Last Thursday, the Greenville Chamber of Commerce held its annual Legislative Breakfast – I think it was a “Power Breakfast,” but not in the sense it was a small, backroom affair. On the contrary, it was wide open and especially well attended – more than two hundred people. While the purpose of the meeting was to review the Chamber’s complete legislative agenda, the major focus of discussion related to the expansion of USCSOM-Greenville. Several speakers talked about the benefit of this initiative to our state and region. The Delegation was invited to comment about a range of legislative issues. A number of them, including Senator, Mike Fair, chair of the delegation, publicly communicated that they would actively support the medical school expansion. Senator David Thomas also came out strongly in support and Representatives Dan Hamilton, chair of the Upstate Caucus, and Bruce Bannister also pledged to actively support the initiative.
Several representatives of the press attended the breakfast including GSA Business, Greenville News, and WYFF. and I was interviewed along with some of the legislators. The Greenville News posted a brief piece on its website that included the following: Greenville County legislative delegation stood beside the Greenville Chamber of Commerce this morning to support expanding a medical school in Greenville.
I am grateful for the support of the Greenville Chamber of Commerce and our elected officials and the open, transparent way in which it was voiced.
I found this email especially important in light of our decision to expand the USC School of Medicine Campus in Greenville from serving 3rd and 4th year students to including all four years. The plan has us expanding to 100 students in each of the 4 years starting in 2012. What is fascinating is that one of the questions we have heard from some parts of the state is whether or not there is a physician shortage. The shortage is real, the impact on the healt of our community is big…I only wish we started this decades ago.
—By Scott Harris
It is widely known that the nation is in the grips of a physician shortage. When doctors, patients, and advocates discuss the effects of that shortage, the conversation typically centers on primary care. And while primary care providers and patients undoubtedly feel the effects, physicians in a range of other specialties also are struggling to meet patient needs.
As with family and internal medicine, specialist shortages can overburden practices and departments, cause longer patient wait times, and severely hamper or altogether prevent access for those living in areas where shortages are most acute.
According to statistics from the federal Health Resources and Services Administration (HRSA), by 2020, demand is set to outstrip supply in several specialties, with nonprimary care specialties in general projected to experience a shortage of 62,400 doctors. General surgery is predicted to be among the hardest hit, with a shortage of 21,400 surgeons. The number of practicing general surgeons is expected to fall to 30,800 by 2020 from 39,100 in 2000. Ophthalmology and orthopedic surgery are each expected to need more than 6,000 additional physicians over current levels. Urology, psychiatry, and radiology all are expected to see shortfalls of more than 4,000 physicians, according to the HRSA figures.
“These shortages are driven by the demographics of the population,” said AAMC Chief Advocacy Officer Atul Grover, M.D., Ph.D. “If you look at how the population has changed, it is not only growing in size but also getting older. The boomers are starting to retire. When you look at the older individuals, they use far more health care services than younger adults do. Individual specialists need to be consulted on systems-based illness. Primary care doctors can do a lot of this, but not all of it.”
The aging population in and of itself will also have a direct impact on specialties. Medical advances mean that once fatal diseases are now treated as chronic conditions. This is great news for patients, but at the same time, specialties such as geriatrics, oncology, and endocrinology (which handles diabetic patients), are becoming more important—and more thinly spread—among the population. A 2007 study conducted for the American Society of Clinical Oncology (ASCO) by the AAMC’s Center for Workforce Studies found that demand for oncology services is expected to rise 48 percent between 2005 and 2020. During the same period, the supply of oncologist services is expected to grow only by 14 percent, translating to a shortage of between 2,550 and 4,080 oncologists.
“One of the big diseases that stands out is cancer,” Grover said. “Older adults are much more likely to get cancer than younger people, increasing demand for oncologists, surgeons, and postoperative cancer care.”
Another severe shortage lies in the relatively small field of dermatology. According to a recent study that analyzed data from the American Medical Association Masterfile of doctors, only 3.5 dermatologists currently are available for every 100,000 Americans. Lead study author Jack Resneck, Jr., M.D., associate professor of dermatology at the University of California, San Francisco, School of Medicine and chair of government affairs for the American Academy of Dermatology (AAD), said the shortage is caused largely by the cap on the number of residency training slots supported by Medicare funding; since 1970, the number of dermatology residencies has hovered at around 300 per year. According to AAD figures, as of September 2009, there were 9,179 practicing dermatologists in the United States. Patient wait times average about 34 days for new patients, and in some cases can run as long as three months.
“It’s an unquenchable thirst in a lot of ways,” Resneck said. “Long wait times are common. You never feel caught up. It’s frustrating. We try to triage patients who need to get in sooner, but we spend a lot of our day dealing with phone calls from people who feel their problems are urgent. And for dermatologists who want to retire or add another physician to their practice, it’s a challenging environment. About a third of dermatologists are looking to hire an associate in their practice at any given time.”
Dermatology practices are trying telemedicine to work in remote areas, and are testing different pilot programs designed to fund new residency slots without Medicare support, as well as “hybrid” residency programs that partner teaching hospitals and health systems with programs in underserved areas.
In general surgery, sea changes in training models are a major reason for the shortage. Anthony G. Charles, M.D., M.P.H., an assistant professor in the department of surgery at the University of North Carolina at Chapel Hill School of Medicine, said the issue is only getting worse. “We have a problem,” Charles said. “Over the past 25 or 30 years, the number of surgeons has been pretty static as the population increases. If you get in a car crash, your primary care doctor will be a surgeon. So we can’t ignore this.” Charles said residency programs need to be created or expanded to address the shortage, but added that expansion alone would not be enough. “The traditional role was that everyone trained in general surgery and then broke off into subspecialties,” Charles said. “But now, early subspecialization exists in some areas, such as plastic surgery and vascular surgery. Good, oldfashioned general surgery now does not exist as much.
The surgeon who can deliver a breadth of care essentially is no more.” Specifically, the phenomenon known as progressive specialization, in which surgeons bypass general surgery training and enter fellowships in subspecialities like laproscopy, oncology, and trauma, is steering physicians away from general surgery, Charles said. Charles proposes shorter training periods for general surgery, as well as more streamlined and standardized expectations for what general surgeons will learn. “Training a general surgeon currently takes five years. Early and progressive specialization are here to stay,” Charles said. “We could reduce the length of training from five years to four, knowing people will subspecialize.
You can increase the pool because you have reduced the training time. There is a natural evolution of narrowing the general surgery practice anyway. So if you train in 15 common procedures very well, you do not need five years to train on that. Other cases can be referred to specialists.” He also said a culture change may be in order. “People also think there are two tiers of surgeons, with general surgeons being surgeon light. We have to change that mindset.” Interestingly, the relentless advance of medical knowledge can also exacerbate shortages. This is particularly true in pediatrics, where, contrary to other specialties, generalists are plentiful but many subspecialists are scarce. “We’ve learned in recent years that kids are more than just small adults,” Grover said. “They are physiologically different.
The knowledge base in pediatrics has expanded rapidly and we now need a broader range of pediatric specialties, which spreads the workforce more thinly.” Another factor behind the shortages in some specialties is work-life balance. According to Resneck, this has been a problem in dermatology for years. “We’ve been dealing with the reality that women and younger physicians in general tend to work a little less, and the younger generation just has a different expectation for work-life balance, “Resneck said.
Resneck said he understood why primary care was the main target of attention on Capitol Hill and in the general public, but said other specialties should be included in the discussion, particularly when it comes to lifting the current cap on the number of residency slots that can be supported by Medicare. “We would love to see the cap lifted,” Resneck said. “A lot of the dialogue in Washington has emphasized primary care. Dermatologists very much understand that we need to do something about our primary care shortage. We just want people to be aware that there are patient care implications from shortages in other specialties, too.”
I thought it would be good to share with you what one of our Leaders, Linda Brees, along with many concerned community partners and individuals recently reported at an event highlighting the SafeKids of the Upstate. Whenever I am asked why GHS does so much more than just provide care, I think of initiatives like this. And, the helmet issue is not just for kids…if you see me in the next few weeks, ask to take a look at my scraped knee from a fall on the bike and even more importantly, ask to see the ding in my bicycle helmet.
2010 SKU Accomplishments
• Thank you to our sponsors: Bradshaw Automotive; Michelin North America; & RE/MAXX Realty (Diane Wilson); State Farm (Elizabeth Sullivan)
• Thank you to our Media Supporters: WHNS—FOX; WYFF; WSPA; WSNW (Brandon Kessler); 107.3 WJMZ-Cox Radio (Frederick Sinclair; Rhonda Rollins; Curtis Johnson; & Kelly Mac); Martha Lucia Show (Martha Lucia)
• Thank you to our car seat safety technicians—please stand.
• We celebrated 15 years this year with several Birthday Events—including our 15 year Birthday Celebration kickoff; Safe Kids Night @ the Drive; & a community car seat check.
• Over the last 15 years we have reduced the number of accidental injuries by 26%.
• We opened our 6th permanent car seat safety inspection station in Seneca at the Seneca Fire Department.
• Over the past 15 years we have educated over 130,000 children on fire prevention with over 5,000 this year alone.
• Over the past 15 years we have had well over 300,000 children visit Buddy’s Home Improvement House with over 10,000 visits in the last year.
• Over the past 15 years we have distributed over 15,000 bike helmets, bike & pedestrian safety materials with over 3,000 distributed this past year.
• We have safety patrol program in 53 elementary schools in Greenville & Pickens County.
• Our Walk this Way campaign for the past year had over 1190 participants from 3 elementary schools.
• With our permanent Car Seat Safety Inspection Stations & open
car seat checks we have conducted 64 car seat checks touching up to 3,000 lives & performed 30 PS safety workshops touching 857 families.
• We have conducted 117 community events this year reaching over 38,000 people.
• We have fitted over 25 special needs car seats and provided 6 bus safety seats.
The following is an internal communication that speaks to our commitment to work with existing, strong organizations and bring more to the community. I welcome your thoughts or comments, on this blog or at the gym….Mike
GHS and the YMCA of Greenville launch second phase of partnership
December 1, 2010 – Greenville Hospital System University Medical Center (GHS) and the YMCA of Greenville established the PATH (Partners Achieving Total Health) initiative in 2008 with the goal of providing fitness and preventative care that’s affordable, easily accessible – and focuses on reaching people before they get sick.
The first phase of the initiative included creation of a PATH membership, which grants members access to all four Greenville County Y locations and two Life Center locations, and Wellness Way, a six-week exercise prescription program for patients at risk for chronic diseases like diabetes and hypertension.
The second phase, being launched now, focuses on improving access to health and wellness services in the Golden Strip area. The Y is currently under contract to purchase the 60,000 square foot LivN Nsidout wellness facility on I-385 in Simpsonville and anticipates transfer of ownership to occur on Dec. 10. The plan is to consolidate the Y’s at-capacity facility on Highway 14 to this new facility over the next 18 months.
The new facility will be co-branded with GHS as the GHS Family YMCA in recognition of the strong, evolving partnership between GHS and the Y and our combined commitment to improving the health of the community. In return for naming rights of the facility and involvement in health-related programs across all YMCA of Greenville sites, GHS has agreed to support the new Y facility with $100,000 a year for 10 years.
“We are thrilled to continue our relationship with GHS and to name this facility in a way that reflects our shared commitment to improving the health and wellness of our community,” said Scot Baddley, president and CEO of the YMCA of Greenville.
“Our investment in this facility is an investment in the health of the Golden Strip community,” said GHS President and CEO Michael Riordan. “By working together, GHS and the Y can create conditions in which everyone has the opportunity to succeed in their journey to better health.”
In addition to consolidating the Golden Strip Y, GHS’ Simpsonville Life Center Health and Conditioning Club will also consolidate to the new GHS Family YMCA.
“Integrating fitness center operations will improve and expand fitness options for Y, Life Center and LivN Nsidout members,” said Baddley. “Consolidating services will also eliminate any unnecessary duplication of services and allow the Y and GHS to better leverage their resources to meet our community’s health and wellness needs.”
The Y plans to begin construction on an aquatic center at the GHS Family YMCA in December, which will take approximately four to seven months to complete. During this time, the Y will begin transitioning its Golden Strip members to the new facility.
Members of the Simpsonville Life Center will begin transitioning to the GHS Family YMCA in January with the Life Center expected to close in May 2012.
The Y will honor all current LivN Nsidout memberships and accept applications from LivN Nsidout employees interested in becoming Y employees.
Current Golden Strip Y and Simpsonville Life Center employees will also have an opportunity to apply for positions at the GHS Family YMCA.
“Our goal is to make this transition as seamless as possible and to keep as many jobs intact as we can,” said Baddley.
A ribbon cutting ceremony and open house for the GHS Family YMCA is planned for Thursday, January 13 at 10 a.m. Employees and the public are welcome to attend. Information on how to join the GHS Family YMCA or obtain a PATH membership will be available at the open house and is currently available at all Greenville County Y locations.