The shortage of primary care physicians may have a negative impact on society, but it could be fixed

Throughout the past several years, more medical school students are choosing to become specialists over generalists (also called primary care physicians, or PCPs for short). Generalists, or PCPs, are those who provide and manage general care for patients; someone you would see for general check-ups and have knowledge in every area. Specialists, on the other hand, focus only on one aspect of care, like cardiologists or dermatologists for instance. This trend is so serious that according to the Association of American Medical Colleges (AAMC), "The U.S. will face a shortage of more than 90,000 primary care physicians by 2020 and 130,000 by 2025." With the impending Affordable Care Act upon us, millions of previously uninsured citizens will now have access to healthcare requiring the need of more primary care physicians. However, it appears that there are some plans to try and limit the problem as much as possible.

Benefits of primary care are not as advantageous as those for becoming a specialist
Currently, less than 25% of graduating medical school students express an interest in a generalist career, and that number is decreasing steadily. According to a Robert Graham Center study, the strongest negative predictor of primary career choice was expected income in primary care compared to that of specialty care, which cut the odds of choosing a primary care career in half. With the average debt of medical students in 2009 around $132,000, most students are deciding to make a decision that best fits their financial needs. Top ranked specialists can see annual salaries around $365,000 while primary care physicians bring home around $177,000 on average. The income gap between generalists and specialists has grown to nearly 3-fold, resulting in an income disparity of around $3.5 million throughout a 40 year career. 

Students feel primary care work is more meaningful
but also comes with more work and stress

Lower quality of life, higher workload, lower prestige, and more stress, are other indirect factors as to why students are not choosing primary care positions. According to a study based on students' views on primary care, the current generation, "millenials", still aspire to excellence as older generations did, but they tend to not want to sacrifice quality of life for career growth.




Affordable Care Act will force us to need more generalists
The physician shortage for our country is going to be magnified for two main reasons: the baby boomer generation is growing older and the newly planned Affordable Care Act (ACA) will soon be implemented. As baby boomers grow older, the demand for physicians is going to increase due to a greater proportion of older people needing health care. As the Affordable Care Act gets implemented, an estimated 14 million previously uninsured people will now begin to seek care from an already depleted amount of physicians. Further adding to the problem is that nearly half of the country's 830,000 physicians are over the age of 50 and are seeing fewer patients then they were four years ago.

The new Act is getting some backlash from current physicians as well. Deloitte conducted a research study where 6 in 10 physicians said it is likely many doctors will retire earlier than planned in the next one to three years. Physicians are now being forced to see a larger number of patients and they feel their reimbursement rate isn't enough for the stark increase in workload. 

Deborah Rivkin, Vice President of Government Affairs for CareFirst BlueCross BlueShield, discusses the implications of the ACA on a state like Maryland. She states that there seems to already be an issue with the amount of PCPs Maryland currently has and this is even before the introduction of millions into the system.

Citizens in southern, western, and eastern Maryland could be most affected because there is about to be a large influx of people into the system and these areas are already have a low amount of PCPs. Deborah goes on to mention how the ACA will create a "network" where other members of the health care system will start getting involved in order to combat some of the shortage we already face.

Plans are in place to try and fix the physician shortage in the future
As the baby boomers get older and the physician shortage continues, new solutions need to be developed in order to combat the growing problem. New research has indicated that new primary care models using nurse practitioners and physician assistants (PA's) could "eliminate" the scarcity of primary care doctors. In fact, researchers at the Rand Corp. estimate that an expansion of patient centered medical homes and nurse managed health centers could eliminate 50% or more of the primary care physician shortage in the U.S. by 2025. Most of these new models indicate that these nurse practitioners and PA's would reach out to patients, make sure they are taking their medications, and are adhering to doctor's orders. The American Academy of Physician Assistants is expecting 10,000 new PA's by 2020. By empowering nurse practitioners and PA's, they are able to provide some, if not most, of the same care that PCPs give to patients.

In a study done by the AAMC, medical schools are also doing their part by enrolling more students into medical programs as well as encouraging these students to pursue generalist careers. The AAMC had recommended a 30% increase in medical school enrollment by 2015, which would be an increase of about 4,946 students for a total of 21,434 students. The study shows that they will reach this 30% increase of first-year medical enrollment in 2017-2018 and that new schools will help with this large growth. Schools also stated that they either had or were planning at least one initiative to increase student interest in primary care and 38% of these schools will implement these changes in the next two years. These initiatives include changes in curriculum, extracurricular opportunities, or expanded faculty resources and training. Deborah offers her own thoughts as to what should be done based on what she experiences in her daily work.



Our country is clearly seeing an issue with the amount of students choosing to become primary care physicians. It is evident that there are some clear benefits for students deciding to specialize; higher pay, less workload, and to some extent, a higher prestige in the medical world. The Affordable Care Act will clearly pose an issue due to the fact we are going to see a mass influx of new citizens into the system, but there are at least some programs in place to try and curb the unfavorable trend. Deborah states that the "network" of people in the health care system will have to grow in order to take some of the workload off current physicians and that there should be some incentive programs for students in the future. It will be interesting to see how much of an effect this trend will have given what we know about the issue and the plans we have to try and fix it before it is too late.

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The shortage of primary care physicians may have a negative impact on society, but it could be fixed

Introduction:
Over the recent years, those in medical school are choosing to become specialists over generalists (or primary care physicians). In general, specialists tend to make more money than generalists and many students are coming out of medical school with more debt hence why they are choosing to become specialists. They can craft their expertise into one specific area as opposed to being a general practitioner. But, this could have negative implications in the future as the country already faces a shortage of primary care physicians with the Affordable Care Act soon to be implemented fully and millions are going to be guaranteed health care.

1. Discuss differences between specialists and generalists
2. Discuss why students are deciding to become specialists over generalists (http://archinte.jamanetwork.com/article.aspx?articleid=227186)
3. Interview Question: Do you see any issues right now with the fact that there are less primary care physicians than specialists?

Subheading: Affordable Care Act will force us to need more generalists

1.  There is already a mass shortage of generalists right now
• The U.S. will face a shortage of more than 90,000 primary care physicians by 2020 and 130,000 by 2025, according to nonprofit firm the Association of American Medical Colleges (AAMC).
2.  What will happen in years to come
3.  Interview question: With the impending Affordable Care Act, what do you see happening with the supply of doctors performing primary care services?

Subheading: Studies may show the situation is not as severe as once thought

1. Nurse practitioners and PA's are being more empowered with more responsibility so the loss doesn't appear as severe
2. There are proposed solutions to the shortage crisis
3. Researchers at the nonprofit research organization Rand Corp. say an expansion of patient-centered medical homes and “nurse-managed” health centers  “could help eliminate 50 percent or more of the primary care physician shortage” in the U.S. by 2025

Subheading: A shortage will still exist, so what is being done to fix it?

1. Medical schools offering more loans and grants to students
2. Medical schools taking in larger number of students
3. Interview Question: In your work, what should be done to encourage more students to become generalists

Conclusion: Right now it appears as though we are in a great shortage of physicians that the country will need to address soon. Some believe we are in trouble while others believe we can curb the issue by giving more responsibility to physician assistants and nurses. As of now, there are programs medical schools are utilizing to encourage those to become primary care physicians. Time will tell if the nation is really in a state of emergency regarding this shortage.

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Audio Summary

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Anonymous Free Information Services like Freenet Impact Us Politically, Socially, and Economically

A Peer-to-peer network (P2P) is a decentralized network in which individual "peers" are connected with one another allowing for information to be shared. P2P networks have been very popular for many years; services like Napster and Gnutella come to mind due to their criticism of illegal music sharing. Another P2P network that is drawing some positive and negative criticism is a service called Freenet, a free software service that allows individuals to anonymously send files without the fear of censorship.

Freenet was designed and started by Ian Clarke who wanted to create a service where people could publish and share files without the fear of being censored or blocked. Users of Freenet contribute to the network by giving hard drive space where encrypted data can be stored. The encrypted data and the fact that the data is transferring through many peers make it nearly impossible to find out where the information originated. Essentially, Freenet was designed to allow for anonymous file sharing, chatting, browsing, and publishing of sites without the fear of censorship. These principles may open the door for some potential positive and negative consequences.

Freedom of speech and press were the main goals:
One of the main principles of a service like Freenet is the protection of freedom of speech and freedom of press, allowing you to publish or share anything on the network. They accomplish this by allowing users to remain anonymous on the network, encrypting the files shared, and transmitting the information through many peers. As discussed above, users contribute some of their hard drive space for the storage of data on the network. The least popular information is discarded to make room for new, more popular information; this seems like its own data "policing" mechanism. An obvious consequence to this anonymity is when potential threats are made and the author cannot be located. With stories like Edward Snowden in the news recently, Freenet seems to be a way for users to share and publish information without the threat of government intervention or tracking.

Anonymity could be dangerous for society:
Completely anonymous sharing of information allows everyone to almost "hide behind the computer screen" with everything that they choose to post. This information they hide behind may be some type of illegal activity that would put a normal person at risk for some serious repercussions. In a recent interview, Clarke was asked about the potential for illegal acts like the sharing of child pornography over the network. Clarke responded by saying that it was unfortunate that this information could be shared, but he would not police it considering it goes against Freenet's principles. Just recently, the government shut down the Silk Road, an online drug trafficking marketplace. Users could browse it anonymously and securely, just like with Freenet. Despite the Silk Road solely being for drug trafficking, it gives light to the circumstance that Freenet could potentially do some similar type of activities and if it could be taken down as well.

File sharing hurts industry, but could generate publicity for artists:
In the 2000s, music sales have decreased drastically due to file sharing. People are no longer buying CDs due to the ease of being able to download them from P2P networks, such as Freenet. People are always find ways to get around the system and illegally downloading copyrighted content through P2P networks is one of them. According to a Forrester Research, "just 44% of U.S. Internet users and 64% of Americans who buy digital music think that that music is worth paying for." Once people can figure out a way to get something for free, it's hard to go back to the way it was before. On the flip side, there are those who believe that file sharing is good for general publicity despite the fact the public isn't paying for their material. Metallica, for example, was a band that made a vast majority of its money from touring; over $20 million versus about $1.5 million from album sales. I feel that the argument can go both ways. Of course musicians/artists are losing out on revenue due to file sharing, but maybe the ultimate goal of a musician is to generate publicity to buy concert tickets and merchandise where they can make the most money.


There are many political, economic, and social effects with any P2P network. However, the fact that Freenet is based on anonymity changes the situation slightly. There are potential advantages of that as well as some drawbacks. Freenet mainly provides an outlet for those to publish and share anything they want with almost no consequences. Ian Clarke's goal was to provide individuals with this outlet so they could have freedom of speech and press and I believe he did so effectively, despite there being both positives and negatives to the system.

The Washington Post, The Chicago Tribune, and Miami Herald discuss similar national and world news but differ in regional news

Being that it is distributed in the capital of our nation, The Washington Post primarily brings national and political news to the public’s attention. The Chicago Tribune and the Miami Herald, on the other hand, detail events that are pertinent to that city or region. Having said that, there are stories in The Washington Post that are discussed in The Chicago Tribune and the Miami Herald.

The Washington Post’s homepage is organized in that there is national political news at the top and as you scroll down the more localized it gets. It also discusses the other headings in the newspaper like opinion, business, and sports. The Chicago Tribune and the Miami Herald actually have local news at the top and in order to get to national news you must click on tabs at the top to navigate away from the home page.

These newspapers all talk about many of the same national topics despite being on different parts of the website. Since The Washington Post is based in D.C., the front-page headlines are about the looming government shutdowns and the implications of Obamacare. These stories are also included in The Chicago Tribune and the Miami Herald but they are at different locations on their website.

We can see that all three of the articles display the facts of the looming government shutdown. The Republicans want to delay Obama’s new healthcare law for a year but negotiations are at a standstill with the shutdown looming next week. Despite being on different locations on the newspaper’s website, they still cover the main facts of what is being talked about in Washington.

The Washington Post also discusses international news, such as Syria, on its homepage. The Chicago Tribune and Miami Herald also link to articles about Syria, but not on its homepage; you have to navigate to the “World Politics” sections on their respected websites. In all three, the overall theme of Syria was the same, but discuss different topics. For example, The Washington Post commented how Syria’s toxins can be defeated easily, The Chicago Tribune outlined how the U.S. and Russia agree on a Syrian chemical arms measure, and the Miami Herald stated how the price of oil is being affected with our involvement in Syria. While the story is different in each newspaper, the overall topic of Syria is discussed in all three websites.

It is interesting to note how localized the other newspapers are; the Miami Herald’s homepage is about hunting for tegu lizards and the Chicago Tribune’s homepage is about how auditors caught a fraud in the region. News prominent in The Chicago Tribune is about Chicago, IL and news prominent in the Miami Herald is about Miami, FL. If you want national or international news, you have to find it yourself since it isn’t on the homepage like The Washington Post. Despite highlighting different articles because they are in different regions, all three newspapers touch upon many of the same articles in different locations of their website.

Addiction to Social Media is most likely not possible

Addiction is really defined as something that people do not have control over, either taking or using. Their bodies simply cannot live without taking or using something because it makes them feel uncomfortable if they do not have it. After reading the article, I agree with Professor Yaros in his explanation of a social media "addiction". I don't think anyone can truly be addicted to social media; it's mainly the convenience factor that is making people think there is an addiction. People can live without checking Twitter, Facebook, etc. and live a normal life. But when you have the ability to check it instantaneously on your phone at any location, that's when people start to beg the question on if there is an addiction, which I believe there is not. The reason I think this is because I am probably the biggest user of Twitter I know; I check Twitter multiple times when I am in class and sometimes sit there just refreshing the page in hopes of more information. My use of Twitter may lead some people to think I am addicted to Twitter, when in reality, I just like the ability and convenience to check the news and other information that is happening in the world at any time. I can go hours without using Twitter with no problem, but if I have the opportunity, why not check and see what is going on in the world at that time? Having said that, I do think it can be very distracting. Sometimes I will be in class and forget what was being taught because I was so entrenched in what news was being updated on Twitter. Personally, my device is more distracting than helpful in class, but that is just because I sometimes do not have self control with checking it. There shouldn't be any rule that governs the use of it in school just because some people, like myself, are being distracted when other people are perfectly capable of learning and using it. There are just a lot of potential games, news, messages, social media sites that can be a distraction to students in class. Using Nearpod in Professor Yaros's class is helpful in that it keeps students on the same slide and focused on what is being discussed at that time. Using social media can be helpful if being used for the right purposes, but as for myself, reading Twitter to find out news for my favorite sports team is only distracting and not useful.

http://www.medicalnewstoday.com/info/addiction/

Video games and TV are near equals when it comes to influence on the public

I don’t think that highly interactive mediums, like video games, have more of an effect on media users than passive mediums do.  I believe that it is more about how entrenched an individual is with the game or show that determines how they react. Take the game ‘Grand Theft Auto’ and the show ‘Dexter’ for instance. Grand Theft Auto forces players to kill civilians and police officers and rewards them if they escape without getting arrested or killed. ‘Dexter’ is about a normal, average forensic scientist who is a serial killer but he kills “those who deserve to die” and has not been caught by authorities. Both have clear, violent themes but to say one is more violent than the other is not correct. What is true in both cases is that there is a reward for not getting caught, something that many individuals can get a thrill out of. Because ‘Dexter’ and Grand Theft Auto are so realistic, it gives the impression that a normal, average individual could execute the same stunts they portray in the show in real life. Whether or not it is a highly interactive medium or passive medium is irrelevant because of how realistic both of those mediums seem to the average viewer; it has the same effect. Rachel Reilly of Mail Online discusses how there is no direct correlation that people become more violent after playing these games. In fact, it would be more unusual if one of these mass murderers had never played a violent game before in their life. A similar study by Wilbur Schramm, Jack Lyle, and Edwin Parker was talked about in the text; even if children were exposed to the same type of violence in TV, there is no direct cause that this was the reason for any violent behavior in real life. Could there be a correlation? Yes, but there cannot be a direct link between the two. Because of this, I don't believe that highly interactive mediums could have any more impact on media users than passive mediums do; they both are realistic enough to make the average viewer think they could pull off the same stunts in real life.

http://www.dailymail.co.uk/health/article-2403032/Violent-video-games-like-Grand-Theft-Auto-DONT-harm-children--therapeutic.html