Few professions are as fast-changing and complicated as medicine. It is a constant swirl of new technology, diagnostic and treatment innovations and ever-more-challenging business models.
Lexington journalist Gil Dunn saw an opportunity in 2010 to create a magazine that would help inform physicians about how these changes are playing out in Kentucky.
Dunn recently published issue 97 of MD-Update, a semi-monthly magazine that profiles Kentucky physicians who are doing innovative things. It is a way for doctors in other cities and specialties to get a broader view of their profession in the state.
Dunn and his Louisville-based editor, Jennifer Newton, work with a staff of local freelance writers to produce all of the content, which is reviewed by doctors for accuracy. The independent, advertising-supported magazine is mailed to subscribers and 8,000 physicians and 1,000 other providers around the state.
This spring, Dunn’s company will broaden its audience to patients as well as doctors. MD-Update.com will become an online archive of the magazine’s content, searchable by physician and diagnosis.
The idea is to help patients learn more about doctors and treatment approaches independent of the marketing initiatives that Kentucky’s big health care systems are doing. “Our role can be a third-party source of information,” he said.
I was curious about some of the latest trends in Kentucky medicine, so I talked with Dunn last week about what he and his staff are hearing as they interview physicians around the state.
Dunn said the growth of major research and clinical hubs in Lexington and Louisville now mean that most Kentucky patients don’t need to leave the state for specialized care. Kentucky doctors have trained in some of the nation’s best institutions, and in some cases have become nationally recognized innovators in their specialties.
They also have become leaders in the profession. The current president of the American Medical Association is Dr. Steven Stack, a Lexington emergency physician. Dr. Ardis Hoven, a Lexington infectious-disease specialist, was AMA president three years ago.
One change Dunn has seen is the way physicians work less on their own and more as leaders of teams of health care professionals and technicians. This means more people focused on different aspects of patient care.
Doctors also are working more collaboratively across disciplines and as teams of specialists, realizing that disease is more often than not caused by a variety of factors.
One thing I hear frequently is what makes our health care better now is their ability to diagnose. And treatment plans are much improved.
Gil Dunn, publisher of the Kentucky physician magazine MD-Update
“One thing I hear frequently is what makes our health care better now is their ability to diagnose,” Dunn said. “And treatment plans are much improved.”
A major innovation has been video and small instrument technology that has increased the use of minimally invasive surgery. These procedures result in quicker recoveries and fewer and shorter hospital stays. He expects that trend to continue.
Dunn also sees a more holistic approach to health care, emphasizing prevention and a healthy lifestyle as well as treatment. The magazine’s current cover story profiles one such effort: the University of Louisville’s Institute for Sustainable Health & Optimal Aging.
In the past decade, research and clinical hospitals have merged into big health care systems, such as Baptist Health and Kentucky One. Those systems have bought many physician practices, and patients are often now referred to specialists in the same system as their primary care doctor.
Like sports teams, those systems try to recruit the best physicians, which has resulted in more doctors coming to Kentucky from other parts of the nation and world. Hospital residency and fellowship programs are key to recruiting.
“Doctors have a great tendency to locate permanently where they’ve done either their residency or that fellowship,” Dunn said. “They’re in that age when they’re starting to put down roots. Residencies and fellowships are very key in retention of physicians.”
Dunn said Kentucky physicians seem to be adjusting well to health care reform.
“Initially there was shock and fear that it was going to be the end of the independent physician practice,” he said. “There was a big rush of physicians selling their practices to the health care systems and that has leveled off.”
Physician-owned practices can be challenging now because of the fee schedules and covered treatment limitations imposed by insurance companies, Medicare and Medicaid.
One result is that most young doctors are now going to work for health systems rather than setting up private practices because “it’s too expensive,” Dunn said. “They have too much debt from med school. And it’s a lifestyle issue: being a doctor businessman is an almost impossible model when you have single-payer systems and you can’t set your rate.”