An expert group, set up by Health Minister Edwina Hart, to look at the issues around funding drugs on the NHS that are not approved by NICE will report on its findings and recommendations in the New Year.

The group, led by Professor Philip Routledge, the chair of the All Wales Medicines Strategy Group, has been canvassing views of health professionals and patient representatives over the summer.

Mrs Hart said: “NICE and the All-Wales Medicines Strategy Group have an extremely difficult job in thoroughly evaluating the clinical and cost effectiveness of new drugs. In the vast majority of cases, their judgement is accepted. However, there have been instances, where I, health professionals and patients have had concerns about their decisions, such as access to Lucentis for Wet AMD and drugs for kidney cancer.

“This is an emotive issue and generates considerable discussion and debate.

“With finite resources the NHS must fund new medications that are proven to benefit. But while these independent organisations determine whether they should be used, there can be variation in access to such drugs.

“I have asked Professor Routledge to look into the potential difficulties surrounding the provision of drugs that do not hold NICE approval.

“He will engage with the leading clinicians across Wales and, in particular, with those involved in cancer care. As well as considering how the ‘non-approved’ or ‘decision pending’ drug issue might be handled in an ethical and fair manner, he will consider the matter of life-prolonging treatments that are prescribed in the last months of life, often at great expense but with little hope of success.”

Professor Routledge added: “It is extremely important that patients in Wales have timely access, which is also fair and equitable, to clinically effective and cost effective new medicines. While the All Wales Medicines Strategy Group already has robust, open and transparent procedures to appraise medicines and treatments, there are certainly ‘grey areas’. I very much welcome the opportunity offered by the Minister to examine how this whole process might be improved, with obvious patient benefit. We are already making progress but there is considerable work still to do before we make our recommendations.”

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View drug information on Lucentis. Continue reading →

Data from one of the largest mammography trials in history demonstrates that overall the radiation dose associated with digital mammography is significantly lower (averaging 22 percent lower) than that of conventional film mammography and that the reduction could be greater in women with larger and denser breasts, according to a study published in the February issue of the American Journal of Roentgenology.

“The ability to reduce the radiation dose for many women is another step forward for breast cancer screening with mammography – which saves thousands of lives each year,” said R. Edward Hendrick, PhD, lead author of the study.

The American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST) published in 2005, enrolled 49,528 women and found that digital mammography detected significantly (up to 28 percent) more cancers than film mammography in women younger than 50 years of age, premenopausal and preimenopausal women, and women with dense breasts.

In this latest DMIST study, published in AJR, technical data from 5,102 DMIST participants were evaluated, demonstrating that the dose received by women imaged with digital mammography was significantly lower than that received by the same women imaged with standard film mammography.

“The average breast radiation dose per view was 2.37 mGy for film mammography and 1.86 mGy for digital (22 percent lower for digital than film mammography),” said Hendrick.

Digital mammography is similar to conventional except with digital, X-ray images are collected on a digital detector and stored on a computer rather than being collected and stored on film. “While the radiation dose from both film and digital mammography are low, further dose reduction is an added benefit of digital mammography over and above its ability to better detect cancers in women with dense breasts,” said Hendrick.

Access to digital mammography continues to increase. More than 60 percent of U.S. breast imaging facilities offer digital mammography and more are acquiring digital services each month. “As digital mammography has now been shown to significantly lower the radiation dose, it is likely that access to it will continue to grow,” said Hendrick.

Source:
Heather Curry

American College of Radiology / American Roentgen Ray Society Continue reading →

The case of a Vermont woman — who is seeking legal recognition of her six-month-old twin fetuses that died in a car accident — could reignite a debate over abortion rights in the state, the AP/Barre-Montpelier Times Argus reports. Some abortion-rights advocates have expressed concerns that revising state law to give legal recognition to fetuses could conflict with the Supreme Court ruling in Roe v. Wade.

The state Supreme Court in 1989 ruled that prosecutors cannot charge anyone for the death of a fetus in a motor vehicle accident. According to the AP/Times Argus, the court cited a common law tradition from the 17th century that ruled a fetus must be born alive for it to be eligible for legal protection. Although 36 states have some form of fetal homicide law, Vermont does not, and the state Supreme Court said it will be up to the Vermont Legislature to revise the law.

The woman involved in the case, Patricia Blair, said, “They’re babies. It just makes no sense to me how anyone can say ‘they’re not babies, they’re a fetus,’” adding, “We need to speak for them. If I can do something for these two I am going to do it.” Blair said, “If I had some direction, I am sure I could be a loud enough voice.” No charges have been filed yet in the case, according to the AP/Times Argus.

Cheryl Hanna, a professor at the Vermont Law School, said that fetal homicide laws nationwide have changed in recent years and that they have, in some instances, been invoked during debates over abortion rights. Hanna said, “Pro-life advocates have seen passing fetal homicide laws as the basis for undermining Roe v. Wade.” She expressed doubt that the Vermont Legislature, which she described as one of the most supportive of abortion rights nationwide, would change the law. Hanna said, “Having said that, the loss to Mrs. Blair is no less significant and real to her,” adding, “It’s a shame that there’s not a very good way for the law to legitimately recognize the loss to her.”

On Thursday, Vermont Senate Judiciary Committee Chair Richard Sears (D) said the committee has not dealt with the issue during the 18 years he has served on the panel, adding, “It’s something we’d consider” (Ring, AP/Barre-Montpelier Times Argus, 8/13).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved. Continue reading →

A comprehensive analysis, published in the online journal ecancermedicalscience, has detailed how cancer death rates in developed countries have fallen substantially in the last 20 years, despite a general increase in the prevalence of cancer.

It was also found that despite recent reports highlighting the UK’s poor cancer performance compared to the rest of Europe and the USA (which led to the UK being branded the ‘sick man of Europe’) England and Wales have seen the largest increase in spending on health of any country, and largest reduction in cancer deaths overall except the Netherlands. The researchers, based at Bournemouth University, found that England and Wales’ health spend increased by 66%, compared to an average rise of 39%, whilst average male cancer deaths (15 to 74 years) decreased by 25%, compared to an average of 12% amongst other major developed countries. Men in England and Wales now have a lower cancer death rate than men in the USA.

Studying World Health Organisation figures for 1979-1980 and 2000-2002, they also found that, with the exception of Japan and Spain, cancer deaths for men declined significantly more than for women. The authors suggest that this may be due to the impact of life-style changes on women as more enter the work force.

The authors propose that the reduction in cancer deaths is influenced by increased expenditure including the use of newer, and invariably more costly, anti-cancer drugs, but also note that: “Despite the recent increase in the health expenditure of England & Wales (9.3%), it remains below the average (9.85%), and only Japan and Spain, amongst the major developed countries*, spent less. Nonetheless, the Anglo-Welsh increase was the highest and the correlation between a reduction in cancer deaths and increased national expenditures on health, should encourage Governments to respond to the challenge.

The reduction in malignancy deaths in all the countries studied, especially amongst the under 74′s, should be a boost for the patient morale, their families and front-line staff, and particularly in England & Wales. However, this encouraging improvement should not distract from the increased incidence of cancer, especially in England & Wales, as well as the continuing negative link with socio-economic factors.”

So whilst the UK is still lagging behind the US and most other countries’ spend on health, it appears to be doing more with proportionately less.

However, lead author Professor Colin Pritchard concludes: “Whilst it may be true to say that the treatment of cancer has never been better, still more needs to be done, especially when facing the challenges posed by the increasing incidence of malignancies in the general population.”

*Major Developed Countries studied: USA, Germany, France, Canada, Netherlands, Australia, England and Wales, Italy, Japan, Spain

Source:ecancermedicalscience
ecancermedicalscience is an open-access, peer-reviewed cancer journal founded by the European Institute of Oncology.

Article will be published online Monday 28th July Continue reading →

Mary Agnes Carey, associate editor of CQ HealthBeat, discusses bipartisan legislation that would allow FDA to approve follow-on biologics, House Energy and Commerce Committee approval of a Prescription Drug User Fee Act reauthorization bill and senators’ efforts to increase funding for embryonic stem cell research in this week’s “Health on the Hill from kaisernetwork and CQ.”

According to Carey, Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.), committee ranking member Mike Enzi (R-Wyo.), Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Orrin Hatch (R-Utah) have agreed to legislation that would authorize FDA to approve lower-cost biotechnology drugs that are similar to the original brand-name versions. Under the measure, follow-on biologics could not be approved until 12 years after the original drug is approved and the first “interchangeable” product would receive one year of exclusive marketing, Carey says. The measure could be included in legislation that would reauthorize the Prescription Drug User Fee Act.

Carey also discusses the House Energy and Commerce Committee approval of PDUFA reauthorization legislation, which would “make major regulatory and drug safety changes.” According to Carey, the amount of user fees collected could be reduced if Congress provides more money for drug reviews, but it is “unclear” whether lawmakers would appropriate the funds. The omnibus measure is expected to be on the House floor next month.

In addition, Carey says Sens. Tom Harkin (D-Iowa) and Arlen Specter (R-Pa.) have included in the Labor-HHS-Education fiscal year 2008 appropriations bill a provision that would overturn President Bush’s veto of legislation that would have expanded federal funding for embryonic stem cell research. Three members of the Senate Appropriations Committee voted against the bill, while others who oppose the stem cell research provision voted in favor of the bill but said they would try to eliminate the provision on the Senate floor. Differences remain over funding between the House and Senate versions of the bill. The Senate bill includes about $1.9 million less in discretionary spending than the House bill and is about $9 billion more than Bush requested, Carey says (Carey, “Health on the Hill from kaisernetwork and CQ,” 6/25).

The complete audio version of “Health on the Hill,” transcript and resources for further research are available online at kaisernetwork.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

HIV and sexual health charity Terrence Higgins Trust Scotland (THT Scotland) is to launch a printed guide aimed at lesbian, gay, bisexual and transgender (LGBT) young people in South Lanarkshire. ‘Knowing Me, Knowing You’, produced in partnership with Universal Connections and South Lanarkshire Council, offers advice for young people who may be questioning their sexuality, and highlights organisations that can help them. Copies will be issued to secondary schools and youth learning services across the region.

Research shows that LGBT young people are noticeably more likely to consider suicide and self harm than their heterosexual peers. Bullying, feelings of isolation, and a fear of being different can combine to make their teenage years a very difficult time. In an effort to combat these issues, ‘Knowing Me, Knowing You’ contains information on a range of topics, including: the difference between sex, gender, and sexuality; advice for young people who are thinking about coming out; and how to deal with homophobia and discrimination.

The guide also includes a list of organisations, both local and national, where LGBT young people can turn for support.

Alison Lord, Centre Manager for THT Scotland in Glasgow, said: “Your teenage years can be a pretty tough time for a lot of people. However, we know they can be especially scary for LGBT young people; they are more likely to experience bullying and discrimination, and yet less likely to feel they can turn to friends and family for support.

“Our aim is to make sure anyone who is experiencing these issues in South Lanarkshire knows they’re not alone. There are so many organisations out there that can help, and we hope this guide will help more LGBT young people find the support they need.”

Robert Burgess, YLS Area Coordinator for Universal Connections, said: “This is an important step forward for the LGBT young people within South Lanarkshire, and builds on the strong support work already offered by Universal Connections. We work closely with young people and have witnessed the need for support networks, and our hope is that this guidance will help young people access the appropriate support they need.”

Source:

Terrence Higgins Trust Continue reading →

Physician, hospital and educator groups have raised concerns about a provision in the House version of a health care information technology bill (HR 4157) that includes a provision under which health care providers and health insurers would have to implement a new billing code system, CongressDaily reports (CongressDaily, 9/28). Under the legislation, which the House approved on July 27, the number of billing codes that providers use to file health insurance claims would increase from 24,000 to more than 200,000 by October 2010. The Senate version of the bill (S 1418), approved in November 2005, does not include the provision (Kaiser Daily Health Policy Report, 9/27). According to CongressDaily, the provision “has become one of the key sticking points” in negotiations to resolve differences in the House and Senate bills. A letter signed by the American Medical Association and 78 other medical groups last week recommended a delay in the implementation of the new billing codes until 2012. The letter — sent to Senate Majority Leader Bill Frist (R-Tenn.), Sen. Hillary Rodham Clinton (D-N.Y.) and the chairs and ranking members of the committees and subcommittees with jurisdiction over the legislation — states that the new billing codes could leave physician offices with the “costly prospect of upgrading or replacing practice management systems for billing and coding and the necessity of retraining their billing and coding staff.” In addition, Wyoming Gov. Dave Freudenthal (R) sent a letter to Senate Health, Education, Labor and Pensions Chairman Mike Enzi (R-Wyo.) that recommended a similar delay over concerns that the new billing codes would “slow or even derail the adoption” of electronic health records in Wyoming. The American Association of Community Colleges and the Higher Education Allied Health Leaders Coalition also sent a letter to Congress that recommended a similar delay (Lee, CongressDaily, 9/28).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

A free help line is available to all residents in Illinois who are trying to cope with the emotional consequences of the recent Northern Illinois University campus shooting. Staffed by experienced master’s-level behavioral health specialists, the free help line offers callers assistance with a range of personal concerns including stress, anxiety and the grieving process. Callers may also receive referrals to a national database of community resources to help them with specific concerns, such as financial and legal issues.

The toll-free help line number is (866) 342-6892. It will be open 24 hours a day, seven days a week for as long as necessary. Service is free of charge. Resources and information are also available via the Internet at liveandworkwell.

These services are routinely available to UnitedHealthcare participants courtesy of OptumHealth, the health and wellness division of UnitedHealth Group. OptumHealth serves customers of its sister companies – such as UnitedHealthcare – as well as customers of non-UnitedHealth Group businesses.

Previously, OptumHealth’s help line was made available to the public following the tornadoes that hit the Southern states, the Indiana floods, Southern California wildfires, the hurricanes hitting Florida and the Gulf Coast and to individuals affected by the tragic shootings on the Virginia Tech campus and the Minnesota Interstate 35W bridge collapse.

About OptumHealth

As one of the nation’s largest health and well-being companies, OptumHealth makes health care easier and better for employers, health plans, public sector entities and the 58 million people with access to its services. The Company’s goal is to optimize health, well-being and financial security, while lowering benefit costs and helping consumers make informed decisions about their health through standalone or integrated services. OptumHealth is a division of UnitedHealth Group (NYSE:UNH). More information about OptumHealth can be found at OptumHealth.

About UnitedHealthcare

UnitedHealthcare provides a full spectrum of consumer-oriented health benefit plans and services. The company organizes access to quality, affordable health care services on behalf of more than 26 million individual consumers, contracting directly with more than 550,000 physicians and care professionals and 4,800 hospitals nationwide to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE:UNH), a diversified Fortune 50 health and well-being company.

UnitedHealthcare Continue reading →

Men now have another good reason to consider taking finasteride, a well known generic drug that shrinks an enlarged prostate and reduces the risk of getting prostate cancer by 25 percent. A new study from the Southwest Oncology Group strongly suggests that for men at risk of the disease which strikes one in six men finasteride also raises the odds that physicians will find fast growing prostate cancers early, when they are most easily treatable.

“It appears that a man concerned about prostate cancer risk, who is having a PSA test on a regular basis, will not only reduce his risk of prostate cancer if he takes finasteride, but will help find the cancers that pose the highest risk,” says Ian M. Thompson, M.D., the study’s senior author and a urologist at the University of Texas Health Science Center in San Antonio.

The new results, embargoed until 4 p.m. Sept. 11, appear online ahead of print publication Sept. 18 in the Journal of the National Cancer Institute.

“This report provides an important interpretation of results that confounded an overall favorable interpretation of the Prostate Cancer Prevention Trial initially, and should help lessen fears that finasteride somehow causes more aggressive prostate cancer,” says Frank L. Meyskens, Jr., M.D., Southwest Oncology Group associate chair for cancer control and prevention.

The Southwest Oncology Group (SWOG), headquartered at the University of Michigan and one of the nation’s largest National Cancer Institute sponsored clinical trial networks, conducted the study to further analyze data from its National Cancer Institute sponsored 18,882 man seven year Prostate Cancer Prevention Trial, which in 2003 found that finasteride was an effective prevention agent. The Food and Drug Administration has not approved finasteride for use in cancer prevention; the drug is approved for treating enlarged prostate.

Four years ago, Southwest Oncology Group researchers closed the Prostate Cancer Prevention Trial (PCPT) early to report very good news. Study results showed that finasteride, commonly used to treat enlarged prostate, could also make a man one fourth less likely to get prostate cancer.

But that positive overall result which potentially could keep around 50,000 men from developing prostate cancer each year was clouded by a troubling finding: Men who took the drug but still developed prostate cancer by the end of the study had higher rates of detected high grade tumors, an aggressive form of the disease, than did men in the placebo group.

The follow up study, along with two others published recently, strongly suggests that finasteride makes it easier for physicians to detect high grade cancers early by improving screening tests and prostate biopsy itself. The two previous studies show that finasteride improves the effectiveness of the two main measures of possible problems: digital rectal examination and the PSA (prostate specific antigen) blood test, which measures hormone changes associated with the disease. In some men who have low PSA test results, cancer is present but not found in time.

“Finasteride makes the PSA test perform better, so we can find the cancer earlier,” Thompson says. “Our current study also shows that by shrinking the prostate gland, finasteride makes a biopsy more sensitive for any cancers that are present.” That increased accuracy is very important, he adds, because if a biopsy reveals a slow-growing cancer but fails to spot a fast-growing one, a doctor and patient may take a “wait and see” approach when prompt treatment is actually needed.

In part because of concerns about possible drawbacks, most urologists, when asked about finasteride, say they seldom prescribe it as a prevention drug, despite the positive 2003 PCPT findings, Thompson says. Now, with several studies allaying concerns about the drug’s possible drawbacks, including concerns about sexual dysfunction, Thompson believes men should be told routinely about the potential benefits of finasteride when they come to the doctor’s office for a PSA test, in much the same way patients at risk of heart disease are told about the benefits of statin drugs.

When the PCPT trial results were announced in 2003, it was unclear whether finasteride produced biological changes that could lead to more high-grade cancers. Researchers in the follow-up study analyzed tissue from biopsies and in men in the finasteride and placebo groups to compare hormonal levels and disease extent. They compared prostate size at the time of biopsy in the two groups. They also examined tumor grade and extent in men in the study who went on to have their prostates removed.

They found no significant differences in degenerative hormone changes when they examined high-grade tumor biopsies in men in both groups. However, the men taking finasteride had smaller prostates. Their biopsies correctly identified a higher proportion of high-grade tumors found later when their prostates were removed, compared to men in the placebo group.

In the study, the researchers conclude that finasteride may have contributed to the increased rate of high-grade cancers detected in the PCPT by making the prostate smaller, helping the biopsy find the cancer. They did not find evidence that the drug caused changes in tumor composition that might contribute to aggressive cancer, though they don’t entirely rule out the possibility that finasteride may have led to high-grade prostate cancer in some men in the study.

“The results suggest that high-grade cancer was detected earlier and was less extensive in the finasteride group than in the placebo group,” the researchers write.

In addition to Thompson, study authors include first author M. Scott Lucia, M.D.;University of Colorado Health Sciences Center; Jonathan I. Epstein, M.D., Johns Hopkins Hospital; Phyllis J. Goodman, M.S., Southwest Oncology Group Statistical Center; Amy K. Darke, M.S., Southwest Oncology Group Statistical Center; Victor E. Reuter, M.D., Memorial Sloan-Kettering Cancer Center; Francisco Civantos, M.D., University of Miami School of Medicine, Catherine M. Tangen, D.R.P.H., Southwest Oncology Group Statistical Center; Howard L. Parnes, M.D., National Cancer Institute; Scott M. Lippman, M.D., University of Texas M.D. Anderson Cancer Center; Francisco G. La Rosa , M.D., University of Colorado Health Sciences Center; Michael W. Kattan, Ph.D., Cleveland Clinic Foundation; E. David Crawford, M.D., University of Colorado; Leslie G. Ford, M.D., National Cancer Institute; and Charles A. Coltman, Jr., M.D., Southwest Oncology Group Operations Office.

The Southwest Oncology Group (swog) is one of the largest cancer clinical trials cooperative groups in the United States. Funded by research grants from the National Cancer Institute, part of the National Institutes of Health, the group conducts clinical trials to prevent and treat cancer and to improve the quality of life for cancer survivors. The group’s network of more than 5,000 physician-researchers practice at nearly 550 institutions, including 16 National Cancer Institute-designated cancer centers. Headquartered in Ann Arbor, Mich. (734-998-7130), the group has an operations office in San Antonio, Texas and a statistical center in Seattle, Wash.

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After remaining stable for 2 decades, the average hours worked per week by physicians decreased by about 7 percent between 1996 and 2008, according to a study in the February 24 issue of JAMA.

“The potential expansion of health insurance coverage and associated reform of the delivery system, combined with recent forecasts of physician shortages (particularly in primary care), have catapulted issues related to the adequacy of the physician workforce high up on the health policy agenda. Whether the workforce is equipped to handle the demand for physician services depends on both the quantity and specialty distribution of physicians and the number of hours worked per physician. Most research and policy debate on the physician workforce, however, has focused on the numbers of current and future physicians and has largely ignored the hours worked by physicians,” the authors write. “Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed.”

Douglas O. Staiger, Ph.D., of Dartmouth College, Hanover, N.H., and colleagues examined trends in hours worked by physicians using data from the U.S. Census Bureau for each year between 1976 and 2008, and also examined whether trends were associated with trends in physician fees both nationally and by geographic region within the United States. The final sample included 116,733 monthly surveys of physicians obtained from 27,874 households. Trends were estimated among all U.S. physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001.

The researchers found that average hours worked per week among all physicians changed significantly during the study period. Between 1977 and 1997, physician work hours were fairly stable, at approximately 55 hours per week. However, between 1997 and 2007, work hours per week decreased steadily, decreasing nearly 4 hours per week to 51 hours per week (7.2 percent). Hours decreased significantly during the last decade (between 1996-1998 and 2006-2008) for both resident physicians (9.8 percent) and all other physicians (5.7 percent). Resident hours remained high through 2002 and then decreased sharply following the imposition of work-hour limits in 2003, whereas hours of all other physicians decreased more steadily during the last decade.

“Between 1996-1998 and 2006-2008, hours worked decreased significantly among younger and older physicians, male and female physicians, physicians employed in hospital and nonhospital settings, and among self-employed and non-self-employed physicians. [Among nonresident physicians], the decrease in hours during this period was largest for [those] younger than 45 years (7.4 percent) and those working outside of the hospital (6.4 percent), and the decrease was smallest for those aged 45 years or older (3.7 percent) and for those working in the hospital (4.0 percent),” authors write.

They add that in contrast, average weekly hours of other professionals such as lawyers, engineers, and registered nurses changed very little during the past 30 years, which is consistent with national trends in average weekly hours among all workers.

The researchers also found that after adjusting for inflation, average physician fees decreased nationwide by 25 percent between 1995 and 2006, coincident with the decrease in physician hours. “In 2001, [average] physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere.”

“Our results have implications for how reform efforts and market forces may affect the future physician workforce. Our findings are consistent with the possibility that economic factors such as lower fees and increased market pressure on physicians may have contributed, at least in part, to the recent decrease in physician hours. Further reductions in fees and increased market pressure on physicians may, therefore, contribute to continued decreases in physician work hours in the future. Whatever the underlying cause, the decrease in [average] hours worked among U.S. physicians during the last decade raises implications for physician workforce supply and overall health care policy,” the authors write.

JAMA.
2010;303[8]:747-753.

Source
Journal of the American Medical Association Continue reading →