Canada’s Great Opportunity To Reduce Maternal & Childhood Mortality

By Keith Martin MD, MP

March 8th is the 100th Anniversary of International Womens Day.

What an extraordinary opportunity this is to introduce an initiative that will save the lives of nine million women and children who perish every year from preventable and treatable causes. As Chair of the UN Commission for Accountability and Transparency on Maternal and Child Health, Prime Minister Harper has the chance to lead this initiative.

Up until recently, the international community has paid scant attention to the catastrophic loss of 340 000 pregnant women a year. Millennium Development Goal 5: to reduce maternal mortality by 75 per cent and achieve universal access to reproductive health by 2015, has actually been the most neglected of all the MDGs. Yet this is the most important one because it can positively influence all the other goals from poverty reduction, access to education, child health, and much more. No other MDG has this power. Dollar for dollar investing in maternal health has the most profound impact on a population’s well being. With this knowledge what should Prime Minister Harper’s next steps be?

Initiatives to address the world’s major health challenges have tended to focus on specific diseases and discreet interventions: anti-retroviral medications for AIDS, bed nets for malaria, and vaccinations for an array of communicable diseases. All of these interventions are very important. However, to effectively implement them you need a mechanism. The tendency to silo our efforts to address specific diseases, rather than develop a system to implement effective public health measures has weakened our ability to save lives and reduce suffering.

Herein lies Mr. Harper’s great opportunity. In his new role he should advocate that resources be used to fund the one common pathway that will not only reduce maternal and child deaths, but can also be used to:

Treat the most common killers in the developing world (gastroenteritis, pneumonia, malnutrition, tuberculosis, malaria, AIDS etc) Address the increased burden of chronic diseases (cardiovascular diseases, diabetes etc.) Manage an array of other health care problems (the 17 neglected tropical diseases that affect 1.4 billion people worldwide, the deplorable lack of access to basic surgical procedures etc.).

The common pathway to address these health challenges is access to primary care. This is the bedrock of a good public health system and is comprised of access to reliable diagnostics, medications, adequate nutrition, clean water, sanitation, electricity, basic surgical capabilities, and most importantly, skilled health-care workers. This is the pathway through which everything from public health education, prevention programs, treatment, and follow up can occur. If you do not invest in a strong primary care system and fit specific interventions into that framework, then you can have scattered, disjointed, individual activities that do not create the long term capacity building low resource communities desperately need.

Investing in primary health care will save the lives of many of the 340 000 pregnant women and 8.8 million children who perish annually. It will also enable local service providers to prevent and treat the greatest health challenges of our time. Mr. Harper can do much to direct the $40 billion pledge by the G8 and UN to strengthen primary care systems in the developing world. He could effectively do this by partnering with organizations that already have sites and reliable logistical systems in place.

Through augmenting existing public health facilities and using reliable non-governmental organizations like The World Food Program, Medecins Sans Frontieres, the International Red Cross, and faith based groups that have successfully been providing care for decades in areas no one else dared to venture into, Mr Harper can leverage these investments and reduce administrative costs by not inventing new pathways.

It is also crucial that interventions have a long term horizon and are guided by the recipient nation, not the donor. Programs that come from distant Western organizations and do not receive local buy-in often fail.

Every dollar spent in primary care ultimately reduces health-care costs by $4 and social costs by a staggering $30. Thus, investing in primary care makes excellent economic sense: healthy people are productive people who can then lift their families, communities and countries out of poverty. Sick people cannot do this. With renewed funding and interest in maternal and child health Canada has a remarkable opportunity to facilitate the most profound change in the health of the world's poorest people.

Carpe Diem Mr. Harper.

About: Dr. Keith Martin is a physician and Member of Parliament. He is also the founder of the Canadian Physicians Overseas Program, Centres for International Health and Development, and www.canadaaid.ca an online mechanism that links people’s needs with those who want to help them.

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First Nonclincal Physician Jobs Posted

Physician Advisor Houston: Accretive Health has posted the first nonclinical job to our new nonclinincal jobs board!

If you're looking for physicians to fill a nonclinical job, please post it. It's free (for now), which is a terriffic price.

Our goal is to add not only nonclinical jobs, but volunteer, temporary and unusual jobs for docs.

Click to read more ...

Health 2.0 San Diego

What can you expect to see at Health 2.0 San Diego?

Companies and creative leaders who are pushing the curve on innovation to tackle three major challenges of our time in health care: prevention, wellness, and the role of food; the user-driven disruption of traditional clinical research; and how smart technology and service design canlower the cost of healthcare. All with the audience mix and engaging format that only a Health 2.0 conference can deliver! 

Register here

San Diego 2011

Following our biggest and highest rated Fall Conference ever, Health 2.0 announces its Spring Fling for 2011. Following trips to Boston and Paris in our two previous Spring Conferences, we’re returning to the scene of our first Spring Fling in 2008 — San Diego.

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Freelance MD: The First 100 Days

Freelance MD's first 100 days of growth is awesome.

Actually, it's really impressive. Here's the chart showing Freelance MD's growth from our launch in mid November of 2010 through the end if February 2011, the first 100 days.

Traffic Overview

In looking at the numbers there are a couple of things that stand out immediately. First, there's a huge gap between the number of visitors and the number of page views that show that there are almost 3 page views for each reader per visit. This is a fantastic ratio and indicates that new readers are actually clicking around the site and not just leaving. If the gap were narrow, we'd know that people were coming to the site but not finding it interesting so this gap is a good indicator of how 'sticky' the site is.

Of course we're still growing traffic at a very respectable pace too. I'd expect to see this trajectory flatten and even have a few bumps but it will certainly continue this upward trend. Breaking 10,000 unique visitors in the first 100 days is fantastic and we're on track to hit all of our traffic and interaction goals.

You'll also notice that we have more than 700 Facebook likes and a growing community of physicians interating in the Freelance MD LinkedIn Group that I'd invite all docs to join.

We've also been contacted by a number of other medical and physician sites that have asked to be able to distribute our content to their audiences. The most notable of these new partner sites is KevinMD.com which is among the web’s most prominent and influential clinical health care blogs. These sites will choose selected posts from Freelance MD that speak to their audiences and republish them to their own sites.

We've also received quite a few inquires about joining or writing for Freelance MD (We've got some really great guest posts already)so we've written a number of posts to get help you get started, from how to add a Freelance MD badge to your website, to how to write a guest post, to how to become a contributing author.

There are also a number of new parts to the site that we've just launches. They're a little bumpy right now as we work out all of the technology kinks but they're live and working.

There's a new nonclinical jobs board, a resources directory and a calendar of upcoming events. There will be many changes to all of these as we add additional functionality and integrations.

It's been some heavy lifting in the last 100 days and there's more to come but Greg and I are committed to making a Freelance MD a must-have portal for physicians looking for more control of their career, income, and lifestyle.

Physicians: Buy a Business?

In my last post I discussed the definition of a true asset and noted that businesses are a type of asset that can produce income for physicians.

Great, you say, but how do I develop or buy a business?

Well, there are numerous ways to purchase or develop a business, but one avenue that I doubt many physicians consider is the use of business brokers.

Business brokers are companies that help match business owners with potential business buyers.  Even if you're not currently interested in purchasing a business it is interesting to surf the website of a business broker since you can search for companies for sale by state, county, or even category of business.  Examples of online business brokers include Sunbelt and BizBuySell .

Of course, always do your research before you consider buying a business of any sort, but if you're looking for a place to start, a business broker can get you thinking about the possibilities.

Nonclinical Physician Jobs & The Long Tail

By Mehul Sheth DO

As I read The Long Tail by Chris Anderson I could not help but draw parallels to the world of medicine.

In the same vein as seminal books such as The World is Flat and Connected, this book looks to make sense of the new world view introduced by the internet. The basic premise is that in a world of infinite options (movies, songs, books, etc) the blockbuster hits are no longer the only way to be profitable. With no cost to list an MP3 in iTunes, it is as profitable to sell 1 million copies of 100 blockbuster hits as it is to sell 100 copies of 1 million less popular songs. There are three main reasons the internet has helped with this shift, one of which is democratization of the tools of distribution.

This paradigm shift has affected medicine in at least two ways. One is witnessed by the super-specialization of clinical medicine. For example, within pediatrics you can sub-specialize in gastroenterology. From there you can further sub-sub specialize in nutrition and from there you can go one level deeper into feeding disorders. One of the reasons such a niche can exist is because individuals and institutions can promote these fields not only to recruit providers, but also patients who have a specific interest in that type of treatment. At the Children’s Hospital of Wisconsin there is not only a feeding disorders clinic, but also an intense 2 week inpatient program that draws patients from all over the world. This could not exist in the pre-internet world where the enchachement area for Children’s Hospital of Wisconsin would include, at best, the entire state of Wisconsin and some of northern Illinois. With the internet the cost of distribution (in this case information of their center) is not only essentially zero, but is also technically easy. You need only to look around at your colleagues to realize that the number of niches is incredible!

More interestingly, to me, is how this democratization has expanded not only clinical jobs, but non-clinical physician jobs. The contrast is exemplified by my father and I, both physicians. My father is an anesthesiologist working for 30 years at the same hospital in service of a small farming town. In stark contrast, I work as a physician executive for Allscripts, a health IT company, working from home and traveling on an almost weekly basis. As I think of physicians in my father’s cohort I find that most of them fulfilled this classic role of clinical physician. Those that went outside of clinical practice did so after years of 70+hour weeks solidifying their clinical prowess thus resulting in promotion to administrative roles that carried heavy titles. Although many of these physicians did their non-clinical role well, a number who were great clinicians did not perform so well outside of the examining room.

But a deeper dive into that generation reveals that many of them had great interest in things outside of medicine. An internist comes to mind who, like my father, has been practicing for many years in the same town, but who also regularly wins stock picking contests. The short term rate of return that he can extract from daily trading is in the triple digits. I can only think that if he had trained 30 years later he would have many more opportunities to take his avocation and turn it into his vocation, combining both medicine and financial analysis. In fact, there are numerous joint medical school programs that bestow not only and MD but also a JD, MPH, MBA, PhD at the time of graduation. And if you don’t complete your second degree before residency, many training programs allow you to get a second degree as part of their program. This has become possible with the increased distribution of information associated with non-clinic careers. There are websites, including nonclinicaljobs.com conferences, such as Medical Fusion and SEAK, and list serves, such as the drop out club, to name a few that have taken advantage of the ease of distribution to cast a large net to help physician find satisfaction in their careers. The unhappy doctor of yesteryear who found his joy in his hobbies now can find a career that combines his medical knowledge to bring about greater job satisfaction.

The internet has profound effects on the career choices of physicians, only some of which I’ve named here. I’d love to hear about other ways the ease of information distribution has helped with physicians’ career choice.

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. His expertise is at the intersection of medicine, technology and social media, having used Twitter, Facebook, and LinkedIn to effectively engage with a wide variety of nonclinical jobs and opportunities. Dr. Sheth is accessable via his LinkedIn profile and his blog at http://techpedsdoc.wordpress.com

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Mid Career Physicians Blew a Great Opportunity

Everywhere I go I see unhappy doctors.

All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks.  This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.

All of those complaints are legitimate, but one question I always have in my mind about the physicians who are in their 50s is “Why are you still practicing medicine full time?”

I keep hearing about the “golden age” in medicine. I don’t know what that means, but I assume it has something to do with making more money than we do now.

Suppose you’re a 55 year old physician and you’ve been practicing medicine for 25 years full time.  If you absolutely love it, that’s great. It’s your passion so go for it. But for the rest of you (which is the majority I think) who are in your 50s, who experienced the “golden age” in medicine and are still practicing full time and complaining, I've got to be blunt: you have failed miserably in your investment career.

What do I mean by this? Let’s say you graduated from residency in June 1985 and started making some money. Suppose you socked away on average $25,000 per year in the US stock market each year for the past 25 years starting in January 1986.  The US stock market as represented by the S&P 500 index had an average annual return of 9.9% in that period.  So over 25 years your investment portfolio should be at least $2.5 million.

And that’s with putting away only $25,000 a year on average. Bump that up to $50,000 every year—which is an entirely reasonable and attainable amount for a physician to invest every year---and you should have at least $5 million in the bank.

Even if you invested only in bonds you’d have about $1.7 million saving $25,000 a year and nearly $3.5 million saving $50,000 a year. This is based upon the US aggregate bond market index.

How many of you actually have that? Sure a few you might, but I’d bet that the vast majority of you don’t. And I also bet that the reason you’re working full time right now is because you realize you didn’t save enough and invest well. Common reasons why you have a meager portfolio value are:

1. You spent every penny you made
2. You didn’t save enough because you overspent
3. You took way too much risk and got burned
4. You hired a commission based financial advisor who put you in inappropriate investments
5. You invested in speculative investments like restaurants, limited partnerships, or hedge funds, and they tanked
6. You got divorced.

Now you feel trapped in your current situation.

So if you are a physician in your 50s or older and are complaining about your situation, you completely blew a phenomenal time to invest and really don’t have anything to complain about except your missed opportunity. You should have enough to walk away if you want. If you don’t and unless you jump up and down in joy every time you go to the hospital or when you’re on call, it’s time to crack the whip and get moving because the next 25 years are going to be a challenging environment to practice medicine to say the least. And if the chatter I’m hearing is accurate, I don’t think you want to practice medicine full time until you’re 80.