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Category Archives: Medical School
Opinion | A Hidden Cost of a Career in Medicine: Barriers to Building a Family – Medpage Today
Zhang and Levy are medical students. King is an incoming PhD student in public health and community medicine.
It's no secret that it's incredibly challenging to balance a career in medicine with having a family, particularly for women. As two medical students and a researcher studying family building in physicians and medical students, we are acutely aware of these challenges.
Medicine does not make building a family easy. Although no one should ever have to choose between having a career in medicine or having a family, many physicians and medical students continue to struggle. In our recent survey, published in JAMA Network Open, our team examined responses from more than 2,000 physicians and medical students to understand the barriers faced by those building families. We uncovered shocking stories that demonstrated a lack of institutional support for the costs of assisted reproductive technology (ART) and surrogacy, a toxic culture of discrimination, and complex interpersonal conflicts surrounding pregnancy. Our findings underscored how profoundly broken the system is.
Due to the implicit and explicit messages encouraging trainees to delay childbearing until after training, many who want to have children would benefit from access to ART, including cryopreservation. Unfortunately, the high cost of cryopreservation and lack of insurance support during residency hinder many from pursuing it as a viable option. The cost of egg freezing for one cycle can range from $8,000 to $20,000.
Those who are not able to have children or pursue cryopreservation during training may need IVF later on, which is also costly and time-consuming. One cycle of IVF can involve many steps, including fertility assessment, monitoring appointments, bloodwork, egg retrieval, embryo creation, storage fees, and expensive medications and injections. Doing all of this within a short period is often unrealistic with a demanding medical work schedule.
Alternative family-building routes, such as surrogacy, which LGBTQIA+ physicians often pursue, are even more expensive. One physician in our study wrote, "At the start of our journey, we were told to expect up to $200,000 worth of costs for a single pregnancy. Now that we have gone through two miscarriages, we've already spent $100,000 and have to start the process of finding a new surrogate, labs, travel, genetic counseling, lawyers, surrogate insurance, and IVF costs all over again." Unfortunately, many residency programs do not provide coverage for fertility care, specifically for elective egg freezing.
Beyond financial hurdles, the culture of medicine is not friendly toward those trying to have children. Respondents in our study described how supervisors and peers would discourage individuals from having children, and they felt pressure not to discuss their pregnancies or pregnancy losses. Multiple individuals shared situations where they continued to work after having a miscarriage due to fear of stigmatization: "I had a miscarriage during rounds as a fellow in a hospital bathroom. There was so much stigma around being pregnant that I went back to round. I only told my mom."
The extreme physical pressures of medicine -- such as making residents endure exhausting 24-hour shifts and adhere to rigid schedules -- can also create barriers to building a family. The statistics are grim: 1 in 4 women in medicine struggle with infertility. And personal stories abound: Ariela Marshall, MD, a hematologist at Mayo Clinic and an author on our study, delayed having children until she was 34. She found that, even with fertility drugs, it was challenging to conceive -- likely due to frequent night shifts, lack of sleep, and stress.
For those who are successful in becoming pregnant, there is little to no accommodation. Parental leave policies are sometimes as short as 4 weeks and often nonexistent for non-birthing parents. One woman wrote, "I wish it was more expected for residents and physicians to take a more reasonable length of maternity leave, rather than having to return to work while your body is still in the acute phase of recovery." This grueling culture in medicine should no longer be embraced as the standard, given the toll it takes on the lives of physicians and medical students.
Interpersonal conflicts may also arise related to pregnancy. The existing system disproportionately burdens our colleagues without children when someone chooses to start a family. As one woman wrote, "As the only resident in my program that didn't have kids, I took more call than everyone in my class combined and at the end of my senior year, nearly committed suicide because of the stress and sleep deprivation." The workload should still be bearable even if someone is on parental leave, but too often that is not the case. Paradoxically, while society often perceives women choosing not to have children as selfish, in medicine, the opposite is true because of these dynamics.
People in medicine already make substantial sacrifices for their career, undergoing years of rigorous training in emotionally taxing environments. Hospital, departmental, and residency program leaders need to take steps to fight against the discriminatory culture toward pregnant workers in medicine. Institutions should provide support to cover the high cost of cryopreservation and ART, create a more humane work schedule, and improve parental leave policies. Additional staff should be brought in to protect co-workers from heavier work burdens when a colleague goes out on leave. Institutions such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education need to speak out and take a stance on this issue to protect all medical students, especially residents. It's time to put in the work to change this unjust system and promote a future of medicine that supports everyone.
Qiang Zhang is a medical student at the UCLA David Geffen School of Medicine in Los Angeles. Morgan S. Levy is a medical student in the MD and Master's in Public Health program at the University of Miami Miller School of Medicine. Zoe King is an incoming PhD student in Public Health and Community Medicine at the University of New South Wales Sydney in Australia.
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Handley Notables: Dr. David W. Powers, Class of 1975 – The Winchester Star
David Powers, valedictorian of the Class of 1975, was a Star Leadership Award winner and voted Most Likely to Succeed by his class. He was a member of Phi Beta Kappa at Randolph-Macon College and Alpha Omega Alpha Medical School Honor Society at the Medical College of Virginia.
David completed his internship and residency in Emergency Medicine at the Hershey Medical Center in 1986. He returned to Winchester and became the first residency trained and board certified Emergency Medicine physician at the Winchester Memorial Hospital. When he became medical director of the Emergency Room, he set the hiring standard that all ER physicians would be board certified. He was dedicated to providing quality healthcare in a compassionate manner in Winchester for 35 years.
He was one of the first physician volunteers at the Free Medical Clinic and served on its endowment committee. He staffed the Winchester Medical Centers Mobile Care Unit for events such as the Shenandoah Apple Blossom Festival and the Battle of Cedar Creek Reenactment. He was the advisor for the Medical Explorers at Winchester Medical Center where high school students were introduced to possible medical careers.
David provided free physicals for scouts attending camps and high adventure activities. The Shenandoah Area Council Boy Scouts of America awarded him the Silver Beaver Award and the Distinguished Eagle Scout Award for his volunteerism. David was able to share his love of local history with everyone, especially young people. He served on the first Tourism Board for the Winchester and Frederick County area and on the board of the Winchester-Frederick County Historical Society. He was a founding member of the Stone House Foundation at the Newtown History Center and of the Shenandoah Valley Battlefield Foundation. He was the vice-president of the Kernstown Battlefield Association from its founding until 2019. David co-chaired the renovation of George Washingtons Office Museum in 1999. He helped organize exhibits for the Historical Society and Kurtz Cultural Center of Preservation of Historic Winchester.
Powers will be remembered not only for his life long commitment to the health of the people in the community but also for his support of youth and his love of local history.
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UConn Health has long history of bailouts – Hartford Courant
Trying to resolve continuing financial problems, Gov. Ned Lamont is turning to an independent consultant to chart the future for the UConn Health center at a time when many hospitals are struggling.
The future of the UConn Health center has challenged state officials for the past 25 years as they have tried to balance the books with state funding and patient fees at the John Dempsey Hospital in Farmington, along with tuition, fees, and research grants at the universitys medical and dental schools.
During that time, Connecticut has had multiple governors, House Speakers, UConn presidents, trustee leaders, and medical school deans who have all studied the situation. Now, its Lamonts turn.
Im thinking about partnerships, where you maximize the value of UConn Health, Lamont said when asked by The Courant. They do extraordinary work. Maybe with some partnerships we can reduce the cost to the taxpayers and make sure UConn Health is all it can be.
Some legislators have questioned whether the health center is run as efficiently as possible, but Lamont said the issue is broader than that.
I dont think thats the question, Lamont said of efficiencies. Look, its obviously a few hundred million dollars a year to the taxpayers. Theyve got an amazing medical school. Weve got to do nothing to compromise that. Great clinical care. Whats the best relationship there so we can maximize the care at the least cost to the taxpayers?
When asked during his first five years as governor about his plans for the future of the health center, Lamont had said that he was thinking about it without offering concrete plans.
Ive been looking at this for a while, Lamont said. Ive been talking to UConn about this for some time, talking to the other hospitals about this, trying to figure out how we can maximize the value there.
Since a request for proposals has not been released yet, a consulting firm has yet to be hired and the exact costs for the consultant have not been announced.
We ought to have some preliminary response in the next 90, 120 days, Lamont said, adding that he wants details before the 2024 legislative session ends in May.
A longtime business executive who likes to cut through the bureaucracy and move quickly as in the private sector, Lamont said, I can be a little impatient sometimes.
During the 2022 fiscal year, the states block grant was $208 million and the allocation for state fringe benefits was $200 million for total state support of $408 million out of overall revenues of $1.6 billion, according to numbers provided to the state legislature by UConn. The tuition revenues of $472 million were higher than the states contribution.
Lamont has received strong pushback from the top leaders of the UConn administration, who say that a consultant is not necessary.
Behind the scenes, UConn President Radenka Maric and other top officials have been trying to block the request for proposals sought by Lamont, which was first reported by Hartford Courant columnist Kevin F. Rennie. Rennie obtained a two-page letter that was written by Maric and three of the universitys highest-ranking officials: board of trustees chairman Daniel Toscano, health center board chairman Sanford Cloud, and medical school dean Bruce T. Liang, who also serves as interim CEO at the health center.
We question the need to issue a broad RFP or RFI, particularly because, as you know, we fear this will cause significant damage to UConn Health, including its schools, its reputation, and most importantly, retention and recruitment of the best and brightest faculty, staff and students, many of whom build their lives and careers in Connecticut, the letter said.
The four leaders also said they are concerned about the future of the UConn medical and dental schools that are based in Farmington.
We are extremely concerned that if any responses include selling the clinical enterprise, the two schools accreditation and therefore their ability to continue to operate could be in serious jeopardy, according to the letter.
During years of previous debates about the future of the health center, Connecticut lawmakers have repeatedly noted that Harvard Medical School does not own its own hospital and students instead learn at hospitals around Boston.
House Republican leader Vincent Candelora, who has served in the legislature since 2007, expressed frustration at the continuing issue of the health centers finances. But he agreed a consultant is not necessary.
Weve known about this problem for decades, Candelora said in an interview. Whats a consultant going to do?
He said it is time to make decisions, rather than relying on a consultant that will push the issue into 2024 and beyond.
Lamont is punting like the rest of the governors who have dealt with this issue and the legislature, Candelora said. This issue has been punted for years. We just keep plugging the dikes temporarily and throwing money at it, and theres never been a systemic fix.
The financial problems at the health center have been a long-running issue with the legislature, dating back at least to 2000 and have continued for the terms of the past four governors. The health center sought millions in additional funding as lawmakers said for years that the fringe benefits for state employees at the state-subsidized hospital in Farmington have traditionally been far beyond those at similar hospitals. At Lamonts direction, the state will be funding the legacy costs of pensions and retiree health care.
In a recent message sent to colleagues, Liang said the consultants report will provide recommendations on the coming years.
The healthcare industry is obviously ever-changing, Liang said. Knowing that, its important to periodically undertake a holistic assessment of how our public health system is operating in this rapidly evolving environment and work to identify potential opportunities to safeguard and promote our continued vitality and plan for the future.
High salaries and pensions with COLAs
The health center has a large number of highly paid employees, according to the state comptrollers office.
The health center has 421 employees being paid at least $200,000 per year, including 118 at $350,000 or more, 32 at $500,000 or more, eight at $800,000 or more and four employees at $1 million or more, according to the comptrollers statistics. The total payroll for 2023 is $525 million for nearly 7,000 employees in a large, sprawling operation that includes a hospital running 24 hours per day.
Statewide, the UConn health center employs 10 of the top 15 highest-paid state employees and 30 of the top 45 highest-paid.
While pensions are paid separately out of the state pension fund, the health center has some of the top-paid retirees in the state. That includes Dr. Jack N. Blechner, a former professor at the health center and former department chairman of obstetrics and gynecology. His pension in 2023 is $342,000, which increases every year under the cost-of-living increase for longtime retirees. The total represents a sharp increase of more than $100,000 from Blechners pension in 2005 that was $216,000.
The consultant, Candelora said, should look at the salaries and benefits that are driving costs higher.
Public sector salaries we tend to overinflate the worth of our public sector, Candelora said. Its no longer the world of getting great benefits for lesser pay. Generally, across the board, on average, state workers are paid far more than the private sector on top of having great benefits.
But university spokeswoman Stephanie Reitz said earlier this year that the highest-paid doctors generated millions in revenue.
The five UConn Health faculty members who recently were listed among the top 10 earners for the past fiscal year collectively generated more than $20 million in 2022 in clinical care revenue for UConn Health nearly quadruple their total combined salaries, Reitz said. From 2016 to 2022, these same five physicians collectively generated $60.7 million in clinical revenue, and overall, UConn Healths 10 highest-paid faculty have brought in more than $140 million in clinical revenue in the same period. This revenue is critical to UConn Health, since about 50% of its revenues come from its clinical operation and state support accounts about 25%.
Oversight at health center
Legislators have questioned the level of financial oversight at the health center, citing a case in which UConn continued to pay an 84-year-old medical school professor, Dr. Pierluigi Bigazzi, after he was dead.
Bigazzi was paid for at least five months with 11 biweekly paychecks until his body was discovered by police on Feb. 5, 2018. He was believed to have been killed in his Burlington home at some point around August 2017 and wrapped in black plastic garbage bags with duct tape in the basement. His 70-year-old wife, Linda, was charged with murder and tampering with physical evidence. The criminal case is still pending.
You would hope people would recognize that somebody is not showing up at the office, Senate Republican leader Kevin Kelly has said of the case.
Later, UConn recovered about $50,000 in wages that had gone electronically to Bigazzis joint bank account that he shared with his wife. The total was reduced by the amount of vacation time that had not been taken by Bigazzi, who was earning about $200,000 per year at the time of his death. He had been working from home on rewriting part of the medical schools curriculum, and he did not answer more than a dozen emails as UConn officials tried to contact him.
Medical malpractice
One financial problems for UConn in recent years is a 2021 Superior Court ruling that a Bristol couple should receive $37.6 million from a medical malpractice lawsuit after an insemination procedure went wrong at UConn Health. One child died in utero in January 2015, while her twin brother will need lifelong medical care after sustaining a brain injury, according to the lawsuit.
Superior Court Judge Mark H. Taylor, a well-known former attorney for the state Senate Democrats before ascending to the bench, wrote in the 107-page ruling that the court agrees with the vast majority of superior courts, concluding that a physician providing obstetric care owes a direct duty to a mother to prevent harm to her child during gestation and delivery.
UConn officials said the size of the ruling, which included both economic and non-economic damages, had been unexpected.
The ruling has been appealed and is awaiting a decision by the Connecticut Supreme Court.
Mark Mirko/The Hartford Courant
Long history
Various ideas and recommendations have been debated by governors and legislators through the years.
In March 2007, five major hospitals teamed up and went public to protest UConns plan to build a $500 million hospital in Farmington as behind-the-scenes feuding over the proposed new hospital spilled into public view.
UConn said at the time that its then-30-year-old hospital in Farmington was too small and seriously outdated, making it increasingly difficult to attract top faculty for its adjacent medical and dental schools. Competing hospitals countered that a larger hospital in Farmington would siphon off suburban patients with good insurance plans, leaving them with a disproportionate number of poor patients and more severe financial problems.
Those particular plans were dropped, and some officials said that Hartford Hospital, St. Francis Hospital and Medical Center, Bristol Hospital, Middlesex Hospital, and The Hospital of Central Connecticut should work with UConn to determine the number of new beds that were needed in the region.
In 2009, officials talked about a merger between Hartford Hospital and the health center that would create a two-campus university hospital in Farmington and Hartford.
That idea fell apart, and the next governor, Dannel P. Malloy, called in 2011 for a bold new plan that was more than double the size of a plan discussed under Gov. M. Jodi Rell. The legislature approved an $864 million multifaceted project to expand the medical and dental schools and generate an estimated 3,000 new construction jobs at the Farmington campus. The proposal called for adding 100 students to the medical school, 48 students to the dental school and about 50 medical researchers overall, as well as a new hospital tower and parking garages.
The proposal said the health center, which had been bailed out four times since 2000 under two governors, would break even by 2018.
The tower was eventually built in Farmington under Malloys direction. But UConns financial problems have continued.
Despite the long-running issues, Candelora said he is trying to remain optimistic.
Ill never give up. Otherwise, I wouldnt run for re-election, Candelora said. Reform is always incremental in government. Its always difficult to get reform, but this is an area that needs it. Im hopeful that it will bear fruit. Ive seen a lot of consultants being hired and a lot of press releases, but I have not seen results.
Christopher Keating can be reached at ckeating@courant.com
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Internationally renowned breast medical oncologist joins the David Geffen School of Medicine at UCLA – News-Medical.Net
Dr. Aditya Bardia, a renowned breast medical oncologist and physician scientist who specializes in developing novel targeted and personalized therapies, has joined the David Geffen School of Medicine at UCLA and the UCLA Health Jonsson Comprehensive Cancer Center where he will assume several leadership roles across the institution. These will include the directorship of the Breast Cancer Clinical and Research Programs and the position of assistant chief of Translational Research in the division of hematology/oncology, department of medicine. He will also be named director of Translational Research Integration and co-director of the Breast Cancer Disease Site Group for the UCLA Health Jonsson Comprehensive Cancer Center; all positions effective January 2, 2024.
Bardia will oversee a team of world-renowned cancer experts to deliver individualized, comprehensive and compassionate care to patients and help advance translational research to improve the outcomes of patients afflicted with the disease.
We are excited to have Dr. Bardia's expertise here at UCLA. Dr. Bardia is globally recognized for his academic leadership and will be an invaluable addition to our leadership team. We look forward to him joining and further enhancing our research enterprise in the greater UCLA academic community."
Dr. Michael Teitell, Director of the UCLA Health Jonsson Comprehensive Cancer Center
Bardia has a distinguished record of leading clinical trials investigating the role of targeted therapy combinations for breast cancer, particularly antibody drug conjugates. He led the development of sacituzumab govitecan, the first antibody drug conjugate approved for patients with metastatic triple negative breast cancer, as well as others including trastuzumab deruxtecan and datapotamab deruxtecan. He also led the clinical development of elacestrant, the first oral SERD approved for patients with metastatic hormone receptor-positive breast cancer. Bardia's translational team also helped discover the role of acquired ESR1 mutations in mediating endocrine resistance, RB1 mutations in mediating CDK 4/6i resistance and TOP1 mutations in mediating antibody drug conjugate resistance.
"Dr. Bardia brings a wealth of knowledge and expertise in integrating clinical and basic science, which will significantly advance our research capabilities for a disease that globally impacts millions every year," said Dr. Dennis Slamon, chief of hematology-oncology and director of Clinical and Translational Research at the UCLA Health Jonsson Comprehensive Cancer Center."We are very excited he is joining our institution and look forward to working with him in directing aspects of the division's overall research and clinical programs."
Bardia currently is an attending physician and director of breast cancer research at Massachusetts General Hospital. He also is an associate professor at Harvard Medical School in Boston. He completed his residency at the Mayo Clinic in Rochester, MN, followed by a fellowship at Johns Hopkins Hospital in Baltimore before joining Massachusetts General Hospital as faculty.
Over the years, he has received several awards including outstanding award for research excellence at Mayo Clinic, Young Investigator Award from the American Society of Clinical Oncology (ASCO), distinguished researcher award from the Massachusetts Society of Clinical Oncologists and the Douglas Family Foundation prize for excellence in oncology research. He was recognized as a Highly Cited Researcher in 2022 and 2023. He is well-regarded among his peers and was also nominated for excellence in mentoring at Harvard Medical School.
"I am thrilled to join one of the best cancer centers in the world, known for its ability to quickly move basic science discoveries into the clinic and transform how we treat cancer globally," said Bardia. "I look forward to working closely with team members and building a patient-centered academic program to accelerate innovative research, help advance the careers of junior faculty members and most importantly, significantly improve the outcomes for patients with cancer."
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Internationally renowned breast medical oncologist joins the David Geffen School of Medicine at UCLA - News-Medical.Net
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Center for Medical Education: Upcoming Events < Yale School of Medicine – Yale School of Medicine
Educator Development Programs
Held at Noon on Zoom
Bimonthly workshops on Fridays
These sessions are designed for Yale School of Medicine educators, from novice to expert, with up-to-date, practical ways to engage and inspire learners in lab, workshop, clinical, and classroom settings.
Monthly groups on Thursdays
This series is for anyone involved in, or interested in getting involved in, medical education. They are designed to address a timely topic of interest, which leads to an engaging discussion among participants.
We would like to highlight a special guest speaker presenting at the February 22 MEDG:
William B. Cutrer, MD, MEd, FAAP, senior associate dean for undergraduate medical education, associate professor, Department of Pediatrics, Critical Care Medicine, Vanderbilt University Medical Center
The Master Adaptive Learner Model: An Innovative Approach to Lifelong Learning
The master adaptive learner (MAL) uses self-regulated learning skills to develop adaptive, efficient, and accurate skills in medical practice. Given the increasingly rapid changes in health care, it is essential that medical students develop into MALs and for faculty educators to acquire the skills to teach them. Dr. Cutrer co-authored the book, The Master Adaptive Learner.
The 12th annual conference will be held in person. The events will include a keynote by Alison J. Whelan, MD, AAMC Chief Academic Officer; workshops; oral presentations; and a poster session.
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The Impact of a New Anesthesiology Residency Program on the Number of Medical Students Matching Into … – Cureus
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The Impact of a New Anesthesiology Residency Program on the Number of Medical Students Matching Into ... - Cureus
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