Positive Reinforcement in Medical Training

From the NY Times:

I believe strongly that we need to train young doctors to be competent, caring and conscientious. And I would also say that most individuals in my profession feel the same way, judging by the degree of interest in journals and professional societies in cultivating “professionalism,” the buzzword used to encompass all those desired qualities. “Placing the interests of patients above those of the physician, setting and maintaining expert standards of competence and integrity, and providing expert advice to society on matters of health” is how one international gathering of medical groups summed up the goals of “professionalism.”

I just wonder, though, if emphasizing the negatives — what not to do and the terrible personal repercussions — is necessarily the best way to go about teaching professionalism.

Recently while reading The Journal of the American Medical Association, I came across a study on professionalism that addresses positive reinforcement. Using observation-based evaluations, Dr. Darcy A. Reed and her colleagues at the Mayo Clinic in Rochester, Minn., assessed aspects of professionalism like compassion, competence and integrity among 148 residents and then examined the specific behaviors of the most outstanding among them.

AHA warns of bad debt, low reimbursements

From Modern Healthcare:

As their revenue from investments vanishes, U.S. community hospitals face worsening financial pressures as shortfalls continue to increase in government reimbursements and bad-debt rates climb higher, two analyses released by the American Hospital Association show.

The amount of underpayment by Medicare and Medicaid programs increased more than eightfold in eight years, growing from $3.8 billion in 2000 to $31.9 billion in 2007, the most recent year in which figures are available, the analysis shows. Those figures were computed using actual care costs, not charge rates. Hospitals were paid 91 cents for every dollar they spent on Medicare patients, and 88 cents for every dollar they spent on Medicaid patients.

Uncompensated-care costs at community hospitals also continued to climb in 2007, reaching 5.8% of all expenses posted, the analysis shows.