Kulesi sigaba sochungechunge lwe-Prioritizing Equity, funda ngokungalingani kwasendulo nokwamanje emfundweni yezokwelapha, emisebenzini, kanye namathuba obuholi.
Uchungechunge lwamavidiyo e-Prioritizing Equity luhlola ukuthi ukulingana ekunakekelweni kwezempilo kubumba kanjani ukunakekelwa ngesikhathi sobhubhane lwe-COVID-19.
Izinga lokunakekelwa alinqunywa ukuthi linikezwa kanjani, ngakho-ke izinsizakalo ze-telehealth kumele zigcinwe ezindinganisweni ezifanayo nezokunakekelwa mathupha.
Engqungqutheleni ye-ChangeMed®️ ka-2023, uBrian George, MD, MS, wathola umklomelo we-2023 Accelerating Change in Medical Education Award. Ukuze ufunde kabanzi.
Ukwethula isayensi yezinhlelo zezempilo ezikoleni zezokwelapha kusho ukuthola ikhaya layo kuqala. Funda kabanzi kubafundisi bezokwelapha asebekwenzile.
Izibuyekezo ze-AMA zimboza izihloko ezahlukahlukene zezempilo ezithinta impilo yodokotela neziguli. Thola ukuthi ungayithola kanjani imfihlo yohlelo lokuhlala oluphumelelayo.
Izibuyekezo ze-AMA zimboza izihloko ezahlukahlukene zezempilo ezithinta impilo yodokotela neziguli. Thola ukuthi ungayithola kanjani imfihlo yohlelo lokuhlala oluphumelelayo.
Ukumiswa kokukhokha imali mboleko yabafundi sekuphelile. Thola ukuthi lokhu kusho ukuthini kodokotela nokuthi yiziphi izinketho abanazo.
Umfundi wezokwelapha noma umhlali angakha kanjani isethulo esihle sephosta? Lawa macebiso amane ayisiqalo esihle.
I-AMA ku-CMS: Thatha isinyathelo esisheshayo ukuqinisekisa ukuthi odokotela abatholi ukulungiswa kwenkokhelo ye-MIPS ngo-2024 ngokusekelwe ekusebenzeni kwe-MIPS ka-2022 kanye neminye imininingwane ekhonjwe kusibuyekezo sakamuva esikhuthaza ukuguqulwa kwenkokhelo ye-Medicare.
Funda ukuthi i-CCB itusa kanjani izinguquko kuMthethosisekelo we-AMA kanye neMithetho kaMasipala futhi isiza kanjani ekubuyekezeni imithetho, imithethonqubo kanye nezinqubo zezingxenye ezahlukene ze-AMA.
Thola imininingwane kanye nolwazi lokubhalisa lwemihlangano nemicimbi ye-Young Doctors Section (YPS).
Thola i-ajenda, amadokhumenti kanye nolwazi olwengeziwe loMhlangano We-YPS Waphakathi Nonyaka ka-2023 ngomhlaka-10 Novemba eGaylord National Resort and Convention Center eNational Harbor, eMaryland.
Ingqungquthela Yokumela Abafundi Bezokwelapha YaseMelika Yenhlangano Yezokwelapha Yango-2024 (i-MAC) izobanjelwa kusukela mhla ziyi-7 kuya ku-8 kuNdasa 2024.
Izinto Ezibalulekile Ze-Sepsis: I-webinar yokugcina ochungechungeni lwe-webinar lwe-Centers for Disease Control and Prevention (CDC) ixoxa ngomthelela wemfundo ye-sepsis ekuqashweni kwabasebenzi bezempilo. Bhalisa.
Izibuyekezo ze-AMA zimboza izihloko ezahlukahlukene zezempilo ezithinta izimpilo zodokotela, izakhamuzi, abafundi bezokwelapha kanye neziguli. Lalela ochwepheshe bezokwelapha, kusukela kubaholi bezokwelapha abazimele kanye nohlelo lwezempilo kuya kososayensi kanye nezikhulu zezempilo zomphakathi, nge-COVID-19, imfundo yezokwelapha, ukumela, ukukhathala, imijovo yokugoma nokuningi.
Ku-AMA News yanamuhla, owayenguMongameli we-AMA uGerald Harmon, MD, ujoyina ingxoxo yokuntuleka kwabasebenzi bezokwelapha kanye nokubaluleka kodokotela asebekhulile. UDkt. Harmon wabelana ngemicabango yakhe ngendima yakhe entsha njengomphathi wesikhashana we-University of South Carolina School of Medicine eColumbia, umsebenzi wakhe njengephini likamongameli wezindaba zezokwelapha eTidelands Health ePawleys Island, eSouth Carolina, nokuthi yini edingekayo ukuze uzulazule emkhakheni wezokwelapha. njengodokotela. Amathiphu okuthi ungahlala kanjani usebenza. Odokotela abangaphezu kweminyaka engama-65 ubudala. Umphathi: Isikhulu Esiphezulu Se-AMA uTodd Unger.
Ngemva kokulwela odokotela ngesikhathi sobhubhane, i-American Medical Association ithatha inselelo yayo elandelayo engavamile: ukuqinisa ukuzibophezela kwesizwe kodokotela.
Unger: Sawubona futhi wamukelekile kuvidiyo ne-podcast ye-AMA ebuyekeziwe. Namuhla sikhuluma ngokuntuleka kwabasebenzi kanye nokubaluleka kodokotela abadala ekuxazululeni le nkinga. Le nkinga ixoxwa lapha nguDkt. Gerald Harmon, umphathi wesikhashana we-University of South Carolina School of Medicine eColumbia, eSouth Carolina, kanye nowayengumongameli we-AMA, noma ngamazwi akhe, “umongameli we-AMA obuyiselwe esikhundleni.” NginguTodd Unger, isikhulu Esiphezulu Solwazi lwe-AMA Chicago. UDkt. Harmon, ngiyajabula ukukwazi. Unjani?
UDkt. Harmon: Todd, lowo ngumbuzo othakazelisayo. Ngaphezu kwendima yami njengoSihlalo Wokululama we-AMA, ngithole indima entsha. Kule nyanga nje, ngiqale indima entsha emsebenzini wami njengoSosayensi Wezinhlelo Zezempilo Oyinhloko kanye noDean Wesikhashana weSikole Sezokwelapha eNyuvesi yaseNingizimu Carolina eColumbia, eSouth Carolina.
UDkt. Harmon: Nokho, lezo yizindaba ezinkulu. Kwakuwushintsho lomsebenzi olungalindelekile kimi. Othile ungithinte mayelana neziqu zakhe kanye nokulindela kwakhe. Nginomuzwa wokuthi kimi lokhu kuwumdlalo owenziwe ezulwini, uma kungenjalo umdlalo owenziwe ezulwini okungenani phakathi kwezinkanyezi.
Unger: Nokho, ngiyaqiniseka ukuthi lapho bebheka i-resume yakho, bahlabeke umxhwele ngezinye zezinto ozifezile. Ubungudokotela womndeni osebenzayo iminyaka engama-35, umsizi kadokotela ohlinzayo jikelele we-United States Air Force, udokotela ohlinzayo jikelele we-National Guard, futhi, vele, muva nje, uMongameli we-AMA. Lokho akulona ngisho nengxenye yempi. Ngokuqinisekile uzuze ilungelo lokuthatha umhlalaphansi, kodwa uqala isahluko esisha ngokuphelele. Yini ebangela lokhu?
UDkt. Harmon: Ngicabanga ukuthi kwaba yimina engiqaphela ukuthi ngisenalo ithuba lokwabelana nabanye ngolwazi lwami lwempilo. Igama elithi “udokotela” livela olimini lwesiLatini futhi lisho “ukuthwala noma ukufundisa.” Nginomuzwa wokuthi ngisakwazi ukufundisa, ukwabelana ngolwazi lwami lwempilo, kanye nokunikeza imfundo kanye nesiqondiso (uma kungesona isiqondiso) esizukulwaneni sodokotela abaqeqeshwayo ngisho nodokotela abasebenzayo. Ngakho-ke kwakukuhle kakhulu ukuba yiqiniso ukuthatha indima yomsizi wocwaningo ngenkathi ngigcina amakhono ami okufundisa emtholampilo. Ngakho-ke angikwazanga ukwenqaba leli thuba.
UDkt. Harmon: Nokho, indima yokuba nguprofesa yinto engingakaze ngiyibone ngaphambili. Nganginguprofesa wasekolishi futhi ngifundisa amakilasi (ngangifundisa ngokoqobo) mathupha kunokuba nginikeze amamaki nokuhlolwa okubhaliwe kubafundi, izakhamuzi, kanye nabanye ochwepheshe bezempilo (abahlengikazi, odokotela be-radiology, odokotela be-sonographer, abasizi bodokotela). Eminyakeni eminingi yokusebenza kwami engu-35-40, nganginguthisha, uthisha osebenzayo. Ngakho-ke le ndima ayiyona into entsha.
Ukukhanga kwezemfundo akunakubhekwa njengokunganakwa. Ngiyafunda – angisebenzisi lesi sifaniso hhayi ngepayipi lomlilo, kodwa ngamabhakede ebhakede. Ngicela abantu bangifundise ulwazi olulodwa ngesikhathi. Ngakho omunye umnyango uletha ibhakede lakhe, omunye umnyango uletha ibhakede lakhe, umphathi uletha ibhakede lakhe. Ngabe sengithatha ibhakede esikhundleni sokugcwala ngepayipi lomlilo bese ngiminza. Ukuze ngikwazi ukulawula amaphuzu edatha kancane. Sizozama elinye ibhakede ngesonto elizayo.
Unger: Dkt. Harmon, imigomo ovula ngayo isahluko esisha lapha iyathakazelisa. Ngesikhathi esifanayo, siyazi ukuthi odokotela abaningi bakhetha ukuthatha umhlalaphansi kusenesikhathi noma ukusheshisa ngenxa yobhubhane. Uke wakubona noma wezwa lokhu kwenzeka phakathi kozakwenu?
UDkt. Harmon: Ngikubonile ngesonto eledlule, Todd, yebo. Sinedatha ephakathi nobhubhane, mhlawumbe inhlolovo yedatha ye-AMA ka-2021-2022, ekhombisa ukuthi u-20%, noma oyedwa kwabahlanu odokotela, uthe bazothatha umhlalaphansi. Bazothatha umhlalaphansi ezinyangeni ezingu-24 ezizayo. Lokhu sikubona phakathi kwabanye ochwepheshe bezempilo, ikakhulukazi abahlengikazi. U-40% wabahlengikazi (ababili kwabahlanu) bathi ngizoshiya indima yami yobuhlengikazi bezokwelapha eminyakeni emibili ezayo.
Ngakho-ke yebo, njengoba ngishilo, ngikubone lokhu ngesonto eledlule. Benginodokotela osezingeni eliphakathi owamemezela ukuthi usethathe umhlalaphansi. Ungudokotela ohlinzayo, uneminyaka engu-60 ubudala. Uthe: Ngiyayeka ukusebenza. Lo bhubhane ungifundise ukuthatha izinto ngokungathi sína kakhulu kunokusebenza kwami. Ngisesimweni esihle sezezimali. Ngasekhaya, udinga ukuchitha isikhathi esiningi nomndeni wakhe. Ngakho wanquma ukuthatha umhlalaphansi ngokuphelele.
Nginomunye umuntu engisebenza naye omuhle kwezokwelapha umndeni. Eqinisweni, umkakhe weza kimi ezinyangeni ezimbalwa ezedlule wathi, “Uyazi, lo bhubhane ubeke ingcindezi enkulu emndenini wethu.” Ngacela uDkt. X, umyeni wakhe, kanye nozakwethu emsebenzini wami ukuthi behlise umthamo. Ngoba uchitha isikhathi esiningi ehhovisi. Lapho ebuya ekhaya, wahlala ekhompyutheni wenza wonke umsebenzi wekhompyutha ayengenaso isikhathi sawo. Wayematasa ebona inani elikhulu leziguli. Ngakho-ke uyayeka. Wayengaphansi kwengcindezi evela emndenini wakhe. Unezingane ezinhlanu.
Konke lokhu kubangela ukucindezeleka okukhulu kodokotela abaningi asebekhulile, kodwa labo abaseminyakeni ephakathi nomsebenzi, abaneminyaka engu-50 nangaphezulu, basengozini enkulu yokucindezeleka, njengezizukulwane zethu ezisencane.
Unger: Okungenani kwenza isimo sokuntuleka kodokotela sibe nzima kakhulu esisibonayo kakade. Eqinisweni, ucwaningo olwenziwe yi-Association of American Medical Colleges lubikezela ukuthi ukushoda kodokotela kuzoba ngu-124,000 ngo-2034, okuhlanganisa inhlanganisela yezici esisanda kuxoxa ngazo, inani labantu asebekhulile kanye nenani labasebenzi bodokotela asebekhulile.
Njengodokotela wezokwelapha womndeni wangaphambili okhonza abantu abaningi basemakhaya, ucabangani ngalokhu?
UDkt. Harmon: Todd, uqinisile. Ukuntuleka kodokotela kuya ngokuya kuba kubi kakhulu, noma okungenani ngokwe-logarithmic, hhayi nje ngokungeza nokususa. Odokotela bayaguga. Sikhuluma ngeqiniso lokuthi eminyakeni eyishumi ezayo, iziguli e-US zizoba neminyaka engu-65 noma ngaphezulu, kanti u-34% wazo manje uzodinga ukunakekelwa kwezokwelapha. Eminyakeni eyishumi ezayo, abantu abangu-42% kuya ku-45% bazodinga ukunakekelwa kwezokwelapha. Badinga ukunakekelwa okwengeziwe. Ukhulume ngokuntuleka kodokotela. Lezi ziguli ezindala zidinga ukunakekelwa okuphezulu, futhi eziningi zihlala ezindaweni zasemakhaya ezinabantu abambalwa.
Ngakho-ke njengoba odokotela bekhula, ukuthatha umhlalaphansi akushiyi ngemuva uquqaba lodokotela nabasebenzi bezempilo abafuna ukuya ezindaweni zasemakhaya, abafuna ukuya ezindaweni ezingakatholakali kahle. Ngakho-ke, isimo ezindaweni zasemakhaya sizoba sibi kakhulu. Kunjengokungathi iziguli endaweni ziyaguga futhi inani labantu ezindaweni zasemakhaya alikhuli. Asiboni futhi ukwanda kwenani labasebenzi bezempilo abathuthela kulezi zindawo zasemakhaya.
Ngakho-ke kufanele siqhamuke nobuchwepheshe obusha, imibono emisha, ukwelashwa ngocingo, ukunakekelwa okusekelwe eqenjini ukusiza ukuhlangabezana nezidingo zabantu baseMelika abaswele usizo.
Unger: Inani labantu liyakhula noma liyaguga, kanti nodokotela nabo bayaguga. Lokhu kudala igebe elikhulu. Ungabheka nje idatha eluhlaza ukuthi lelo gebe libukeka kanjani?
UDkt. Harmon: Ake sithi isizinda sodokotela samanje sikhonza iziguli ezingu-280,000. Njengoba inani labantu base-US likhula, manje lingama-34% kanye nama-42% kuya kuma-45% eminyakeni eyishumi, ngakho-ke njengoba ubonile, ngicabanga ukuthi lawo manani acishe abe ngu-400,000. Ngakho-ke leli yigebe elikhulu. Ngaphezu kwesidingo esilindelwe sodokotela abengeziwe, uzodinga nodokotela abengeziwe ukuze bakhonze inani labantu asebekhulile.
Ake ngikutshele. Hhayi odokotela kuphela. Lona udokotela we-radiology, lo umhlengikazi, ingasaphathwa eyokuthi abahlengikazi bathatha umhlalaphansi kanjani. Izinhlelo zethu zezibhedlela ezindaweni zasemakhaya zaseMelika zigcwele: azikho izangoma ze-sonographer ezanele, izangoma ze-radiology, kanye nochwepheshe belebhu. Zonke izinhlelo zezempilo e-United States sezivele zinwetshiwe ngenxa yokuntuleka kwabasebenzi bezempilo bazo zonke izinhlobo.
Unger: Ukulungisa noma ukuxazulula inkinga yokushoda kodokotela manje kusobala ukuthi kudinga ikhambi elihlanganisa zonke izinhlangothi. Kodwa ake sixoxe ngokuqondile. Ucabanga ukuthi odokotela asebekhulile bangena kanjani kulesi sixazululo? Kungani befaneleka kakhulu ekunakekeleni abantu asebekhulile?
UDkt. Harmon: Kuyathakazelisa lokho. Ngicabanga ukuthi akungabazeki ukuthi okungenani bazozwelana, uma kungenjalo bazozwelana, neziguli ezifikayo. Njengoba nje sikhuluma ngabaseMelika abaneminyaka engu-65 nangaphezulu abakha u-42% wabantu, lolu hlobo lwabantu lubonakala nasemsebenzini wodokotela: odokotela abangu-42-45% nabo baneminyaka engu-65. Ngakho-ke bazoba nokuhlangenwe nakho okufanayo empilweni. Bazokwazi ukuqonda ukuthi ngabe kungumkhawulo wemisipha yamalunga, ukwehla kwengqondo noma ukwehla kwezinzwa, noma umkhawulo wokuzwa nokubona, noma mhlawumbe ngisho nokugula esikutholayo njengoba sikhula, isifo senhliziyo. isifo sikashukela.
Sixoxe ngendlela i-podcast engiyenzile ebonise ngayo ukuthi abantu baseMelika ababalelwa ezigidini ezingu-90 banesifo sikashukela esingakafiki, kanti amaphesenti angu-85 kuya kwangu-90 abo abazi nokuthi banesifo sikashukela. Ngenxa yalokho, abantu asebekhulile baseMelika nabo bathwele umthwalo wezifo ezingamahlalakhona. Uma sifika ezinhlwini zodokotela, uzothola ukuthi banozwela, kodwa futhi banokuhlangenwe nakho empilweni. Banekhono. Bayazi ukuthi bangaxilonga kanjani.
Ngezinye izikhathi ngithanda ukucabanga ukuthi odokotela abangontanga yami nami singacabanga futhi senze ngisho nokuxilonga ngaphandle kobuchwepheshe obuthile. Akudingeki sicabange ngeqiniso lokuthi uma lo muntu enenkinga encane ngesistimu yezitho ezithile, ngeke ngikwenze i-MRI noma i-PET scan noma yiluphi uhlobo lokuhlolwa kwelabhorethri. Ngingabona ukuthi lokhu kuqubuka kuyi-shingles. Lokhu akuyona i-contact dermatitis. Kodwa kungenxa yokuthi bengilokhu ngibona iziguli iminyaka engu-35 noma engu-40 kuphela lapho nginohlu lwezengqondo olungisiza ukusebenzisa lokho engikubiza ngokuthi ubuhlakani bomuntu bangempela, hhayi ubuhlakani bokwenziwa, ekuxilongweni.
Ngakho-ke akudingeki ngenze zonke lezi zivivinyo. Ngingakwazi ukuxilonga kusengaphambili, ngelaphe futhi ngiqinisekise abantu asebekhulile ngempumelelo.
Unger: Lokhu okulandelayo okuhle kakhulu. Ngifuna ukukhuluma nawe kabanzi ngale ndaba mayelana nobuchwepheshe. Uyilungu elisebenzayo le-Senior Doctorian Division, uveza imibono futhi wenza izincomo ezindabeni ezithinta odokotela abaphezulu. Enye yezinto eziphakama kakhulu muva nje (eqinisweni, 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: Nokho, uke wangibona ngaphambili – ngikhulume obala ezinkulumweni nasemaphaneli – sidinga ukwamukela lobu buchwepheshe obusha. Ngeke buphele. Lokho esikubonayo kubuhlakani bokwenziwa (i-AMA isebenzisa leli gama futhi ngivumelana kakhulu nalo) ubuhlakani obuthuthukisiwe. Ngoba ngeke buyithathe indawo yale khompyutha ngokuphelele lapha. Sinamakhono athile okwahlulela nokwenza izinqumo ngisho nemishini engcono kakhulu engenakuwafunda.
Kodwa sidinga ukuba yingcweti kulobu buchwepheshe. Akudingeki sibambezele intuthuko yakhe. Akudingeki sibambezele ukubusebenzisa. Akudingeki sibambezele ukuqoshwa kwe-elekthronikhi esikhuluma ngakho ngokuhlambalazayo. Lobu ubuchwepheshe obusha. Ngeke buphele. Lokhu kuzothuthukisa ukuhlinzekwa kwezinsizakalo zokunakekelwa. Lokhu kuzothuthukisa ukuphepha, kunciphise amaphutha, futhi ngicabanga, kuthuthukise ukunemba kokuxilonga.
Ngakho odokotela badinga ngempela ukwamukela lokhu futhi bakuqaphe. Kuyithuluzi, njenganoma yini enye. Kufana nokusebenzisa i-stethoscope, ukusebenzisa amehlo akho, ukuthinta nokubuka abantu. Kuthuthukisa amakhono akho, hhayi isithiyo.
Unger: UDkt. Harmon, umbuzo wokugcina. Yiziphi ezinye izindlela odokotela abanquma ukuthi abasakwazi ukunakekela iziguli abangahlala ngazo bekhuthele emisebenzini yabo? Kungani kuzuzisa odokotela kanye nomsebenzi ukugcina uxhumano oluqinile kangaka?
UDkt. Harmon: Todd, wonke umuntu wenza izinqumo zakhe endaweni yakhe esebenzisa idatha yakhe. Ngakho-ke, nakuba udokotela engase abe nemibuzo mayelana nekhono lakhe, ukuphepha kwakhe, kungakhathaliseki ukuthi kusegumbini lokuhlinza noma endaweni yokulaliswa esibhedlela lapho usanda kwenza khona ukuxilongwa, awudingi ngempela ukwenza imishini noma ukuhlinzwa. Kukhona ukushintshashintsha okuvamile. Sonke sidinga ukukhathazeka ngalokhu.
Okokuqala, uma ukhathazekile ngempela, uma ungabaza amakhono akho, okungokwengqondo noma okungokomzimba, khuluma nosebenza naye. Ungabi namahloni. Sinenkinga efanayo ngempilo yokuziphatha. Uma ngikhuluma namaqembu odokotela, ngiyazi ukuthi sikhuluma ngokukhathala kodokotela. Sikhuluma ngezinkinga zomsebenzi nokuthi sicasukile kangakanani. Idatha yethu ikhombisa ukuthi odokotela abangaphezu kuka-40% babecabanga ngezinketho zabo zomsebenzi—ngisho ukuthi, lelo inani elithusayo.
Isikhathi sokuthunyelwe: Okthoba-13-2023