Migraine Doctors in Short Supply Across U.S.

Only 416 specialists available nationwide, study found

By Robert Preidt

HealthDay Reporter

FRIDAY, June 28 (HealthDay News) -- There are too few migraine headache specialists in the United States, a new study finds.

Migraines affect about 36 million Americans over age 12 (more than 11 percent of the population). That's more than the number affected by asthma and diabetes combined. However, only 416 specialists nationwide are certified by the United Council for Neurologic Subspecialties to diagnose and treat migraine, according to researchers.

States with the highest number of migraine specialists include New York (56), California and Ohio (29 each), Texas (25), Florida (24) and Pennsylvania (23). Six states have no migraine specialists, according to the study presented this week at the International Headache Congress meeting in Boston.

States with the worst specialist-to-patient ratios include Oregon, Mississippi, Arkansas and Kansas. The District of Columbia has the best ratio, followed by New Hampshire, New York and Nebraska.

"This is a troubling picture," study leader Dr. Noah Rosen, of the Pain and Headache Center of the North Shore-Long Island Jewish Health System, said in a congress news release. "Migraine is a highly disabling disorder -- the seventh most disabling in the world and the fourth most disabling among women. It's clear that many more specialists need to be trained and certified to meet the need."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Migraine costs the United States more than $29 billion a year in direct medical expenses such as doctor visits and medications, and indirect expenses such as missed work and lost productivity, the release noted.

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Doctors Reluctant to Expand Nurse Practitioners' Role: Survey

By Amy Norton
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- The United States has a shortage of primary care doctors, and some policymakers want to fill the gap by expanding the role of nurse practitioners. But the two professions are engaged in a turf war over who can do the job better, a new survey finds.

The results of the survey were reported in the May 16 issue of the New England Journal of Medicine.

Experts expected some controversy, but said they were surprised at how far apart doctors and nurse practitioners were in their opinions.

The nearly 1,000 doctors and nurse practitioners surveyed were most divided on the question of who gives the higher quality of care: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better.

Perhaps predictably, few nurse practitioners agreed with that. And although 82 percent of nurse practitioners felt nurse practitioners should lead their own practices, only 17 percent of doctors did.

"We weren't surprised that there were differences in their opinions, but we were surprised by the magnitude of the difference," said lead researcher Karen Donelan, a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston.

Dr. David Blumenthal, co-author of an editorial published with the study, agreed.

"It's striking how different their perceptions are, even though they work in the same physical environment," said Blumenthal, president of the Commonwealth Fund, a New York-based foundation that supports research on health policy.

So what does all of that mean? Blumenthal and Donelan said the divide between doctors and nurse practitioners has implications for how U.S. health care looks in the future.

Based on a number of studies, Americans' demand for primary care providers is straining the limited supply. The Association of American Medical Colleges estimates that by 2015 the United States will face a shortage of more than 33,000 primary care practitioners.

A Commonwealth Fund survey found that 16 percent of U.S. adults have to wait at least six days for a doctor's appointment when they have a health problem that needs attention. And experts expect the shortage to worsen with health care reform, which will extend insurance coverage to about 30 million more Americans.

Some policymakers think nurse practitioners offer a way to address the problem.

Nurse practitioners go through advanced education and training beyond the requirements to become a registered nurse. In about 16 states, they can do most of what doctors do -- including heading their own primary care practices, prescribing drugs and performing medical procedures unsupervised.

In other states, nurse practitioners may be required to work with a doctor.

On paper, it makes sense to expand the role of nurse practitioners in primary care because their education and training is shorter -- an average of six years versus 11 or 12 years for doctors, including residency training. By some estimates, anywhere from three to 12 nurse practitioners can be educated for the price of producing one doctor.

Donelan said there also is evidence that nurse practitioners do just as well as doctors when it comes to primary care -- and that patients needing urgent care actually give nurse practitioners better marks on communication.

But what is not known, she said, is how well nurse practitioners measure up against doctors when things get more complicated, such as in cases in which a patient's diagnosis is unclear or a patient has multiple chronic health conditions.

In those cases, Blumenthal said, "there's no literature as to the superiority of one profession over the other."

If nurse practitioners are to gain an expanded role in primary care, laws in many states will have to change, Blumenthal said.

In 2010, the Institute of Medicine, an independent panel that advises the federal government, issued a report saying that many states' regulations on nurse practitioners were "overly restrictive" and based on politics.

The two professions' national societies see the issue differently. Some doctors' groups, including the American Medical Association and American Academy of Family Physicians, have said that nurse practitioners should be able to practice only under the supervision of a doctor.

But the trend seems to be going against those groups. According to the American Association of Nurse Practitioners, bills have recently been introduced in 10 states to expand nurse practitioners' scope of practice.

Donelan said both sides need to "be at the table" in figuring out what primary care will look like in the future. "Achieving collaboration will take a lot of work, and it needs to be based on data rather than rhetoric," she said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Karen Donelan, Sc.D., senior scientist, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston; David Blumenthal, M.D., president, Commonwealth Fund, New York City; May 16, 2013 New England Journal of Medicine

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Look Beyond the Sun for Skin Cancer Culprits, Doctors Warn

Tanning beds, organ transplants and smoking among additional risk factors

By Serena Gordon

HealthDay Reporter

FRIDAY, June 21 (HealthDay News) -- Think "skin cancer" and blame immediately goes to the sun. Justifiably so -- though not totally, skin doctors say.

"Hands down, sun exposure is the biggest risk factor for skin cancer," said Dr. Sherrif Ibrahim, an assistant professor of dermatology at the University of Rochester Medical Center in New York. "And it's a cumulative risk. The more exposure you've gotten, the bigger the risk. The skin doesn't know if you're out one time for an hour or 12 times for 5 minutes at a time. Your skin keeps a running meter."

That's important to know as summer officially begins, according to skin health experts at the American Academy of Dermatology.

Each year, more than 3.5 million basal and squamous cell skin cancers, known as non-melanoma cancers, are diagnosed in the United States, according to the American Cancer Society. These types of skin cancer aren't as deadly as melanoma, which affects about 75,000 U.S. residents annually. About 9,000 people die from melanomas and 2,000 from non-melanoma skin cancers each year, according to the society.

However, the sun isn't the only thing that can be problematic. Tattoos, certain chemicals, other diseases and possibly even those better-for-the-environment light bulbs all have been linked to skin cancer.

And people who think tanning beds are safer than soaking up the sun should think again, Ibrahim suggested.

"There's an unquestionable link between tanning booths and skin cancer," Ibrahim said. "There's been an enormous surge in the popularity of tanning booths, and with it the average age of people with melanomas is much lower. I had a 22-year-old patient just the other day."

This is because it doesn't matter if the ultraviolet light comes from the sun or from an artificial source. Dr. Alan Fleischer, a dermatology professor at Wake Forest Baptist Medical Center in Winston-Salem, N.C., explained that "the kind of light produced by tanning beds isn't better or worse than natural sunshine, but people may get more and longer exposure, especially in areas where outside, they might display more modesty."

Even getting a manicure can expose you to ultraviolet light.

"Ultraviolet nail treatment units do produce UV light, but the risk is quite small," said Fleischer. The lights are used to help gel or regular polishes set or harden.

Despite the low risk, the American Academy of Dermatology still recommends putting sunscreen on your hands before you get a manicure.

Even things that seem unrelated to UV light -- such as getting an organ transplant or a tattoo, or having an autoimmune disease -- have been linked to skin cancer diagnoses.

People who've had an organ transplant have an extremely elevated risk for skin cancer -- up to 200 times higher than others, according to Ibrahim.

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A Deadly Form of Diabetes That Doctors Sometimes Miss

Common signs of type 1 diabetes often resemble symptoms of other illnesses

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- Addie Parker was a happy 4-year-old who appeared to have the flu. But within hours she was in a coma.

Tragically, her parents weren't familiar with the signs of type 1 diabetes -- extreme fatigue, thirst and sweet-smelling breath, among others -- in time to save their little girl. Soon after she was diagnosed, Addie's brain hemorrhaged. She died six days later, about a month shy of her fifth birthday.

Experts say a lack of awareness of the signs of type 1 diabetes is all too common. Just this month, a Wisconsin toddler died apparently because of undiagnosed type 1 diabetes.

"Addie had flu symptoms," recalled her mother, Micki Parker, who works in the operating room at a nearby hospital but was unfamiliar with type 1 diabetes.

"By the next morning, she was throwing up every hour," Parker said. Addie didn't have a fever, but later that day, she couldn't get up from the bathroom floor because she was so dizzy.

Eventually, the Parkers learned that Addie's blood sugar level was 543 milligrams per deciliter (mg/dL) -- more than four times higher than normal, according to the American Diabetes Association.

Most people have heard of type 2 diabetes, but type 1 diabetes is far less common. It can strike at any age -- even though it used to be known as juvenile diabetes -- and it always requires treatment with injected insulin or insulin delivered through a pump. People with type 1 diabetes don't produce insulin, a hormone needed to convert the food you eat into fuel for the body. Without insulin, glucose (blood sugar) rises to unhealthy levels.

Untreated, type 1 diabetes causes serious complications and even death. But it's often mistaken for other illnesses -- even by doctors.

"There's an underawareness of type 1 diabetes in the public, and in the healthcare system," said Dr. Richard Insel, chief scientific officer for JDRF (formerly the Juvenile Diabetes Research Foundation). "Missed diagnoses even occur in emergency rooms; people don't always think of it."

Every day, about 80 Americans are diagnosed with type 1 diabetes, and the total number rose 23 percent between 2000 and 2009 in children under 20. Currently, about 3 million Americans -- most of them adults -- are living with type 1 diabetes, according to the JDRF.

One of them is 20-year-old Amanda Di Lella, who was 13 when she knew something was seriously wrong.

"I was losing weight, but I was always hungry. I was always tired. My symptoms weren't extreme at first, but they quickly got worse," she said. "I went from being tired to not being able to get out of bed, from being thirsty to drinking 10 bottles of water in the middle of the night. I had lost 15 pounds, and only weighed 75 pounds when I begged my mother to take me to the doctor."

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U.S. Doctors' Group Labels Obesity a Disease

Advocates say AMA's move will boost resources to fight weight-gain epidemic, but others question decision

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- In an effort to focus greater attention on the weight-gain epidemic plaguing the United States, the American Medical Association has now classified obesity as a disease.

The decision will hopefully pave the way for more attention by doctors on obesity and its dangerous complications, and may even increase insurance coverage for treatments, experts said.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans," AMA board member Dr. Patrice Harris said in a statement Tuesday. "The AMA is committed to improving health outcomes and is working to reduce the incidence of cardiovascular disease and type 2 diabetes, which are often linked to obesity."

One expert thinks the AMA's decision, approved Tuesday at the group's annual meeting, could lead to greater coverage by insurance companies of treatments for obesity.

"We already treat obesity as a chronic illness," said Dr. Esa Matius Davis, an assistant professor of medicine at the University of Pittsburgh. "But this decision will bring more resources into the picture because it will, hopefully, allow for more insurance coverage and that really has been the issue of getting people the help that they need," she said.

Treatments for obesity -- including drugs, nutritional counseling and surgery, if needed -- often don't get reimbursed by insurance companies, Davis said. That means many patients aren't getting the care they need because they can't afford to pay the out-of-pocket costs, she said.

If insurance covered these services "it would increase referrals and treatment and that would be a huge step in the right direction," Davis said.

Right now, Davis gets insurance coverage for her obese patients by diagnosing them with high blood pressure or high cholesterol or diabetes, or other obesity-related conditions. But, that still leaves many obese patients out in the cold, she said.

The Obesity Society, which calls itself the leading scientific society dedicated to the study of obesity, applauded the AMA's decision. "The passage of a new American Medical Association policy classifying obesity as a disease reinforces the science behind obesity prevention and treatment," Theodore Kyle, advocacy chair, said in a statement.

"This vital recognition of obesity as a disease can help to ensure more resources are dedicated to needed research, prevention and treatment; encourage health care professionals to recognize obesity treatment as a needed and respected vocation; and, reduce the stigma and discrimination experienced by the millions affected," he said.

Kyle said the AMA has now joined a number of organizations that have previously made this classification, including the U.S. National Institutes of Health, the Social Security Administration, and the Centers for Medicare and Medicaid Services.

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Doctors' Spouses, Partners Say They're Satisfied

Title: Doctors' Spouses, Partners Say They're Satisfied
Category: Health News
Created: 4/4/2013 6:36:00 PM
Last Editorial Review: 4/5/2013 12:00:00 AM

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doctors orders

So I can't do ANY exercise for the next two weeks and I'm already miserable :( how do I not gain/lose any weight in the next two weeks. I am going to go out to eat 3 times and on those days I am about 700 over maintenance is it possible to maintain without any exercise

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Certain Parents Less Likely to Follow Doctors' Advice: Poll

Title: Certain Parents Less Likely to Follow Doctors' Advice: Poll
Category: Health News
Created: 3/25/2013 6:36:00 PM
Last Editorial Review: 3/26/2013 12:00:00 AM

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Primary Care Doctors Can Make the Wrong Call

Title: Primary Care Doctors Can Make the Wrong Call
Category: Health News
Created: 2/25/2013 6:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM

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Primary Care Doctors Can Make the Wrong Call

By Amanda Gardner

HealthDay Reporter

MONDAY, Feb. 25 (HealthDay News) -- In one case documented in a new study, an elderly patient was misdiagnosed with bronchitis but actually had full-blown pneumonia and ended up being admitted to the hospital.

Although that patient recovered, other symptoms that aren't properly diagnosed could be even more serious: numbness, tingling and dizziness that aren't recognized as the first signs of a stroke, for instance.

According to the new study, published online Feb. 25 in the journal JAMA Internal Medicine, primary care physicians can make diagnostic errors across a wide range of conditions, many of them common conditions such as urinary tract infections and anemia.

"There's a great heterogeneity of conditions [that are missed]," said study author Dr. Hardeep Singh.

Although much is known about medication errors and mistakes that occur in hospitals and other inpatient settings, less is known about mistakes that happen in doctors' offices or clinics, said Singh, chief of the Health Policy, Quality and Informatics Program at the Houston VA Health Services Research and Development Center of Excellence.

Similarly, while "high-profile" diagnostic mistakes -- missed cancer that ends in unnecessary death, for example -- often make the news, more mundane diagnostic errors can fly under the radar, he added.

In the study, Singh and his colleagues used electronic medical records to identify 190 cases of diagnostic errors that took place in a primary-care physician's office, either at a VA facility or in a private health care system. Sixty-eight of those were missed diagnoses, according to the study.

Diagnostic errors occurred across many common conditions, including pneumonia (6.7 percent of the cases), congestive heart failure (5.7 percent), kidney failure (5.3 percent) and urinary tract or kidney infection (4.8 percent). Cancer made up 5.3 percent of missed diagnoses, on a par with kidney failure.

Eighty percent of the errors were due to communication breakdowns between the patient and practitioner. This could have been failing to take a proper medical history or not performing a comprehensive physical exam. There also were problems with ordering and interpreting tests and follow-up care.

More than 40 percent of the cases studied involved more than one of these factors.

Although all the cases reviewed in this study involved patients coming back for -- and receiving -- follow-up care, the cases did have the potential for "moderate to severe harm," the authors said.

It's not clear if these findings would extrapolate into other primary care settings, especially ones that aren't part of a larger health care network, the authors said. (Even in this study, the authors found different patterns in the VA network versus the private system.)

The authors did not say what proportion of total diagnoses were in error, said Dr. Doug Campos-Outcalt, chairman of family medicine at the University of Arizona College of Medicine, in Phoenix.

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Doctors: Clinton Should Recover Fully From Clot

Jan. 2, 2013 -- Medical experts say Secretary of State Hillary Clinton is extremely lucky that her medical team found the blood clot they are now treating with blood thinners.

The rare clot in a vein between her brain and skull was discovered during a follow-up exam Sunday, weeks after she reportedly sustained a concussion after a fall in her home during a bout of stomach flu.

The experts agreed that Clinton’s clot could have threatened her life if it had been missed during the routine exam.

Where is Secretary Clinton’s blood clot exactly?

The clot is in a vein between her brain and skull behind her right ear. The bleeding was reportedly contained within the vein, and there was no bleeding within the brain, which could have led to stroke or brain damage.

So why was the clot so dangerous if left untreated?

If the clot had grown large enough to cause a major blockage of blood, it could have led to serious swelling and even death, says Keith Black, MD, who is head of neurosurgery at Cedars-Sinai Medical Center in Los Angeles.

“I think Secretary Clinton is very lucky that this clot was caught early and treated early,” he says.

How rare are these blood clots?

Blood clots occurring in the legs are very common, especially among older people, but clots occurring in the head are pretty rare, says Jack Ansell, MD, who chairs the Department of Medicine at Lenox Hill Hospital in New York City. Ansell says the clots occur in about 1 in 100,000 people and that women experience them about three times more often than men.

Ansell suspects that Clinton’s fall-related head injury along with flu-related dehydration caused her blood clot.

“I would have to assume that if she didn’t fall and hit her head this would not have happened,” he says.

Secretary Clinton had a previous blood clot in the 1990s. Could the earlier clot be related to the new one?

Both doctors agree that it could. In 1998, when Bill Clinton was in his second term as president, then first lady had a deep vein clot behind her right knee. Some people do have a genetic predisposition to develop blood clots, but it is not publicly known if Hillary Clinton does.

Isn’t it dangerous to treat someone who has sustained a concussion with blood thinners?

It is true that brain bleeds are a concern after a blow to the head, and that blood thinners like the anti-coagulant Coumadin (warfarin) increase the risk for bleeding. But Black says Secretary Clinton’s brain has undoubtedly healed enough in the three weeks since her fall to allow safe treatment with the clot-targeting drugs.

“At this point enough time has elapsed between the fall and the use of blood thinners so that I would not worry about this,” he says.

What’s next for Secretary Clinton?

Both doctors expect her to be out of the hospital as soon as her blood-thinning medications have been regulated, and she will be followed closely by her medical team while she is on them. That could be a few months or longer. After that, both doctors say she should require no further special medical care involving the clot.

“I would expect her to make a full recovery,” Ansell says.

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Are Primary Care Doctors a Vanishing Breed?

Title: Are Primary Care Doctors a Vanishing Breed?
Category: Health News
Created: 12/4/2012 5:19:00 PM
Last Editorial Review: 12/5/2012 12:00:00 AM

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Are Primary Care Doctors a Vanishing Breed?

ByKathleen Doheny
WebMD Health News Reviewed byLouise Chang, MD

Dec. 4, 2012 -- Doctors who practice general internal medicine, known as internists, may be a vanishing breed, according to a new study.

In the new research, few medical residents in general internal medicine programs say they plan to pursue that career path. Instead, they plan to become specialists.

"What this study is showing is, only one in five graduating internal medicine residents is planning a career in general medicine or primary care," says researcher Colin West, MD, PhD, associate professor of medicine and general internal medicine physician at Mayo Clinic in Rochester.

The study is published in the Journal of the American Medical Association.

Internists: The Survey

West used an annual survey that is linked to an exam. He focused on data from nearly 17,000 third-year residents in 2009, 2010, and 2011.

These residents told which career paths they planned to follow. 

Overall, just 21.5%, or about one in five, said they planned to pursue a general internal medicine career.

Of those who enrolled in a primary care program (typically with the goal of entering primary care), only about 40% said they still planned to stay with general internal medicine. Of those who entered a traditional “categorical” program, about 20% planned to be general internists.

The others planned to specialize in cardiology, gastroenterology, pulmonary medicine, or other areas, West says.

Internists' Shortage by the Numbers

West and others have long predicted a shortage of generalist doctors. The new study is yet more evidence, he says.

Research published in 1992 found that more than half of all internal medicine residency graduates stayed with general internal medicine, so West's findings have slashed that number even more.

In a 2010 report, the Association of American Medical Colleges predicted that the doctor shortage will reach 91,500 by 2020. It says about half of that will be primary care doctors.

The situation may be even worse than expected, West says, as the provisions of the Affordable Care Act (ACA) go into effect. Health care reform focuses on coverage of tens of million of people in the U.S. who are uninsured.

Internal medicine doctors would be expected to be the caregivers for many.

The ACA includes many provisions to expand the workforce of primary care doctors, writes Mark D. Schwartz, MD, of the VA's New York Harbor Healthcare System, but implementation depends on getting enough money from Congress.

Schwartz wrote an editorial to West's study in JAMA.

Explaining Career Goals

While the survey did not ask residents to explain their career decisions, West cites two possibilities.

Life-work balance. "A major consideration is lifestyle and work-life balance, particularly from younger residents," he says. Some specialists may have more control over their schedule and office hours. Money. "Subspecialists can make twice as much," he says. While a general internist may make about $200,000, West says, citing a 2011 report, specialists such as a cardiologist often make twice that annually. 1 | 2 Next Page > #url_reference {display: none};#url_reference { display: block; line-height: 150%; margin-bottom: 10px; }#logo_rdr img { visibility: visible; }.titleBar_rdr .titleBarMiddle_fmt { padding-top: 1.5em !important;} Top 12 News Topics 1. Lipitor Recall 2. Brooke Burke 3. Energy Drinks 4. Salty Six 5. ADHD & Crime 6. Cholesterol Test 7. Soda & Arthritis 8. HFC Diabetes 9. Grapefruit v. Drugs 10. Heart Risk 11. Weight Loss Pill 12. Green Coffee Top 12 Topics 1. Psoriasis Treatment 2. Eye Allergies 3. Joint Replacement 4. Avoid Heartburn 5. Atrial Fibrillation 6. Chronic Gout 7. Quiz: Cold or Flu? 8. Toothbrush Truths 9. Eczema Symptoms 10. Heartburn Causes 11. Got Kitchen Germs? 12. ADHD in Kids FROM CBS NEWS App lets phone accurately measure lung capacity

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