Each and every day the U.S. Government piddles with Healthcare reform and inadvertently degrades, disgraces and distresses the Practice of Medicine, more senior Doctors will Retire, fewer Young Doctors will Aspire to become Doctors and more Doctor Shortage will be Acquired, especially in rural areas.

Government interfearance with the practice of medicine and interfearance with the doctor-patient relaltlionship and the governments control of the patients’ and doctors’ decision-making are predominately cited by Doctors as the main cause for the Doctor Shortage.

The resultant carnage from the Las Vegas ‘run-amok’ horrific shooting has focused a lens on the current and mounting Doctor Shortage in the United States.

The first recorded use of the phrase to run amok in English dates from the 1670s. The word amok is from Malay amuk, “attacking furiously” or “a murderous frenzy”.

The following code(s) above F68.8 contain annotation back-references that may be applicable to F68.8: F01-F99 Mental, Behavioral and Neurodevelopmental disorders. ICD-10-CM F68.8 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):
880 Acute adjustment reaction and psychosocial dysfunction. Convert F68.8 to ICD-9-CM

Diagnosis Index entries containing back-references to F68.8:
Amok F68.8
Change(s) (in) (of) personality (enduring) F68.8
Disorder (of) – see also Disease, adult personality (and behavior) F69, specified NEC F68.8, relationship F68.8
Syndrome – see also Disease

“By sunrise on Monday, the staggering toll at an outdoor country music festival on a cool desert night in Las Vegas was 59 people killed and 527 injured, either by gunfire or in the flight to safety.” [A Burst of Gunfire, a Pause, Then Carnage in Las Vegas That Would Not Stop by Ken Belson, et al OCT. 2, 2017, NY Times]

The gunman rapidly and relentlessly, used automatic weapons, firing from the 32nd floor out hotel windows to mow-down innocent concert attendees.

“Nevada Gov. Brian Sandoval on Monday afternoon declared a public health and medical disaster, allowing licensed out-of-state healthcare professionals to immediately assist hospitals after the mass shooting in Las Vegas.

“This attack has created a public health and medical emergency in Clark County and the surrounding areas,” states the governor’s executive order directing all Nevada agencies to help the county with resources and protect its welfare.

“The order temporarily suspends all necessary statutes and rules to enable licensed healthcare workers employed by a hospital “and in good standing in another state” to practice in Nevada while lending a hand in its disaster response operations.

“Las Vegas-area hospitals have been crowded with patients from the deadliest mass shooting in modern U.S. history.

“Sunrise Hospital and Medical Center, a level-two trauma center and the closest to the Las Vegas Strip, reported on Monday it had performed about 30 surgeries and treated 180 shooting-victim patients, 14 of whom have died.

Sunrise Hospital and Medical Center workers needed a break and rest from the overload of critically injured patients said Nevada Hospital Association spokesperson.

“We’ve had people contact us from Florida, Ohio, Utah, California, ready to come and help us,” Shogren tells Newsweek, adding that Monday was the first time in recent memory that such an order had been granted in Nevada.

“The governor’s order will remain in effect until terminated, or until the state of emergency is lifted. [Las Vegas Shooting: Nevada Governor Declares ‘Public Health and Medical Emergency’ by Jessica Kwong 10/2/17 Newsweek]

A Doctor shortage deepens in the U.S. Presently, the shortage is reflected in longer waiting periods before a doctor encounter, but in the near future the shortage will be total Doctor inaccessibility for certain patients.

In response to the shortage, U.S. Rep. Jacky Rosen, D-Nev., addressed the situation during an interview after hosting a press conference at Nevada Health Centers to discuss legislative efforts to address doctor shortage in Nevada [by Bizuayehu Tesfaye, Las Vegas Review-Journal, Aug. 21, 2017]

Likewise, Maureen Schafer, chief of staff at the University of Nevada, Las Vegas School of Medicine, addressed the doctor shortage at the state department. [Sep 27, 2017 by Brenda Yahm KVVU-TV]

The Medical School Association warned everyone that the U.S. faces 90,000 doctor shortage by 2025. [By Lenny Bernstein March 3, 2015 Washington Post]

One reason was explained. “The United States is facing a serious shortage of physicians. The 1997 cap on Medicare support for graduate medical education (GME) has stymied the necessary commensurate increases in residency training, creating a bottleneck for the physician workforce.

“A 2017 study conducted for the AAMC by IHS Inc., predicts that the United States will face a shortage of between 40,800-104,900 physicians by 2030.

“There will be shortages in both primary and specialty care, and specialty shortages will be particularly large.

“These shortages pose a real risk to patients. Because it takes up to 10 years to train a doctor, projected shortages in 2030 need to be addressed now so that patients will have access to the care they need. [GME Funding: How to Fix the Doctor Shortage Thursday, June 29, 2017 Association of American Medical Colleges News]

Another Conclusion for the shortage was physician burnout., which was described as a shared responsibility of individual physicians and the organizations in which they work.

“Having an engaged physician workforce is critical for health care organizations to meet institutional objectives and achieve their mission.

“Given the strong links to quality of care, patient safety, and patient satisfaction, there is a strong business case for organizations to reduce physician burnout and promote physician engagement.

“Although some factors driving burnout are larger than the organization, organizational-level efforts can have a profound effect on physician well-being. Herein, 9 organizational strategies were outlined to reduce burnout and promote engagement along with examples of how these strategies have been operationalized at Mayo Clinic.

Leadership and attention from the highest level of the organization are the keys to making progress. [Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout Tait D. Shanafelt, MD, and John H. Noseworthy, MD, CEO 2016 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2017;92(1):129-146]

“A report prepared for the Association of American Medical Colleges found that American demographics will lead to a shortage of between 40,000 and 100,000 physicians by 2030. The shortage of primary care doctors alone could hit 43,100 by 2030.

“The projected increase in the U.S. population and disproportionate increase among Americans 65 and older, who utilize health care services at a much higher rate is another reason for the drastic shortage, even when the number of Physician Assistants and Nurse Practioners are factored in.

“There is going to be a significant workforce shortage under all of the likely projections. We see that, quite frankly, only getting worse as the population ages,” said Janis Orlowski, MD, AAMC chief health care officer.

“And the report notes that the shortage could become even greater. If underserved populations had fewer barriers to care, demand for physicians could rise “substantially,” according to the report.

“Even though the U.S. had a new record for family medicine placements, Match 2017 paired 132 more medical students and graduates with positions than in 2016, according to the AAFP, the increase is not nearly enough to cover the coming shortage of primary care physicians.

“This marks the eighth straight year that the number of students entering family medicine has increased and not enough to forestall the Doctor Shortage.

“We’ve seen a slow and steady upward trend for eight years now, but slow is not good enough,” said AAFP President John Meigs, MD. “Slow is not going to cut it.”

At the University of Washington, 43 students matched into family medicine, including 19 who will remain in the state. PNWU was tabulating its match figures as of this writing.

The Starting news that beginning July 1, 2017 “First-Year Residents Can Work 24-Hour Shifts.” This reporter does not regard that news as good policy.

“First-year residents will again be on the same schedule as other residents and fellows after the Accreditation Council for Graduate Medical Education announced revisions to its Common Program Requirements. As of July 1, they can again work 24-hour shifts, up from the current limit of 16 hours.

“The revised requirements return first-year residents to the same schedule as other residents and fellows, re-establishing the commitment to team-based care and seamless continuity of care while also ensuring professionalism, empathy, and the commitment of first-year residents to their patients,” the ACGME wrote in the memo.

“The Washington Post fleshed out some of the other details: Residents cannot average more than 80 hours or work per week, must have one day off every seven days, and cannot work overnight in a hospital more than once in a three-day span. [Washington Academy of Family Practice, March 2017 Newsletter]

“American Psychiatric Association joins medical directors in looking at causes of and remedies for the shortage of psychiatrists in the United States.

“An increasing shortage of psychiatrists, especially those working in public sector and Medicaid-funded programs, is occurring even as demand for services increases, according to a report from the National Council for Behavioral Health.
The report cited a study commissioned by the U.S. Department of Health and Human Services indicating that the current workforce of approximately 45,580 psychiatrists would need to increase by 2,800 to meet current demands for psychiatric care. In other words, there is currently a 6.4 % shortage in the psychiatry workforce.

“Based on estimates of retirement and new entries into the workforce, the projected unmet need in 2025 will be 6,090 psychiatrists, or a deficit of 12 percent of the workforce.

“Psychiatrists are essential to the larger mental health care system because of their medical training and their ability to prescribe and manage medications for patients, but they face a number of constraints.

“Aging of the current workforce, low rates of reimbursement, burnout, burdensome documentation requirements, and restrictive regulations around sharing clinical information necessary to coordinate care are some of the reasons for the shrinkage,” said the report, which was produced by representatives from professional societies (including APA), insurers, patient groups, government agencies, and service providers.

Like other medical professionals, psychiatrists are concentrated in metropolitan areas, leaving 77 percent of U.S. counties ranked as “underserved.”

“National politics could play a role, as well. About 50 % of new psychiatry trainees are international medical graduates, and possible changes in the H1B visa program could interfere with that flow, said Parks, who is also director of the Missouri Department of Mental Health

“APA is advocating for additional funding and slots for graduate psychiatric training and for loan-forgiveness programs that encourage psychiatrists and other clinicians to practice in underserved areas, said APA CEO and Medical Director Saul Levin, M.D., M.P.A. New billing codes are needed to pay for collaborative care as well. Last year the Centers for Medicare and Medicaid Services created a CPT code and a fee for Psychiatric Collaborative Care Management Services that are now part of the 2017 Medicare fee schedule.

“However, better reimbursement and a commitment to mental health parity are meaningless unless all insurance networks have adequate numbers of psychiatrists on their panels, he said.

“As a practical matter, training must align with needs, said Patrick Runnels, M.D., an associate professor of psychiatry at Case Western Reserve School of Medicine in Cleveland and co-chair of the National Medical Director Institute.

“That process should start in medical schools, beginning with stronger and longer rotations in psychiatry to expose medical students to the range of practice in psychiatry today,” he said.

In residency, trainees need more exposure and experience with telepsychiatry, medication-assisted treatment for substance use, and collaboraton with other professionals. Experience with updated integrated care models and time in Federally Qualified Health Centers should be required for all residents, said Runnels, who is also program director for community psychiatry at University Hospitals Cleveland Medical Center.

“The biggest opportunity to expand the workforce is to reduce the portion of psychiatric providers who practice exclusively in cash-only practice,” said the report. “APA and the National Council need to work with their members to implement a wide range of incentives that promote the engagement of psychiatric providers with outpatient and inpatient psychiatric programs that accept commercial, Medicare, and Medicaid coverage that pays for the majority of Americans with psychiatric health care needs.”

The report’s conclusions will be pushed out through professional associations and advocacy as a step toward placing its recommendations into action, said Parks.

“The report, produced by representatives from many medical professional societies (including APA), insurers, patient groups, government agencies, and service providers arrived at the following Factors For Doctor Shortage”

• Aging of the current workforce
• Low rates of reimbursement
• Burnout
• Burdensome documentation requirements
• Restrictive regulations around sharing clinical information necessary to coordinate care are some of the reasons for the shrinkage”

Like other medical professionals, psychiatrists are concentrated in metropolitan areas, leaving 77 percent of U.S. counties ranked as “underserved.v [Report Details National Shortage of Psychiatrists and Possible Solutions by Aaron Levin April 14, 2017 American Psychiatric Association Professional News]

Student Athletes have always been regared as outstanding Medical Doctor candidates. They should be encourged, not discouraged.

“A new study suggests athletic achievement could be the best indicator of how well a doctor-in-training will do as a resident.

“When residency programs evaluate medical school applicants for a few coveted spots, they typically consider grades, standardized test scores, recommendations and interviews.

“But researchers found that a resident having excelled in team sports was a more accurate predictor of success in the medical specialty program than any of those other factors. [Dr. Richard Chole et al, Washington University School of Medicine St. Louis, Archives of Otolaryngology-Head & Neck Surgery] [Do athletes make better doctors? by Genevra Pittman, Aug 21, 2012, Reuters]

“Team sports are actually a very telling thing. That’s what medicine is nowadays,” said Dr. Marvin Fried, an otorhinolaryngologist from Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, New York.

“If they have achieved well as team player, they tend to do the same as a professional physician,” Fried, who wasn’t involved in the new study, told Reuters Health.

Our U.S. Government should immediately proceed to reform Healthcare, promote the homorable Practice of Medicine and inspire students to achieve graduation from medical school and professonal excellence.

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