EPtalk by Dr. Jayne 3/25/21

Last week marked Match Day 2021, which is the day that the majority of the graduating physicians in the US learn where they’ll spend the next several years training. According to the National Resident Matching Program, which runs the residency program application process, this was the largest Match on record. More than 48,000 people applied for 38,000 available positions, and 95% of the positions were filled. Nearly 6,000 programs participated in Match Day. Primary care specialties such as family medicine, pediatrics, and internal medicine made up about half of the positions available for first-year residents. The number of MD medical students applying broke records with 19,866 applicants; DO applicants participating in The Match also broke records at 7,101.

Due to the COVID-19 pandemic, residency programs had to conduct interviews online and students were challenged to figure out which schools might be a good fit without having the benefit of visiting them in person. Overall, nearly 95% of the offered positions were filled. Although many specialties recruited a majority of US seniors, some specialties like pathology had less than 50% of its positions filled by US grads. The number of international grads applying who are US citizens increased this year, although their success rate remained static. The count of international grads applying who are not US citizens grew by over 1,000, representing a 15% increase from last year and resulting in the highest number of matched candidates ever.

The success of non-US citizen international grads seemed to surprise some given the restrictions on travel, but I would argue that being able to interview via videoconference might have placed them on a more equal footing as their US citizen competitors. Although it might be harder to select your top training programs without in-person visits, the graduating seniors I’ve spoken with are happy that they didn’t have to accrue tens of thousands of dollars of additional debt crisscrossing the country. Congratulations to everyone heading off to training. It’s a brave new medical world and we’re happy to have you in it.

For patients suffering from prolonged symptoms related to COVID-19, the condition finally has a name. Anthony Fauci, MD announced that it will be called Post-Acute Sequelae of SARS-CoV-2 infection, or PASC. The National Institutes of Health will be starting research to further study the condition, which can happen even when patients have mild initial infections. Some of the symptoms include: fatigue, “brain fog” or trouble focusing, digestive issues, depression, anxiety, sleep disturbance, and decreased lung function. A recent study from the University of Washington found that 30% of the patients had symptoms that lasted up to nine months. Other viral infections such as varicella (chicken pox) can have manifestations that don’t appear for decades, as anyone who has experienced an episode of shingles can attest. I certainly hope COVID-19 doesn’t have another shoe waiting to drop in the future.

DoorDash is slated to offer same-day delivery of COVID-19 test collection kits through partnerships with Vault Health and Everlywell. The kits will initially be available in Chicago, Dallas, Cleveland, Phoenix, Baltimore, Denver, and Minneapolis with other cities to follow. The test kits are approved under FDA Emergency Use Authorization. The Vault Health kit costs $119 and uses a saliva test that requires proctoring via Zoom. The Everlywell kit costs $109 and features a nasal swab that can be performed without observation.

Researchers at the University of Cincinnati are working on a drone that can facilitate telehealth visits and even enter the home to assess living conditions. The drone includes a compartment to carry laboratory specimens and supplies and includes audio-visual tools. Researchers liken it to the telehealth robots that hospitals are using within brick-and-mortar environments and hope that it can assist in management of chronic conditions, health coaching, and consultations.

I spend the majority of my time looking at how technology impacts healthcare, but the pandemic has uncovered ways that low-tech services could really make a difference. I was surprised to read a recent piece in JAMA Internal Medicine that addressed unmet basic healthcare needs. The study found that more than 42% of individuals with decreased ability to bathe or toilet independently lacked equipment that could help them – things such as shower chairs, raised toilet seats, and grab bars. As a representative sample, it could indicate that more than 5 million people have unmet needs. The study participants were followed for more than four years to determine if they eventually acquired the assistive equipment. Approximately 35% of those with bathing needs and 52% of those with toileting needs never received it. Such low-cost interventions can reduce injuries, promote independence, and improve quality of life. Sure, it’s not as sexy as mRNA vaccines or monoclonal antibodies, but we should be able to do better.

A headline on “How Hospitals are Using AI to Teach Physicians to Better Express Empathy” caught my eye recently. Startup company Virti has been working with hospitals, including Cedars-Sinai Medical Center (which is also an investor) and the UK’s National Health Service, to use AI-powered virtual patients to coach patients on bedside manner. The animations are designed to test users on empathetic interactions and interpersonal skills while collecting data on performance. The software can be used on smart phones or computers and there is also an option for virtual reality headsets. Users are scored on their speed, what questions they asked, and whether they arrived at an accurate diagnosis.

Mr. H recently ran a poll on company culture, asking respondents to compare current culture to a year ago. Responses had a fairly equal distribution – 33% “about the same,” 32% “worse,” and 26% “better” with 9% reporting they have changed employers, quit working, or don’t have an employer. I had the opportunity to think about this in depth this week as I spent some time with an executive recruiter. The conversation was made more enjoyable by the fact that it occurred in New Orleans and involved cocktails, which always makes things more interesting.

We also had a chance to talk about toxic workplace culture, which I’ve experienced several times in my career. It’s always interesting in healthcare when leadership promotes safety publicly, but does not support it behind the scenes. I’ve heard reports from several institutions recently as staff are refused adequate personal protective equipment (PPE) while caring for COVID-19 patients. One of my nursing colleagues reported that additional PPE was delivered to their unit for a media visit, and then the carts full of isolation gowns and face shields were removed once the reporters left. Another hospital was floating specialized nurses (such as labor and delivery nurses) to medical/surgical units, where they were not comfortable caring for patients outside their usual scope of practice. Only after a half dozen nurses resigned did they decide that it was probably not the best plan. Organizations are offering meditation rooms and wellness apps to employees that are stressed to the max rather than adjusting caregiver to bed ratios or looking at other tangible solutions.

How is your workplace culture evolving to meet the new normal? Leave a comment or email me.

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