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From the December ACP Observer, copyright 2006 by the American College of Physicians.

Women still scarce at top medical school posts

The ranks of women who apply to, attend or teach at U.S. medical schools are increasing, but women are still underrepresented as senior leaders at those schools, according to an October report by the Association of American Medical Colleges (AAMC).

Thirty-two percent of full-time faculty in the May 2006 AAMC Faculty Roster were women, with the highest representation (22%) found in pediatric departments and the lowest (2%) in orthopedic surgery departments. While 52% of men were either full or associate professors, only 29% of women held that rank.

Women are represented in the positions of associate and vice deans in roughly the same proportion as their representation among senior faculty, but are underrepresented among department chairs and medical school deans. Eleven percent of medical school deans are women; 10% are department chairs.

Still, every U.S. medical school now has at least one woman department chair or dean, and the current number of female deans is double what it was in 1999. Women are most likely to hold leadership positions as assistant deans (43%) or associate deans (32%). Forty percent of female assistant, associate or vice deans report directly to the dean of the medical school, compared with 48% of men in similar positions.

Five medical schools reported having no women as department chairs in 2006, compared with 28 schools in 1998. Also in 2006, 13% of basic science department chairs and 8% of clinical department chairs were women. Twenty-eight schools had only one woman as a department chair.

The number of female applicants to medical schools has slowly increased from 2002-03 to 2005-06, but the percentage of women peaked in 2003-04 due to a more rapid increase of male applicants in the last two years, the analysis found. In 2003-04, 34,791 women, or 50.8% of the total, applied, compared with 37,364 women, or 49.8%, in 2005-06.

Due in large part to more women graduating from medical schools in the U.S. and abroad, the percentage of women in U.S. residency training programs rose to about 42.5% in 2005 from 34% more than a decade ago. The proportion of women in each specialty hasn't changed much over the past few decades, the report said.

The report, "An Overview of Women in U.S. Academic Medicine, 2005-06," was published in the October 2006 issue of AAMC's "Analysis in Brief". It is available online.

From charts to computers

Computers and personal digital assistants are increasingly essential tools in the delivery of healthcare. But there are few resources available to help physicians engage in the rapidly changing landscape of health care technology. One such resource is the 10 x 10 program, an introduction for physicians who want to become more involved in HIT projects in their institutions or medical practices.

The College collaborated with Oregon Health & Science University (OHSU) and American Medical Informatics Association (AMIA) to offer the course to its members. The program consists of an 11-week, online curriculum followed by one day of face-to-face activities, which will be held at the ACP's Internal Medicine 2007 annual meeting.

The College's collaboration with OHSU-AMIA signifies its ongoing commitment to helping physicians understand the importance of HIT to the practice of medicine. Since the program was launched in 2005, over 120 people have completed the course, with many going onto advanced study in the field.

AMIA president and CEO Don Detmer, MD, said, "Virtually every hospital, clinic, physician office or other health care provider organization will in some way utilize information technology solutions in the coming years and will need health care professionals versed in informatics to assist with the implementation, use and success of these systems."

A few of the competences participants can expect to take away from the program include:

  • EHRs in various settings
  • clinical decision support
  • computerized provider order entry
  • basic principles of health care quality assessment
  • the role of health information exchanges and RHIOs
  • clinical data standards
  • HIPAA concerns
  • evidence-based medicine
  • telemedicine and barriers to use.

For more information about the 10 x 10 program, click here. The registration deadline is Jan. 3, 2007 and you can register online. Participants in the program may earn up to 56 Category 1 CME credits.

CMS releases 2007 fees

Medicare payments for many evaluation and management services (E/M) will increase next year, but unless Congress acts to stop it, a 5% overall cut to physician payments will effectively cancel out the initial benefit for internists from the changes, according to an ACP analysis of a final rule announced by the CMS in November.

By increasing the relative value units (RVUs) for office visits and other face-to-face services, CMS would begin to pay physicians more for the time they spend with patients, leading to better outcomes. CMS based the increased work RVUs on evidence submitted by the College and other physician organizations showing that the physician work associated with E/M services has increased substantially over the past 10 years.

The RVU increases will result in a shift of approximately $4 billion to office visits and other E/M services. According to CMS, internists would gain an average of 5% in total Medicare payments because of the E/M increases, but the SGR cut will reduce overall 2007 Medicare payments to internists by about the same amount, resulting in no net gain in payments.

The SGR formula was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy the difference is subtracted from physician payments. This is the seventh consecutive year that physicians have faced SGR-related payment cuts. ACP is urging Congress to take action to eliminate the SGR cut in a post-election "lame duck" session.

"The initial potential benefit to Medicare patients that would result emphasizing the value of personalized, primary care, will be cancelled out by the 5% SGR cut," said ACP President Lynne M. Kirk, FACP, in a letter to lawmakers. "This lost potential makes it even more imperative that Congress not allow the SGR cut to go into effect."

Internists will still fare better than most other physician specialties, many of which will experience cuts of 10% or more because of the SGR cut and the redistribution of dollars from their services to increasing pay for E/M services. Internists and their patients will benefit with higher Medicare payments from the improved RVUs and also from private payers that follow Medicare's lead on rates.

ACP's press release is online.

Try more meds for depression

A new study found that two-thirds of depression victims can eventually feel better if they try several medications, but the likelihood of relapse increases with each new treatment.

All of the 3,671 adults in the study were diagnosed with major depression, and started on citalopram (brand name: Celexa), a selective serotonin reuptake inhibitor, said the Nov. 1 New York Times. Thirty-seven percent saw their depression go into remission. The rest switched to a second antidepressant or continued with citalopram and added another treatment, which helped 31% of that group.

Third and fourth treatment steps helped 14% and 13% of the remaining depression sufferers, respectively. The cumulative remission rate was 67%. Those who required more treatment steps had higher relapse rates within a one-year follow-up phase.

Broadly effective treatments and better understanding of individual responses to different depression treatments are needed, said the National Institute of Mental Health, which funded the study. The study was published in the November issue of the American Journal of Psychiatry.

FDA speeds device response

The FDA announced an action plan for monitoring the safety of medical devices aimed at speeding the government's response to problems that arise after devices reach the marketplace.

The action plan includes:

  • developing a system for marking all medical devices with a unique number so they can be tracked,
  • reorganizing the Center for Devices and Radiological Health so safety information can be more easily shared, and
  • developing internal performance measurements to track how recalls are handled.

Also under discussion is the mandatory use of electronic reporting of adverse events. More information is on the FDA's Web site.

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