Amerika kapısı kapanıyor mu?

Bu başlık çok moralimi bozdu son durum hakkında bilgisi olan var mı?

Son durum nedir?

House Bill Would Increase Residency Positions, Ease Doctor Shortage
Washington, D.C., March 14, 2013—A House bill reintroduced today by Reps. Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.) would increase the number of Medicare-supported graduate medical education (GME) residency positions by 15,000 over five years and begin to alleviate the doctor shortage facing the nation, according to the AAMC (Association of American Medical Colleges). In addition to increasing the number of residency positions, the House legislation, “Training Tomorrow’s Doctors Today Act,” also would establish Medicare GME accountability and transparency measures.


Denmis, mezun sayisi artisiyla pozisyon sayisi da artacak gibi duruyor. Kapi kapanmaz ama gecis kolaylasir ya da zorlasir onu bilemiyoruz. Zaman gosterecek.

Bu dogru ama net sayilari gormek lazim, cunku hali hazirda hatri sayilir bir img ihtiyaci var, aciklan fakulteler hepsini karsilayacak mi?? Bir de surekli yazilan asistan kadrolarinin artmasi gerektigi halde artmadigi, ekonomik bir toparlanma olursa mezun sayisinin artmasi destegiyle kadro sayisinin da arttirilacagini dusunuyorum. Yine img olur, ama oran ne olur onu zaman gosterecek .

Bizim haber kanallarında haber bulamayınca araya sıkıştırılan kansere çare bulundu , kelliğe son haberleri gibi img konusunda sürekli çıkan bir yazı . Bu tarz yabancı medikal haber sitelerini takip edenler bilir . Bu haberleri her okuyan amerika hayalinden vazgeçseydi bugün amerikada doktor deyince insanların gözünde bir hintli canlanmazdı .

Yazdigim mesaj nereye gitti yauu.

Ozet geciyim, bu img ler icin kotu haber ama tabiki amg ler icin de.. Geneli imgler tarafindan doldurulan family medicine lar, community dahiliyeler, pediatriler, psikiatriler de amglerin ellerinden opecek...

No More IMGs for Residency Training Programs After 2015, Says Journal of American Medical Association

Gerçekten yeni USMLE maceracıları için çok sıkıntılı bir haber gibi gözüküyor. Kısacası 2012'den itibaren mezun sayısının artmaya başladığı ve 2015ten sonra Amerika kökenli tıp mezunları sayısının residency sayısını aşacağı gözleniyormuş. Her ne kadar bunlardan bir kısmı yerleşemeyecek, bir kısmı da ilaç firmaları gibi dışa yönelecek olsa da gerçekten bizim gibi IMG ler için çok sıkıntılı bir durum gibi.

Üzüntüm had safhada. Geçen sene 5. sınıftayken TUS ve USMLE çalışmasını bir arada yürütemeyeceğimi düşünerek sadece TUSa yoğunlaşma kararı almıştım, asistanığımda da USMLE steplerini verir, araştırmalara dahil olmaya çalışırım, observer olarak gitmeye çalışırım, buradaki asistanlığım da hem artı puan olur, hem de başarısız olursam veya geri dönmek istersem açık bir kapı olur diyordum. Yanlış ata oynadım sanırsam

Bu haberler ışığında ve Amerika'nın şu anki içinde bulunduğu ekonomik sıkıntıları düşünürsek, Amerika hayalinden vaz mı geçmeliyiz? Ne dersiniz?

ADDITIONAL INFORMATION:

VIEW INTERACTIVE GRAPHIC
Where the new schools are

Since 2007, more than two dozen medical schools have opened, begun accreditation or started discussions to open -- the biggest surge in decades.

There are 13 allopathic schools in the accreditation process, with at least 10 more in the planning stages. In addition, five new osteopathic schools have opened across the country. Educators and physician leaders hope that the graduates of the new schools will help ease a predicted physician shortage, but they add that more funding and residency positions will be needed to avert future holes in the overall work force.

Sources: American Assn. of Colleges of Osteopathic Medicine; Assn. of American Medical Colleges; news reports; "Institutions with Developing Medical Education Programs that have Applied for Preliminary Accreditation by the LCME," Liaison Committee on Medical Education, March 5 ( www.lcme.org/newschoolprocess.htm )

www.ama-assn.org/amednews/2010/03/29/prl20329.htm

sitesinden alintidir.
Yeni okullarin acildigi dogru ama IMG match oranlarini ne kadar etkiler kestirmek zor. Acilan bircok okul ilk etapta az ogrenciyle basliyor. Bu da her gecen sene daha fazla AMG demek.

Birinci basamak hekimlikte hasta sayıları olarak benzer olsak da sağlık hizmetlerinin en temel noktası olan sağlık sigortası kısmında Amerika'dan ayrılıyoruz bu iki ülkenin sisteminin işleyişini tamamen değiştiriyor .

Ama 23 saniye kısmı oldukça benzer bizde de bir araştırmada 21 çıktığından bahsediyorlardı . Bu konuyla ilgili güncel bir TED konuşması :

www.ted.com/talks/lang/tr/abraham_verghe..._doctor_s_touch.html

Aşağıda linklerini vereceğim son okuduklarımdan şunu çıkardım, Amerika'da birinci basamak genel temel sağlık hizmetlerindeki hekimlerin(primary-care phycian) sayı yetersizliği dışında giderek azalmakta olan hizmet kalitelerinden de şikayetler var. Newsweek dergisinin 16 Nisan sayısındaki bir makalede birinci basamak hizmetlerindeki bir hekimin verimli çalışması için 1800 hastadan sorumlu olması gerekirken bu sayının ortalamada 2300 olduğunu ve eyaletlerdeki fakir insanlarında faydalandığı Medicaid sisteminin iş yüküyle beraber bu sayının 3000 olduğu yazmakta. Ayrıca yapılan bir çalışmada hastanın konuşmaya başladıktan 23 saniye sonra hekim tarafından sözünün kesildiğini, vizitlerin %25 inde hekimin hastanın neden şikayetçi olduğunu bile sormadığını yazmakta. Ayrıca güçlü ve deneyimli ekibi olmayan bir temel sağlık hizmeti veren hekimin ortalama 2000 hastasına yapması gereken kontrolleri testleri ve diğer işlemler yetiştirebilmesi için ortalama günde 17 saat çalışması gerekirmiş. Daha buna benzer birçok hekimlerin performansı ile ilgili çalışmalarla ilgili bilgiler verilmiş. "The Doctor Will See You-If You Are Quick"-http://www.thedailybeast.com/newsweek/2012/04/15/why-your-doctor-has-no-time-to-see-you.html

Hekimlerde mevcut sağlık politikasından mağdurlar ve bunu Diana REED, MD.'in yazdığı "The Other End Of The Stethoscope: The Physician's Perspective On The Health Care Crisis" kitabında anlatılanlardan anlaşılıyor. Ben kitabı okumadım ama amazon.com'da kitabın serbest erişilebilir kısımları genel bir fikir veriyor. www.amazon.com/The-Other-End-Stethoscope...id=1335861595&sr=8-3

Sonuç olarak Amerika'daki birinci basamak sağlık hizmetinde yaşanan sorunlar aslında bizim birebir yaşadığımız sorunlara çok benziyor. Bunun sebebi onların modelini kendimize uyarlamaya çalışmamız diye düşünüyorum. Siz nedersiniz?

PHYSICIAN SHORTAGE & DISTRIBUTION
CEOs and administrators of small or rural hospitals have identified physician workforce issues as among their highest priorities. Following is a brief synopsis of the issue, policy, and options on physician workforce.
The Problem:
• According to the Association of American Medical Colleges (AAMC), “projections indicate America will face shortage of M.D.s by 2020.”1 Because of this, the AAMC is calling for a 30 percent increase in U.S. medical school enrollment by 2015, which will result in an additional 5,000 new M.D.s annually. The AAMC also supports a conjoined increase in the number of federally supported residency training positions in the nation’s teaching hospitals.
• The American Academy of Family Physicians (AAFP) came out with a report in 2006 stating that it is a priority to fund primary care (primarily family medicine residency program training) given the growing shortage of family physicians.2 The full report can be found here: AAFP Family Physician Workforce Reform Report.
• The Council on Graduate Medical Education (COGME) has also strongly advised that we need to train more physicians. COGME, for which specialty supply is of particular concern, recommends that the number of physicians entering residency programs increase by 3,000 over the next ten years to partially remedy an anticipated shortfall of 85,000 physicians by 2020.3
• Back in 1998, COGME had also produced a report demonstrating that the tendency for physicians to practice in affluent urban and suburban areas – a phenomenon known as geographic maldistribution of physicians—creates barriers to care for people living in rural and inner-city areas. Even as an oversupply of some physician specialties is apparent in many urban health care service areas across the country, many inner-city and rural communities still struggle to attract an adequate number of health professionals to provide high-quality care to local people.4
Current Public Policy:
• Code of Federal Regulations, Title 42, Chapter 1, Parts 5, 62, 57
www.access.gpo.gov/nara/cfr/waisidx_03/42cfrv1_03.html
o Part 5 – Designation of Health Professional(s) Shortage Areas: www.access.gpo.gov/nara/cfr/waisidx_03/42cfr5_03.html
o Part 62 – National Health Service Corps Scholarship and Loan Repayment Programs www.access.gpo.gov/nara/cfr/waisidx_03/42cfr62_03.html
o Part 57 – Grants for Construction of Teaching Facilities, Educational Improvements, Scholarships and Student Loans www.access.gpo.gov/nara/cfr/waisidx_03/42cfr57_03.html
1 Association of Medical Colleges (AAMC) (2006). Help Wanted: More Use Doctors – Projections Indicate America Will Face Shortage of M.D.s by 2020 [Brochure]. AAMC.
2 American Academy of Family Physicians (AAFP) (2006). Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians (Draft Reprint No. 305b) [Brochure]. AAFP.
3 Council on Graduate Medical Educations (COGME) (2005). Physician Workforce Policy Guidelines for the United States, 2000-2020 [Sixteenth Report]. COGME.
4 Council on Graduate Medical Educations (COGME) (1998). Physician Distribution and Health Care Challenges in Rural and Inner-City Areas. COGME.
• United States Code Title 42, Chapter 6A Public Health Service www.law.cornell.edu/uscode/html/uscode42...1_42_10_6A_20_V.html
• The Shortage Designation Branch in the HRSA Bureau of Health Professions National Center for Health Workforce Analysis develops shortage designation criteria and uses them to decide whether or not a geographic area or population group is a Health Professional Shortage Area (HPSA) or a Medically Underserved Area or Population (MUA or MUP). More than 34 federal programs depend on the shortage designation to determine eligibility or as a funding preference. And, about 20 percent of the U.S. population resides in primary medical care Health Professional Shortage Areas. bhpr.hrsa.gov/shortage/ HPSA Database: hpsafind.hrsa.gov/ MUA/MUP Database: muafind.hrsa.gov/
Rural Resources:
• A J-1 Visa allows an international medical graduate to come to the United States under an educational exchange program for up to seven years. When the visa expires, the physician must return to his/her own country for at least two years before applying for a permanent visa in the United States. J-1 Visa categories include Physicians, Professor & Research Scholar, Trainee, International Visitor, Government Visitor, College & University Student, and Short-Term Scholar. www.raconline.org/info_guides/hc_providers/j1visafaq.php#whatis
• An H1-B Visa valid for three years for the first time, you can then apply for an extension of another three years. After that time an alien must remain outside the United States for one year before another H1-B petition can be approved. www.raconline.org/info_guides/hc_providers/j1visafaq.php#visa
• The National Health Service Corps continually seeks clinicians dedicated to working with our Nation's underserved. We have created a program to connect these unique individuals with the communities that need them, and to support them during their initial time of service. Fully trained health professionals who are dedicated to working with the underserved and have qualifying educational loans are eligible to compete for repayment of those loans if they choose to serve in a community of greatest need. In addition to loan repayment, these clinicians receive a competitive salary, some tax relief benefits, and a chance to have a significant impact on a community. nhsc.bhpr.hrsa.gov/join_us/lrp.cfm
• The National Rural Recruitment & Retention Network (3RNet) are not for profit organizations helping health professionals find practice opportunities in rural areas throughout the country, serving physicians, dentists, nurse practitioners, physician assistants, registered nurses, mental health professionals, and other health care professionals. www.3rnet.org/
• American Medical Student Association (AMSA) - Rural Residencies/Health Opportunities www.amsa.org/programs/gpit/ruralurban.cfm
• The National Advisory Committee on Rural Health and Human Services - 2006 Recommendations ruralcommittee.hrsa.gov/2006rec.htm
• Rural Assistance Center – Health Care Workforce www.raconline.org/info_guides/hc_providers/
Options:
• Recruit foreign medical graduates
o Recruiting foreign physicians is not a long-term answer, but many health facilities would be at a total loss without them www.nasrecruitment.com/MicroSites/Health...cles/featureH5b.html
o International Medical Graduates (IMGs) take less desirable specialties and residencies www.ama-assn.org/ama/pub/category/print/14908.html
• “Outsource” to a specialty firm
o It’s a short-term solution that can be pricey, but it is possible for rural and other populations to access specialized care not locally available www.acponline.org/journals/news/may06/outsource.htm
• Recruit professionals online
o 90% of 3RNet placements have gone to underserved areas www.raconline.org/newsletter/web/summer06.html
• Work with other health professionals
o Switch the focus from production of physicians to provision of services and how PAs, NPs, and physicians will work together to care for all the people. www.graham-center.org/PreBuilt/physician_workforce.pdf
o Rely on physician assistants and nurse practitioners to staff rural hospitals www.aapa.org/gandp/rhos.html
o New national council, Council on Physician and Nurse Supply (based at the University of Pennsylvania in Philadelphia), plans to act as an advocate for change, finding practical methods to solve the physician and nurse staffing shortage, advising legislators on what they can do to solve the problem and working to shape policy www.ama-assn.org/amednews/site/free/prse0814.htm
• Improve salary and benefits
o Increase pay and benefits www.sph.umn.edu/img/assets/15702/Workfor...rtageReportFinal.pdf
o Offer flexible schedules and telecommuting opportunities
www.sph.umn.edu/img/assets/15702/Workfor...rtageReportFinal.pdf
o Training programs are expensive—states can invest money in expanding educational programs www.cfpc.ca/cfp/2003/Sep/vol49-sep-research-3.asp
• “Grow your own”
o Mentor (i.e. work with school mentoring programs that pair students with either professionals, faculty or more advanced students for social support, academic and career guidance) www.futurehealth.ucsf.edu/pdf_files/Beth...versity%20Strategies
o Build strong relationships with area colleges and partner with community organizations to attract students www.sph.umn.edu/img/assets/15702/Workfor...rtageReportFinal.pdf
o Expand existing medical school programs and streamline the expansion process www.ama-assn.org/ama/pub/category/print/14908.html
o Pique student interest www.fdl.uwc.edu/news/6-30-2006.html
o Part-time or semi-retired physicians can be important sources of physician involvement (leadership) in program development www.ncmedicaljournal.com/jan-feb-06/Crane.pdf
• The more efficient the medical care, the need for fewer physicians
o Train physicians to work within a multi-disciplinary collaborative care model www.med.wisc.edu/news/item.php?id=950
o Enhance leadership development programs for the public health workforce www.apha.org/about/news/pressreleases/2006/06crisis.htm
• Implement HIT
o Although planning, financing and implementation take a lot of time and energy, technology increases efficiency and manageability
www.hhnmag.com/hhnmag_app/jsp/printer_fr...alIT_1&domain=HHNMAG
• Request community support & collaboration
o Community leaders and local funding are crucial www.jems.com/data/pdf/rural-ems-recruit-report.pdf
o Federal and state intervention to address physician maldistribution www.healthworkforce.health.nsw.gov.au/am...ss1_calmanhauser.pdf
o Support and ensure that a variety of public and private interventions are tightly integrated and mutually supportive www.cogme.gov/rpt10_3.htm
Workforce Development – Case Examples:
• National Center for Health Workforce Analysis bhpr.hrsa.gov/healthworkforce/reports/wia/wia.htm
• Rural Kentucky’s Physician Shortage www.mc.uky.edu/RuralHealth/Research/
• Solutions for Rural Physician Shortage – Lexington, KY www.uky.edu/PR/News/040216_physician_shortage.htm
• Addressing a Physician Shortage – University of Wisconsin www.med.wisc.edu/news/item.php?id=950
• Overcoming Rural Physician Shortage – Appalachian Region www.arc.gov/index.do?nodeId=1283
• Healthcare Workforce Shortage – Minnesota Healthcare Workforce Collaborative www.heip.org/documents/FactorFiction.pdf

Konuyla ilgili herhangi bir gelişme var mı?

Daha sonra uygulanıp uygulanmayacağı belli değil ama böyle bir kararı tatil öncesi son güne bırakmak istemediler herhalde 2 ay da biraz zaman kazanmak için süre gibi .

Kesinti sadece 2 aylığına ötelendi ama daha sonra uygulanacak anlamına mı geliyor yani.

Congress Approves Legislation Temporarily Blocking Medicare Payment Reduction

Updated: 12/23/2011, 12:55 p.m. -- In a last-minute effort before the holidays, a bickering Congress finally came together to pass a bill to extend the Medicare payment rate for the next two months, thus blocking a 27.4 percent payment reduction that was scheduled to go into effect on Jan. 1. President Obama now has signed the bill.

www.aafp.org/online/en/home/publications...0111223paypatch.html

www.hanys.org/news/?date=2011-12-23#story_2423

ABD'de kongre oylamasına birçok şey gelir 6-7 senedir green card da kalktı kalkacak deniyor ama değişmiş birşey yok . Bakalım 23 Aralığı bekleyelim görelim .

Böyle bir şeyi kolay kolay kongreden geçiremezler.

Zor zaten bizim işimiz, imkansız biraz zaman alır.

Ben pek anlamiyorum bu Amerikan yonetiminden. Kongreden gecmis bir karar mi bu? Yoksa taslak mi? Bir de eyaletten eyalete programdan programa degisen ekonomik kosullar mevcut. Alinan bir ulusal karar butun eyaletlerde uygulanir mi? Buyuk bir soru isreti?

www.acgme.org/acWebsite/home/ImpactReduc...ralGMEFundingTJN.pdf
alindigi sayfa

Yukaridaki iki linke (ki birisi resmi site) bakilacak olursa, butce kisitlamalari ile Amerika'daki ihtisas pozisyonlarinin sayisi yuzde 33 azalacak.
Asagida moral bozmak gibi olmasin ama bu konuda detayli bilgiler var

www.aamc.org/initiatives/gmefunding/

Bu yeni kosullar 23 Aralikta gecerli olursa, goreceli olarak Amerika kapisinin kapandigini soyleyebilir miyiz?

Sevgili buyuklerimiz, bize yol gosterin