Stephanie Poley

Continuing effects of Medicare Part D on rural independent pharmacies who are the sole retail provider in their community

BACKGROUND The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established funding to allow Medicare beneficiaries to enroll in plans providing outpatient prescription drug coverage beginning in January 2006. The Medicare Part D program has changed the means by which beneficiaries purchase prescription drugs, impacting the business operations of pharmacies. OBJECTIVES To describe the experiences of rural independently owned pharmacies that are the sole retail pharmacy in their community 1 year after implementation of Medicare Part D, in order to learn if the initial financial and administrative problems associated with the implementation of the program in 2006 resolved over time. METHODS A semistructured interview protocol was used in telephone interviews with 51 pharmacist owners of rural sole community pharmacies in 27 states who were identified through a random sampling process. RESULTS The sole community pharmacists interviewed continue to face challenges directly related to Medicare Part D. Dealing with Part D plans and working with patients during enrollment periods remains administratively burdensome. Reimbursement amounts, complexity of dealing with multiple plans, and timeliness of payments continue to be cited as problems which could threaten the viability of independently owned pharmacies who are the sole retail providers in their communities. CONCLUSIONS Actions should be considered to help sole community pharmacies deal with the ongoing administrative and financial challenges of Part D. To ensure full choice for rural Medicare beneficiaries and full access to pharmaceuticals through the ongoing presence of a local pharmacy, the development of a mechanism to structure prescription reimbursement so that drug acquisition costs and related overhead are covered and a reasonable profit margin provided should be considered. Further study is needed to determine how existing policies and regulations can be modified to ensure reasonable access to pharmacy services for rural Medicare and Medicaid beneficiaries.

Increasing the number of trainees in general surgery residencies: is there capacity?

Purpose General surgeons have decreased as a proportion of the total U.S. surgical workforce. Given the likelihood of increasing shortages of general surgeons, the authors evaluated available expansion capacity of existing general surgery residency programs. Method In November 2009, the authors e-mailed a Web-based questionnaire to the program directors and coordinators of the 246 U.S. general surgery residency programs that were then certified by the Accreditation Council for Graduate Medical Education. Results Of the 246 programs the authors contacted, 123 (50%) completed the survey. Community hospital programs and academic programs had similar response rates (52% and 50%, respectively). Of the 115 program directors who responded to the relevant question, 92 (80%) reported sufficient existing case volume capacity to accommodate additional surgery residents. Both community and academic program directors reported modest expansion capacity: an average of 1.7 and 2.0 additional residents per year, respectively. Across all programs, the average additional capacity reported was 1.9 additional residents per year. An expansion of this size would increase the number of general surgery residency positions from 1,137 to 1,515 annually. After accounting for subspecialization, this increase of 378 residents would result in approximately 249 additional general surgeons entering the workforce per year after five years. Conclusions Expansion capacity within existing approved general surgery residency programs is insufficient to meet the expected demand for general surgeons in the United States. Strategies to alleviate shortages include developing new training programs, cultivating new medical education funding streams, and changing the surgical training paradigm.

The Acshpri: Shaping Surgical Workforce Policy Through Evidence-Based Analyses

Editors note: This article is being published jointly in the Bulletin of the American College of Surgeons and the Bulletin of The Royal College of Surgeons of England. With health reform underway in both countries, the issues confronting the surgical workforce in the US are strikingly similar to the challenges facing the surgical workforce in England. This article describes the American College of Surgeons (ACS) Health Policy Research Institutes (HPRI) role in collecting, analysing and disseminating information about the surgical workforce in the US and suggests that HPRI might serve as a model for The Royal College of Surgeons of England to assist the UK government in workforce planning.