The Children’s Hospital in Aurora was rated the fifth-best children’s hospital in the country by U.S. News and World Report.

The magazine surveyed nearly 180 children’s hospitals and 1,500 pediatric specialists. In the pediatric categories The Children’s Hospital ranked fourth in the country in cardiology, heart surgery and orthopedics.

Admittedly, I did grad school ‘much’ after the fact. I took time off between undergrad and graduate school to pursue all the random things out there in the world.  I was pretty sure before I attended grad school  the stakes were going to be much higher financially, time wise, perserverance and outcome  (it was – squared then cubed – still owing on student loan).  Grad school in my mind was an educational feast to be partaken when you knew what you loved to eat (besides dessert first!).   The plethora of jobs and varied W-2′s for taxes served as a kind of funky personal/sequential/interval/numerical time line  leading up to grad school and when I attended, it paid off in spades.  First off, I was ready for the big questions, the ideas, the thoughts and most importantly, weighing two or more ideas simultaneously and exploring the potential merits of all.  In no small part, my greatest preparation came from being a Peace Corps Volunteer which challenged my thinking at every turn. 

Graduate school was indeed a feast. I had wonderful professors, classmates and worked my bottom off to enjoy said feast.  I graduated and was pretty self assured questions were a part of the bigger picture of life - the more you thoughtfully asked, the more you gleaned.   In some respects I was more fortunate than my counterparts pursuing education as I earned an undergrad degree in Communicative Disorders (speech pathology/audiology) instead of general studies.  My science experiences were far more in depth and my appreciation of the dilemmas for learning disorders well above what the average teacher learns.  In some respects I was very unfortunate – I asked a great deal of questions and challenged what many people said about the learning process in graduate school.  I actually had the temerity to believe   Algebra taught behind a hut in Namibia while drawing in the sand  was of equal quality to that in a city classroom with 35 students.  I questioned ridiculous curricular programs (FOSS kits at the middle school level), memorization in lieu of learning a concept, grinding the numbers for Algebra (yes, you have to as there are no short cuts or easier methods), text books instead of actual science labs (wrong and ridiculous) and so forth.  Those who were willing to join the fray of debate became my closest friends; those who were too afraid to join the debate or (literally) had nothing to say became my acqaintances until such time they desired opening their minds and standing up for ideas/experiences they believed in.  Instead of being fearful, I was always exploring new information – the more to choose from the better.

I found the closed mouth, closed minded people willingly drank Kool Aid (with or without sugar) without question  and followed the group think.  It is now all of sudden these self same people which are questioning whether or not U.S. News and World Report should rank teacher preparation programs.   The horror they must be facing is the very fact that some one or group of  ’ones’ is going to start asking some very challenging questions about their teacher preparation programs (curriculum, experiences, supervision, etc.)

Imagine if you will, a teacher prep program where FOSS kits were donated to the science department, so, that is what was taught…..or some (if not all) text book companies from TX decided to re-do their Algebra text books to ‘align to state standards’ and so that is what was used to ‘develop’ new math teachers.   Imagine where the ‘five paragraph essay’ came from and you should be horrified (it is the absolute minimum standard of writing deemed necessary to graduate high school and in many cases, enter college).   Think about all of those teachers who obtained a graduate degree while serving time in a charter school (where you absolutely must follow group think) and you begin to see why fear is a reality for so many schools of education.

We should ‘know’ what best practices are and they are not the same for every situation and every student. We should know the difference between learning, applying and synthesizing a concept versus memorizing a bit of information to take a multiple choice test with a 25% given success rate upon guessing.  We should know what a good education looks like as we seem to be getting students from foreign countries who have one.  And yet we are afraid to have some one look at our book shelves, peer into our teaching methods, evaluate our ‘sacred’ teacher development practices – on what grounds might some one be afraid if you are RIGHT??

In the last 10 years, I became the ‘go to’ person for friends and friends of friends for various potential questions to ask employers during an interview as I have the audacity to believe it is just as important what a potential employer asks you, as you ask them – you are going to be working together for awhile (hopefully) so get it all out on the table.  I have found over and over by painstaking experience, those people who follow the party line/pitch/game, etc.  at the interview are the self same people who will turn on a dime when led to the new Kool Aid as they are too insecure and/or desperate to have their own thoughts.   It is these people I fear and avoid because they do have something to hide.  Anything right out in the open, up front and to the point is not  hidden.   People who have the ability to discern the difference of right/wrong zero sum games from different/equal benefit and broader scope do not fear people looking in their bookshelves AND are willing to do things to improve for they know they do not have all the answers.

We have all manner of tests for teachers to prove they are highly qualified. We need to start having some methods for demonstrating the higher ed institutions are qualified to prepare teachers.  In fact, there should be a ranking, like the Michelin Stars for restaurants.  This is the result of what happens when you don’t teach people to think – they forget how and become fearful when asked.

As for me, I am going to watch from the sidelines. I did not think ‘From Good to Great’ by Jim Collins, varied state standards, Wendy Kopp and Teach for America, charter schools or Michelle Rhee and Students First was the whole picture.  This new reformation is going to be very interesting indeed.

Speaking of messages, two surveys whose results were published in the May issue of Pediatrics and picked up by U.S. News and World Report found that 93 percent of parents who participated had or were going to get all recommended vaccines for their children, while 76 percent said they trusted their doctors a lot. However, 24 percent of respondents said they placed trust in what celebrities say about vaccinations, which segued to autism activist Jenny McCarthy, who is known among the autism community for her opposition to vaccinations despite numerous studies refuting a link and the official retraction of the study that initiated the controversy (some of those stories are featured on this very site).

Dr. Gary Freed, one study author who is also the director of the child health evaluation and research unit at the University of Michigan, cautioned giving too much credit to celebrities who may not share the same background as researchers do. Freed was quoted saying there is a danger in the media of putting up celebrities as experts for any topic they have an opinion on, even though they have no expertise in immunizations or infectious diseases.

The second survey highlights a second obstacle that was explored by PBS’ Frontline documentary on vaccinations last year. 22 percent of those respondents said they were concerned about their child receiving too many vaccinations and the potential for damage to a child’s immune system (some vaccines, including flu shots, will use dead cells of the virus for the body’s immune system to absorb, allowing cells to fight off active versions of those viruses). Freed said that even if parents feel uneasy about their child getting poked often and early, that shouldn’t dissuade the notion of staying on schedule with vaccinations since many diseases they protect can be lethal for children and cause outbreaks for everyone else; Minnesota has been fighting a measles outbreak in recent weeks.

Jenifer Goodwin, the reporter who published the U.S. News study, faced a difficult proposition by covering two studies based on survey questions. One can be tricky enough for the audience to consume, as many stories that report poll figures will throw out a lot of statistics. Goodwin found an effective way to include both by finding one of the study authors and a second researcher who specializes in pediatric care for infectious diseases to spell out what the numbers mean. Not all writers do this when they recap poll numbers. Goodwin used her lead to highlight the biggest finding from the surveys, the overwhelming majority of parents who will follow the recommended vaccination schedule for their children, and quickly tied that to the ongoing controversy of the vaccine-autism link.

Some readers will read the first few paragraphs and then skim through the rest of the story, which is why print writers often employ the strategy Goodwin executes in her piece: the inverted pyramid. The inverted pyramid promotes placing the most important details of a story first, then include relevant but less necessary data in later paragraphs. While the web and various forms of blogging means writers don’t have to be as rigid with the format, the inverted pyramid remains a common form of print journalism and won’t stop being taught in workshops and classes that teach the craft.

Regarding the surveys, my biggest curiosity was the story reporting women and Hispanics being more likely to trust celebrities of the 24 percent that said they trusted them for vaccine information. Women cover just over half of the population and will have many backgrounds in their family lineage, while Hispanics are a growing segment of the American population that doesn’t rule out men believing what celebrities have to say. To gauge why the two responded the way they did would require a psychological expertise I don’t have, but we do see women more often for autism stories than men when it comes to the personal experience. Even the article from my last post on Holly Robinson-Peete spent the entire duration on her efforts, even though she and her husband are both involved in autism awareness. I’ve heard anecdotal suggestions that women are more enticing for autism stories because of their increased likelihood to display more volatility with emotional output, while men continue to live with the assumption they must be “tough guys.” Nothing is linear, of course, and families, researches, and other caretakers familiar with autism are well aware that support isn’t limited to the female gender.

There is potential for a follow-up story with the Hispanic community and autism (which would require a more complete perspective than their belief in celebrities), but I doubt the same regarding women, since that would leave many stations and papers in a state of self-critical research, and they’re not keen to highlighting trends they either caused or promoted that may not be beneficial for journalism itself.

Goodwin’s ability to guide us through two polls and not overwhelm us with numbers allows readers to feed off its notes, and also continues to suggest that the public is either growing tired of the vaccine-autism debate when evidence is clearly one-sided, taking more initiative to learn about all facets of autism, or both. Autism may not exist without a controversy for several years, but signs suggest the most visible issue in the last five years is slowly fading.

For some readers of this blog that may seem like an odd statement. Texas is one of the few states that still prohibit “corporate practice.” This is where physicians work directly for a business entity rather than either working for another physician or physician group.

For Texas and the states that prohibit this practice, the reasoning has always been that this separation helps maintain the clinical autonomy of the doctor-patient relationship. And I would agree with this wholeheartedly.

Having a physician’s judgement clouded in any way by the perceived need to make a bottom line is a recipe for disaster. Fortunately, most physicians understand this risk and are masters at handling the tense relationship they might have with their employers.

But the question here isn’t whether physicians should be employed, but will they make good employees?

Most people would define a “good employee” as one that shows up for work on time, provides dedicated service, treats the business like their own and functions well in a team environment.

Most of the physician friends that I know all show up to work on time.

And most physicians I know treat the business like their own — if they are the owner.

And as for team play? Well, let’s just say that coed basket ball games in medical school were tense at times. Team play isn’t something that is necessarily a reviewed credential in medical school applications.

As a former hospital based medical director, I’ve seen physician groups owned by health care systems have a turnover near 25%. And with the cost of recruiting a physician close to $250K including startup costs, first year salary guarantees and signing bonus — that’s absurd.

Physicians that are hired fall into two basic groups. They are right out of school, owe $200K in school loans and are uncomfortable in the current environment with starting a new practice from scratch. They have no experience with this model anyway — most of their teachers are already working in an employed relationship at a medical school or hospital. Their exposure to business is only through these providers.

Or, the physicians are frustrated with private practice: the alarming increase in overhead, growth in liability risks, the long hours, lack of good call coverage and the continual decline in reimbursement. They are seeking employed relationships primarily so they can continue to do what they are called to do. They want to see patients and continue to practice medicine and let someone else worry about the business.

See the commonality here? Both groups don’t want to worry about the business.

Hiring employees that “don’t want to worry” about the business seems like a recipe for disaster for me.

For now hospitals and health care systems can pay a premium to hire doctors. They are funded under a payment scheme that allows them to have either profits (for profit hospitals) or margin (non profit hospitals) that can be redirected to hire doctors to refer to their hospital so they can make more profits and more margin.

But, for many systems, this doesn’t work long term.

Here’s an example: Dr. Welby has practiced for years in a community as a family practice doctor. He is well known, works 80 hours a week, has a nurse, two office staff, and a small office that is paid for and hasn’t been updated since the 70′s — including the magazines.

Despite this frugal existence he is financially challenged because of the escalating benefit costs for his employees, higher malpractice premiums, and he can’t remember the last time he received a rate increase from any payer. Most of his patients are Medicare; twice in the last year he wasn’t paid at all because Congress didn’t fund the health care for older Americans.

He’s tired and looking for help.

In rolls Sister Daughter Felicia Hospital System — they are a not-for-profit health care system (not-for-profit means they don’t pay taxes and “System” is a word right from Modern Healthcare: makes you seem like a big health care team — read on). They have a physician run medical group that they own, but don’t directly control. Well, let’s just say they do control the budget for the doctor group. And it always runs at a loss, so the hospital system is perpetually in a position of having to “bail out” the group and define budgetary goals and direction. So there is some control.

They meet with Dr. Welby, show him their electronic health record, how they achieve quality metrics in virtually every measure of health improvement, how U.S. News and World Report thinks they are a Top 100 hospital, and how they will take care of the front desk operations and provide staff. And, oh by the way, they have a new medical office building that has a gym, day care, and even a Starbuck’s.

To make things better for Dr. Welby they’ll even buy out his practice by purchasing his accounts receivable (there aren’t that many), take all of his records, and give him a guaranteed salary for a year and a signing bonus. All he has to do is sign here and start to work.

Now Dr. Welby will have the agreement looked over by a lawyer — the same guy who did his home refinance and his divorce. The hospital will say that “it’s the same agreement that we all sign” and then will grin — they have Fulbright and Jaworski on their side.

There is back slapping, and maybe even champagne if its a Catholic hospital system, and everyone enjoys the moment and the win.

All will be good for a few months. The staff will not like the move with all the new processes and procedures and uniformity. The patients will not like it because they have to pay to park, will get bills they may not be familiar with and there will like be some changes in health insurance coverage.

The doctor won’t like it all either: certain drugs won’t be on formulary, there will be an electronic medical record to learn that will “hurt my work flow,” and there won’t be the complete control of the practice that he’s used too.

But there are benefits. It is likely that he will slow down his daily schedule by 25 to 30 percent, there will be less importance on admitting his patients to the hospital (“I’ll let the hospitalist do that”), and when it comes to doing procedures it will just mean more work and more risk of weekend responsibilities.

The hospital system will overlay a whole new set of overhead for the physician ranging from new office space (read: more cost/foot), “indirect costs or overhead” that is difficult to explain (but includes many things the physician never purchased before like legal retainers, marketing, telecommunications infrastructure, bill boards, JCAHO, nurse managers, case managers, coding and compliance staff, float nurses, retreats and meetings, helicopters — you get the picture), and staff whose benefit and salary structure is the same as that of the hospital and is richer and more expensive.

So fast forward one year later.

The hospital is not happy because the physician’s practice is losing money — actually bleeding money. Patient volume is lower and revenue is stark. They don’t understand why the physician isn’t working harder. They are now going to roll him into an income distribution formula where part of his compensation will be based on volume and the rest on “performance measures.” The result will likely be lower pay.

He’s not happy with the lower pay and pushes back. He claims its the hospital system’s fault: all that higher overhead, not collecting his payments, not billing his claims right, and he can’t read, understand, or have access to the right financials. “And what about that indirect costs — what’s that?!?”

So one of three things will happen. He will either leave, and the hospital will have to recruit a replacement. He will stay and conform somewhat but continue to publicly gripe about the system and be disruptive and not a team player. Or, he will conform to the hospital model and all will be well.

The hospital will be in little position to do anything about the overhead issue. But, most systems will work with the physician for awhile, supporting the practice, because they don’t want to be seen as “running someone off.”

What’s the solution?

Certainly models that allow the physician to maintain some autonomy and responsibility for their own practice will help some. Convincing the physician of the long term benefits of some of the good things the hospital has to offer (such as quality improvement and infrastructure) and getting buy-in will be good for all involved. Convincing the hospital that the physician needs to be included under the tent and as a part of the team will also be part of the solution.

Congress could go a long way by aggressively creating gain sharing models that allow both sides of the health care team to be paid for improvement in health care value. This would promote team work and alignment.

But in the end, in the current model, do physicians really make good employees? And do hospitals really make good employers?

Loyola University Chicago Law School outranked DePaul University’s law school in the newest rankings of law schools released Tuesday by U.S. News and World Report.

Loyola’s law school ranked No. 71 on the U.S. News 2011 list of Best Law Schools, while DePaul ranked No. 84.

Other local law schools making the list include the University of Chicago at No. 5; Northwestern at No. 12;  University of Illinois, No. 23; and John Marshall Law School at No. 140.

The U.S. News rankings of 190 law schools fully accredited by the American Bar Association are based on a weighted average of 12 measures of quality. Click here for an explanation: methodology  

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Thanks to that list, released in January 2011, the whole world knows the Hyundai Elantra Touring is a great value!  The compact took top honors in the “wagon” category for its convenience, safety features and spaciousness.  For all the details visit:  http://usnews.rankingsandreviews.com/cars-trucks/Hyundai_Elantra-Touring/.

U.S. News and World Report released a list of the cities with the greatest “crime risks.”

Minneapolis is tied for 10th place with Cleveland.

The magazine collected data from the FBI, including information on violent crimes and property crimes.

The scale for the study has a national average of 100. Minneapolis scored three times that.

St. Louis is ranked first on the list, at nearly five times the national average for crime.

Atlanta, Birmingham, Orlando and Detroit round out the top five.

To see the whole list click here.

Chancellor Wrighton would never advocate replacing our math department with a "meth department" just to make more money

We all know that Twitter is the future—Time Magazine (the future of print media) even had an article called “Twitter is the Future” last week—but as we mold our future through 140 char “Tweets,” it’s important that we remember that the internet is a dangerous tool.  Just as easily as Twitter can be a force for good, it can be a force for evil—the Chancellor Wrighton feed is a sad, but fortunately rare example of this.

Don’t get me wrong, I’m not the kinda of guy who takes myself too seroiusly.  I like doing random things like throwing snowballs at Freshman outside of Sig Chi and chugging Red Bull+Vodka contests on Thursday nights (Cultural Anthro can suck my dick for having class on Friday).  But the fake chancellor feed has advocated for stealing university property, forcing alcoholic beverages on freshman, and consuming illicit beverages (Four Loko).  This isn’t funny.

After touring the country’s best colleges with my mom and doing countless hours of research, I decided to apply to Wash U because it had no supplement (Common app only) and they said during the tour that it was ranked 10th in the U.S. News and World Report best colleges guide.  I did not come to this university to see a bunch of immature Phi Delt guys make a fake Twitter account that impersonates the chancellor, portraying him as a person that vandalizes school property (by using Bear’s Den trays as sleds) and prank texts his students.  While Chancellor Wrighton is a quirky man with a great sense of humor, I can guarantee you that he is nothing like what is said on the fake Twitter feed.  Let me emphasize that again: the Chancellor W Twitter is FAKE, as in NOT REAL, as in NOT ACTUALLY WRITTEN BY CHANCELLOR WRIGHTON.  If the site were to start posting real rumors about the chancellor, (like his frequent 2am Steak n’ Shake sightings or how the flowers from in front of brooking mysteriously disappear every few months), it could be humiliating for the everyone who attends this university.  I didn’t come to a top-ranked U.S. News and World Report university to have that happen.

Traditional curators are extremely knowledgeable about art/artifacts. New curators may have to be extremely knowledgeable about people.

Curators decide what to show the public and manage how visitors will experience art and artifacts.  They are the gatekeepers who decide which artworks will be presented… but engaging visitors no longer stops with choosing which painting to hang on the wall and telling docents and interpreters to help build the bridge between academia and public understanding.  Curators will need to become increasingly involved in the bridge-building process.

We are in the midst of an incredible time of information-share, user-generated content, and social technology. Everyone’s a curator.

Museums will need people who can help visitors curate for themselves in creative ways.

According to the U.S. News & World Report article,  “The Labor Department projects the number of curators will rise by 23 percent over the next several years, well above the average rate for all careers. By 2018, there should be about 2,700 new positions added.” I argue that a good portion of these positions added will not be asked to serve the role of traditional curators.

The upcoming need for more curators is great news for museum professionals- especially since the employees that museums need to curate content to optimize visitor engagement may not be the traditional PhD’d curators of the industry in the past. We may find that new curators are specialists in people and communication. We’re already seeing these changes take place in the museum field. For example, Allison Agsten is the Curator of Public Engagement at the Hammer Museum in Los Angeles. She was hired in order to help make the museum more interactive. She’s not a traditional curator; her background is in communications. But in many ways, she is the traditional curator- evolved. Museum marketers, object conservators, museum interpreters, and program producers may be filling some (perhaps most?) of those 2,700 curator job openings as museums heed the call of community engagement and social technology opportunities.

Specialists and academics are critical for museums and similar institutions to have on staff and their importance will not diminish. However, museums of the future may find that they need people to actively build and maintain the bridge between the academic realm and the sphere of public understanding. They will need people to not only choose works of art for display, but to chose them with a new focus on conversation and audience engagement.

Thanks to emerging tools, the walls between highly academic museums and the communities these institutions serve is more easily scaled , and museums will likely continue to become more interactive. The institution that keeps up the wall may one day wake up to find itself isolated. They’ll need a curator to help lift people up… which, we are learning, will require touching them.

The curators of the future may not look like the curators of the past.

Tell us what YOU like about Columbia, Missouri.

A venerable old weekly print news mag (it was reduced to monthly in November 2008) is riding off into it’s last sunset (the last issue is this month)…

BUT, the U.S. News & World Report will re-appear in digital clothes with an expanded online edition that will appear 8 times per year and definitly include it’s famous “list” issues…you remember them: the best colleges, hospitals, etc.

Famous for its annual rankings on the best colleges, hospitals, personal finance and a slew of other topics, the magazine had already slipped from a weekly to a bi-weekly and then a monthly over the last two years.

Its circulation plunged last year to 1,269,260 from 1,721,377 the year before, Magazine Publishers of America estimated.

The rankings issues will continue to be published in-print, along with four special topic issues, but the rest of the publication’s content will only be available online, the memo said.

Its last regular print edition will be next month.

“All of us at U.S. News Media Group have been aggressively responding to the changing habits in the media marketplace,” Kelly wrote. “These latest moves will accelerate our ability to grow our online businesses and position ourselves to take advantage of the emerging platforms for distributing information.”

Read more: http://www.nypost.com/p/news/business/us_news_world_report_to_cease_printing_9xPz94206ODF1ctrccrQxK#ixzz14vWzXogY

Read and enjoy more

When tragedy strikes the entire nation, online news doesn’t compare to the newspaper you hold in your hands.

U.S. News & World Report, the American monthly news magazine published since the 1930s, decided yesterday to become an online only subscription for subscribers.  The last issue will be out in December and the remaining print subscriptions will be replaced by other publishers.

It also compiles America’s Best Colleges and America’s Best Hospitals.  But of course, those will remain available in print.  Among being great providers of news on wars, politics, economics, and other issues, it seems that some contents (school and hospital ranking) are more likely to be read.  On average, are we getting our daily intake of news? Apparently not.  Are you getting your Daily Variety intake? Probably not as much either.

Leo Wolinsky, the editor of Daily Variety magazine and a 30-year  veteran of LA Times, was fired after less than a year on the job.  Due to online blog competitors like TheWrap.com and Deadline.com, the Variety has not been able to break Hollywood news as fast.  Wolinsky brought credibility to the table and he’s a veteran, but still he was let go.  The ability to breakthrough online is now a job requirement.

Condé Nast publications, which include Allure, Vogue, GQ, Lucky and more, is also changing its reputation to online because of declining ad revenue in their print editions.  They hired Joe Simon from Viacom this year and created the position chief technology officer to boost their digital operations.

Niche magazines are a great route for publishers to take, but it’s targeting people to get a better profit margin rather than caring about what what we can gain from it.  How can we stay connected to politics and school or work without getting the reports compiled together by journalists or other news sources.  We practically decide what they will print.  More entertainment is put in place of newsworthy stories to get readers, because that’s how business works.  Now business is online.

Print eventually would not be the route, even if some magazines show the latest red carpet style.  Unless you’re at a doctor’s office waiting, chance of picking one up is slim to none.