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As students we were nurtured and became doctors in hospitals’ hallowed halls. Academic centers, county, city and community hospitals were our homes. We toiled there and became physicians there. We’ve been linked together in a symbiotic relationship. Our families and patients were born, treated and given comfort in institutions. Hospitals and academic centers were led by physicians. Boards of trustees were well represented by physician and community leaders. Philanthropists helped make up for the deficits that threatened hospitals’ bottom lines. Community doctors admitted patients and made rounds with residents. Salaried full-time academicians and voluntary attending doctors supported residency training programs. Emergency room coverage was a condition of hospital admitting privileges. Private doctors came to the ER in the middle of the night. Salaried intensivists were not yet on the scene. In the past decade we have seen consolidation and closure of local community hospitals. Larger hospitals have purchased or affiliated with smaller hospitals and formed health care systems. The growth of these health care systems in response to reduced reimbursements by public and private sector insurers is not a local phenomenon. Look around and you’ll see it in every major metropolitan area. Today, bottom-line-oriented, full-time, non-physician administrators lead most hospitals. CEOs and media budgets for profitable surgical procedures are staples of today’s health care landscape. In the past, ‘ publish or perish’, not ‘profit or perish’, were by-words for academics. Today, unless hospital chairs can run departments without deficits they’re asked to pack their bags. The stars of medicine and surgery are courted to bring their high reimbursement patients into medical centers. . Financial incentives akin to signing bonuses are not uncommon. Loss of medical staff confronts hospitals handling these situations poorly.
So what of the community doctor, our modern day Marcus Welby? Is there a place for him or her in today’s health care market? Can the Long Island physician survive? Fortunately most patients don’t require hospital care, but affiliations are necessary for those doctors wishing to offer continuing care. Surgeons can do local procedures in ambulatory centers that pose a threat to hospitals. As more procedures become ambulatory, hospitals will lose many of their surgeons. For now, however, hospitals will be home to many of our patients. As physicians, our primary responsibility is to our patients. We also need to be vigilant in protecting ourselves. The institutions in which we lived during our professional lives are not the same. While hospitals need us to supply patients, the symbiotic relationship has changed. We may not always find ourselves on the same side. We’re both trying to survive. We must support each other and not sit by idly while the forces that are changing medicine pick us apart. We must fight for our patients and our profession and realize the hospital may be both friend and foe. As individuals, we are powerless against the financial clout of large health care systems and insurers. As part of county, state and national medical organizations we stand a fighting chance. Get involved. It’s your profession that is at stake. Wishing all of you a happy and healthy New Year and holiday season. Arnold S. Prywes, M.D.
Bowing to the economic pressure of maintaining a print library, and succumbing to the fate of many libraries that house print materials, the Library has seen its utilization dwindle to the point where it no longer makes financial sense to remain open as a conventional print library. While more than 50% of the Nassau Academy of Medicine’s annual budget is allocated to the Library, much less than 1% of the membership utilize its services at any time during the year. Most services are provided to non-member entities and the fees charged for services cannot cover the costs of maintaining the library in its current format.
An expert has been brought in to evaluate the collection and to guide us with regard to retention of rare and valuable publications that may be in our possession. He will also guide us through the complicated maze of alternatives available to us for the disposal of over 30,000 print volumes in our possession. A recommendation is expected shortly. The John N. Shell Library has been a shining star for the Nassau Academy of Medicine and the decision to transition was not an easy one, nor one made without considerable time and effort to find a viable alternative. However, preserving the fiscal integrity of the Academy is and always will be of paramount importance. The Academy is taking a new track and beginning to develop new and innovate ways to utilize the internet and all it has to offer so that it can continue to fulfill its mission to educate physicians and the public.
Both
Senator Clinton and Senator Schumer had indicated support for the
legislation which would have forestalled a 5.4% cut in Medicare
physician payments starting early next year but political wrangling kept
the bill locked up in the Senate Finance Committee and it never reached
the floor for a vote. "We are grateful to the New York members of
the House of Representatives who understood the looming disaster and
supported our efforts," said Dr. Cea, "and we won’t forget
them." Over the next three years, physicians will see reimbursement
rates decline by 12% if a legislative correction is not enacted.
Publication of the new 2003 fee scheduled is slated for December 2. MSSNY physicians are indicating they may be forced to cut back on accepting Medicare patients but are now challenged with analyzing some thorny options within the next few weeks.
Wednesday, February 09, 2005 9:30 AM to 11:30 AM at the Nassau Academy of Medicine 1200 Stewart Ave. Garden City, NY 11530 Both
members and non-members who wish to attend
Is Your Site
Linked to Ours? HERE IS WHAT YOU WILL FIND AT WWW.NACMED.ORG
Nassau County Medical Society's web site has all
this information -
WWW.NACMED.ORG - We
welcome your comments and suggestions on our web site and its contents.
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After
nearly 40 years of operation as the premier medical library on Long
Island, the John N. Shell Library as is, will close its doors on
December 31 and begin a transition. During this transition phase,
telephone and online requests for searches will continue but the
facility will no longer be open for on-site activities. Within the next
few months we will be moving forward with our plans.
Doctors
are not adhering to guidelines recommending flu and pneumonia
vaccinations for all hospitalized adults ages 65 and older, and as a
result millions of seniors are left "vulnerable to potentially
deadly ailments," according to a study published in the Nov. 11
issue of the Archives of Internal Medicine. Researchers analyzed the
medical records of 107,311 Medicare patients hospitalized in 1998 and
1999. More than 95% of patients ages 65 and older were not vaccinated
for either flu or pneumonia during their hospital stays, according to
the report. The CDC Advisory Committee on Immunization Practices
recommends that both vaccines be given to adults during hospitalization.
Bratzler cited both ignorance about the guidelines and "patients'
unfounded concerns" about receiving vaccinations as reasons behind
the low rate of compliance. The researchers recommend that hospitals
incorporate the vaccines into routine inpatient treatment.
A
major drive is now being mounted to again address the issue when
Congress returns on January 7. A correction is clearly possible with the
addition of four new members to the Senate Finance Committee. 
