specialists will still retain the key advantage over primary care physicians (PCP) of performing procedures and therefore enjoying a salary advantage (see: Two Definitions for the Physician Proceduralist). This may make the idea of developing a position of regional surgicalist more feasible.

Humana purports to cut through all the jargon and traditional media with a new series of faux naif video clips on YouTube accessible through the managed care giant's Stay Smart Stay Healthy web site, which tells us:

Why read your subscriber agreement or a summary when you can watch a "new media" video?

The videos are undeniably clever and engaging, and they do contain some valid information.  (I'm making this blanket generalization after watching only the latest addition to the series -- the tenth video, on Medicare.)  However, at least this most recent video includes the managed care organization point of view slipped in -- not-so-subtly -- among the "facts."  Specifically, the clip explains Medicare Advantage as managed care for Medicare beneficiaries that reduces cost and improves quality.  Of course, Medicare Advantage is also a program that provides an essentially guaranteed profit margin to (mostly) for-profit managed care organizations.

The installment on "Why Is Health Care So Expensive?" was similarly deconstructed by Michael Miller at his Health Policy and Communications Blog, one of the other bloggers apparently getting the Humana email updates on this series.

It will be interesting to see whether this series of videos will spawn replies or parodies, as often happens on YouTube.  Once "old economy" companies engage with "new media," they no longer control the discourse.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Regular HealthBlog readers know how much of my time I spend traveling the nation and the world.  The upside is that I get to see a lot of things and share them with you.  The downside is that I’m frequently away from home.

With the Holidays upon us, I want to take time to first thank all of you for your loyal readership and the comments you leave on this blog. The blogosphere is a special place inhabited by knowledgeable people who are passionate about what they do.  Thanks for sharing your ideas, and helping to shape the future of health and healthcare IT around the world.

Over the next 3 weeks I plan to reconnect with family and friends and do all  those things that make life so wonderful.  And although I thoroughly enjoy the “virtual” relationship I have with you, it is time to pull the plug on work and recharge my soul.  Hence, don’t expect new posts until the New Year.

But, fear not! 2009 is just around the corner and I’ll be back to record more of my observations and adventures from the world of health IT including what promises to be another eye-opening journey during the month of February to visit colleagues, customers, and partners all over Australia.

Until we meet again; soldier on! I wish each and every one of you a very Happy Holiday Season.  Thank you for all that you do for the industry.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation

• The Scientist : The Scientist Top Innovations of 2008 [2008-12-01] 'The winning technologies will either make your work easier (and cheaper) or push you into new frontiers, letting you visualize and capture molecular processes that were heretofore invisible. Some are totally novel, while others improve on existing technology, an indication that the field is still growing and developing. ' (tags: bioinformatics scenario+planning)
• Technology Review: Memristors Make Chips Cheaper 'Entire industries and research fields are devoted to ensuring that, every year, computers continue getting faster. But this trend could begin to slow down as the components used in electronic circuits are shrunk to the size of just a few atoms. Researchers at HP Labs in Palo Alto, CA, are betting that a new fundamental electronic component--the memristor--will keep computer power increasing at this rate for years to come. ' (tags: scenario+planning nanotechnology memristor)
• HOW TO: Convert Your Blog Into a Podcast on iTunes for Free Bloggers can now add text-to-speech capabilities to their site with new tools such as Odiogo, allowing readers to actually listen to blog posts on the website, and even on iTunes (as well as iPods and iPhones) as a podcast. While this is a cool feature for readers, it could be a very valuable tool for the visually impaired. These tools also provide benefits to readers with learning disabilities like Dyslexia. (tags: Web2.0 texttospeech howto blogging)
• ICT Results - Up close and personal networks 'The MAGNET Beyond project developed a breakthrough platform to cope with a world where every individual owns up to a thousand personal devices. But what will such a world look like?' (tags: ubicomp research mobile)
• High speed broadband will create energy bottleneck and slow Internet, new University of Melbourne study : News : The University of Melbourne From the ACM TechNews commentary on the news release: 'Hinton says the exponential growth of the Internet is not sustainable. The results of the study show that, even with more efficient electronics, the power consumption of the Internet will increase from 0.5 percent of today's electricity consumption in Australia to 1 percent by 2020. The growing use of VOD, Web-based real-time gaming, social networking, peer-to-peer networking, and other advanced Web applications will drive the increase in power consumption. "To support these new high-bandwidth services, the capacity of the Internet will need to be significantly increased," Hinton says. "If Internet capacity is increased, the energy consumption, and consequently the carbon footprint of the Internet, will also increase." He notes that some major ICT and Internet-based companies are already experiencing difficulties due to the size and power requirements of servers, routers, and data centers.' (tags: research internet sustainability)

Choosing a microphone is one of the most important decisions you can make when implementing a speech recognition software like Dragon Naturally Speaking Medical 10. Thanks to Eric over at Speech Recognition I’ve gotten some interesting information about a microphone called the PowerMic II. Looks like it’s a microphone on steroids. Definitely one other microphone to consider when selecting a microphone to use with voice recognition software. Here’s an overview of the PowerMic II utilized with Dragon Medical 10 thanks to 1450, Inc. with commentary by Jay Goodfellow.

OVERVIEW:
The PowerMic II is a speech recognition microphone designed to be used with Dragon Medical 10.

However, the PowerMic II is much more than a hand held microphone. It is a powerful tool that enhances a physician’s control of dictation and navigation through documents, templates, electronic medical records and other applications. It has been designed specifically to be utilized with Dragon Medical 10, and the extraordinarily tight integration shows that to be true.

Not only does the PowerMic II have full mouse functionality, but there are 10 function keys that are programmable to provide practically any operation that a physician might want to do on his/her computer.

Yes, you can already use Dragon Medial 10 to do almost anything you want to on your computer by voice. However, using the PowerMic II and Dragon Medical, you substantially enhance your ability to do essentially anything you’d like on your computer, using the more convenient method at that moment: voice or function button.

The PowerMic II is designed to be fully functional with Dragon Medical 10 only. Dragon Preferred 10, Professional 10, and Legal 10 are not capable of using all of the programmable PowerMic II features.

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