A US hospital director is now 30 X less likely to have medical training than 30 years ago

Shouldn’t Doctors Control Hospital Care? New York Times

• “Today, < 5 % of America’s roughly 6,500 hospitals are run by chief executives with medical training”

• “Independent practices are also disappearing, as hospitals buy them up and put doctors on salary”

  • Comment by VitaminDWiki
    • A doctor used to be rewarded for evolving the best ways to provide health – no longer

• “For example, doctors are being pressed to discharge patients quickly — sometimes too quickly — to maintain “throughput.”

• “There is a focus on increasing the rates of profitable procedures, such as orthopedic and heart surgeries, at the expense of relatively poorly remunerated general medical care.”

The author of this New York Times article, Sandeep Jauhar, also wrote a book on the topic in 2014

Doctored: The Disillusionment of an American Physician $7

Now most doctors have many barriers to trying new ways to improve the health of patients

When doctors had individual practices they were rewarded for improving the health of patients - both prevention and treatment

Now they are given no reward for prevention nor treatment

See also VitaminDWiki

• Sepsis is both prevented and treated by Vitamin D - many studies
  • However, decreasing sepsis decreases hospital business
• VA showed increased vitamin D associated with lower health costs - Lancet May 2012
  • However, Vitamin D testing decreases hospital business

• ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017

• 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016

  • However, giving Vitamin D before the ICU decreases hospital business
• Pregnant women were 2.6 times more likely to stop smoking when given financial rewards – RCT Jan 2015
  • Financial rewards work, Why not give doctors financial rewards?
• Give Vitamin D to all fracture patients – cd ost effective to prevent nonunions – Aug 2016
  • However, nonunions bring in more business))

• Omega-3 supplementation during pregnancy reduce early preterm births (save 1500 USD per child) – Aug 2016

  • However, pre-term births increases hospital income

  There are a few health systems which economicall benefit from improved patient health

• Concierge medicine would benefit from healthier patients (vitamin D)

• HMOs will save millions of dollars with vitamin D