The moonlighting dilemma: balancing education, service, and quality care while limiting risk exposure

Article Abstract:

Moonlighting by medical residents is controversial and has recently received attention as states attempt to regulate residents' work hours and teaching hospitals seek to avoid liability exposure. Moonlighting represents additional income to residents and also provides additional hands-on experience and increased responsibility. Moonlighting also permits essential night and weekend staffing of community hospital emergency rooms and walk-in centers. Analysis of these important considerations for residents, community hospitals, and risk management led the University of Massachusetts Medical Center to develop a unique approach to the problem that addresses the concerns of all parties involved. Known as extended employment, it is regarded as an extension of the resident's training position at the medical center, allowing institutional control over moonlighting. The development of guidelines for extended employment has also enabled the medical center to develop a detailed database on such activity.

Analysis, Management, Employment, Residents (Medicine), Supplementary employment, Massachusetts, University of. Medical Center

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HIV exposure during nuclear medicine procedures

Article Abstract:

Three patients undergoing nuclear medicine procedures have been accidentally injected with blood or blood products from an HIV-positive patient since 1989. Two of these patients have become HIV-positive, and the HIV status of the third patient is not known. Nuclear medicine procedures often involve the removal and re-injection of the patient's own blood or blood products. The two HIV-positive patients were infected when health care workers confused the patient's blood with that of an HIV-positive patient. Blood was injected into the third patient using a syringe that had been previously used on an HIV-positive patient. Hospitals and clinics should take precautions to prevent these types of accidents. All health care workers should receive training in infection control and infection control policies for nuclear medicine. Patient samples should be labeled properly and all procedures should be well documented.

Health aspects, HIV infection, HIV infections, Disease transmission, Blood transfusion, Autologous, Autologous blood transfusion, Nuclear medicine

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Balancing incentives: how should physicians be reimbursed?

Article Abstract:

Many proposals for reforming physician payment involve either fee-for-service, salary or capitation, but some of these payment methods have drawbacks. Capitation -- paying physicians according to the number of patients they see -- encourages physicians to do only the minimum for a patient, while fee-for-service encourages physicians to provide too many services. A better payment method might be to combine the two. Primary care physicians would receive a monthly fee for each patient seen, but would also receive a fee-for-service based on the Resource-Based Relative Value Scale. The proportion of income physicians receive from either payment plan would be balanced so there would be no incentive to do too little or too much. Specialists could also be paid in this manner. This plan could be implemented easily and cheaply in a single-payer system.

Finance, Physicians, Medical professions

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