When the doctor’s away

first_imgWhen you’re hospitalized and the regular doctor is out sick, on vacation, or at a conference, you’re increasingly likely to receive treatment not from the doctor’s colleague or another staff physician but by an outsider hired to fill in, like a substitute school teacher.The trend, a multibillion-dollar industry, is fueled by physician staffing shortages and shifting employment patterns.But do these temps — so-called locum tenens physicians — provide the same level of care as the doctors for whom they’re filling in? 
The answer appears to be yes, at least when it comes to death rates in the month following treatment, according to research led by Harvard Medical School (HMS) and published Dec. 5 in the Journal of the American Medical Association.The findings, based on a review of millions of Medicare hospitalization records, provide the first insights into this booming business. The results show that patients treated by substitute doctors and regular hospital staffers had similar death rates in the 30 days following hospitalization.Yet the researchers caution there were some small but statistically significant differences in other measures. Patients treated by substitute physicians had somewhat higher spending and slightly longer hospitalizations.“Our findings so far are reassuring, but some of the trends we found demand that we look more closely at how the system works in a more granular way,” said study senior author Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at HMS.Temporary docs might pick up shifts at a number of hospitals around a single metropolitan area, or they might travel across the country to work in a rural hospital far from their homes, Jena explained.These doctors generally do not have any relationship with their patients, are not familiar with the local community, and may never have worked with the hospital’s electronic health records system, staff, or network of local facilities to which patients may be discharged after hospitalization, the researchers said.The researchers analyzed 1.8 million Medicare hospital admissions that took place between 2009 and 2014, using algorithms that allowed the analysts to compare the results for doctors working with similar patients at similar hospitals. Nearly 40,000 of the 1.8 million admissions received care from substitute doctors. In that time frame, one of 10 physicians was replaced by a substitute doctor.Patients who received care from substitute physicians were no more likely to die within a month of hospital admission (8.8 percent of those patients died) than those who received care by regular staff physicians (8.7 percent died in that group).However, when the researchers analyzed various subgroups within the overall sample, they noticed some worrisome trends. Hospitals that used substitute physicians less often had somewhat worse patient mortality outcomes. Daniel Blumenthal, HMS instructor in medicine at Massachusetts General Hospital and the study’s first author, said the finding might be due to the geographic remoteness of these hospitals, to limited financial resources, or to a lack of robust support systems to help temporary doctors plug into the hospitals’ systems.“As the marketplace shifts and employment patterns fluctuate, we owe it to our patients to make sure that the way we cover for doctors who are out of the office is safe and effective,” Blumenthal said.Co-authors of the study included Andrew Olenski of Columbia University and Yusuke Tsugawa of the University of California, Los Angeles.This study was supported by funding from the Office of the Director, National Institutes of Health.last_img read more

How To: Marlinton, WV

first_imgYou’ve probably never heard of Marlinton. And, after a quick Google search, you might think there’s really no reason this little West Virginia town should have crossed your radar prior to now.Wrong-o.No town sits closer to the bounty of jaw-dropping-beauty that is the Cranberry Wilderness than Marlinton (unless you count the unincorporated cluster of dwellings called Edray). This part of the world might be a little rough around the edges, but that’s what we find so dear about it. Arguably the wildest place east of the Mississippi, the Cranberry Wilderness, a 47,815-acre swath of wilderness in the Monongahela National Forest, affords wildlife, solitude, and rain in spades. Here’s how we like to go outside and play!IMG_2568_MG_5788 _MG_5828_MG_5958 _MG_5978Play: Ditch the car, the phone, the computer, the inbox, pack your bag, and hit the trail. To really experience the Cranberry, you need to immerse yourself in it. For a great 25ish-mile loop, try the North/South Trail-Middle Fork Trail-North/South Trail. Camping at the confluence of Hell For Certain Branch is out-of-this-world remote. The trail is often unmarked, save for a few cairns, and overgrown, so be sure to bring a map with you. And, because this area is designated wilderness, try not to make your own campsite. There are plenty of clearly established campsites along the trail and even shelters once you drop down onto FR76.Not feeling like tackling a backpacking trip? The boardwalk along the Cranberry Glades is absolutely stellar and you’re likely to see plenty of signs of wildlife. Keep a close eye out for pitcher plants and other unique flora that are more commonly found in the arctic-like ecosystems of Canada. FR76 along the Cranberry River is also a great gravel road that is relatively flat and perfect for biking or strolling. Shelters along the river are first come, first serve but there are plenty of options. Even on the busiest of weekends, you’re likely to find an opening.Stay: There are tons of dispersed camping sites along the Cranberry River and Williams River that are available on a first come, first serve basis. Should you want some comforts from home, the Tea Creek Campground is hands down our favorite semi-primitive campground. The sites here are shrouded in rhododendron with the gentle roar of the Williams to lull you to sleep. Rates are somewhere in the vicinity of $10 and there are no showers, but there are vault toilets and potable water available.Eat: It’s slim pickins in Marlinton, but no visit is complete without a hearty breakfast from the Greenbrier Grille and Lodge. Otherwise, it’s recommended you plan ahead and prepare—the nearest legitimate grocery store is just under an hour’s drive away if you want more than gas station offerings._MG_5836 _MG_5867_MG_5782 IMG_2641last_img read more

Haberdasher Hangs His Hat Again in Sea Bright

first_imgBy Michele J. KuhnSEA BRIGHT – In a sense, Brian George is back home.After three months in temporary quarters in Rumson, the longtime area haberdasher has moved his Northshore Menswear shop back to the borough in a new location at 1127 Ocean Ave.After refurbishing the space, George is now ensconced in a building he has nicknamed “big yellow.Brian George, owner of Northshore, stands in his new store at 1127 Ocean Ave. days before moving back to Sea Bright.“If you’re looking for us, just look for the ‘big yellow’ building,” he said recently with a smile as he was preparing to move back to Sea Bright.The store will continue to sell men’s “traditional clothing with a twist,” but is now reintroducing fashion for females. George previously sold women’s clothes but jettisoned that part of the business about eight years ago.When the official grand opening of Northshore is held on Saturday, April 6, George hopes to have space for four lines of women’s apparel – Vineyard Vines, Tori Richards, Island Company and Castaway. “My daughter, Mary, helped me put these lines together,” he said.Meanwhile, Northshore customers have been buying menswear in a makeshift store at 45 River Road in Rumson, in space meant for offices and using the men’s room to try on clothes.The space and his loyal customers have been good to George. The building is the same one he occupied 30 years ago – in three offices on the second floor – when he first opened his store and his customers have followed him there since his Sea Bright store at 1080 Ocean Ave. was substantially damaged and his entire inventory swept out by the tidal surge of Super Storm Sandy.“When the threat of the storm came, we never anticipated what would happen would happen, not in our wildest dreams,” George said. “The year before was Irene and all we got moisture.”Though he prepared for the Oct. 29 storm by putting merchandise higher up and boarding windows, the surge – coupled with extraordinary high winds – broke through. It filled the store with about 8 feet of water and then tore the shop’s contents out through huge gaping holes broken open by the tide along the building’s side wall.George’s merchandise and store fixtures, including two pool tables, were swept away.“I didn’t even have a chance to think … because we were going into the Christmas season. This is the retail business and the fourth quarter is 40 percent, sometimes 50 percent, of your sales and so I couldn’t afford to miss December,” he said. “I had nothing left.”George’s vendors were helpful and after about two weeks of planning and restocking he put together the temporary shop.George had flood insurance so he was able to pay the bills on merchandise that had just washed away and then started anew.He moved into the Rumson building on Dec. 1 and spent three months there. He closed the shop at the end of business on Feb. 27 and was expected to move the contents Feb. 28 and reopen March 1 in Sea Bright. “It has really worked out,” he said.George initially moved to Sea Bright about 10 years ago. He started in the building occupied by Cono’s Sea Bright Pizza, which he owned. When he sold that, he moved to 1080 Ocean Ave.Now he is in a building he has “always loved.” He calls it a “classic building … and it hasn’t changed much.”George has overseen the renovation of the space. There are white cabinets, hardwood floors, Oriental rugs and traditional mahogany furnishings.“I’m very proud of the way it looks … It’s nice and clean and kind of beachy,” he said. “We’re really excited.”George is a big supporter of Sea Bright. As an officer in the Businesses of Sea Bright group, he has high hopes for its rebuilding.“Believe it or not, behind the scenes in some of these buildings, there is cleaning up being done,” he said. “There is progress going on. But, the lifeblood of the town is in the downtown business district. Even the governor said, if the business district gets together, the whole town will feel better.”George is working to do just that.“I think Sea Bright will be better than ever. It’s just going to be a matter of time and people have to be patient.”last_img read more

Bomber boys romp to provincial soccer berth with 3-0 win over Creston

first_imgThe L.V. Rogers Bombers pitched a pair of shutouts en route to capturing the Kootenay High School AA Boy’s Soccer Championships Saturday in Creston.Simon Sheppard scored twice and Ryan Lewis added a single sparking the Bombers past the Prince Charles Comets 3-0 in the Championship Final Saturday afternoon.”The team showed superior possession play throughout the tournament,” the coaching staff off Dave and Jamie Spendlove exclaimed after the game.LVR entered the game as the top-ranked team and received a bye into the semi final of the six-team tournament.The Bombers advanced to the final by easily picking apart the David Thompson Lakers of Invermere 5-0. Lewis led the charge offensively with a pair of goals. Danny Rodman, Luis Loeschnick, and Cormac Southam, on a penalty shot, also scored for the Bombers.The Lakers got past Stanley Humphries Rockers in quarterfinal play.Andrew Woodward and Cole Sutherland registered wins in goal for the Bombers.LVR now advances to the 16-team B.C. High School Boy’s Soccer Championships November 19-21 in Burnaby.OVERTIME: Saturday’s win marks the first time in three years a team from LVR has advanced to the boy’s soccer provincials. The past two seasons, at the AAA level, Mount Baker Trojans of Cranbrook defeated the Bombers to advance the the provincial tournament — 3-2 in 2010 and 3-1 in overtime in 2011. . . .The Bombers padded their goal average stats with the two shutouts. In 11 games this season, LVR has scored 50 times while allowing only four goals.last_img read more