Curious Bioethics, March 18-25, 2023
Child Labor Laws, Match Day, Cigna, William Carlos Williams
Hey there, Curious Human!
In today’s curated collection, you’ll find:
Bioethics in the News: Child Labor Laws, Match Day, Cigna denies claims without reading them, and hospitals close labor and delivery units because they don’t have doctors.
What I’m Reading: How abortion restrictions changed Match Day, Telepsychiatry and the DEA, physician-poet Willam Carlos Williams
Bioethics in the News
Child Labor Laws are Under Attack
Several states (Arkansas, Iowa, and Ohio) are suddenly rolling back long-standing child labor laws. This will put younger and younger teens at risk of severe physical injury and exploitation. Child labor jeopardizes children’s health. In places like Ohio, where kids cannot consent to almost any medical care, they will be able to work long hours but not consent to non-emergency medical care for any injuries they may sustain. Importantly, kids who are working long hours are not in school. Migrant children are especially vulnerable to this exploitation throughout the country - not just in states actively seeking to put children to work. Kids can’t vote, so this puts more young people in the labor pool without representation.
Match Day
Match Day is the day when most medical students in the U.S. find out where they will complete their residency training - like an apprenticeship for physicians.
The biggest news out of Match Day 2023 was that 555 Emergency medicine spots went unfilled. This is more than double the unfilled spots last year. This is a multifactorial issue - related to employment predictions, COVID, and massive moral injury (especially in EM), among other factors.
Bryan Carmody has some of the most insightful Tweets on residency and the Match. Below he shows the most significant changes in EM, followed by a series of additional tweets on the winners and losers this year based on Match data.
Cigna Doctors Reject Claims Without Reading Them
ProPublica’s newest reporting reveals that doctors working for one of the country’s largest insurers routinely deny patients’ claims without opening their files.
It’s not unusual for me to hear from friends or family that their insurance company refused to reimburse them for the care they’ve already received. This is the painful inflection point where many folks learn that the primary goal of insurance companies is to deny as many claims as possible. This shifts the work to the patient and their care team to fight for coverage. It’s an exhausting uphill battle.
For many of us who have interacted with insurance, we know the “peer” physician review system is a sham - both for prior authorizations and for reimbursement. ProPublica’s report shows how Cigna took denials further by implementing a bulk denial system. Physicians can deny 50 claims with the click of a button.
Cigna uses these denials to lower costs in two ways: 1) they turn down claims they would have paid in the past, and 2) it makes it cheaper to deny claims because they are not paying their doctors to complete any review at all, let alone an in-depth review.
Below is a chart of how many claims Cigna’s medical directors could deny in just one month.
Ob/Gyn’s Flee States with Restrictive Abortion Laws
This week in Idaho, a hospital closed its labor & delivery ward, citing the state’s political climate. Idaho’s near-total ban on abortion includes prison terms and loss of medical licenses for physicians that provide care. Critics of restrictive abortion laws predict the exodus of doctors means major companies will soon follow - taking their jobs to other states.
What I’m Reading This Week
How Abortion Restrictions Changed Match Day
I highly recommend this MedPage Today essay and article from some of my smart MedTwitter friends.
“In a survey of more than 2,000 current and future physicians on social media, we found that most (82.3%) would prefer to work or train in states with preserved abortion access. In fact, more than three-quarters (76.4%) of respondents would not even apply to states with legal consequences for providing abortion care. The same holds true for states with early or complete bans on abortion or Plan B. In other words, many qualified candidates would no longer even consider working or training in more than half of U.S. states.”
Telepsychiatry & New DEA Rules
Psychiatrist Dr. Jessi Gold wrote I finally got used to practicing telepsychiatry. Now the DEA wants to change everything in Stat News. An abrupt shift to telehealth in the pandemic helped increase access to mental health care, and the DEA’s impending plan to require in-person visits for controlled substance prescriptions will undo a lot of good. Public comment on the rule ends in a few days (on March 30), so if you have an opinion to share with the government, please do.
William Carlos Williams
Poetry Foundation has some lovely dedications to poets. I enjoyed reading this one about physician-poet William Carlos Williams.
Williams's deep sense of humanity pervaded both his work in medicine and his writings. "He loved being a doctor, making house calls, and talking to people," his wife, Flossie, fondly recollected. Perhaps a less subjective appraisal came from Webster Schott, who defined Williams as "an immensely complicated man: energetic, compassionate, socially conscious, depressive, urbane, provincial, tough, fastidious, capricious, independent, dedicated, completely responsive. ... He was the complete human being, and all of the qualities of his personality were fused in his writings."
That’s it!
As always, thanks for being curious!
Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!
See you next week!
Be Well & Be Curious,
Alyssa
