There's a shortage of primary care doctors and it's getting worse. Sen. Chuck Schumer says he has at least a partial solution. He will introduce an amendment to the Senate health-care bill that would add 2,000 new medical residency slots.

While well-intentioned, Schumer's idea seems unlikely to make much of a difference. There isn't even enough interest among qualified young docs to fill existing residency slots. Hundreds of slots went unfilled this year and graduates of foreign med schools filled many of the available positions.

Docs Tend to Follow the Money

Furthermore, doctors who go through residencies in internal medicine often choose do further training in a sub-specialty, rather than practice as primary-care internists. They do so, in large part, because many sub-specialties have higher pay, higher status and, in some cases, better hours. Adding more residency slots won't change that.

$50,000 Educational Loan Repayment Could Help

The shortage of primary-care doctors is especially acute in underserved rural areas. Doctors finishing up their residencies tend to gravitate to places where there are already lots of other doctors, not to places where physicians are scarce. Pointedly, there are other provisions of the health-care legislation that could encourage more young doctors to go into primary care and to move to the places where docs tend to be scarce. The Senate bill increases funding for the National Health Service Corps, which helps repay student loans for docs and other providers who work in underserved areas. Primary-care doctors who participate can get up to $50,000 of loans repayment.

This subject matter will seem self-serving, coming from a health insurance broker, but I'll risk it. This article appeared in the Los Angeles Times yesterday, Uninsured trauma patients are much more likely to die by Karen Kaplan. I cited the article on twitter and it got so much attention that I thought that many of my blog readers would be interested.

The point is this: Patients who lack health insurance are more likely to die from car accidents and other traumatic injuries than people who belong to a health plan -- even though emergency rooms are required to care for all comers regardless of ability to pay, according to a study published on Nov. 17, 2009.

An analysis of 687,091 patients who visited trauma centers nationwide from 2002 to 2006 found that the odds of dying from injuries were almost twice as high for the uninsured than for patients with private insurance, researchers reported in Archives of Surgery.

Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health insurance coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance.

But insurance status isn't supposed to be a factor for trauma patients. The Emergency Medical Treatment and Active Labor Act, passed by Congress in 1986, guarantees that people brought to emergency rooms get all necessary treatment no matter what kind of insurance they do -- or don't -- have.

The research team from Harvard University and Brigham and Women's Hospital in Boston used information from 1,154 U.S. hospitals that contribute to the National Trauma Data Bank. The team found that patients enrolled in commercial health plans, health maintenance organizations or Medicaid had an equal risk of death from traumatic injuries when the patients' age, gender, race and severity of injury were taken into account.

The risk of death was 56% higher for patients covered by Medicare, perhaps because the government health plan includes many people with long-term disabilities, said Dr. Heather Rosen, who led the study while she was a research fellow at Harvard Medical School.

The risk of death was 80% higher for patients without any insurance, the report said.

The researchers also did a separate analysis of 209,702 trauma patients ages 18 to 30 because they were less likely to have chronic health conditions that might complicate recovery. Among these younger patients, the risk of death was 89% higher for the uninsured, the study found.

Rosen, now a surgical resident at USC's Keck School of Medicine, said the group expected to find at least some disparity based on insurance status. But she said the group was surprised at the magnitude of the gap.

Dr. Frank Zwemer Jr., chief of emergency medicine for the Hunter Holmes McGuire VA Medical Center in Richmond, Va., said he was "kind of shocked."

"We don't ask people, 'What's your insurance?' before we decide whether to intubate them or put in a chest tube," said Zwemer, who wasn't involved in the research. "That's not on our radar anywhere."

Possible Explanations

The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility.

Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses because they don't interact with them as often. All of these factors could influence whether a trauma patient is able to recover.

Coincidence?

But the link could also be coincidental, the authors acknowledged. Perhaps the hospitals that have fewer resources at their disposal also happen to see the most uninsured patients, they said.

The types of injuries may differ too, Zwemer said. Gunshot and stabbing victims -- frequently younger people involved in crime -- were much more likely to die from their wounds than other trauma patients tracked in the study. These people are generally uninsured, but the type of injury -- not insurance status -- is the reason for their higher fatality rates, he said.

More research is needed to figure out whether lack of insurance actually harms trauma patients or whether the data simply reflect a correlation, said Dr. A. Brent Eastman, chairman of trauma at Scripps Memorial Hospital in La Jolla.

The issue is particularly relevant as Congress and the Obama administration weigh various measures to reduce the number of uninsured Americans, Eastman wrote in a short critique that accompanied the study.

Perhaps you've heard stories in the media about mix-ups at fertility clinics where the identities of the parents of embryos become uncertain due to mislabeling of sperm, eggs, or resulting embryos. Statistically, these mishaps are rare, but you can imagine what a nightmare it is for the patients as well as the medical practitioners when mistakes do happen.

A new software technology is helping to reduce the risk of laboratory errors in infertility treatment, by electronically identifying the sperm, eggs, resulting embryos and other materials used in in vitro fertilization (IVF) treatment cycles. Non-invasive Radio Frequency Identification (RFID) can track a patient's sperm, eggs and embryos during the course of treatment. If the wrong material is introduced in the lab environment, RFID alerts the staff, via visual and audible signals, to help prevent mislabeling of any materials.

RFID tags contain a microchip that acts as a unique digital fingerprint, safely identifies samples at the outset and tracks them through the fertilization process. Each patient is given an RFID identity card, with a unique identification, that are used with all sample materials for that patient, including Petri dishes and test tubes used in a patient's treatment cycle. The entire system is electronically managed. By creating an automated system to minimize the chance for mix up, RFID safeguards the infertility treatment process and gives patients peace of mind.

Some fertility practices in the US and UK have already installed RFID. Since launching this new technology last year, over 20,000 infertility treatment cycles have employed RFID to ensure the safety and security of patients' genetic material.

The American Society for Reproductive Medicine (ASRM) recently pledged to work with patient groups, policy makers and other stakeholders to develop systems to reduce the risk of errors.

The House Bill would ban all abortions performed directly with public money in the new government-sponsored public plan and it bans abortions in private health insurance plans for women receiving public subsidies. This is where the dispute is. Backers of the amendment say insurance companies could still offer plans that provide abortion as a benefit to people who buy policies with their own money (read middle-class and above). But opponents say there are other provisions in the bill that would make that basically impossible. So, the net result is that there would be no plans in the insurance exchanges that offer abortion coverage at all.

Do women currently have coverage for abortion?

Many women have abortion coverage right now - somewhere between 50 and 80 percent. However, and this is admittedly a disputed statistic, only 13 percent of all abortions are billed to insurance. That's because the vast majority of abortions are done early in pregnancy in the first trimester. They're normally done in abortion clinics and they're cheap - a couple of hundred dollars. Probably, most of the insurance coverage used for abortions are for later abortions that are done for medical reasons, either fetal abnormalities or pregnant women with health problems. Those are abortions that are usually done in hospitals and cost thousands of dollars. Those are the ones that you'd want insurance for. The house bill has no provision for these abortions, no exceptions. They would be banned, too.

What now?

Now the debate switches back to the Senate bill that currently would ban direct federal funding of abortion. There are already some pro-life Democrats who are talking about adding the House language.

However, back in the House there are some 40 pro-choice Democrats who say they won't vote for final bill unless the abortion language is taken out.

They're going to have to find a compromise and it won't be easy.