Thursday, October 10, 2013

Medical Musings: Part One--Healthcare exchange and women in medicine

Long post so I'll split this into a two parter. I had a lot of random articles I have been saving to post so here's tonight's:

With the recent healthcare exchange, I'd like to post some links and my thoughts:

(1) Despite the effort to expand medicaid there are still a vast majority who need the expansion but will not receive coverage. The eye-opening part of this is that the 26 states that are "not participating in an expansion of Medicaid are home to a disproportionate share of the nation’s poorest uninsured residents." What this means is that a good portion of individuals who need the expansion most (those living in some of the poorest states) will not getting it because the State Government has decided not to participate in the expansion. These states are not only some of the most populous, but also some of the poorest and also have the some of the highest concentrations of illnesses. To distill this down: the poorest and sickest are not benefiting because a choice was made not to allow them to be covered. What happened to the days where the purpose of the government was to consider the welfare of the people? All the people, not just the rich ones. A look at the charts below show that it just so happens that a large portion of these poor and uninsured will be blacks and other minorities. Something tells me that this correlates with the disparity in social mobility between races (another topic that the Times published over the summer.) It's hard to go to work when you're ailing and it's even harder to go to school instead of work when you're buried in medical bills. And it's harder to accumulate wealth when all of it is going towards paying for said medical bills. BAH humbug for the empathy gap.

Here's the fast and easy breakdown:

 For the full article click here:

Here's some answers to some common questions about what these changes may bring:

Here's one more article:

(2) Not sure how I missed this at the first go, but as someone who has some interest in academic medicine, it appears that the prospect of succeeding is still a little grim for women unfortunately. As if I need any more evidence about gender discrimination,  this is an old study so let's hope the past decade has brought some progress (not necessary to read, but I like to substantiate what I write here with evidence-based results.)

Some more links (most are short but the NYtimes one at the end is long but I believe the most important.)

Women Still Missing From Medicine’s Top Ranks and we're also still paid less.
Although apparently this also happens in Silicon Valley and they're know as the Silicon Valley Mafia.
This article is extremely interesting though (why are there so few women in science?)

To briefly comment on this, I was recently shocked to find that the department I used to do research at in Boston (a very very very large hospital) had zero women attendings (full-time physicians.) Sure there were residents (physician's still in training but already with their medical degree and learning how to practice in their specialties), but no female attendings in sight. I did a quick search at my current institution and sure enough, again, no female attendings here either in that particular specialty. Sure there are plenty of excuses and explanations such as this being a grueling surgical specialty that has a lot of manual labor involved and long hours so perhaps women steer away from it. Not really accurate assumptions since they appear to be fine going through the hard 5 year residency training. What is concerning is that although it is great that there are some female residents, who can they look to for guidance and mentorship as well as being examples of respected females in this field? Furthermore, how do the men who are training beside these female surgeons become accustomed to having female superiors and equals if none exist? Additionally, this specialty is a 5 year residency plus 1-2 year fellowship. That means that in the past 5-7 years not a single female was hired as an attending in this specialty despite there being qualified candidates. I'm afraid to look up the numbers of females that graduated from residency in this specialty. Something tells me that it's not zero. This sends the message to male surgeons-in-training that their current female classmates are temporary and will somehow disappear after fellowship or worse just can't "hack-it" along the way and drop out or, at the very least, just aren't real contenders in the field to end up at these top institutions. The fact that there are female residents indicates that they are accepted to train as surgeons, they're just not allowed to get hired and actually practice the craft. Mind you, these are two of the nation's largest hospitals sitting at the forefront of medical care. Precluding women from opportunities to learn and contribute at these institutions, teach at them, and mentor others is a loss for future physicians and future patients. I haven't bothered to fully research this at all institutions so I can only comment on what's in front of me but the prospect doesn't seem promising to say the least. 

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