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Morning Read: Health job growth starts to fizzle

Highlights of the important and the interesting from the world of healthcare: Health job growth starts to fizzle: Through the Great Recession, health care seemed to be one of the few industries that continued to add jobs–or at the very least jobs cuts weren’t quite as severe as other industries. But now as the U.S. […]

Highlights of the important and the interesting from the world of healthcare:

Health job growth starts to fizzle: Through the Great Recession, health care seemed to be one of the few industries that continued to add jobs–or at the very least jobs cuts weren’t quite as severe as other industries. But now as the U.S. slowly emerges from the recession’s fog, job growth in health care is slowing down substantially, American Medical News reports. For example, in February physician offices added only 900 jobs, down significantly from 5,800 in January. Likewise, hospitals added 1,300 people in February, far fewer than the prior month’s 7,700.

So what’s behind the drop? Industry insiders blame two often-cited scapegoats: the prospects of Medicare and Medicaid cuts and uncertainty surrounding health reform. Now that half of that equation has (almost) been removed with reform’s passage imminent, let’s hope those HR departments go back to making lots of job offers.

Care about cost control? Comparative effectiveness research is for you! Bloomberg highlights an item in the health reform law (it’s nice to no longer have to say “bill”) that hasn’t generated too  much attention or “political heat,” but could be the most important cost-cutting provision of all. It’s “comparative effectiveness research,” which seems to be in serious need of a marketing firm to provide it with a more catchy moniker. In any case, it’s research into what devices, treatments and drugs work best for any given condition. And the new law requires the government to put at least $500 million a year into it.

Alas, what’s good for patients may not be good for companies. Whenever you have devices, treatments and drugs that are winners, you’ll have some ones that are found to be less effective and thus become the losers. That’s good if you believe medicine USA-style is too influenced by Big Business. But it’s not so good if you’re a shareholder of one of those companies that loses out. Nonetheless, give some credit to the drug device makers for giving their blessing to the new law, though, as always, the devil will be in the details.

Comparative effectiveness research will only be truly effective if it’s conducted–and more importantly, reported–in an environment that’s free of undue influence from industry. Judging from the bold part of the following sentence, it doesn’t look like we’re off to a good start: “The industry favored the legislation because it focuses on clinical effectiveness, rather than cost and because manufacturers will be part of the decision-making,” Bloomberg reports.

CYA medicine: Medscape has a nice look at how physicians perceive the widely discussed phenomenon of defensive medicine, or as one doctor puts it, “CYA medicine.” Doctors complain ad nauseum about defensive medicine, but that’s not to say that it isn’t a real problem for them. Fear of a malpractice lawsuit seems an ever-present issue for physicians. From the outside, it’s easy to say they’re overreacting, but it’s apparent that the fear is real–and a real consequence for health care in the U.S. As for what causes defensive medicine, no one should doubt that physicians sometimes acquiesce to the unhinged demands of paranoid patients, likely a big factor driving unnecessary and costly testing. But this article points out another contributing factor: peer pressure. Doctors also fear being perceived of as lesser physicians by their  professional counterparts.

“I’d estimate that 50% of my testing,” says a vascular surgeon, “is at least partly influenced by the need to demonstrate objective proof of something that I’ve already diagnosed by taking a history and physical examination.”

A cog in a broken machine: On a related topic, Xconomy blogger Wade Roush provides a glimpse into his time sitting on a jury in a malpractice case for three weeks. The experience was enough to turn Roush against our current malpractice system, and left him advocating for “no-fault” malpractice laws, which award patients money but don’t assign blame to doctors. In Roush’s view, the U.S. system of adjudicating malpractice claims is broken–to the detriment of both patients and doctors.

Photo from flickr user Seattle Municipal Archives