Whitney Palmer

Healthcare. Politics. Family.

On Halloween, Medical Schools Celebrate and Educate

Published in the October 2010 AAMC Reporter

—By Whitney L. J. Howell, special to the Reporter

When Jennifer Bartlotti and Brian Telesz returned to the University of Texas Medical Branch (UTMB) on Oct. 20, 2008, the area around campus resembled a war zone. Hurricane Ike had raged through Galveston, Texas, felling trees, knocking down stoplights, and ripping up street signs. But Bartlotti, Telesz, and several of their fellow medical students did not focus on when they would return to class. Their first concern was that Galveston’s children would be unable to celebrate Halloween.

“We knew the kids needed a safe place to have fun on Halloween,” said Bartlotti, now a fourth-year student at UTMB. “It was a huge undertaking, but in 10 days, we put together a great event.”

Although they only had a few days to gather supplies and prepare, Telesz said UTMB students were able to assemble a full-fledged Halloween carnival.

“Everyone was falling over themselves wanting to do something for the community,” said Telesz, also now a fourth-year student. “Most of the students enjoyed the games and events just as much as the kids.”

UTMB is one of several medical schools to host Halloween celebrations in their areas. Some are for medical

UTMB students held a limbo contest for costumed trick-or-treaters during last year’s Halloween carnival and costume contest.

students, while others are for the communities. Some incorporate festivities into clinical service programs already provided to various groups. Some are educational, and some focus on simply having fun. But all blend health information with the tricks and treats.

 

Every October, Eastern Virginia Medical School (EVMS) students build a large haunted house and maze in the school’s courtyard for more than 500 children and their families. The youths also participate in arts and crafts and pumpkin bowling, but according to Terri Babineau, director of the EVMS office of student community outreach, children also learn about health professions and healthy living through career mentoring and health education.

Various departments at Oregon Health and Science University join together for Halloween parties and contests. The molecular and medical genetics department often follows a costume theme, focusing one year on Dolly the Sheep. Organizers say it is a way for incredibly busy students and faculty to blow off steam.

In Galveston, the UTMB Halloween carnival has become an annual fixture, with students spending up to $2,000 on supplies and countless hours working with local businesses to secure prize donations. To drum up attendance, they cover the communities surrounding campus with nearly 1,500 fliers. The result: more than 500 children and their parents attend the carnival.

Special games teach children about the parts of the body. There is also trick-or-treating for books, and parents can look through donated clothes, said Michael H. Malloy, M.D., professor of pediatrics and UTMB’s assistant dean of Oslerian education. As much as the families enjoy the event, medical students learn an equal amount by planning the activities and socializing with the carnival attendees. First- and second-year students are responsible for the majority of carnival planning. Third- and fourth-year students function mainly as student mentors.

“They learn the importance of trying to be part of the community as a physician,” Malloy said. “It promotes the concept of community service that we stress in all of the student societies at UTMB.”

Halloween is not the sole property of the lower 48. Though the October weather may not be very crisp on the Hawaiian island of Manoa, students at the University of Hawaii’s John A. Burns School of Medicine (JABSOM) recently added Halloween festivities to the health services they provide at three local homeless shelters. The shelters house between 250 to 300 people, including between 80 and 130 children.

“The students wanted to start the carnival because a shelter isn’t conducive to trick-or-treating,” said Jill S. Omori, M.D., director of the school’s Homeless Outreach and Medical Education project. “They hold a costume contest for the kids, and all the games are health-related.”

For example, in the “Knock out Tobacco” game, JABSOM students paint cardboard boxes to look like cigarette packs; and children toss balls to knock them over. To emphasize dental health, the carnival offers a game for children to push out Frankenstein’s bad teeth. Many of the prizes help reinforce the games’ lessons, such as the toothbrush and toothpaste prizes for the Frankenstein game.

 

The EVMS art therapy department provides arts and crafts for the more than 500 children and families who attend the annual Halloween carnival.

 

For many of the children, these carnivals are their only opportunity to learn good health behaviors, and they are more receptive to the messages because they come from the same students who give them regular health care, said Rita Martin, community relations coordinator for the United States Veterans Initiative’s Waianae Civic Center.

“The students show our kids that doctors are child-friendly and aren’t rigid,” Martin said. “They’re not just health professionals, they are friends to these children. They have a happy, good relationship.”

Solid relationships between medical students and children in the shelters play an important part in how the children develop into adults and how they approach their careers, said Max Gray, program coordinator at the Kaka’ako Shelter.

“The carnival is a good chance for the kids, most of whom have had rough childhoods, to see responsible, mature, knowledgeable adults that they normally see in a professional environment letting their hair down and having fun,” Gray said. “It’s excellent role modeling. It shows the kids that you can have a good time and still be professional.”

Halloween fun is not only for young children, however.  Approximately 300 University of California at Los Angeles (UCLA) David Geffen School of Medicine students celebrate the holiday annually. Each year’s theme changes, including a Halloween hoe-down in 2008. As with UTMB, most participants are first- and second-year students.

According to Meredith Szumski, UCLA director of student affairs, students dress in costumes to attend classes, relax at a schoolwide picnic, and play games. The day is designed to be a stress reliever for the students and give them an opportunity to showcase their medical knowledge.

The highlight of UCLA’s festivities is a pumpkin-carving contest in which participants use surgical tools to create their designs, and faculty judge the entrants based on creativity and finesse with the scalpel.

“The day is part of our school’s attempt to preserve the students’ well-being,” she said. “We want them to remember the good parts about being a physician.”

October 10, 2010 Posted by | Education, Healthcare | , , , , , , , , , , , , , | Leave a comment

Physician-Owned Hospitals Get an Overhaul

Published in the October 2010 AAMC Reporter

—By Whitney L. J. Howell, special to the Reporter

Physician-owned hospitals, also known as specialty or limited-service hospitals, are about to undergo serious changes.

The health care reform law created in March bans any new building expansions for existing specialty hospitals, freezes the level of physician ownership allowed in each hospital, and essentially pushes them toward accepting more Medicare and Medicaid patients by establishing a Dec. 31 deadline by which physician-owned hospitals must secure Medicare provider numbers.

No strangers to controversy, physician-owned hospitals typically focus on nonemergency services, such as orthopedic or cardiac care, that are low-risk and fairly lucrative. They are often owned solely or in part by the doctors who work there, with physicians “self-referring” patients to the facilities they own.

Many health care organizations have opposed the practices of these hospitals, accusing the facilities of “cherry-picking” patients and pushing away uninsured or complex cases. Health care analysts also worry they foster the overutilization of certain procedures or treatments. Responding to opposition from the AAMC and other groups, such as the American Hospital Association and the Federation of American Hospitals, Congress in 2003 imposed an 18-month moratorium on doctor self-referrals to physician-owned specialty hospitals.

“We’re trying to develop better health care models,and this levels the playing field,” said Leonard Marquez, AAMC’s director of government relations. “Once you do that, providers will be more likely to collaborate and seek new ways to align their services and expertise.”

Before the reform law, physician-owned hospitals werea growth market. According to Physician Hospitals of America (PHA), a trade and advocacy group, the numberof physician-owned facilities increased by 140 percent from 2001 to 2010, with 265 facilities in existence today (including those under construction) versus 110 in 2001.

“I think other hospitals watched physicians steer patients to facilities where they have a lucrative interest,” said Jeffrey G. Micklos, J.D., the Federation of American Hospitals’ executive vice president of management, compliance, and general counsel. “In these cases, patients with more comorbidities or those who have more difficult-to-treat chronic conditions are sent to the teaching andcommunity hospitals.”

In addition to limiting hospital growth, the health reformlaw requires that doctors tied to physician-owned hospitals be

Indiana Orthopaedic Hospital will be one of the most affected physician-owned hospitals when its expansion is completed in late October. New legislation that puts new restrictions and guidelines in place for specialty hospitals puts the new building's use in question.

bona fide investors, meaning any profit they glean must directly result from services they personally render. Craig A. Conway, a health law specialist with the Health Law and Policy Institute at the University of Houston Law Center, said the new law will not necessarily spell the end of specialty hospitals—or an automatic revenue boost forother hospitals.

 

“This is definitely a significant hit to physician-owned hospitals, and they will suffer in the long term, but a lot more needs to be done to flesh out how the provisions will actually work before we know what the future holds,”Conway said. “Whether things get better for teaching hospitals or stay at the status quo doesn’t just depend on this reform. You have to look at Medicare reimbursement and the impending physician shortage, too.”

Conway said urban areas will feel the most impact because physician-owned hospitals tend to congregate in more highly populated areas. Some teaching hospitals have been affected by the presence of physician-owned facilities. Officials at Harris County Hospital District in Houston said they anticipate serving 30,000 additional uninsured patients next year, and potentially 375,000 annually by 2015, as a result of a nearby specialty hospital declining to treat those cases.

The physician-owned hospital effect does tend to vary, however. Leni Kirkman, executive director of corporate communications and marketing for University Health System in San Antonio, said nearby physician-owned hospitals have not adversely affected the university’s bottom line.

“We do have a few small physician-owned specialty hospitals in San Antonio, but they have not grown to be major players in the market,” Kirkman said. “I would not expect [their impact] to be significant. Our market share has remained fairly constant over the past decade.”

Physician-owned hospitals have their supporters, and some plan to fight the health care reform provisions. PHA and Texas Spine and Joint Hospital filed a lawsuit in the U.S. Federal Court in the Eastern District of Texas, questioning the law’s constitutionality and asking that hospitals with ongoing construction projects be allowed to finish.

Curtailing physician-owned hospitals and preventing doctors from having an ownership stake in a hospital will not improve the quality of health care overall, said PHA Executive Director Molly Sandvig.

“This is a lose-lose situation for everyone,” Sandvig said. “We want patients to have choices for better services. This law restricts those options and affects patients in a hugely negative way.”

Some physician-owned hospitals and their patients already feel the effects of the legislation, particularly those with new buildings under construction. As of June, Indiana Orthopaedic Hospital (IOH), a 42-bed, physician-owned hospital, was 70 percent finished with a $27 million expansion that initially included three new operating rooms. When the building is finished in late October, John Dietz, M.D., IOH chairman and an orthopedic surgeon, said he does not know how the hospital will use the new space. IOH’s expansion could become an extremely small hospital or, if it cannot secure a Medicare provider number by the deadline, the hospital could opt to reject future Medicare and Medicaid patients. Neither option is palatable, he said.

“We don’t want to become what we don’t believe in,” Dietz said. “This law is forcing us to think about trying things we don’t want to be. We don’t want to step back from any of our patients, including those with Medicare and Medicaid. This legislation is making it difficult to do the right thing.”

October 10, 2010 Posted by | Healthcare, Politics | Leave a comment

   

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