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Date: May 31, 2009


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Pay Growing Faster for Nurse Practitioners Than Physicians PDF Print E-mail
Written by From Robert Lowes Medscape Medical News   
Tuesday, 07 September 2010 01:41



August 25, 2010 — In a sign of their value in a shorthanded clinical workforce, nurse practitioners (NPs) in group practices saw their compensation increase 4.9% last year, outpacing physicians as a whole, according to the Medical Group Management Association (MGMA).
Compensation for primary care physicians rose 2.9% in 2009, the MGMA reports in its latest Physician Compensation and Production Survey: 2010 Report Based on 2009 Data. Specialists took a 4.1% pay cut, although some individual specialties such as dermatology (12.3%) and ophthalmology (7.7%) posted sizable gains.
At $85,706, the median compensation for NPs in 2009 was far less than what primary care and specialist physicians earned — $191,401 and $325,916, respectively — in group practices. Still, NPs are slowly gaining ground. Since 2005, their compensation has risen 21.9% compared with 13.9% for primary care physicians and 2.9% for their specialty counterparts, according to the MGMA.
"We're in demand," said NP Jan Towers, PhD, director of health policy for the American Academy of Nurse Practitioners, about the compensation trend. "NPs don't have any problems getting work."
The job market is so good that it has been able to absorb a tidal wave of new NPs. The ranks of the profession have grown from 82,000 NPs in 2000 to 140,000 today, according to Dr. Towers.
At the same time, Dr. Towers told Medscape Medical News, a 4.9% pay raise in 2009 is not spectacular. "We should be getting more of an increase," she said.
Physician assistants (PAs) are not far behind NPs in their earnings trajectory. Compensation has risen 17.8% for PAs in primary care and 19.8% for those in surgical specialties since 2005. PA pay hikes in 2009 were less impressive, however, at 1.8% and 0.3%, respectively.
NPs Generate More Revenue Relative to Compensation Than Physicians
The current shortage of primary care physicians is creating higher demand for NPs, which in turn increases their compensation, said Justin Chamblee, a consultant with the Coker Group, a practice management consulting firm in Atlanta, Georgia.
By all accounts, this demand promises to grow stronger under healthcare reform, which will extend insurance coverage to 32 million additional individuals through 2019. Healthcare reformers view both NPs and PAs as an economical way to help tend to these newly insured individuals. Licensed to diagnose illness and prescribe medications, NPs, along with PAs, can perform about 80% of the services provided by primary care physicians, with comparable quality, according to a number of published studies.
Dave Duncan, a senior search consultant with the healthcare recruitment firm Cejka Search in St. Louis, Missouri, said medical practices hire NPs to relieve overworked physicians, share call duty, and staff rural clinics. "But it's getting tougher to find these folks," Duncan told Medscape Medical News. One reason is the growing number of retail clinics operated by drug stores, big-box retailers, and health systems, which also hire NPs to treat patients.
NPs can boost the bottom line of a medical practice in several ways, experts say. By assigning simpler medical cases to NPs, physicians can concentrate on the more complex ones, which insurers reimburse at higher rates.
At the same time, a primary care medical practice that traditionally would hire extra physicians to help carry a burgeoning patient workload can get more bang for its buck hiring NPs instead, based on the ratio of compensation to collections — that is, revenue — for the 2 professions. General internists, for example, received a median $197,080 in compensation last year while generating $366,622 in collections, according to the MGMA. In contrast, the ratio of compensation to collections is better for an NP in primary care, at $84,488 to $228,668. Put another way, 2 such NPs would generate more revenue than a single internist, but their combined compensation would be less than the internist's. The same math also works in favor of PAs.
Last Updated on Tuesday, 07 September 2010 01:43
 
Why is the Filipino Special? PDF Print E-mail
Written by > By Ed Lapiz >   
Friday, 03 September 2010 09:27

> Filipinos are brown. Their color is at the center of human racial strains. This point is not an attempt at racism, but just for many Filipinos to realize that our color should not be a source of or reason for an inferiority complex. While we pine for a fair complexion, white people are religiously tanning themselves, under the sun or artificial light, to approximate the Filipino complexion.
>
> Filipinos are a touching people. We have lots of love and are not afraid to show it. We almost inevitably create human chains with our perennial akbay (putting an arm around another's shoulder), hawak (hold), yakap (embrace), himas (caressing stroke), kalabit (touching with the tip of the finger), kalong (sitting on someone else's lap), etc. We are always reaching out, always seeking interconnection.
>
> Filipinos are linguists. Put a Filipino in any city, any town around the world. Give him a few months or even weeks and he will speak the local language there. Filipinos are adept at learning and speaking languages
>
> In fact, it is not uncommon for Filipinos to speak at least three: his own local dialect, Filipino, and English. Of course, a lot speak an added language, be it Chinese, Spanish or, if he works abroad, the language of his host country.
>
> In addition, Tagalog is not 'sexist.' While many 'conscious' and 'enlightened' people of today are just by now striving to be 'politically correct' with their language and, in the process, bend to absurd depths in coining 'gender sensitive' words, Tagalog has, since time immemorial, evolved gender-neutral words like asawa (husband or wife), anak (son or daughter), magulang (father or mother), kapatid (brother or sister), biyenan (father-in-law or mother-in-law) , manugang (son or daughter-in- law), bayani (hero or heroine), etc.
> Our languages and dialects are advanced and, indeed, sophisticated!
>
> Filipinos are groupists. We love human interaction and company. We always surround ourselves with people and we hover over them, too. According to Dr. Patricia Licuanan, a psychologist from Ateneo and Miriam College, an average Filipino would have and know at least 300 relatives.
>
> At work, we live bayanihan (mutual help); at play, we want a kalaro (playmate) more than laruan (toy). At socials, our invitations are open and it is more common even for guests to invite and bring in other guests. In transit, we do not want to be separated from our group. So what do we do when there is no more space in a vehicle? Kalung-kalong! (Sitting on one another). No one would ever suggest splitting a group and wait for another vehicle with more space!
>
> Filipinos are weavers. One look at our baskets, mats, clothes, and other crafts will reveal the skill of the Filipino weaver and his inclination to weaving. This art is a metaphor of the Filipino trait. We are social weavers. We weave theirs into ours that we all become parts of one another. We place a lot of premium on pakikisama (getting along) and pakikipagkapwa (relating). Two of the worst labels, walang pakikipagkapwa (inability to relate), will be avoided by the Filipino at almost any cost.
>
> We love to blend and harmonize with people, we like to include them in our 'tribe,' our 'family'- and we like to be included in other people's families, too. Therefore we call our friend's mother nanay or mommy; we call a friend's sister ate (eldest sister), and so on. We even call strangers tia/tita (aunt) or tio/tito (uncle), tatang (grandfather) , etc.
>
> So extensive is our social openness and interrelations that we have specific title for extended relations like hipag (sister-in-law' s spouse), balae (child-in-law' s parents), inaanak (godchild), ninong/ninang (godparents) kinakapatid (godparent's child), etc.
>
> In addition, we have the profound 'ka' institution, loosely translated as 'equal to the same kind' as in kasama (of the same company), kaisa (of the same cause), kapanalig (of the same belief), etc. In our social fiber, we treat other people as co-equals. Filipinos, because of their social 'weaving' traditions, make for excellent team workers.
>
> Filipinos are adventurers. We have a tradition of separation. Our myths and legends speak of heroes and heroines who almost always get separated from their families and loved ones and are taken by circumstances to far-away lands where they find wealth or power.
>
> Our Spanish colonial history is filled with separations caused by the reduccion (hamleting), and the forced migration to build towns, churches, fortresses or galleons. American occupation enlarged the space of Filipino wandering, including America, and there is documented evidence of Filipino presence in America as far back as 1587.
>
> Now, Filipinos compose the world's largest population of overseas workers, populating and sometimes 'threshing' major capitals, minor towns and even remote villages around the world. Filipino adventurism has made us today's citizens of the world, bringing the bagoong (salty shrimp paste), pansit (sautéed noodles), siopao (meat-filled dough), kare-kare (peanut-flavored dish), balut (unhatched duck egg), and adobo (meat vinaigrette) , including the tabo (ladle) and tsinelas (slippers) all over the world.
>
> Filipinos are excellent at adjustments and improvisation, managing to recreate their home, or to feel at home anywhere. Filipinos have Pakiramdam (deep feeling/discernment ) . We know how to feel what others feel, sometimes even anticipate what they will feel.
>
> Being manhid (dense) is one of the worst labels anyone could get and will therefore, avoid at all cost. We know when a guest is hungry though the insistence on being full is assured.
>
> We can tell if people are lovers even if they are miles apart. We know if a person is offended though he may purposely smile. We know because we feel. In our pakikipagkapwa (relating), we get not only to wear another man's shoe but also his heart.
>
> We have a superbly developed and honored gift of discernment, making us excellent leaders, counselors, and go-betweens. Filipinos are very spiritual. We are transcendent. We transcend the physical world, see the unseen and hear the unheard. We have a deep sense of kaba (premonition) and kutob (hunch). A Filipino wife will instinctively feel her husband or child is going astray, whether or not telltale signs present themselves.
>
> Filipino spirituality makes him invoke divine presence or intervention at nearly every bend of his journey. Rightly or wrongly, Filipinos are almost always acknowledging, invoking or driving away spirits into and from their lives. Seemingly trivial or even incoherent events can take on spiritual significance and will be given such space or consideration.
>
> The Filipino has a sophisticated, developed pakiramdam. The Filipino, though becoming more and more modern (hence, materialistic) is still very spiritual in essence. This inherent and deep spirituality makes the Filipino, once correctly Christianized, a major exponent of the faith.
>
> Filipinos are timeless. Despite the nearly half-a-millennium encroachment of the western clock into our lives, Filipinos-unless on very formal or official functions-still measure time not with hours and minutes but with feeling. This style is ingrained deep in our psyche. Our time is diffused, not framed. Our appointments are defined by umaga (morning), tanghali (noon ), hapon (afternoon), or gabi (evening). Our most exact time reference is probably katanghaliang- tapat (high noon), which still allows many minutes of leeway. That is how Filipino meetings and occasions are timed: there is really no definite time. A Filipino event has no clear-cut beginning nor ending. We have a fiesta , but there is visperas (eve), a day after the fiesta is still considered a good time to visit. The Filipino Christmas is not confined to December 25th; it somehow begins months before December and extends up to the first days of January.
>
> Filipinos say good-bye to guests first at the head of the stairs, then down to the descanso (landing), to the entresuelo (mezzanine), to the pintuan (doorway), to the trangkahan (gate), and if the departing persons are to take public transportation, up to the bus stop or bus station.
>
> In a way, other people's tardiness and extended stays can really be annoying, but this peculiarity is the same charm of Filipinos who, being governed by timelessness, can show how to find more time to be nice, kind, and accommodating than his prompt and exact brothers elsewhere.
>
> Filipinos are Spaceless. As in the concept of time, the Filipino concept of space is not numerical. We will not usually express expanse of space with miles or kilometers but with feelings in how we say malayo (far)or malapit (near). Alongside with numberlessness, Filipino space is also boundless. Indigenous culture did not divide land into private lots but kept it open for all to partake of its abundance.
>
> The Filipino has avidly remained 'spaceless' in many ways. The interior of the bahay-kubo (hut) can easily become receiving room, sleeping room, kitchen, dining room, chapel, wake parlor, etc. Depending on the time of the day or the needs of the moment.
>
> The same is true with the bahay na bato (stone house). Space just flows into the next space that the divisions between the sala, caida, comedor, or vilada may only be faintly suggested by overhead arches of filigree. In much the same way, Filipino concept of space can be so diffused that one 's party may creep into and actually expropriate the street! A family business like a sari-sari store or talyer may extend to the sidewalk and street. Provincial folks dry palayan (rice grain) on the highways!
>
> Religious groups of various persuasions habitually and matter-of-factly commandeer streets for processions and parades. It is not uncommon to close a street to accommodate private functions, Filipinos eat. sleep, chat, socialize, quarrel, even urinate, or nearly everywhere or just anywhere!
>
> 'Spacelessness, ' in the face of modern, especially urban life, can be unlawful and may really be counter-productive. On the other hand, Filipino spacelessness, when viewed from his context, is just another manifestation of his spiritually and communal values. Adapted well to today's context, which may mean unstoppable urbanization, Filipino spacelessness may even be the answer and counter balance to humanity's greed, selfishness and isolation.
>
> So what makes the Filipino special? Brown, spiritual, timeless, spaceless, linguists, groupists, weavers, adventurers; seldom do all these profound qualities find personification in a people.
>
> Filipinos should allow - and should be allowed to contribute their special traits to the world-wide community of men - but first, they should know and like themselves.
>
>
Last Updated on Friday, 03 September 2010 09:29
 
The Silent Killer PDF Print E-mail
Written by by Ma. Sonia G. Astudillo   
Friday, 03 September 2010 08:00

Tuesday, 31 August 2010 20:22
http://www.journal.com.ph/index.php/opinion/17375-the-silent-killer.html

MERCURY, although generally thought of as the gold standard for
measuring devices, is actually harmful to people’s health and the
environment.

Mercury causes tremors, emotional changes, insomnia, neuromuscular
changes, headaches, disturbance in sensations, changes in nerve
response and performance deficits on cognitive function tests.  At
higher exposure, mercury damages the lungs and kidneys as well as the
nervous, digestive, respiratory and immune systems.

It has been called many names: from “the silent killer” to “the enemy
on your bedside.”

For more than five years now, the environmental-health group Health
Care Without Harm-Southeast Asia (HCWH-SEA) has been pushing for the
phase-out of mercury-containing devices in health care.

Mercury is found in thermometers, blood pressure devices, laboratory
chemicals, cleaners, and building products such as thermostats,
pressure gauges and switches.  In households, there are
mercury-containing fluorescent lamps, merthiolate, contact lens
solutions and mercury-containing batteries.

Mercury is the silvery substance that people were once so fond of
playing especially in Chemistry classes.  But the sad and dangerous
fact about mercury is it is lethal. One gram of mercury -- this is the
amount in one thermometer -- can contaminate 80,940 square meters of
lake or 192 professional basketball courts.  And the effect is not
contained in one area, it travels from continents to continents.

Mercury’s effect is also “digital”, meaning it travels so fast.  With
one click or one breakage, it is out there in the open, for everyone
to linger on and breathe.

In 2008, the Department of Health (DoH) issued Administrative Order
(AO) 21 mandating the gradual phase-out of mercury-containing devices
in health care by September 2010. The AO prioritizes phase-out of
mercury-containing thermometers and sphygmomanometers which have the
most amount of elemental mercury.  The Philippines is the 1st
Southeast Asian country and the 1st developing country to have a
national policy like AO 21.

The DoH directive mandated all health care facilities to go clean
(malinis) and stink-free (mabango).

AO 21 is a jump-start.  If we can rid our hospitals of all
mercury-containing devices, then we are a step towards malinis at
mabango.

The other half of cleaning hospitals and making them malinis at
mabango and mercury-free is mercury importation ban.  Such a ban has
been carried out in the U.S., European Union and Argentina.  It can be
done in the Philippines.

In the private sector, several distributors of mercury-containing
devices are now moving to safer alternatives and even the big retail
stores like Watsons Personal Care are now mercury-free. Alternatives
to mercury-containing devices in health care are very much available
and have been proven accurate.

Even celebrities have made their stance clear on mercury phase-out.
The roster of celebrities supporting the campaign now includes actor
Albert Martinez, VJ Judah Paolo, Survivor Philippines Shaun Rodriguez
and DJ Papa Dudut.

At the Senate, Sen. Edgardo J. Angara pledged to re-file the Mercury
Reduction Act.  It proposes a three-pronged plan: switch of
mercury-using products and processes to non-mercury alternatives,
control of mercury release and mercury waste management.  The Act is
far more encompassing as it covers mercury used in toys, cosmetics and
apparel, health care, schools and universities, and other sources.

The health care sector may very well serve as a model for a massive
mercury phase-out and the Philippine case may be a good example to
showcase to the world.
Last Updated on Friday, 03 September 2010 08:01
 
DOE eyes system for proper disposal of light bulbs with mercury PDF Print E-mail
Written by By Amy R. Remo Philippine Daily Inquirer   
Friday, 03 September 2010 08:11

First Posted 14:13:00 09/01/2010
http://business.inquirer.net/money/breakingnews/view/20100901-289949/DOE-eyes-system-for-proper-disposal-of-light-bulbs-with-mercury

MANILA, Philippines—The Department of Energy is planning to issue
rules and regulations as well as a system to ensure the proper
disposal of compact fluorescent lamps that contain the hazardous
chemical mercury.

“True, we have switched from inefficient incandescent bulbs to
efficient lighting systems such CFLs. But it comes with a
price—mercury is an integral component of CFLs. And mercury, if not
properly disposed of, poses health hazards to humankind and the
environment,” said Energy Undersecretary Loreta Ayson.

The extended producer responsibility (EPR), also known as “producer
take back,” is a system in which producers take responsibility,
physical and/or financial, for the environmental and social impacts of
their products throughout their life cycle.

“Specifically, this will mean that producers of fluorescent lamps will
be in charge of the collection, processing, and reclamation of their
products when they are no longer useful or discarded,” added Thony
Dizon of the EcoWaste Coalition, in a statement.

“At present, there is no safe system for managing end-of-life lamps,
which are often thrown into regular bins and sent to disposal sites
where these are dumped, burned, or recycled in unsafe conditions,”
Dizon explained.

Information from the Philippine Efficient Lighting Market
Transformation Project (PELMATP) has shown that 88 percent of
households and 77 percent of commercial establishments dispose of
their old lamps just like they do with ordinary domestic waste.

The DoE has commissioned the International Institute for Energy
Conservation and Innogy Solutions Inc. to conduct the feasibility and
policy studies on EPR for mercury-containing lamp waste.

This government-led initiative has earned the support of waste and
pollution non-government organizations, namely EcoWaste Coalition and
the Global Alliance for Incinerator Alternatives (GAIA).

Aside from the DoE, the Departments of Environment and Natural
Resources, Science and Technology, and of Trade and Industry, as well
as importers and distributors of energy-efficient lightings, hazardous
waste treaters and environmental NGOs took part in a meeting over the
feasibility of developing the EPR.

“We envisioned a robust EPR that will impose lower levels of mercury
in CFLs imported into the country, uphold consumer right to full
product and safety information, internalize the environmental
costs, and operate an environmentally-sound system for managing spent
lamps, including a collection scheme that is easy for the public to
access,” added Manny Calonzo, co-coordinator of GAIA.

Under the laws (Republic Acts 6969 and 9003), lamp waste is considered
hazardous and should not be mixed with recyclable and compostable
discards. These laws further require the proper management and
disposal of lamp waste through appropriate hazardous waste treatment
facilities.
Last Updated on Friday, 03 September 2010 08:12
 
Govt initiative on disposing mercury lamps takes shape PDF Print E-mail
Written by http://www.gmanews.tv/story/199944/govt-initiative-on-disposing-mercury-lamps-takes-shape   
Friday, 03 September 2010 06:43

09/01/2010 | 02:46 PM


The departments of Energy and Environment and Natural Resources on
Wednesday said that talks are underway on how to tackle an "extended
producer responsibility" program for mercury lamps, including a policy
study on establishing a plan of action for it.

EPR, or "producer take back," is a system in which producers take
physical and financial responsibility for the social and environmental
impact of a product.

“True, we have switched from inefficient incandescent bulbs to
efficient lighting systems such as compact fluorescent lamps. But it
comes with a price – mercury is an integral component of CFLs. And
mercury, if not properly disposed of, poses health hazards to
humankind and the environment," Energy Undersecretary Loreta Ayson
said.

To establish an EPR in the Philippines, the Energy Department has
commissioned Innogy Solutions Inc. and International Institute for
Energy Conservation to do feasibility and policy studies on a program
for mercury-based lamps.

Previous studies showed that mercury lamps must be disposed of in a
hazardous-waste landfill or government-approved recovery facility. The
disposal of mercury lamps and light bulbs in open dumps is prohibited,
the department said.

Small quantity waste generators may dispose lamp wastes in a municipal
landfill for hazardous waste registered with the Energy Management
Bureau and the National Solid Waste Management Commission.

The Philippines needs a pilot program on EPR with a central agent
buying new bulbs from suppliers, collecting spent bulbs, and handling
waste disposal and treatment services for mercury lamps.

A strong EPR policy

The EcoWaste Coalition and the Global Alliance for Incinerator
Alternative said that a strong EPR policy initiative will curb the
practice of throwing busted CFLs in waste bins and regular dumps, a
practice that negatively affects people and the environment.

“Specifically, this will mean that producers of fluorescent lamps will
be in charge of the collection, processing, and reclamation of their
products when [these] are disposed or no longer useful," Thony Dizon,
representing EcoWaste Coalition’s Project PROTECT, said.

Data from last year's energy audit seminar, Philippine Efficient
Lighting Market Transformation Project, showed that 88 percent of
households and 77 percent of commercial establishments treat their
mercury-based and other lamps as domestic waste.

EcoWaste Coalition has raised the problem with former Energy Secretary
Angelo Reyes and former Environment Secretary Joselito Atienza, saying
the disposal of busted lamps exposes informal recyclers in dumpsites
and junk shops and their immediate communities to mercury – a highly
toxic substance.

“We envisioned a robust EPR that will impose lower levels of mercury
in CFLs imported into the country, uphold consumer rights to full
product and safety information, internalize the environmental costs,
and operate an environmentally sound system for managing spent lamps,
including a collection scheme that is easy for the public to access,"
co-coordinator of Global Alliance Manny Calonzo said.

Environment advocates also urged the Energy Department to ensure
meaningful stakeholders’ participation in establishing a “mercury
waste management facility," stressing the importance of public
consultations in the process.

Republic Acts 6969 and 9003 defined lamp waste as hazardous, requiring
proper disposal and waste management in the right treatment
facilities. —VS, GMANews.TV
Last Updated on Friday, 03 September 2010 06:45
 
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