Jane Anderson

More minority students enrolled as first-year medical students in 2010, with Hispanic male medical students especially increasing their numbers, new data show.

The number of black/African American and American Indian first-year medical students also grew this year, and every U.S. region saw increases in medical school enrollment diversity, said AAMC President and CEO Darrell Kirch.

“The bottom line is, we see more minority students pursuing a career in medicine,” Dr. Kirch said in a telephone press briefing to announce the findings.

Improved diversity will help communities meet their health needs, especially with the increased need for physicians triggered by the Affordable Care Act. “You don't improve the health of a community without having a workforce that reflects the diversity of that community,” Dr. Kirch said, adding that it's not enough for health care reform to provide insurance if there aren't enough physicians. “An insurance card can't take care of you – you need to have a physician to do that.”

Hispanic men increased their enrollment in medical school by 17.1%, while enrollment by Hispanic women grew by 1.6% over 2009, according to the AAMC report. Total Hispanic enrollment rose by 9%. First-year Hispanic enrollees in U.S. medical schools totaled 1,539 in 2010, compared with 1,412 in 2009, according to AAMC.

Black/African American enrollment, meanwhile, grew by 2.9% over 2009. A total of 1,350 black/African American students enrolled in medical school as first-year students in 2010, compared with 1,312 students in 2009. Asian students also saw gains, with enrollment increasing 2.4% in 2010 to 4,214 from 4,114 in 2009, according to the AAMC report.

Overall, the level of applicants to U.S. medical schools has remained steady for at least the past 4 years, although the total number of first-time applications increased by 2.5% in 2010, said Dr. Kirch.

“Medical school remains a very compelling career choice,” he said. About 42,000 potential students, including 31,063 first-time applicants, competed for about 18,000 openings, he said.

About 53% of applicants were male and 47% were female; men also outnumbered women first-year enrollees by 53% to 47%, the report showed.

One new medical school – the Virginia Tech Carilion Medical School – accepted its first class this year, and two more are in line to accept their first classes next year, Dr. Kirch said. Another seven medical schools are in the accreditation process, he said.

“This effort to expand medical school enrollment will enable us to add 7,000 more annual graduates,” he said, adding, “we're not focused solely on new schools. We're also focused on [increasing enrollment at] existing schools.”

More minority students enrolled as first-year medical students in 2010, with Hispanic male medical students especially increasing their numbers, new data show.

The number of black/African American and American Indian first-year medical students also grew this year, and every U.S. region saw increases in medical school enrollment diversity, said AAMC President and CEO Darrell Kirch.

“The bottom line is, we see more minority students pursuing a career in medicine,” Dr. Kirch said in a telephone press briefing to announce the findings.

Improved diversity will help communities meet their health needs, especially with the increased need for physicians triggered by the Affordable Care Act. “You don't improve the health of a community without having a workforce that reflects the diversity of that community,” Dr. Kirch said, adding that it's not enough for health care reform to provide insurance if there aren't enough physicians. “An insurance card can't take care of you – you need to have a physician to do that.”

Hispanic men increased their enrollment in medical school by 17.1%, while enrollment by Hispanic women grew by 1.6% over 2009, according to the AAMC report. Total Hispanic enrollment rose by 9%. First-year Hispanic enrollees in U.S. medical schools totaled 1,539 in 2010, compared with 1,412 in 2009, according to AAMC.

Black/African American enrollment, meanwhile, grew by 2.9% over 2009. A total of 1,350 black/African American students enrolled in medical school as first-year students in 2010, compared with 1,312 students in 2009. Asian students also saw gains, with enrollment increasing 2.4% in 2010 to 4,214 from 4,114 in 2009, according to the AAMC report.

Overall, the level of applicants to U.S. medical schools has remained steady for at least the past 4 years, although the total number of first-time applications increased by 2.5% in 2010, said Dr. Kirch.

“Medical school remains a very compelling career choice,” he said. About 42,000 potential students, including 31,063 first-time applicants, competed for about 18,000 openings, he said.

About 53% of applicants were male and 47% were female; men also outnumbered women first-year enrollees by 53% to 47%, the report showed.

One new medical school – the Virginia Tech Carilion Medical School – accepted its first class this year, and two more are in line to accept their first classes next year, Dr. Kirch said. Another seven medical schools are in the accreditation process, he said.

“This effort to expand medical school enrollment will enable us to add 7,000 more annual graduates,” he said, adding, “we're not focused solely on new schools. We're also focused on [increasing enrollment at] existing schools.”

More minority students enrolled as first-year medical students in 2010, with Hispanic male medical students especially increasing their numbers, new data show.

The number of black/African American and American Indian first-year medical students also grew this year, and every U.S. region saw increases in medical school enrollment diversity, said AAMC President and CEO Darrell Kirch.

“The bottom line is, we see more minority students pursuing a career in medicine,” Dr. Kirch said in a telephone press briefing to announce the findings.

Improved diversity will help communities meet their health needs, especially with the increased need for physicians triggered by the Affordable Care Act. “You don't improve the health of a community without having a workforce that reflects the diversity of that community,” Dr. Kirch said, adding that it's not enough for health care reform to provide insurance if there aren't enough physicians. “An insurance card can't take care of you – you need to have a physician to do that.”

Hispanic men increased their enrollment in medical school by 17.1%, while enrollment by Hispanic women grew by 1.6% over 2009, according to the AAMC report. Total Hispanic enrollment rose by 9%. First-year Hispanic enrollees in U.S. medical schools totaled 1,539 in 2010, compared with 1,412 in 2009, according to AAMC.

Black/African American enrollment, meanwhile, grew by 2.9% over 2009. A total of 1,350 black/African American students enrolled in medical school as first-year students in 2010, compared with 1,312 students in 2009. Asian students also saw gains, with enrollment increasing 2.4% in 2010 to 4,214 from 4,114 in 2009, according to the AAMC report.

Overall, the level of applicants to U.S. medical schools has remained steady for at least the past 4 years, although the total number of first-time applications increased by 2.5% in 2010, said Dr. Kirch.

“Medical school remains a very compelling career choice,” he said. About 42,000 potential students, including 31,063 first-time applicants, competed for about 18,000 openings, he said.

About 53% of applicants were male and 47% were female; men also outnumbered women first-year enrollees by 53% to 47%, the report showed.

One new medical school – the Virginia Tech Carilion Medical School – accepted its first class this year, and two more are in line to accept their first classes next year, Dr. Kirch said. Another seven medical schools are in the accreditation process, he said.

“This effort to expand medical school enrollment will enable us to add 7,000 more annual graduates,” he said, adding, “we're not focused solely on new schools. We're also focused on [increasing enrollment at] existing schools.”

Major Finding: The use of mental health courts for some defendants results in fewer posttreatment arrests and days of incarceration.

Data Source: A prospective, longitudinal, quasiexperimental study of 447 people enrolled in mental health courts and 600 controls.

Disclosures: The study was supported by the Research Network on Mandated Community Treatment of the John D. and Catherine T. MacArthur Foundation. No financial disclosures were reported.

Inmates who participate in mental health courts that are designed to facilitate treatment and reduce incarceration experience lower posttreatment arrest rates and fewer days in jail, according to a study in the journal.

The study found that the mental health court participants with the best outcomes included those with fewer arrests and incarceration days in the 18 months prior to their participation in the mental health court.

In addition, higher rates of mental health treatment in the 6 months prior to participation in the court led to better outcomes, as did a diagnosis of bipolar disorder, the study said (Arch. Gen. Psychiatry 2010 [doi:10.1001/archgenpsychiatry.2010.134

Meanwhile, diagnoses of schizophrenia or depression and illegal substance use in the 30 days prior to court participation led to worse outcomes in inmates, Henry J. Steadman, Ph.D., who works public policy in a group practice in Delmar, N.Y., and his colleagues found.

About 250 mental health courts operate across the country with the goal of moving people with serious mental illness out of the criminal justice system and into community treatment without sacrificing public safety, Dr. Steadman and his colleagues reported. They called their investigation the first prospective, multisite study of mental health courts.

This is how mental health courts work: Potential clients are referred by jail staff, after which the court holds a hearing. Individuals then have the option of entering a guilty plea and agreeing to the terms established by the court, which usually includes treatment.

Individuals who agree to the terms usually are released into the community under mental health court supervision. The court holds subsequent hearings repeatedly, and can sanction individuals who violate the terms of their agreements through bench warrants, temporary reincarceration, and agreement revocation. The court also facilitates treatment options for these individuals.

The study looked at 447 individuals enrolled in four mental health courts in three states: California, Minnesota, and Indiana. A total of 600 individuals served as controls.

In the pre-court period, almost all the individuals in both groups had at least two arrests. However, in the 18-month postarrest period, 49% of the group that attended mental health court had an additional arrest, compared with 58% of the treatment-as-usual control group.

Both groups showed a decline in their annual arrest rates, but, overall, the mental health court group's annual arrest rates declined more than did the control group's rate.

When days of incarceration were measured, the study found that the mental health court group saw a 12% increase during the 18 months following their court participation, from 73 days to 82 days. However, those in the control group saw their incarceration days shoot up by 105%, from 74 days to 152 days, when those same two 18-month periods were compared.

“The average number of jail days increased for both samples,” the investigators wrote. “However, the small increase of 9 days for [mental health court] is not statistically significant and is unlikely to have practical implications.”

When the study compared the group attending the mental health court vs. the treatment-as-usual group, it was clear that the mental health court participants did much better in the follow-up period. “It appears that mental health courts are diversion programs for justice-involved persons with mental illness and, usually, co-occurring substance abuse disorders that warrant public policy support,” Dr. Steadman and his colleagues wrote.

Major Finding: The use of mental health courts for some defendants results in fewer posttreatment arrests and days of incarceration.

Data Source: A prospective, longitudinal, quasiexperimental study of 447 people enrolled in mental health courts and 600 controls.

Disclosures: The study was supported by the Research Network on Mandated Community Treatment of the John D. and Catherine T. MacArthur Foundation. No financial disclosures were reported.

Inmates who participate in mental health courts that are designed to facilitate treatment and reduce incarceration experience lower posttreatment arrest rates and fewer days in jail, according to a study in the journal.

The study found that the mental health court participants with the best outcomes included those with fewer arrests and incarceration days in the 18 months prior to their participation in the mental health court.

In addition, higher rates of mental health treatment in the 6 months prior to participation in the court led to better outcomes, as did a diagnosis of bipolar disorder, the study said (Arch. Gen. Psychiatry 2010 [doi:10.1001/archgenpsychiatry.2010.134

Meanwhile, diagnoses of schizophrenia or depression and illegal substance use in the 30 days prior to court participation led to worse outcomes in inmates, Henry J. Steadman, Ph.D., who works public policy in a group practice in Delmar, N.Y., and his colleagues found.

About 250 mental health courts operate across the country with the goal of moving people with serious mental illness out of the criminal justice system and into community treatment without sacrificing public safety, Dr. Steadman and his colleagues reported. They called their investigation the first prospective, multisite study of mental health courts.

This is how mental health courts work: Potential clients are referred by jail staff, after which the court holds a hearing. Individuals then have the option of entering a guilty plea and agreeing to the terms established by the court, which usually includes treatment.

Individuals who agree to the terms usually are released into the community under mental health court supervision. The court holds subsequent hearings repeatedly, and can sanction individuals who violate the terms of their agreements through bench warrants, temporary reincarceration, and agreement revocation. The court also facilitates treatment options for these individuals.

The study looked at 447 individuals enrolled in four mental health courts in three states: California, Minnesota, and Indiana. A total of 600 individuals served as controls.

In the pre-court period, almost all the individuals in both groups had at least two arrests. However, in the 18-month postarrest period, 49% of the group that attended mental health court had an additional arrest, compared with 58% of the treatment-as-usual control group.

Both groups showed a decline in their annual arrest rates, but, overall, the mental health court group's annual arrest rates declined more than did the control group's rate.

When days of incarceration were measured, the study found that the mental health court group saw a 12% increase during the 18 months following their court participation, from 73 days to 82 days. However, those in the control group saw their incarceration days shoot up by 105%, from 74 days to 152 days, when those same two 18-month periods were compared.

“The average number of jail days increased for both samples,” the investigators wrote. “However, the small increase of 9 days for [mental health court] is not statistically significant and is unlikely to have practical implications.”

When the study compared the group attending the mental health court vs. the treatment-as-usual group, it was clear that the mental health court participants did much better in the follow-up period. “It appears that mental health courts are diversion programs for justice-involved persons with mental illness and, usually, co-occurring substance abuse disorders that warrant public policy support,” Dr. Steadman and his colleagues wrote.

Major Finding: The use of mental health courts for some defendants results in fewer posttreatment arrests and days of incarceration.

Data Source: A prospective, longitudinal, quasiexperimental study of 447 people enrolled in mental health courts and 600 controls.

Disclosures: The study was supported by the Research Network on Mandated Community Treatment of the John D. and Catherine T. MacArthur Foundation. No financial disclosures were reported.

Inmates who participate in mental health courts that are designed to facilitate treatment and reduce incarceration experience lower posttreatment arrest rates and fewer days in jail, according to a study in the journal.

The study found that the mental health court participants with the best outcomes included those with fewer arrests and incarceration days in the 18 months prior to their participation in the mental health court.

In addition, higher rates of mental health treatment in the 6 months prior to participation in the court led to better outcomes, as did a diagnosis of bipolar disorder, the study said (Arch. Gen. Psychiatry 2010 [doi:10.1001/archgenpsychiatry.2010.134

Meanwhile, diagnoses of schizophrenia or depression and illegal substance use in the 30 days prior to court participation led to worse outcomes in inmates, Henry J. Steadman, Ph.D., who works public policy in a group practice in Delmar, N.Y., and his colleagues found.

About 250 mental health courts operate across the country with the goal of moving people with serious mental illness out of the criminal justice system and into community treatment without sacrificing public safety, Dr. Steadman and his colleagues reported. They called their investigation the first prospective, multisite study of mental health courts.

This is how mental health courts work: Potential clients are referred by jail staff, after which the court holds a hearing. Individuals then have the option of entering a guilty plea and agreeing to the terms established by the court, which usually includes treatment.

Individuals who agree to the terms usually are released into the community under mental health court supervision. The court holds subsequent hearings repeatedly, and can sanction individuals who violate the terms of their agreements through bench warrants, temporary reincarceration, and agreement revocation. The court also facilitates treatment options for these individuals.

The study looked at 447 individuals enrolled in four mental health courts in three states: California, Minnesota, and Indiana. A total of 600 individuals served as controls.

In the pre-court period, almost all the individuals in both groups had at least two arrests. However, in the 18-month postarrest period, 49% of the group that attended mental health court had an additional arrest, compared with 58% of the treatment-as-usual control group.

Both groups showed a decline in their annual arrest rates, but, overall, the mental health court group's annual arrest rates declined more than did the control group's rate.

When days of incarceration were measured, the study found that the mental health court group saw a 12% increase during the 18 months following their court participation, from 73 days to 82 days. However, those in the control group saw their incarceration days shoot up by 105%, from 74 days to 152 days, when those same two 18-month periods were compared.

“The average number of jail days increased for both samples,” the investigators wrote. “However, the small increase of 9 days for [mental health court] is not statistically significant and is unlikely to have practical implications.”

When the study compared the group attending the mental health court vs. the treatment-as-usual group, it was clear that the mental health court participants did much better in the follow-up period. “It appears that mental health courts are diversion programs for justice-involved persons with mental illness and, usually, co-occurring substance abuse disorders that warrant public policy support,” Dr. Steadman and his colleagues wrote.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to a study published online.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences of those actions, according to the study.

“The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos,” Jordan Grafman, Ph.D., the senior investigator, said in a statement.

“The implications of this … include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior,” said Dr. Grafman, chief of the cognitive neuroscience section at the National Institute of Neurological Disorders, Bethesda, Md.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (Soc. Cogn. Affect. Neurosci. 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject quickly viewed all 60 videos, one after another, and judged whether each video was more or less aggressive than the one prior to it.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes. Electrodes were attached to the subjects' skin to measure skin conductance responses.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The subjects also were asked to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

“As the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses,” Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which might in turn prevent subjects from connecting the consequences of aggression with an appropriate emotional response. This, in turn, could increase the likelihood that the subject will see aggression as acceptable behavior, the investigators said.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to a study published online.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences of those actions, according to the study.

“The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos,” Jordan Grafman, Ph.D., the senior investigator, said in a statement.

“The implications of this … include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior,” said Dr. Grafman, chief of the cognitive neuroscience section at the National Institute of Neurological Disorders, Bethesda, Md.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (Soc. Cogn. Affect. Neurosci. 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject quickly viewed all 60 videos, one after another, and judged whether each video was more or less aggressive than the one prior to it.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes. Electrodes were attached to the subjects' skin to measure skin conductance responses.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The subjects also were asked to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

“As the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses,” Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which might in turn prevent subjects from connecting the consequences of aggression with an appropriate emotional response. This, in turn, could increase the likelihood that the subject will see aggression as acceptable behavior, the investigators said.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to a study published online.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences of those actions, according to the study.

“The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos,” Jordan Grafman, Ph.D., the senior investigator, said in a statement.

“The implications of this … include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior,” said Dr. Grafman, chief of the cognitive neuroscience section at the National Institute of Neurological Disorders, Bethesda, Md.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (Soc. Cogn. Affect. Neurosci. 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject quickly viewed all 60 videos, one after another, and judged whether each video was more or less aggressive than the one prior to it.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes. Electrodes were attached to the subjects' skin to measure skin conductance responses.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The subjects also were asked to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

“As the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses,” Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which might in turn prevent subjects from connecting the consequences of aggression with an appropriate emotional response. This, in turn, could increase the likelihood that the subject will see aggression as acceptable behavior, the investigators said.

UPDATED 11/3/2010 - Alabama has a dermatologist as its governor-elect. Dr. Robert Bentley, a Republican dermatologist from Northport, has won the contest to become the state's next governor.

Dr. Bentley, who was elected to the Alabama House of Representatives in 2002, credits his strong showing in the race in part to his opposition to the health reform law. A survey released Oct. 25 by the University of South Alabama Polling Group indicated that 48% of voters said they would choose Dr. Bentley, while just 35% voiced a preference for his opponent, Democrat Ron Sparks.

Photo credit: Dr. Robert Bentley for Governor

Dr. Bentley will head a small but growing contingent of dermatologists who have become involved in political office (see box below).

"The fact that I'm running as a doctor has helped tremendously," in large part because of public distaste for the Affordable Care Act (ACA), Dr. Bentley told Skin & Allergy News digital network. He opposes the law, as does the majority of Alabama residents, he said.

"Sixty-nine percent of state residents want this bill repealed," he said, quoting recent polling data. "I have read excerpts of the entire bill and understand how it is going to affect not only businesses and individuals – especially the elderly – but how it's going to affect our state." Alabama residents respect that, he said.

This election is the first in which Dr. Bentley has actively run as a physician.

"In this race, I have marketed myself as a doctor," he said. "We've used the slogan, 'The people of Alabama are hurting, and they need a doctor.' I think that's helped me. I would not have done that if this health care legislation had not been an issue right now."

Dr. Bentley supports repeal of the ACA, and favors replacing it with provisions that would:

• Make health insurance portable across state lines.
• Allow the self-employed to deduct 100% of the cost of their health insurance.
• Institute a $250,000 cap on noneconomic damages in malpractice.
• Increase Medicare payments to hospitals and primary care physicians.

Dr. Bentley also supports establishing a statewide health insurance exchange, independent of the federal government. An exchange would encourage more companies to offer health insurance policies for people in Alabama, he said.

Dr. Bentley also said that Medicaid is an important issue in Alabama.

Photo credit: Dr. Robert Bentley for Governor

"Being a doctor has helped also with understanding Medicaid and what providers and nursing homes face [under the program]," he said. He supports changes in Medicaid funding so that states with high rates of low-income residents, such as Alabama, would receive more federal Medicaid money, regardless of what the state itself spends.

In addition, he said Alabama should immediately adopt a statewide, interconnected electronic medical records system tailored for each medical specialty, and said that Alabama residents should own their own personal, portable health records in electronic format, allowing them to bring their records to any physician they see.

To encourage medical students to choose primary care, Dr. Bentley supports dedicating 25% of each class at both of Alabama's medical schools to students who plan to enter family medicine, internal medicine, pediatrics, obstetrics-gynecology, and general surgery.

In addition, he supports awarding $40,000 per year in scholarships to any student who pursues primary care, in exchange for 4 years of full-time service in a medically underserved area of Alabama.

Dr. Bentley also said that medical school curricula and residency programs should be modified to teach students and residents about reducing health care costs.

He acknowledges that, as Alabama's governor, he won't have control over federal physician issues, such as cuts mandated by Medicare's sustainable growth rate (SGR) rules. But as governor, he said, he can work with the state's congressional delegation to enact a permanent fix.

Dr. Bentley said that being a dermatologist has helped him become intimately familiar with various aspects of health care reimbursement, and has helped him understand the concerns of small business owners. As doctors, he said, "we run a small business. We have hands-on experience."

Jobs and the economy rank as the No. 1 concerns of about half of Alabama residents, he said, while education and health care come in second and third.

While Dr. Bentley has not been able to attend his dermatology practice for over a year due to the heavy campaign demands, he said he plans to keep up his medical license and maintain his efforts to address his continuing medical education.

"I will always be a doctor," he said. "What I'm doing now is public service. I will always be a doctor at heart."

UPDATED 11/3/2010 - Alabama has a dermatologist as its governor-elect. Dr. Robert Bentley, a Republican dermatologist from Northport, has won the contest to become the state's next governor.

Dr. Bentley, who was elected to the Alabama House of Representatives in 2002, credits his strong showing in the race in part to his opposition to the health reform law. A survey released Oct. 25 by the University of South Alabama Polling Group indicated that 48% of voters said they would choose Dr. Bentley, while just 35% voiced a preference for his opponent, Democrat Ron Sparks.

Photo credit: Dr. Robert Bentley for Governor

Dr. Bentley will head a small but growing contingent of dermatologists who have become involved in political office (see box below).

"The fact that I'm running as a doctor has helped tremendously," in large part because of public distaste for the Affordable Care Act (ACA), Dr. Bentley told Skin & Allergy News digital network. He opposes the law, as does the majority of Alabama residents, he said.

"Sixty-nine percent of state residents want this bill repealed," he said, quoting recent polling data. "I have read excerpts of the entire bill and understand how it is going to affect not only businesses and individuals – especially the elderly – but how it's going to affect our state." Alabama residents respect that, he said.

This election is the first in which Dr. Bentley has actively run as a physician.

"In this race, I have marketed myself as a doctor," he said. "We've used the slogan, 'The people of Alabama are hurting, and they need a doctor.' I think that's helped me. I would not have done that if this health care legislation had not been an issue right now."

Dr. Bentley supports repeal of the ACA, and favors replacing it with provisions that would:

• Make health insurance portable across state lines.
• Allow the self-employed to deduct 100% of the cost of their health insurance.
• Institute a $250,000 cap on noneconomic damages in malpractice.
• Increase Medicare payments to hospitals and primary care physicians.

Dr. Bentley also supports establishing a statewide health insurance exchange, independent of the federal government. An exchange would encourage more companies to offer health insurance policies for people in Alabama, he said.

Dr. Bentley also said that Medicaid is an important issue in Alabama.

Photo credit: Dr. Robert Bentley for Governor

"Being a doctor has helped also with understanding Medicaid and what providers and nursing homes face [under the program]," he said. He supports changes in Medicaid funding so that states with high rates of low-income residents, such as Alabama, would receive more federal Medicaid money, regardless of what the state itself spends.

In addition, he said Alabama should immediately adopt a statewide, interconnected electronic medical records system tailored for each medical specialty, and said that Alabama residents should own their own personal, portable health records in electronic format, allowing them to bring their records to any physician they see.

To encourage medical students to choose primary care, Dr. Bentley supports dedicating 25% of each class at both of Alabama's medical schools to students who plan to enter family medicine, internal medicine, pediatrics, obstetrics-gynecology, and general surgery.

In addition, he supports awarding $40,000 per year in scholarships to any student who pursues primary care, in exchange for 4 years of full-time service in a medically underserved area of Alabama.

Dr. Bentley also said that medical school curricula and residency programs should be modified to teach students and residents about reducing health care costs.

He acknowledges that, as Alabama's governor, he won't have control over federal physician issues, such as cuts mandated by Medicare's sustainable growth rate (SGR) rules. But as governor, he said, he can work with the state's congressional delegation to enact a permanent fix.

Dr. Bentley said that being a dermatologist has helped him become intimately familiar with various aspects of health care reimbursement, and has helped him understand the concerns of small business owners. As doctors, he said, "we run a small business. We have hands-on experience."

Jobs and the economy rank as the No. 1 concerns of about half of Alabama residents, he said, while education and health care come in second and third.

While Dr. Bentley has not been able to attend his dermatology practice for over a year due to the heavy campaign demands, he said he plans to keep up his medical license and maintain his efforts to address his continuing medical education.

"I will always be a doctor," he said. "What I'm doing now is public service. I will always be a doctor at heart."

UPDATED 11/3/2010 - Alabama has a dermatologist as its governor-elect. Dr. Robert Bentley, a Republican dermatologist from Northport, has won the contest to become the state's next governor.

Dr. Bentley, who was elected to the Alabama House of Representatives in 2002, credits his strong showing in the race in part to his opposition to the health reform law. A survey released Oct. 25 by the University of South Alabama Polling Group indicated that 48% of voters said they would choose Dr. Bentley, while just 35% voiced a preference for his opponent, Democrat Ron Sparks.

Photo credit: Dr. Robert Bentley for Governor

Dr. Bentley will head a small but growing contingent of dermatologists who have become involved in political office (see box below).

"The fact that I'm running as a doctor has helped tremendously," in large part because of public distaste for the Affordable Care Act (ACA), Dr. Bentley told Skin & Allergy News digital network. He opposes the law, as does the majority of Alabama residents, he said.

"Sixty-nine percent of state residents want this bill repealed," he said, quoting recent polling data. "I have read excerpts of the entire bill and understand how it is going to affect not only businesses and individuals – especially the elderly – but how it's going to affect our state." Alabama residents respect that, he said.

This election is the first in which Dr. Bentley has actively run as a physician.

"In this race, I have marketed myself as a doctor," he said. "We've used the slogan, 'The people of Alabama are hurting, and they need a doctor.' I think that's helped me. I would not have done that if this health care legislation had not been an issue right now."

Dr. Bentley supports repeal of the ACA, and favors replacing it with provisions that would:

• Make health insurance portable across state lines.
• Allow the self-employed to deduct 100% of the cost of their health insurance.
• Institute a $250,000 cap on noneconomic damages in malpractice.
• Increase Medicare payments to hospitals and primary care physicians.

Dr. Bentley also supports establishing a statewide health insurance exchange, independent of the federal government. An exchange would encourage more companies to offer health insurance policies for people in Alabama, he said.

Dr. Bentley also said that Medicaid is an important issue in Alabama.

Photo credit: Dr. Robert Bentley for Governor

"Being a doctor has helped also with understanding Medicaid and what providers and nursing homes face [under the program]," he said. He supports changes in Medicaid funding so that states with high rates of low-income residents, such as Alabama, would receive more federal Medicaid money, regardless of what the state itself spends.

In addition, he said Alabama should immediately adopt a statewide, interconnected electronic medical records system tailored for each medical specialty, and said that Alabama residents should own their own personal, portable health records in electronic format, allowing them to bring their records to any physician they see.

To encourage medical students to choose primary care, Dr. Bentley supports dedicating 25% of each class at both of Alabama's medical schools to students who plan to enter family medicine, internal medicine, pediatrics, obstetrics-gynecology, and general surgery.

In addition, he supports awarding $40,000 per year in scholarships to any student who pursues primary care, in exchange for 4 years of full-time service in a medically underserved area of Alabama.

Dr. Bentley also said that medical school curricula and residency programs should be modified to teach students and residents about reducing health care costs.

He acknowledges that, as Alabama's governor, he won't have control over federal physician issues, such as cuts mandated by Medicare's sustainable growth rate (SGR) rules. But as governor, he said, he can work with the state's congressional delegation to enact a permanent fix.

Dr. Bentley said that being a dermatologist has helped him become intimately familiar with various aspects of health care reimbursement, and has helped him understand the concerns of small business owners. As doctors, he said, "we run a small business. We have hands-on experience."

Jobs and the economy rank as the No. 1 concerns of about half of Alabama residents, he said, while education and health care come in second and third.

While Dr. Bentley has not been able to attend his dermatology practice for over a year due to the heavy campaign demands, he said he plans to keep up his medical license and maintain his efforts to address his continuing medical education.

"I will always be a doctor," he said. "What I'm doing now is public service. I will always be a doctor at heart."

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

"Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement," Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

"Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult," the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

"Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation," Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and "support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments," the investigators wrote. "Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms."

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, "indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians."

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

"Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement," Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

"Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult," the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

"Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation," Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and "support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments," the investigators wrote. "Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms."

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, "indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians."

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

"Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement," Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

"Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult," the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

"Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation," Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and "support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments," the investigators wrote. "Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms."

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, "indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians."

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians’ opinions on reform, published Oct. 25 in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren’t compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant financial conflicts of interest.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to study published online Oct. 19.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences from those actions, according to the study, published in Social Cognitive and Affective Neuroscience.

(c) Vytenis Slajus/Fotolia.com

"The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos," Jordan Grafman, Ph.D., one of the investigators, said in a statement.

"The implications of this ... include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior," said Dr. Grafman, senior investigator at the National Institute of Neurological Disorders.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (SCAN 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject was asked to quickly view the videos, one after another, and to judge whether each video was more or less aggressive than the one prior to it. The subjects viewed each of the 60 video snippets and rated them.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes, the part of the brain thought to govern emotions and emotional responses to events. Electrodes were attached to the subjects' skin to measure skin conductance responses, which track sweat levels. Sweat levels can accurately indicate people’s emotions and responses to internal or external stimuli.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The study also asked the subjects to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

"We found that as the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses," Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which in turn might prevent the subjects from connecting the consequences of aggression with an appropriate emotional response, the study said. This, in turn, could increase the likelihood that the subject will see aggression as an acceptable behavior, the study said.

"It remains unknown, however, whether individuals with elevated levels of aggression may be at particular risk for altered desensitization patterns towards media violence, pro-violent attitudes, and the acceptance of real-world violence as normal social behavior," the study concluded.

The investigators reported no conflicts of interest.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to study published online Oct. 19.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences from those actions, according to the study, published in Social Cognitive and Affective Neuroscience.

(c) Vytenis Slajus/Fotolia.com

"The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos," Jordan Grafman, Ph.D., one of the investigators, said in a statement.

"The implications of this ... include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior," said Dr. Grafman, senior investigator at the National Institute of Neurological Disorders.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (SCAN 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject was asked to quickly view the videos, one after another, and to judge whether each video was more or less aggressive than the one prior to it. The subjects viewed each of the 60 video snippets and rated them.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes, the part of the brain thought to govern emotions and emotional responses to events. Electrodes were attached to the subjects' skin to measure skin conductance responses, which track sweat levels. Sweat levels can accurately indicate people’s emotions and responses to internal or external stimuli.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The study also asked the subjects to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

"We found that as the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses," Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which in turn might prevent the subjects from connecting the consequences of aggression with an appropriate emotional response, the study said. This, in turn, could increase the likelihood that the subject will see aggression as an acceptable behavior, the study said.

"It remains unknown, however, whether individuals with elevated levels of aggression may be at particular risk for altered desensitization patterns towards media violence, pro-violent attitudes, and the acceptance of real-world violence as normal social behavior," the study concluded.

The investigators reported no conflicts of interest.

Watching repeated violence on television and video and in movies can blunt emotional responses to aggression in teenage boys. This desensitization might, in turn, promote aggressive attitudes and behavior, according to study published online Oct. 19.

Reactions to aggressive media decrease with repetition, which could in turn prevent teens from relating aggressive actions to the consequences from those actions, according to the study, published in Social Cognitive and Affective Neuroscience.

(c) Vytenis Slajus/Fotolia.com

"The important new finding is that exposure to the most violent videos inhibits emotional reactions to similar aggressive videos over time and implies that normal adolescents will feel fewer emotions over time as they are exposed to similar videos," Jordan Grafman, Ph.D., one of the investigators, said in a statement.

"The implications of this ... include the idea that continued exposure to violent videos will make an adolescent less sensitive to violence, more accepting of violence, and more likely to commit aggressive acts, since the emotional component associated with aggression is reduced and normally acts as a brake on aggressive behavior," said Dr. Grafman, senior investigator at the National Institute of Neurological Disorders.

The study enrolled 22 healthy male adolescents aged 14-17 years, none of whom had any history of psychiatric or neurologic illness. The subjects were paid to participate (SCAN 2010 [doi:10.1093/scan/nsq079]).

The researchers used 60 mute video snippets, each 4 seconds long, which contained real scenes of aggression, such as fist fights, street brawls, and stadium violence. They divided the videos into groups of 20 depending on their levels of aggression: low, mild, and moderate.

Each subject was asked to quickly view the videos, one after another, and to judge whether each video was more or less aggressive than the one prior to it. The subjects viewed each of the 60 video snippets and rated them.

As the subjects viewed and rated the videos, the investigators used MRIs to measure changes in their lateral orbitofrontal cortexes, the part of the brain thought to govern emotions and emotional responses to events. Electrodes were attached to the subjects' skin to measure skin conductance responses, which track sweat levels. Sweat levels can accurately indicate people’s emotions and responses to internal or external stimuli.

Data from the MRIs and the skin conductive responses showed that the boys reacted less to the videos the longer they watched them. They also reacted less over time to the mildly and moderately aggressive videos, indicating that they had become desensitized to them.

The study also asked the subjects to rate how much violence they saw on a regular basis in television, movies, video games, books, magazines, and Web sites. Those subjects who had the highest exposure to violence in their normal lives were the most desensitized to violence in the study, the authors wrote.

"We found that as the boys were exposed to more violent videos over time, their activation in brain regions concerned with emotional reactivity decreased and that was reflected in the data from the functional MRI and in the skin conductance responses," Dr. Grafman said.

Exposure to aggressive media results in a blunting of emotional responses, which in turn might prevent the subjects from connecting the consequences of aggression with an appropriate emotional response, the study said. This, in turn, could increase the likelihood that the subject will see aggression as an acceptable behavior, the study said.

"It remains unknown, however, whether individuals with elevated levels of aggression may be at particular risk for altered desensitization patterns towards media violence, pro-violent attitudes, and the acceptance of real-world violence as normal social behavior," the study concluded.

The investigators reported no conflicts of interest.