Kulesi sitolimende sochungechunge lwe-Prioritizing Equity, funda ngokungalingani komlando nokwamanje kwezemfundo yezokwelapha, ukuqashwa, namathuba obuholi.
Uchungechunge lwevidiyo ye-Prioritizing Equity luhlola ukuthi ukulingana ekunakekelweni kwezempilo kukulolonga kanjani ukunakekelwa phakathi nobhadane lwe-COVID-19.
Izinga lokunakekelwa alinqunywa indlela elethwa ngayo, ngakho izinsiza zezempilo kufanele zigcinwe ezindinganisweni ezifanayo nezokunakekelwa komuntu mathupha.
Engqungqutheleni ka-2023 ye-ChangeMedEd®️, uBrian George, MD, MS, uthole umklomelo we-2023 osheshisa ushintsho kuMklomelo Wezemfundo Yezokwelapha.Ukuze ufunde kabanzi.
Ukwethula isayensi yezinhlelo zezempilo ezikoleni zezokwelapha kusho ukuqala ngokuyitholela ikhaya.Funda okwengeziwe kothisha bezokwelapha abaye bakwenza.
Izibuyekezo ze-AMA zihlanganisa izihloko eziningi zokunakekelwa kwezempilo ezithinta izimpilo zodokotela neziguli.Thola ukuthi ungathola kanjani imfihlo yohlelo lokuhlala oluphumelelayo.
Izibuyekezo ze-AMA zihlanganisa izihloko eziningi zokunakekelwa kwezempilo ezithinta izimpilo zodokotela neziguli.Thola ukuthi ungathola kanjani imfihlo yohlelo lokuhlala oluphumelelayo.
Ukumiswa kokukhokhwa kwemali mboleko yabafundi kuphelile.Thola ukuthi lokhu kusho ukuthini kodokotela nokuthi yiziphi izinketho abanazo.
Umfundi wezokwelapha noma umhlali angadala kanjani isethulo esihle sephosta?Lawa macebiso amane ayisiqalo esihle.
I-AMA eya ku-CMS: Thatha isinyathelo esisheshayo sokuqinisekisa ukuthi odokotela abazitholi izinguquko zenkokhelo ye-MIPS ngo-2024 ngokusekelwe ekusebenzeni kwe-MIPS ka-2022 kanye nenye idatha ehlonzwe kusibuyekezo sakamuva esimela ukuguqulwa kwezinkokhelo ze-Medicare.
Funda ukuthi i-CCB incoma kanjani izinguquko kuMthethosisekelo we-AMA Nemithetho Yedolobha futhi isize ukubuyekeza imithetho, izimiso nezinqubo zezingxenye ezihlukahlukene ze-AMA.
Thola imininingwane nolwazi lokubhalisa lwemihlangano nemicimbi Yesigaba Sodokotela Abancane (YPS).
Thola i-ajenda, imibhalo kanye nolwazi olwengeziwe loMhlangano we-YPS Midterm ka-2023 ngoNovemba 10 e-Gaylord National Resort and Convention Centre e-National Harbor, Maryland.
I-2024 American Medical Association Medical Student Advocacy Conference (MAC) izoba ngoMashi 7-8, 2024.
Izakhi Ezibalulekile Ze-Sepsis: I-webinar yokugcina ochungechungeni lwe-webinar yeCenters for Disease Control and Prevention (CDC) ixoxa ngomthelela wemfundo ye-sepsis ekuqashweni kwabasebenzi bezempilo.Bhalisa.
Izibuyekezo ze-AMA zihlanganisa uchungechunge lwezihloko zokunakekelwa kwezempilo ezithinta izimpilo zodokotela, izakhamuzi, abafundi bezokwelapha neziguli.Izwa kochwepheshe bezokwelapha, kusukela kubaholi abazimele nabesistimu yezempilo kuya kososayensi nezikhulu zezempilo zomphakathi, nge-COVID-19, imfundo yezokwelapha, ukukhulumela, ukutubeka, imigomo nokunye.
Ezindabeni ze-AMA zanamuhla, owayenguMongameli we-AMA uGerald Harmon, MD, ujoyina ingxoxo yokushoda kwabasebenzi bezokwelapha kanye nenani lodokotela asebekhulile.UDkt. Harmon wabelana ngemicabango yakhe ngeqhaza lakhe elisha njengomphathi wesikhashana we-University of South Carolina School of Medicine e-Columbia, umsebenzi wakhe njengephini likamongameli wezindaba zezokwelapha e-Tidelands Health e-Pawleys Island, eNingizimu Carolina, kanye nokuthi yini edingekayo ukuze uzulazule. insimu yezokwelapha.ensimini njengodokotela.Amathiphu okuthi ungahlala kanjani usebenza.Odokotela abangaphezu kweminyaka engama-65 ubudala.Umsingathi: Isikhulu Esiphezulu Sesipiliyoni se-AMA u-Todd Unger.
Ngemuva kokulwela odokotela phakathi nalolu bhubhane, i-American Medical Association ithatha inselelo elandelayo engajwayelekile: iqinisekisa ukuzibophezela kwesizwe kodokotela.
Unger: Sawubona futhi wamukelekile kuvidiyo ebuyekeziwe ye-AMA ne-podcast.Namuhla sikhuluma ngokushoda kwabasebenzi kanye nokubaluleka kodokotela asebekhulile ekuxazululeni le nkinga.Lolu daba luxoxwa lapha nguDkt. Gerald Harmon, umqondisi wesikhashana we-University of South Carolina School of Medicine e-Columbia, eNingizimu Carolina, nowayengumongameli we-AMA, noma ngamazwi akhe, “umongameli we-AMA obuyiselwe esikhundleni.”Ngingu-Todd Unger, Isikhulu Esiphezulu Solwazi se-AMA Chicago.UDkt. Harmon, ngiyajabula ukukwazi.Unjani?
UDkt. Harmon: Todd, lowo umbuzo othakazelisayo.Ngaphezu kwendima yami njengoSihlalo Wokubuyisela I-AMA, ngithole indima entsha.Kule nyanga nje, ngiqale indima entsha emsebenzini wami wokuba nguSosayensi Omkhulu Wesistimu Yezempilo kanye Nesikhulu Sesikhashana SeSikole Sezokwelapha eNyuvesi yaseNingizimu Carolina e-Columbia, eNingizimu Carolina.
UDkt. Harmon: Nokho, izindaba ezinkulu lezo.Kwakuwushintsho lomsebenzi engangingalulindele kimi.Kukhona ongithintile mayelana neziqu zabo nalokho abakulindele.Ngizizwa sengathi kimina lokhu kuwumdlalo owenziwe ezulwini, uma kungewona umdlalo owenziwe ezulwini okungenani phakathi kwezinkanyezi.
Unger: Hhayi-ke, nginesiqiniseko sokuthi lapho bebheka kabusha kwakho, bahlabeke umxhwele ngezinye zezinto ozifezile.Ube ngudokotela womndeni osebenzayo iminyaka engama-35, Umsizi Wodokotela Ohlinzayo Jikelele we-United States Air Force, Udokotela Ohlinzayo Jikelele we-National Guard, futhi, eqinisweni, muva nje, uMongameli we-AMA.Akuyona ngisho nengxenye yempi leyo.Impela ulizuzile ilungelo lokuthatha umhlalaphansi, kodwa uqala isahluko esisha.Yini ebangela lokhu?
UDkt. Harmon: Ngicabanga ukuthi kwakuyimina engangiqaphela ukuthi ngisenalo ithuba lokuhlanganyela okuhlangenwe nakho kwami nabanye ekuphileni.Igama elithi “dokotela” livela esiLatini futhi lisho “ukuthwala noma ukufundisa.”Ngempela nginomuzwa wokuthi ngisengakwazi ukufundisa, ukwabelana nabanye okuhlangenwe nakho kwami kokuphila, futhi nginikeze imfundo nesiqondiso (uma kungenjalo isiqondiso) esizukulwaneni sodokotela abaqeqeshwe ngisho nodokotela abasebenzayo.Ngakho-ke bekukuhle kakhulu ukuba yiqiniso ukuthatha indima yomsizi wocwaningo ngenkathi ngigcina amakhono ami okufundisa emtholampilo.Ngakho angikwazanga ngempela ukwenqaba leli thuba.
UDkt. Harmon: Yebo, indima ye-provost yinto engingakaze ngiyibone ngaphambili.Nganginguprofesa wasekolishi futhi ngifundisa amakilasi (afundiswa ngokoqobo) mathupha esikhundleni sokunikeza amamaki nokuhlola okubhaliwe kubafundi, izakhamuzi, nabanye ochwepheshe bezempilo (abahlengikazi, izazi ze-radiologists, izazi zesonographer, abasizi bodokotela).Esikhathini esiningi seminyaka yami engama-35-40 yokuprakthiza, benginguthisha, uthisha osebenzayo.Ngakho le ndima ayiyona into engavamile.
Isikhalazo sezemfundo asikwazi ukubukelwa phansi.Ngiyafunda – lesi sifaniso angisebenzisi ipayipi lomlilo, kodwa ngamabhakede.Ngicela abantu bangifundise ulwazi olulodwa ngesikhathi.Ngakho omunye umnyango uletha ibhakede labo, omunye umnyango uletha ibhakede labo, umphathi ulethe ibhakede labo.Ngabe sengithatha ibhakede esikhundleni sokugcwala ipayipi lomlilo ngigwilize.Ngakho ngiyakwazi ukulawula amaphuzu edatha kancane.Sizozama elinye ibhakede ngesonto elizayo.
Unger: Dr. Harmon, amagama ovula ngawo isahluko esisha lapha ayathakazelisa.Ngasikhathi sinye, siyazi ukuthi odokotela abaningi bakhetha ukuthatha umhlalaphansi kusenesikhathi noma basheshise ngenxa yalolu bhubhane.Uke wakubona noma ukuzwile lokhu kwenzeka kozakwenu?
UDkt. Harmon: Ngiyibonile ngesonto eledlule, Todd, yebo.Sinedatha yamaphakathi nobhubhane, mhlawumbe inhlolovo yedatha ye-AMA ka-2021-2022, ekhombisa ukuthi u-20%, noma udokotela oyedwa kwabahlanu, uthe bazothatha umhlalaphansi.Bazothatha umhlalaphansi phakathi nezinyanga ezingama-24 ezizayo.Lokhu sikubona phakathi kwabanye ongoti bezempilo, ikakhulukazi abahlengikazi.U-40% wabahlengikazi (ababili kwabahlanu) bathi ngizoyishiya indima yami yobuhlengikazi eminyakeni emibili ezayo.
Ngakho-ke, njengoba ngishilo, ngikubone lokhu ngesonto eledlule.Nganginodokotela osezingeni eliphakathi owamemezela ukuthi uthatha umhlalaphansi.Ungudokotela ohlinzayo, uneminyaka engu-60 ubudala.Uthe: Ngiyawushiya umkhuba wokuzilolonga.Lo bhubhane ungifundise ukuthatha izinto ngokungathi sína kunomkhuba wami.Ngisesimweni esihle ngokwezimali.Ngaphambili ekhaya, udinga ukuchitha isikhathi esengeziwe nomndeni wakhe.Ngakho wanquma ukuhoxa ngokuphelele.
Nginomunye engisebenza naye omuhle kwezokwelapha zomndeni.Eqinisweni, umkakhe weza kimi ezinyangeni ezimbalwa ezedlule wathi, “Uyazi, lolu bhubhane lufake ingcindezi enkulu emndenini wethu.”Ngacela uDkt X, umyeni wakhe, kanye nozakwethu emsebenzini wami ukuba behlise umthamo.Ngoba uchitha isikhathi esiningi ehhovisi.Lapho ebuyela ekhaya, wahlala kukhompyutha wenza wonke umsebenzi wekhompyutha ayengenaso isikhathi sawo.Wayematasa ebona inqwaba yeziguli.Ngakho uyanciphisa.Ubengaphansi kwengcindezi yomndeni wakhe.Unezingane ezinhlanu.
Konke lokhu kubangela ukucindezeleka okukhulu kodokotela abaningi asebekhulile, kodwa labo abaphakathi nendawo, abaneminyaka engu-50 nangaphezulu, basengozini enkulu yokucindezeleka, njengezizukulwane zethu ezincane.
Unger: Okungenani kwenza isimo sokushoda kodokotela sibe nzima esesivele sisibona.Eqinisweni, ucwaningo olwenziwa yi-Association of American Medical Colleges luveza ukuthi ukushoda kodokotela kuzofika ku-124,000 ngo-2034, okuhlanganisa inhlanganisela yezinto esisanda kuxoxa ngazo, inani labantu asebekhulile kanye nezisebenzi zodokotela asebekhulile.
Njengodokotela wangaphambili wemithi yomndeni osebenzela abantu abaningi basemaphandleni, ithini imibono yakho ngalokhu?
UDkt. Harmon: Todd, uqinisile.Ukushoda kodokotela kuya kuba kubi kakhulu, noma okungenani ngokwe-logarithmically, hhayi nje ngokungeza nokukhipha.Odokotela bayaguga.Sikhuluma ngeqiniso lokuthi eminyakeni eyishumi ezayo, iziguli zase-US zizoba neminyaka engama-65 noma ngaphezulu, futhi ama-34% azo manje azodinga ukunakekelwa kwezokwelapha.Kule minyaka eyishumi ezayo, abantu abangama-42% kuya ku-45% bazodinga ukunakekelwa kwezempilo.Badinga ukunakekelwa okwengeziwe.Ubalule ukushoda kodokotela.Lezi ziguli esezikhulile zidinga ukunakekelwa okusezingeni eliphezulu, futhi eziningi zihlala ezindaweni zasemakhaya ezigqagqene.
Ngakho-ke njengoba odokotela bekhula, ukuthatha umhlalaphansi akushiyi ngemuva izikhukhula zodokotela nabasebenzi bezempilo abafuna ukuya ezindaweni zasemakhaya, abafuna ukuya ezindaweni ezivele zingasebenzi.Ngakho, isimo ezindaweni zasemakhaya sizoba sibi kakhulu.Sengathi iziguli endaweni ziyaguga futhi nenani labantu basemakhaya alikhuli.Asiboni futhi ukwanda kwesibalo sabasebenzi bezempilo abafudukela kulezi zindawo zasemakhaya.
Ngakho-ke kufanele siqhamuke nobuchwepheshe obusha, imibono emisha, i-telemedicine, ukunakekelwa okusekelwe eqenjini ukusiza ukuhlangabezana nezidingo zaseMelika yasemaphandleni enganakiwe.
Unger: Isibalo sabantu siyakhula noma siyaguga, nodokotela nabo bayaguga.Lokhu kudala igebe elibalulekile.Ungakwazi yini ukubuka idatha eluhlaza ukuthi lelo gebe libukeka kanjani?
UDkt. Harmon: Ake sithi isizinda sodokotela samanje sisebenzela iziguli ezingama-280,000.Njengoba inani labantu baseMelika likhula ngeminyaka, selingama-34% manje kanye nama-42% kuye kwangama-45% eminyakeni eyishumi, ngakho-ke njengoba niphawulile, ngicabanga ukuthi lezo zinombolo zingabantu ababalelwa ku-400,000.Ngakho-ke lesi yigebe elikhulu.Ngaphezu kwesidingo esicatshangelwayo sodokotela abengeziwe, uzodinga nodokotela abengeziwe ukuze usize abantu asebekhulile.
ake ngikutshele.Hhayi odokotela kuphela.Lona ngudokotela oyi-radiologist, lona umhlengikazi, ayisaphathwa eyokuthi abahlengikazi bathathe umhlalaphansi.Izinhlelo zethu zezibhedlela ezisemaphandleni aseMelika zixakile: abekho ochwepheshe be-sonographer abanele, ochwepheshe be-radioologist, nochwepheshe baselabhorethri.Lonke uhlelo lokunakekelwa kwezempilo e-United States seluvele lunwetshiwe ngenxa yokushoda kwabasebenzi bezempilo bazo zonke izinhlobo.
Unger: Ukulungisa noma ukuxazulula inkinga yokushoda kodokotela manje kudinga ngokusobala isixazululo samazwe amaningi.Kodwa ake sikhulume ngokuqondile.Ucabanga ukuthi odokotela asebekhulile bangena kanjani kulesi sixazululo?Kungani bekufanelekela ngokukhethekile ukunakekela abantu asebekhulile?
UDkt. Harmon: Kuyathakazelisa lokho.Ngicabanga ukuthi akungabazeki ukuthi okungenani bazozwelana, uma bengazwelana neziguli ezifikayo.Njengoba nje sikhuluma ngabantu baseMelika abaneminyaka engu-65 nangaphezulu abakha u-42% wabantu, lesi sibalo sabantu siphinde sibonakale kubasebenzi bodokotela: ama-42-45% odokotela nawo aneminyaka yobudala engama-65. Ngakho bayoba nakho okufanayo ekuphileni.Bazokwazi ukuqonda ukuthi ingabe ukulinganiselwa okuhlangene kwe-musculoskeletal, ukwehla kwengqondo noma izinzwa-cognitive, noma ukulinganiselwa kokuzwa nombono, noma mhlawumbe ngisho ne-comorbidity esiyitholayo njengoba sikhula, isifo senhliziyo.isifo sikashukela..
Sikhulume ngokuthi i-podcast engiyenzile ikhombise kanjani ukuthi abantu baseMelika ababalelwa ezigidini ezingama-90 bane-prediabetes, futhi amaphesenti angama-85 kuye kwangama-90 abo abazi nokuthi banesifo sikashukela.Ngenxa yalokho, abantu baseMelika abaguga nabo bathwele umthwalo wezifo ezingapheli.Uma singena ezinhlwini zodokotela, uzothola ukuthi banozwelo, kodwa futhi banolwazi lwempilo.Banesethi yamakhono.Bayakwazi ukwenza ukuxilongwa.
Ngezinye izikhathi ngithanda ukucabanga ukuthi odokotela abangontanga yami nami singacabanga futhi senze ukuxilonga ngaphandle kobuchwepheshe obuthile.Akudingekile ukuba sicabange ngeqiniso lokuthi uma lo muntu enenkinga encane nalokhu noma leso simiso sezitho zomzimba, ngeke ngempela ngenze i-MRI noma i-PET scan noma noma yikuphi ukuhlolwa kwaselabhorethri.Ngingasho ukuthi lokhu kuqubuka ama-shingles.Lokhu akuyona i-dermatitis yokuxhumana.Kodwa kungenxa yokuthi sekuphele iminyaka engu-35 noma engu-40 ngibona iziguli nginenkomba yengqondo engisiza ukuba ngisebenzise lokho engikubiza ngokuthi ukuhlakanipha kwangempela komuntu, hhayi ubuhlakani bokwenziwa, ukuze ngixilongwe.
Ngakho-ke akufanele ngenze zonke lezi zivivinyo.Ngingakwazi ukuxilonga kusengaphambili, ngelaphe futhi ngiqinisekise abantu asebekhulile.
Unger: Lokhu kulandelana okuhle kakhulu.Ngifuna ukukhuluma nawe kabanzi ngalolu daba mayelana nobuchwepheshe.Uyilungu elisebenzayo le-Senior Physician Division, uzwakalisa imibono futhi wenza izincomo ezindabeni ezithinta odokotela abaphezulu.Enye yezinto eza kakhulu kamuva nje (empeleni, bengikhuluma kakhulu ngobuhlakani bokwenziwa emasontweni ambalwa edlule) umbuzo wokuthi odokotela asebekhulile bazozivumelanisa kanjani nobuchwepheshe obusha.Yiziphi iziphakamiso onazo mayelana nalokhu?I-AMA ingasiza kanjani?
UDkt. Harmon: Hhayi-ke, uke wangibona ngaphambili - ngike ngakhuluma esidlangalaleni ezifundweni nasemaphaneli - sidinga ukwamukela lobu buchwepheshe obusha.Ngeke ihambe.Esikubona kubuhlakani bokwenziwa (i-AMA isebenzisa leli gama futhi ngivumelana nayo kakhulu) ubuhlakani obungeziwe.Ngoba ayisoze yashintsha ngokuphelele le khompyutha lapha.Sinamakhono athile okwahlulela nawokwenza izinqumo angakwazi ukufunda ngisho nemishini engcono kakhulu.
Kodwa sidinga ukwenza kahle lobu buchwepheshe.Akumele sibambezele inqubekela phambili yakhe.Asikho isidingo sokulibala ukuyisebenzisa.Akudingekile ukuba simise ukurekhodwa kwe-elekthronikhi esikhuluma ngakho ngendlela ehlambalazayo.Lobu ubuchwepheshe obusha.Ngeke ihambe.Lokhu kuzokwenza ngcono ukuhlinzekwa kwezinsiza zokunakekela.Lokhu kuzothuthukisa ukuphepha, kunciphise amaphutha futhi, ngicabanga, kuthuthukise ukunemba kokuxilongwa.
Ngakho odokotela badinga ngempela ukwamukela lokhu futhi bakuqaphe.Kuyithuluzi, njenganoma yini enye.Kufana nokusebenzisa i-stethoscope, usebenzisa amehlo akho, ukuthinta nokubheka abantu.Kuthuthukisa amakhono akho, hhayi isithiyo.
Unger: UDkt. Harmon, umbuzo wokugcina.Yiziphi ezinye izindlela odokotela abanquma ukuthi ngeke besakwazi ukunakekela iziguli bahlale bekhuthele emisebenzini yabo?Kungani kunenzuzo kodokotela kanye nomsebenzi ukugcina ukuxhumana okuqinile kangaka?
UDkt. Harmon: Todd, wonke umuntu uzenzela izinqumo endaweni yakhe yonke esebenzisa idatha yakhe.Ngakho-ke, nakuba udokotela engase abe nemibuzo mayelana nekhono lakhe, ukuphepha kwakhe, kungakhathaliseki ukuthi usegunjini lokuhlinza noma endaweni yesiguli esingalaliswayo lapho usanda kuxilongwa khona, awenzi ngempela izinsimbi noma ukuhlinzwa.Kukhona ukushintshashintsha okuvamile.Sonke sidinga ukukhathazeka ngalokhu.
Okokuqala, uma ukhathazeke ngempela, uma ungabaza amakhono akho, ingqondo noma ngokomzimba, khuluma nozakwenu.Ungabi namahloni.Sinenkinga efanayo ngempilo yokuziphatha.Uma ngikhuluma namaqembu odokotela, ngiyazi ukuthi sikhuluma ngokutubeka kodokotela.Sikhuluma ngezinkinga zabasebenzi nokuthi sikhungatheke kangakanani.Imininingwane yethu ibonisa ukuthi odokotela abangaphezu kuka-40% bebecabangela izinketho zabo zemisebenzi—ngiqonde ukuthi, leyo inombolo ethusayo.
Isikhathi sokuthumela: Oct-13-2023