Page 25

Mr. Edward Salsberg, director of

in order to make it profitable, at these

input. The MEC-controlled rules and

Workforce Studies at the Association

stores’ volumes.

regulations can house procedural details

of American Medical Colleges, spoke on “Who Will Staff the Front Lines.” Some pretty compelling MD workforce and scope of practice things: 1. There is certainty of a significant

2. Wal-Mart is the business world’s IT leader, and IT is what will drive medicine. 3. More than 50% of Wal-Mart shoppers

for some critical medical staff functions, but cannot be where the process resides. 4. Hospitals have expressed concern that MS.1.20 will weaken MECs and leave

have no health insurance – this

hospital boards unclear about who

physician shortage in the U.S. in the

is a population in need of access,

represents the medical staff. However,

next 20 years – over a wide range of

convenience, and transparency of cost of

physicians should welcome these Joint

assumptions that still holds.

care. (One would think the intent would

Commission changes.

2. Enrollment in U.S. medical and osteopathic schools will increase 30% by 2016, from 2000 levels. The bottleneck will be in post-graduate training.

be to also have the clinics be part of major provider panels to capture insured

Dr. David Carlisle, director of

shoppers, too.)

California’s Office of Statewide Planning

4. Wal-Mart has made many public relation

and Development (OSHPD), discussed

Current threats to federal funding of that

blunders, so they want to get this right.

“Population Diversity: Challenges and

education may make the bottleneck a

They likely will partner with local

Opportunities for California’s Health Care

severe one.

providers – hospitals or clinics – to


co-brand their clinics. That would also

1. We are on the bleeding edge of diversity

3. Internal Medicine graduates (IMGs) are 25% of the current U.S. physician workforce and 27% of those in U.S.

facilitate referrals. 5. America has a love/hate relationship

in this state. 2. Data shows that some chronic disease

post-graduate training now are IMGs.

with Wal-Mart, but a large slice of the

outcomes – when controlled for

This is not likely to be sustained – as Dr.

American populace votes with its feet

prevalence and economic status – sort

Fickenscher also said.

and its dollars every week.

with race and ethnicity. There are many

4. Younger physicians have different

potential explanations, but we need to

personal goals and priorities. This will

Attorney Elizabeth Snelson, an expert

drive scope of practice practicalities and

in Hospital Medical Staff Governance,

will also drive the hiring of specialist

alerted the audience to a new Joint

in physician density in the Los Angeles

physicians by hospitals to staff acute care

Commission Standard intended to strengthen

metropolitan area.

hospitals and emergency departments.

the independence of the medical staff:

keep this in mind. 3. Data presented showing huge disparities

4. California’s physician workforce race

5. The number of physician assistants has

1. Medical staff governance is not what

tripled in the past 15 years (heading for

it used to be – physicians are busier,

population’s profile – with large Latino

a five-fold increase) and the number of

meetings are fewer, the number of

and African-American imbalances.

nurse practitioners has risen 25%.

physicians having paid-relationships with

6. The relationship between MD and

and ethnicity is far different from the

hospitals is higher, and the medical staff-

All that, and we haven’t even discussed the

non-MD clinicians should be governed

related regulatory stakes for hospitals are

lunchtime speakers – Congressman Pete

by the question: “What can non-MD


Stark, on one day (he wants to toss out

clinicians do as well as or better than

2. In 2007, the Joint Commission

sustainable growth rate (SGR) and stop the

MD clinicians?” The very real cost and

announced a new standard (MS.1.20)

looming Medicare cuts), and Dr. Arnold

access issues – that will get worse –

to strengthen the independence of the

Relman, many-year editor of the New

argue for maximizing non-MD providers

medical staff. MS.1.20 takes effect July

England Journal of Medicine (NEJM) and

so long as that question is always central

2009. It offers the medical staff at-large

author of a 2007 book that has garnered

to discussion.

better defined authority over and the

much attention: “A Second Opinion: Rescuing

ability to act independently of its own

America’s Health Care,” the next day. There

Medical Executive Committee (MEC).

is just too much to say about Dr. Relman’s

Mr. Ronald Galloway, the world authority on all things Wal-Mart, made

3. MS.1.20 (you can easily search this

passionately presented ideas – search on-line

it clear that medicine is about to become yet

on-line) codifies that certain critical

more corporatized:

processes (such as credentialing and

1. Wal-Mart has 3,700 U.S. stores, and

privileging) must be described in the

After drinking at the Leadership Academy

around 2,000 of them are likely to have

bylaws – and be subject to approval by

fire hydrant, I was very glad to be part of our

in-store, nurse-staffed clinics in the

the entire medical staff – rather than live

county medical association, as well as CMA

next five years. Less than 0.5% of daily

in “rules and regulations” that can be set

and AMA. The issues and decisions facing us

shoppers would need to use the clinic

and changed by the MEC with no other

the many interviews with him.

Continues on page 33

the bulletin



Profile for SCCMA/MCMS

2008 July/August  

2008 July/August  

Profile for 18621