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From the July/August 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

Working less, earning less

American physicians are working fewer hours, but their pay is suffering.

According to a recent AMA survey, physicians spent 56.6 hours a week on professional activities, including patient care, in 1998. That was the lowest number of hours charted by the AMA in 10 years. In 1997, the average work week was 57.9 hours; in 1996, it was 58.5.

The survey, which was reported in the May 24 issue of Modern Healthcare magazine, found that for internists, the average work week in 1998 had dropped to 59.5 hours, down 2.6% from the year before. Family practitioners clocked 55 hours, down 3.8% from 1997, while pediatricians logged 54.2 hours, down 4.4%.

The survey also found that the average number of office visits per week dropped to 105 last year, down from 109.4 in 1996, and that time spent on hospital rounds decreased to 6.8 hours per week, down from 7.2 hours two years before.

The survey found that median physician income dropped 1.2% to $164,000 in 1997 after rising for two years in a row. Specialty-specific information was not available at press time.

Patient dissatisfaction grows with managed care

In another sign that familiarity may be breeding contempt for managed care, consumers' dissatisfaction with managed care plans continues to grow. A new study by Illinois-based consulting firm Hewitt Associates found that 22% of consumers were dissatisfied with their health plans in 1998, up from 17% in 1997.

Consumers were most dissatisfied with point-of-service plans; 29% of surveyed patients said they were unhappy with these plans. In comparison, only 17% of consumers surveyed expressed dissatisfaction with HMO plans.

The major complaints related to a plan's inability to resolve problems, as well as its lack of professionalism, timeliness and accuracy. In addition, 22% of the surveyed patients reported that they were unhappy with the cost of deductibles and copayments. About 18% also said they were dissatisfied with their access to physicians, citing problems scheduling appointments and seeing their physician after-hours.

Consolidation hits HMOs

Due to the fast pace of mergers and acquisitions in the managed care world, nearly 30% of all Americans enrolled in health plans now belong to just four HMOs.

According to a survey by the consulting firm Scott-Levin, the top four managed care companies in 1998 were Kaiser Permanente, with 9.3 million members; United HealthCare, with 7.1 million; Aetna U.S. Healthcare, with 6.4 million; and Cigna Healthcare, with 6 million covered lives.

The survey also found that more regional HMOs are now part of larger corporations. In 1998, 53% of regional HMOs were part of a larger corporation, compared with 46% in 1997.

Help sought to rebuild Nigerian hospitals

A Canadian internist, Megeri Ede, ACP-ASIM Member, is seeking help from internists around the world to rebuild two hospitals in the Benue state of Nigeria.

Dr. Ede, a Nigerian native who now practices in Petawawa, Ontario, is working with the Canadian 3rd World Agri-Medical Project Inc. to upgrade a 50-bed hospital near Iga-Okpaya and a 200-bed hospital near Oturkpo. The facilities will be used to provide training for local paramedics, nurses, doctors and other health care professionals.

For more information, contact Dr. Ede at P.O. Box 301, Petawawa, Ont., Canada K8H3J1, or call him at 613-687-6008.

Minorities' health status sinking

The health care system serves minority Americans poorly regardless of their age, sex or income, according to a report released this spring by the New York-based Commonwealth Fund.

The report notes that black women are more likely to die from breast cancer even though they are less likely than white women to get the disease. In addition, black infants in 1995 were more than twice as likely to die of sudden infant death syndrome as white babies. More than 40% of Hispanic and black Americans over age 65 report their health status as fair or poor, compared with 23% of elderly white Americans.

The study also documents the disparity in access to health insurance and to a regular physician. While 14% of white adults are uninsured, 24% of Asian-Americans, 24% of blacks and 38% of Hispanic adults do not have insurance. While 26% of white adults report they do not have a regular doctor, the rate for black adults is 39%, and 46% for Hispanic adults.

For more information, or to order a copy of the report, "U.S. Minority Health: A Chartbook," contact the Commonwealth Fund at 800-472-4248.

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