Monday, December 28, 2009

Dispatch from the medical front

Like many other would-be physicians, my journey into medicine started full of energy and hope.  In the face of a very public doctor shortage, I thought surely Canada would do everything to retain its best and brightest. Applying to Canadian medical schools quickly changed my opinions on this.

Ontario is one of, if not the most difficult place to get into medical school in North America; entry is especially difficult if you are from the greater Toronto area.

I cannot tell you how many of my colleagues with near perfect grades, extensive community involvement and great Medical College Admission Test scores, were unable to get in.

The lucky few get in somewhere in Canada or the United States, like myself, now enrolled in Jefferson Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. The rest end up mainly at schools in the Caribbean, Australia, or Ireland. Or turn away from medicine.

Why is that?

The first thing that jumps into my mind is the acceptance format for the universities of Toronto and McMaster, the two schools in greater Toronto area. Neither gives preference to students from the area. Yet, most other schools have set aside spaces and favour applicants from their own geographic region. For example, the University of Ottawa, Northern Ontario School of Medicine, and the University of Western Ontario all treat “local” applicants preferentially.

It seems unfair that someone who grew up 2-3 hours down the 401 can get an interview with lower grades and MCAT scores. We are all from Ontario and should be treated as equals, shouldn’t we?

As well, applying to out-of-province schools is even more problematic, as few spaces are available for us “foreign” applicants.

I am sensitive to the needs of underserved communities for whom these regional acceptance practices were created. The purpose of extending preferential recruitment to local applicants is, of course, to encourage doctors to stay and practice in the area.

However, the end result remains: many qualified, motivated, enthusiastic and otherwise-deserving students are being turned away from medical schools simply because of where they live.

What is the answer?

It seems logical that another medical school should be built in the greater Toronto area and and that more spaces for out-of-province students should be created across the country.

Our current admission policies are losing students with a passion, drive, and commitment to medicine - not because they are unqualified, but because we haven’t created space for them. We are losing some of our best students to schools in other countries, which is an admission that no Canadian should prefer.

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Tuesday, December 15, 2009

Medical examiner IDs man in Pa. standoff suicide

PITTSBURGH - The Allegheny County Medical Examiner's Office has identified a man who police believe shot himself to end a standoff in the Pittsburgh suburb of Mount Lebanon.

Police say officers were trying to serve a protection from abuse order on 51-year-old Ronald Giron Wednesday afternoon. Police say a standoff resulted because Giron had a gun, so officers backed off and requested backup. Police attempted to negotiate with the man but he broke off contact at around 6:15 p.m.

When police entered his home, they found him dead.


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Saturday, November 28, 2009

Mayo's prowess indisputable, but can it be replicated

ROCHESTER -- The Mayo Clinic looms out of the prairie here like the mecca it has become, a world-renowned medical complex that is often cited by President Obama as his model for national heath-care reform.

"Look at what the Mayo Clinic is able to do. It's got the best quality and the lowest cost of just about any system in the country," Obama said in Minneapolis this month. "So what we want to do is we want to help the whole country learn from what Mayo is doing. ... That will save everybody money."

Few dispute the prowess of Mayo, which brings in $9 billion in revenue a year and hosts 250 surgeries a day. But a battle is under way among health-care experts and lawmakers over whether its success can be so easily replicated. Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.

They point out that Mayo's patients are wealthier, healthier and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.

Armed with their new stature, officials from Mayo and a handful of similar facilities have become determined lobbyists in their own right. They are pushing for an overhaul of Medicare that would reward cost-effective hospitals and doctors, while punishing others.

But if the Mayo model is, in fact, difficult for even the most dutiful hospitals elsewhere to mimic, such an overhaul could set up many providers nationwide for failure -- and a big loss of funds.

"It's not (Mayo's) model. It's their patients and money. If you have the money, you can attract good staff, good doctors, good nurses," said Richard A. Cooper, a professor of medicine at the University of Pennsylvania. "You are going to force hospitals to find ways to avoid taking care of poor people just because they are going to be penalized because poor people cost more."

Mayo and other oft-cited model facilities also are lobbying against one of Obama's favored provisions: a government-run insurance plan, or public option, which would work against these hospitals' financial position.

"What they want to do is leverage their high-quality delivery systems to keep as much of a private delivery system as possible," said Gerry Shea, the AFL-CIO's chief health-care negotiator.

Mayo and the other model centers -- which tend to be in the Upper Midwest, Mountain West and Pacific Northwest -- have gained their current stature because of Dartmouth University research showing that they spend less per Medicare patient than their counterparts elsewhere, including in Miami, Los Angeles, New York and much of Texas and the South. Many experts have seized on the data to conclude that the key to reining in health-care spending is to emulate Mayo -- a large group practice in which physicians are on salary and have less incentive to perform unnecessary procedures than physicians paid on a "fee for service" basis.

"These communities are able to control utilization [of health care] without harming patients," said Don Berwick, head of the Institute for Healthcare Improvement.

Mayo officials say their model dates to the clinic's founding in the late 19th century by brothers Charles and William Mayo, still known around the campus simply as "Charlie and Will." As their clinic grew, it became known for its quality and the brothers' insistence that doctors work on salary.

That, Mayo physicians said, has drawn doctors more committed to their professional obligations than to making high salaries by racking up procedures. "I didn't go to medical school to be the hardest-working guy in the room. I went to medical school to take care of patients," said cardiac surgeon Thoralf Sundt.


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Sunday, November 15, 2009

Doctors group donates $10,000 to medical college

A group of local doctors wants to cultivate the next generation of physicians to fill one of the area's most pressing needs — access to health care.

"We know there's a physician shortage in this area," Dr. Natale Falanga, a doctor of internal medicine and geriatrics, said in a telephone interview. "The goal is to recruit students in the area, get them training and hopefully they'll stay in this area."

Falanga is president of the Monroe County Medical Society, which next month will give $10,000 to The Commonwealth Medical College in Scranton.

The new college, which is focused on developing local talent and researching the health needs of the northeast region of the state, welcomed its first crop of 65 medical students and master's candidates in biomedical science last month.

The aim of the college is to bolster the region's depleted supply of doctors.

Northeast Pennsylvania suffers from a shortage of approximately 100 doctors, and the situation could grow worse without new doctors coming to the region. Nearly one-half of the physicians practicing in northeast Pennsylvania are over the age of 50, according to Pocono Medical Center.

The region's shortage of doctors is compounded by gaps in insurance coverage in the county.

Monroe County's share of uninsured adults exceeds the state average. More than 16,500, or nearly 16 percent, of the county's residents between 18 and 64 have no health insurance, according to the U.S. Census Bureau's American Community Survey for 2008. This outpaces the state average for this age group by more than 3 points.

It is hoped that bringing medical residents to the area will lead to new clinics for the uninsured and under-insured.

"This can lead to so many things down the road," Falanga said. "But you have to start somewhere."

PMC and Sanofi Pasteur have also pledged their aid to the college. Sanofi has given $1.5 million — one of the largest financial donations ever made by the company in the United States — to help build research labs at the medical school.

PMC has awarded money for a scholarship. Its staff also serves on the faculty of the college.


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Wednesday, October 28, 2009

Eligibility for nutritional assistance expands in Pennsylvania

Bonnie Frederick tried to get food stamps last year, but her $9.50-an-hour pay from a packaging company put her monthly income $3 over the limit.

But new guidelines, put in place July 27 by the Pennsylvania Department of Public Welfare, make Frederick, 61, of North Versailles and her husband Gary, 62, eligible for food stamps, they learned this week.

"I'm a couponer, and I cook. We don't eat out a lot," Bonnie Frederick said. "We eat a lot of chicken. It will be nice to have some pork."

The couple are among those who fall into the gap between working full time and receiving Social Security. Gary Frederick worked for Nabisco and then Atlantic Baking in East Liberty but lost his job when the plant closed in 2004. He has held part-time jobs, but they get by on her salary and have dipped into savings.

The Fredericks and others like them are being urged to reapply under the changed guidelines that were designed to open the food stamp program to more needy Pennsylvanians. It is the first time in nearly 30 years that Pennsylvania has raised income limits.

"People have been excruciatingly borderline," Esther Bush, president of the Urban League of Greater Pittsburgh, said of those applying for food stamps. "We've seen a tremendous increase in people asking for (emergency) food."

More than 230,000 people receive food stamps in Allegheny, Westmoreland, Fayette, Beaver, Washington and Greene counties. The Welfare Department isn't sure how many more will become eligible under the new rules.

"While we believe the number applying will certainly be contingent on the state of the economy, our best estimate is that (new applicants) will not exceed 200,000 (statewide)," said spokeswoman Stacey Witalec.

The gross income limit for food stamps increased from 130 percent of the federal poverty line to 160 percent. That means under these guidelines, a family of four making as much as $33,924 a year is eligible. The limit was $27,564.

Rachel Meeks, food stamp campaign manager at the Greater Philadelphia Coalition Against Hunger, said Welfare Department officials expressed concern about raising the income limits. Pennsylvania took a cautious approach by upping the limits to 160 percent of the federal poverty line, not the 200 percent that federal rules allow.

"With the budget constraints we're under, it made sense to go halfway," she said.

The Pennsylvania Hunger Action Center says most food stamps recipients are children younger than 17 or senior citizens.

In an example calculated by the organization, a single mother of two who earns $12 an hour at a full-time job and pays child care costs of $200 a week, $650 rent and some utility costs, would be eligible for about $480 a month in benefits.

Income guidelines for the elderly and disabled were raised to 200 percent of the federal poverty line — which ranges from $10,830 a year, or $903 a month, for one person to $37,010 a year, or $3,085 a month, for a family of eight.

An elderly couple collectively receiving $1,500 a month in Social Security benefits, with medical expenses of nearly $200 a month, an escrowed mortgage payment of $1,000 and some utility costs, would be eligible for about $275 a month in food stamp benefits.

From a public health perspective, Pennsylvania's jump is beneficial because research shows food stamps improve the nutritional value of the food that people can buy, said Mariana Chilton, a hunger expert and a professor at Drexel University's School of Public Health.

"We're both diabetics. This will mean more vegetables and less starches," Frederick said. She shops at discount grocers Aldi and Sav-A-Lot, and sometimes gets food from Angel Food Ministries, a food bank.

Advocates first started talking in 2007 with the Welfare Department about overhauling the food stamp program that serves more than 1.3 million Pennsylvanians per month.

"I think the policymakers are aware of the deep stresses that people are in," said Joni Rabinowitz, co-director of Just Harvest, a Pittsburgh advocacy group. "It's really going to help a lot of people who really need it."

The agency is recontacting people who didn't qualify under the old guidelines to get them to reapply, as is a hunger services program at the Urban League. In a recent two-week period, almost two dozen people signed up, said Karen Garrett, the Urban League's program manager.

"Some people are working two jobs and still struggling," Garrett said.

Even the name of the program changed. It's now called the Supplemental Nutrition Assistance Program, or SNAP.

The changes were "done in part through coordination with advocates," Witalec said. "We wanted to capture more families that really have a need during a really difficult time."

Higher income limits will help working families and seniors who have struggled to stretch their food dollars, said Laura Tobin, operations and food stamp manager at the Pennsylvania Hunger Action Center.

Hunger costs Pennsylvania $3.2 billion a year — including almost $2.4 billion for medical and mental health care because of increases in illness and psychosocial dysfunction; $330 million from reduced educational achievement and lowered worker productivity; and $517 million in expenses for charitable activities, the state said.

Dawn Rice of Coraopolis found out she now qualifies for the program. She isn't sure how much assistance she'll get, but anything would help, she said.

She spends about $500 a month on food. That includes costly formula for her 9-month-old son. Rent is $800, and her electric bill is about $120. She pays a baby-sitter about $100 a week. To qualify for the program, Rice can't earn more than $2,347 a month.

"It will definitely keep me afloat. I might be able to start getting out of debt. I'm behind on everything," said Rice, who until recently made too much at her job at a veterinary clinic to qualify.

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Thursday, October 15, 2009

Students Arrive At Scranton Med School

Scranton's first medical college opened its doors Sunday to welcome its inaugural class. More than 60 medical school students have arrived from all across the country, getting ready to hit the books and the classroom.

Orientation began Sunday morning for the brand new class of medical students in Scranton. The school received more than 1,000 applications and only 65 of those applicants received acceptance letters, something to make any student proud.

"There are a lot of schools and it is a tough decision, but for me, the thing that really made a difference was getting to be a part of a new school, something the whole community is behind," Lucas Gilbride of Colorado.

After a few hours of getting to know one another in Scranton, the new med students went on a 35 minute bus ride that took them to an overnight adventure at Camp Ladore near Waymart.

The future doctors took part in ice-breaking activities as they continued to bond with their classmates, and even though students came from all over the country and applied to dozens of different schools, many of them already like the hospitality of the northeast.

"Well, it's pretty competitive! And there are a lot of cut-throat people, but I liked the people that I met up here. That's why I came," said Emily Roe of Malvern.

For now, Commonwealth Medical College students will study in the main building at Lackawanna College. Over $5 million was invested to update the structure. Even so, a brand new home is already in the works.

Construction on the new facility has already begun. The brand new class will spend about two years there. It's set to be finished in 2011.

Dr. Robert Wright and Dr. Robert Naismith both sit on the school's board of trustees. They said the new medical college is off to a grand start.

"This is really exciting. It really is a thrill to see something of this magnitude accomplished in such a short time," said Dr. Wright.

"One of our people had a hat on in Germany that said TCMC and someone ran up to him in Germany and said that's the new medical school in northeastern Pennsylvania," Dr. Robert Naismith.

Once the brand new building along Pine Street in Scranton is finished, TCMC will be able to accept even more students per class. School leaders hope that means more doctors will stay in the northeast and they say that could help defray the cost of medical care.

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Monday, September 28, 2009

Healthy welcome to new class

One thousand six hundred and ninety-one days since it was first proposed, 410 days after it was certified by the Commonwealth of Pennsylvania and less than one day before the start of classes, The Commonwealth Medical College (TCMC) officially welcomed the school’s charter class on Sunday.

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State senator Robert Mellow speaks at the convocation of The Commonwealth Medical College on Sunday afternoon. Mellow, who helped procure start-up funding for the school, received its first honorary degree for ‘his steadfast support, his belief and his passion’ for the medical college.
Don Carey / The Times Leader
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Margaret Mathewson, of Dallas, signs the convocation oath of The Commonwealth Medical College during a ceremony Sunday afternoon.
Don Carey / The Times Leader
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In a ceremony full of praise for all who made the college a reality, President and Founding Dean Robert D’Alessandri, M.D., presided over the inaugural convocation, held in TCMC’s temporary home at Lackawanna College.

“I feel great,” D’Alessandri said moments before the ceremony, which officially began the first year for the first independent medical college in the United States in more than 50 years and the first medical college in Pennsylvania since Hershey Medical Center opened theirs in 1962.

“I couldn’t be more pleased with this inaugural class. We have 65 students, with 75 percent from Pennsylvania including 18 from this region. That’s the largest percentage of students from the state in any college,” he said. “I’m very impressed with this class, especially their commitment and dedication to service.”

D’Alessandri recognized the school’s founders, board, faculty, the community and the students for taking “a leap of faith” in a school with no track record and, for the moment, no facilities of its own. “We’ll never forget that you took this leap of faith with us,” D’Alessandri told the class of 2013. “I promise you we will not let you down.”

There was also praise for State Senator Robert J. Mellow, who received the school’s first honorary degree for what D’Alessandri called “his steadfast support, his belief and his passion” for the school.

Mellow, who helped procure start-up funding for the college, received a standing ovation from the more than 600 present.

Before the ceremony, Mellow said he was “overwhelmed” to receive the honor. “Every place there is a medical college, there is prosperity,” Mellow said. “I don’t think we can calculate the value of this day to the economy and health of this area.”

Also recognized were the first three recipients of the President’s Distinguished Service Awards. Denise Cesare, TCMC board member and Chief Executive Officer of Blue Cross of Northeastern Pennsylvania, accepted an award on behalf of Blue Cross NEPA, which donated $75 million towards start-up costs. Robert Wright, M.D., chairman of TCMC’s trustees and founder of the Scranton Temple Residency Program, was honored for recognizing the need for a medical college in the area and his assistance in making it a reality. Robert Naismith, Ph.D, Chairman and Chief Executive Officer of Roosevelt Capital Partners and Director of Penn Security Bank, was recognized for giving his “time, his advice and his imagination in making this day a part of history.”

But Sunday’s focus was the college’s first class, as each signed a convocation oath that said, in part, the class vows “always to act to preserve the finest traditions of my college and profession, and long may I experience the joy of healing those who seek my help.”

“I’m excited to finally get going and be part of this,” said Meg Mathewson, one of 25 women in the class. Mathewson, a Dallas resident and University of Scranton graduate, said she chose TCMC because it seemed community-oriented. Mathewson said she’ll wait until she does her rotations to decide on a specialty, but is leaning toward pediatrics or sports medicine. “It’s just really cool to be able to go here, in my hometown area,” she said. “And yes, I plan to stay here to practice.”

Having their son, Scott, choose an unproven school didn’t concern Stephen and Barbara Dalanes, who traveled from Vernon, N.J., for the ceremony. They said the college was highly recommended by the world-renowned surgeons Scott worked with last year in Philadelphia. “This is a unique opportunity for Scott,” said Stephen. “We’re very thankful they were able to get the college started this fast.” Barbara praised the support from the school’s staff and community. “This has been such a great experience,” she said.

For the class, the next step is the start of classes at 8 a.m. today, but D’Alessandri is already looking ahead. “There are 1,365 days until graduation,” he said. “I think that day will be the culmination of all we want to do for this area and we want the community there with us. I think we’ll rent the stadium and invite the whole town!”


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Tuesday, September 15, 2009

FIU medical students to get their `white coats

The White Coat Ceremony -- a medical school ritual held before classes officially begin -- arrives Friday at Florida International University.

That's when the new medical school's inaugural class of 43 students will be presented their medical coats, a sign that their journey toward becoming physicians has begun. ``The White Coat Ceremony is their rite of passage, their formal introduction to the art of healing. Once they put their coats on, they will be changed forever, '' said John Rock, the founding dean of the Herbert Wertheim College of Medicine.

The public ceremony will be held at 4 p.m. at the school's performing arts center at FIU's Modesto A. Maidique Campus, 11200 SW Eighth St.

Each student will receive a traditional white medical coat. The student coats will be short in order to distinguish them from doctors when doing their clinical rotations at hospitals.

They will also be given a stethoscope, donated by Leon Medical Centers. In 2008, Benjamin León Jr., founder of Leon Medical Centers, donated $10 million to the medical school.

The first full-fledged White Coat Ceremony was held in 1993 at Columbia University College of Physicians and Surgeons. More than 100 medical schools in the United States now hold the ceremonies at the start of the year.


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Friday, August 28, 2009

Commonwealth Medical College Opens

Today is a historic one for Pennsylvania and especially Scranton. For the first time in more than 40 years the Keystone State has a new medical school.

With butterflies in their stomachs and years of hard work ahead, future doctors filed into the first day of classes at the new Commonwealth Medical College in Scranton.

"I could barely sleep last night. I was so ready to learn," said Ryan Wilson of Northampton.

"I'm so excited. I've been preparing for this for a long time," said Joe Marchese of Dunmore.

"It's going to be hard but I'm ready for the job at hand," said Jeff Farrell of Pittsburgh.

The job at hand started at 8 a.m. at the college's temporary location, Lackawanna College.

The medical school's president gave a quick pep talk before students started their studies.

Nearly 1,300 people applied but only 65 students were accepted, 40 men and 25 women and the majority of these future doctors is from our area.

"I'm from Green Ridge. I grew up on North Washington Avenue. It's definitely awesome to come home and have something like this going on in the city," said Melissa Rader. "My mom does my laundry still so it's fine!"

The president said what sets this medical school part from all of the others is the fact that students actually do the beginning of their clinical work after a few months of classes whereas other places wait until after the first year.

Some of that hands-on work will include students following a local multi-generational family for four years.

Other experiences will be in the school's clinical and simulation center.

"They'll learn to listen to lungs, listen to hearts to assess our simulated patients just as they would with real patients in real life," explained Maria Olenick of the Clinial Skills and Simulation Center.

With the heavy course work ahead students said it helps to have so much support.

"Everyone here is so receptive of us. They're treating us like rock stars up here in Scranton," Wilson added.

Rock stars who may just end up saving your life one day.


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