Healthcare in the USA today.

[missy]

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UnitedHealth CEO Andrew Witty Is Wrong. Just Plain Wrong.​

— Everyone in healthcare bears some blame for our broken system​

by N. Adam Brown, MD, MBA, Contributing Writer, MedPage TodayFebruary 2, 2025


Here is a hard truth for those of us who are care providers: Americans are unsatisfied with the country's healthcare system. It is not just about cost or lack of access. Gallup recently found only 44% of Americansopens in a new tab or window think the quality of the care they get in this country is excellent or even good.

Here is another hard truth: every one of us who is involved in the healthcare ecosystem bears some responsibility for this prevailing feeling -- and we must each do our part to solve it. From the doctor who doesn't even glance up from charts to look a patient in the eye to the pharmacy benefit managers (PBMs) who manipulate prescription drug prices, it is time to recognize these hard truths and take decisive action toward reform.



Unfortunately, Sir Andrew Witty, British business executive and CEO of UnitedHealth Group, appears to think insurers bear no blame for Americans' discontent. In recent comments to investorsopens in a new tab or window in the wake of the killing of UnitedHealthcare CEO Brian Thompson, Witty essentially absolved UnitedHealthcare of any insurer's role in the dissatisfaction plaguing the U.S. healthcare system. While acknowledging healthcare costs are significantly higher than in other countries, Witty seemed to lay the blame squarely on the cost of careopens in a new tab or window-- prescription drugs, hospital procedures, and physician services -- without acknowledging UnitedHealthcare's role in this broken system. (Interestingly, Witty was previously CEO of pharma giant GSK.)

Make no mistake: insurers are certainly one reason Americans are angry.

Profits Over People

Witty talked about the growing costs of healthcare while on the earnings call -- an earnings call that made plain how much Witty and his company are raking in. Specifically, as Axios spelled out, UnitedHealth Group posted revenue of $400.3 billionopens in a new tab or window for 2024, up 7.8% from 2023.



Earnings were down, but that appears mostly due to the cyberattack against UnitedHealth's Change Healthcare in the first half of last year, wreaking havoc for hospitals, doctors' offices, and patients. Even so, as Healthcare Dive reportedopens in a new tab or window, excluding the cyberattack costs and other factors that UnitedHealth believes were not representative of its overall business performance in the year, the company reported an adjusted profit of $25.7 billion, which was an all-time record. Additionally, by the fourth quarter, revenue had increased 6.8% year-over-year to $100.8 billion and net earnings were up 1.6% from a year earlier to $5.5 billion.

As Axios wrote, the company's "profits are still large enough, though, to rank among America's 25 most profitable companies."

The massive scale of UnitedHealth Group's revenue is due to its ability to operate as a massively consolidated, vertically integrated organization that touches nearly every corner of the healthcare value chain. From employing the largest group of cliniciansopens in a new tab or window (Optum) in the country to owning one of the largest PBMsopens in a new tab or window (OptumRx), UnitedHealthcare plays a pivotal role in determining costs and shaping patient experiences -- and outcomes.



Failing to Hear Americans' Frustrations

In the immediate aftermath of Thompson's murder, Witty failed to connect with Americans who, while condemning the murder, understood how frustrating it isopens in a new tab or window to deal with health insurance companies. Back in December, Witty also seemingly played the blame gameopens in a new tab or window in an internal video message for employees.

Witty's more recent statement that "healthcare costs more in the U.S. because the price of a single procedure, visit, or prescription is higher here than it is in other countries" is accurate -- but it is also incomplete. Time and time again, he fails to publicly address the frustration patients feel when their care is delayed or denied due to prior authorizations, restrictive networks, or unreasonable claims denials -- all hallmark behaviors of the health insurance industry.

We should also consider UnitedHealth Group's role in perpetuating the myth that PBMs help alleviate drug costs for patients. A Federal Trade Commission (FTC) reportopens in a new tab or window issued mid-January examined the practices of the country's three largest PBMs: CVS Health's Caremark Rx, Express Scripts, and UnitedHealth Group's OptumRx. According to the report, these organizations marked up the prices of many specialty generic drugs by hundreds or thousands of percent, helping to generate more than $7.3 billion in revenue for the PBMs and their affiliated specialty pharmacies between 2017 and 2022.



$7.3 billion. That's more than the GDP of some small countries.

What's more, these companies have a corner on the market. In 2023, the firms examined by the FTC received 68% of all dispensing revenue generated by specialty drugs in the U.S.

The January report was the FTC's second on PBMs. The first studyopens in a new tab or window, released mid-2024, found that, instead of helping keep healthcare costs down, PBMs steer patients toward more expensive drugs and, incredibly, even overcharge for cancer treatments.

And, yet, Witty shows no remorse and no willingness to drive change.

Time for Insurers to Take Ownership

UnitedHealth Group cannot ignore these issues. Shifting blame to providers, hospitals, and pharmaceutical companies is disingenuous, particularly given that the company itself employs many of those providers and controls major portions of the drug supply chain.

If members of the healthcare ecosystem want to change Americans' attitudes, we need all stakeholders to take responsibility for their role in our systemic healthcare challenges -- not just point fingers elsewhere.

It is time for a real conversation about improving affordability, access, and patient satisfaction without the hollow rhetoric. Let's keep pushing for a better, more equitable healthcare system. Patients and clinicians deserve better than what we have right now.


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[missy]

‘Losing A Generation Of Doctors’: Black, Hispanic Medical School Enrollment Drops Sharply After Supreme Court Decision​

Randy Dotinga

Med School Students Less Diverse Post–Supreme Court Decision

The number of Black and Latino medical students dropped by more than 10% in the first class affected by the US Supreme Court’s 2023 decision to effectively end affirmative action.

www.medscape.com

Black and Latino enrollment in American medical schools has fallen sharply after the 2023 US Supreme Court decision effectively ending affirmative action in higher education, a new report finds.

In the first class selected post-affirmative action, the numbers of Black and Latino individuals entering medical school in the 2024-2025 academic year dropped by 11.6% and 10.8%, respectively, compared with the previous year, according to annual data compiled by the Association of American Medical Colleges (AAMC).

“These are pretty devasting numbers,” Dan Ly, MD, PhD, University of California at Los Angeles (UCLA), told Medscape Medical News. “When you compare to last year, it’s as if we lost over 250 Black medical students and over 300 Hispanic medical students.”


“We’re losing a generation of doctors from these underrepresented groups,” said Ly, who studies diversity in medicine.

The number of incoming American Indian or Alaska Native students declined even more sharply, by 22.1%. Native Hawaiian or other Pacific Islander student enrollment declined by 4.3%.





About half of the 23,156 1st-year enrollees described themselves as White individuals (50.7%; 11,73, followed by Asian (31.6%, 7323), Latino (11.2%, 2595), and Black (8.8%, 2036) individuals. Participants could describe themselves as being in more than one group.


In contrast, the US Census reports that the percentages of these groups among the general American population are 58.4% (non-Latino White), 6.4%, 19.5%, and 13.7%, respectively, and another 3.1% are multi-race.

In its ruling, the Supreme Court banned affirmative action programs in both public and private colleges/universities. “Many universities have for too long...concluded, wrongly, that the touchstone of an individual’s identity is not challenges bested, skills built, or lessons learned but the color of their skin,” wrote Chief Justice John Roberts for the majority. “Our constitutional history does not tolerate that choice.”

The new report suggests — but doesn’t prove — that the court ruling contributed to the sharp decline in acceptances. Meanwhile, states such as Florida, North Carolina, and Texas have recently cracked down on diversity, equity and inclusion (DEI) programs in higher education.

What Do Numbers Mean Going Forward?​

In an interview, Norma Poll-Hunter, PhD, AAMC’s senior director of DEI, said the declines in certain enrollment numbers are expected.

“We knew, based on history, that this would happen,” she said. “What’s concerning is that it’s at double digits.”

Applicants from historically underrepresented groups can face challenges such as weak public school education, lack of knowledge about opportunities, and unaffordable tuition, Poll-Hunter said.

Diversity in medical school classrooms helps students “feel better prepared to work with patients who are different than themselves, she added. “Based on higher education research, we know that diverse classrooms lead to more civic engagement and better understanding of people from different perspectives, values, and viewpoints.”

The AAMC report finds that more Black and Latino applicants applied in 2024-2025, with applications up among these groups by 2.8% and 2.2%, respectively.

“The most straightforward explanation is that students from groups underrepresented in medicine have yet to be discouraged to apply,” UCLA’s Ly said. “But due to the inability to consider race and ethnicity as one of many factors in admissions decisions, rates of acceptance into medical school have precipitously dropped for (underrepresented) students.”

The Supreme Court’s Motivation​

Ronnie A. Sebro, MD, PhD, of the Mayo Clinic, offered another perspective.

“The Supreme Court wants to ensure a fair environment for all citizens. Favoring one group over another has the potential to lead to tremendous inequalities,” said Sebro, who studies diversity in medicine. “In fact, this behavior has led to the current inequalities in medical training as noted.”

The new report also finds that women still make up most applicants (56.8%) and 1st-year enrollees (55.1%). Few 1st-year enrollees are military veterans (166), and nearly all new students are under age 30 years (97.2%).

Ly had no disclosures. Sebro is an advisor and co-founder of the startup company RadiologyVRIfy.

 

[missy]

Where Are All the Nurses?

Why do some states have an abundance of nurses, while others struggle with shortages? Data reveal disparities in nurse distribution across the United States.

www.medscape.com

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Where Are All the Nurses? Data Show That Some States Have a Far Higher Number of Nurses Per Capita Than Others​

Jodi Helmer
March 07, 2025


During their 12-hour shifts, registered nurses (RNs) in Arizona and Arkansas perform many of the same tasks as RNs in Wisconsin and Wyoming: Assessing patients, monitoring vital signs, administering medications, and charting records to provide the best patient care. The work might be similar, but there are vast differences in the number of RNs in each state.

In states like Idaho, Utah, and Nevada, which have the lowest number of nurses per capita, there are as few as 7 nurses per 1000 residents compared with South Dakota and the District of Columbia, which have double the number of nurses than underserved states — giving them the highest number of nurses per capita.

Even states with the largest number of nurses per capita are not immune to the nursing shortage. The National Bureau of Labor Statistics estimates that there will be 195,400 job openings for RNs from 2021 to 2031.


So, what makes it easier for some states to recruit and retain RNs than others?

About Our Research

Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example,

Nurse Career Satisfaction Report 2024 found that

• 92% of nurses are happy with their career choice.
• 32% said that helping people is their biggest job reward.
• 87% of nurses belong to a union.

States With the Highest Number of Nurses Per Capita​

South Dakota​

RNs per 1000 residents: 15.79





Average wage: $67,030 or $32.23 per hour


Average rent in Sioux Falls: $1192 per month

The Midwestern state has more miles of shoreline than Florida, herds of wild buffalo, the highest summit east of the Rockies, and more nurses per capita than all other states . Healthcare is one of the major industries in the Mount Rushmore State.

Haifa Abou Samra, dean and professor at the University of South Dakota School of Health Sciences in Vermillion, South Dakota, isn’t surprised that RNs want to call the state home.

“South Dakota is a nice place to live,” Samra said. “[The] schools are wonderful. If people are growing families, there is support; neighbors support their neighbors, and it’s a relatively safe community.”


South Dakota has 19 approved nursing education programs that graduated 878 RNs in 2022. Scholarships and student loan forgiveness programs have helped attract qualified RNs, and collaborations between education and industry have been instrumental in addressing the nursing shortage, Samra told Medscape Medical News.

Even though RNs earn less than the median wage ($87,070 per year/41.38 per hour), South Dakota has a low cost of living and no individual income tax, which helps stretch those earnings.

District of Columbia​

RNs per 1000 residents: 15.39

Average wage: $105,220 or $50.59 per hour
Average rent in Washington, DC: $2485 per month

After a shift at some of the top-ranking hospitals in the nation, RNs working in the compact capital region can explore museums, monuments, and cultural sites; walk along the banks of the Potomac River; or grab a bite at award-winning restaurants.

Washington, a top-ranking metro area due to its growth, high wages, and access to economic opportunities, is also home to several top-tier hospitals and some of the best healthcare in the nation, and RNs who want to pursue continuing education have access to top-tier universities.


Nurses in Washington, DC, might make some of the highest wages in the nation, but the region also has the second highest cost of living in the United States, with average rents topping $2400 per month and an average home price of $594,337.

North Dakota​

RNs per 1000 residents: 12.99

Average wage: $74,930 or $36.03 per hour


Average rent in Fargo: $1051 per month

North Dakota projects a 10.4% increase in employment for RNs, which is higher than the national average, and the state has implemented several strategies to address chronic nursing shortages. The Nurse Staffing Clearinghouseconnects nursing school graduates with local employers and created a statewide nursing staffing pool for in-state recruitment of travel nurses.

But it’s not just plentiful job opportunities and a low cost of living that attract nurses to the Peace Garden State. The state and its largest cities, Bismarck and Fargo, hold several “best of” accolades, including nods for the safest places to live and among the Best Places to Raise a Family, giving it high marks for quality of life.


Sure, the winters are cold, but the outdoor recreation can’t be beaten. RNs can bundle up and see the bighorn sheep in the Badlands at Theodore Roosevelt National Park or explore expansive terrain for skiing, snowboarding, and snowmobile trails.

States With the Lowest Number of Nurses Per Capita​

Nevada​

RNs per 1000 residents: 7.92

Average wage: $96,201 or $46.25 per hour

Average rent in Las Vegas: $1478 per month

Despite a projected 23% job growth for RNs between 2020 and 2030, the state has struggled to fill open positions. It might be the higher-than-average cost of living (9.7% higher than the US average) or higher-than-average crime rates that make RNs reluctant to gamble on a job in the Silver State. But there are some big wins for nurses in the state.

Salaries are higher than the national average, there is no state income tax, and some of the lowest property taxes in the nation. Thanks to new legislation, RNs with student loan debt won’t have to bet on black at the casino to make their payments. The Health Equity and Loan Assistance Program is a new initiative that offers up to $120,000 in loan repayment assistance to providers, including RNs, who commit to working in underserved and rural areas across the state for 5 years.

The state also has incredible attractions, from the neon lights and over-the-top architecture in Las Vegas to iconic red rock canyons, stunning state parks, and landmarks like Hoover Dam and Lake Tahoe.

Utah​

RNs per 1000 residents: 7.05

Average wage: $79,790 or $38.36 per hour

Average rent in Salt Lake City: $1611 per month


Healthcare is one of the biggest employers in Utah, and nurses are the most in-demand healthcare workers in the state. But below-average wages and a cost of living that is a whopping 28% higher than the national average could be some reasons that the Beehive State is struggling to attract nurses.

A high number of job vacancies mean higher patient-to-nurse ratios, creating additional stress for a workforce prone to burnout. Much of the state is rural, public transportation is inadequate, and poor air quality causes frequent haze and smog.

The challenges are offset by some big benefits: Utah has been ranked as the “best state” thanks to the strong economy, infrastructure, and quality education — and it doesn’t hurt that Utah is home to myriad outdoor recreation opportunities and the stunning scenery at landmarks like Bryce Canyon and Arches National Park.


Moreover, Utah is hustling to boost its RN workforce. The University of Utah, Salt Lake City, Utah, has increased enrollment by 25% and hired additional faculty to help boost the nursing workforce — and those who work in hospitals and health clinics across the state benefit from a flat 4.55% individual income tax rate.

Idaho​

RNs per 1000 residents: 7.02

Average wage: $80,130 or $38.53 per hour


Average rent in Boise: $1646 per month

Although the nursing workforce in Idaho has increased, it still ranks as the lowest in the nation. Teresa Stanfill, DNP, RN, executive director for the Idaho Center for Nursing, said that the number of new nurses is too low to replace the number of retiring nurses.

The state introduced loan repayment programs that award up to $25,000 to cover student loan debt, and hospitals and health systems often offer sign-on bonuses and relocation packages to attract RNs. But long winters, an isolated location, and limited cultural options can make it harder to attract nurses to the state.

It’s easier to recruit RNs to suburban areas like Boise, Meridian, and Nampa, but rural parts of the state struggle, Stanfill adds. The nursing shortage is among the reasons that 11 hospitals and emergency departments closed in 2024, and healthcare organizations slashed services across the state.

Idaho has a lot to offer RNs, from small-town charm, reasonable cost of living, and gorgeous landscapes that make it one of the top 10 fastest-growing states in the nation. Collaboration between industry leaders and nursing programs is focused on finding creative solutions to boost the nursing workforce in Idaho.

Where Are the Nurse Practitioners (NPs)?

There are significant differences between the number of RNs and NPs in each state.

Massachusetts is the lone state that ranks in the top five for the highest number of RNs and NPs. The other states with the highest number of NPs per capita — Tennessee, Mississippi, and New Hampshire — are the middle of the pack when it comes to per capita numbers of RNs.

In contrast, California, Hawaii, and Idaho, the states with the fewest NPs per capita, also have lower numbers of RNs.

Here are the NP numbers:

5 States With the Highest Number of NPs Per Capita:

• Tennessee: 19.4 per 1000 residents
• Mississippi: 13.7 per 1000 residents
• New Hampshire: 13.3 per 1000 residents
• Missouri: 11.9 per 1000 residents
• Massachusetts: 11.3 per 1000 residents

5 States With the Lowest Number of NPs Per Capita:

• Washington: 5.72 per 1000 residents
• Idaho: 5.65 per 1000 residents
• Oregon: 5.64 per 1000 residents
• California: 5.5 per 1000 residents
• Hawaii: 3.5 per 1000 residents

Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.

 

[missy]

More Women Entering Medical School Than Men for 6th Straight Year: Why?

Women continue to make up the majority of medical school applicants, matriculants, and total enrollment. Experts share what’s fueling the ongoing rise of women in medical school.

www.medscape.com

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More Women Entering Medical School Than Men for Sixth Straight Year: Why?​

Alicia Gallegos


When she was an undergraduate, internist Theresa Rohr-Kirchgraber, MD, remembers having second thoughts about going into nursing as originally planned. She spoke with a college counselor about her desire to go to medical school instead.

At the time, it was the 1980s, and women made up about 30% of medical school students, Rohr-Kirchgraber said. When she mentioned medical school, the counselor sat her down and told her point-blank, “Well, if you become a physician, you won’t be able to be a mother then!”

“There was this expectation that you couldn’t do it all or if you would have to choose,” Rohr-Kirchgraber said. “I think that probably dissuaded a lot of women from going to medical school.”


Forty years later, the landscape for women in medical school — and the stereotypes associated — have vastly changed, said Rohr-Kirchgraber, a professor of medicine at Augusta University/University of Georgia Medical Partnership in Athens, Georgia, and a married, mother of three. Women now outnumber men in medical school, a trend that continues to rise.

Theresa Rohr-Kirchgraber, MD
In the 2024-2025 academic year, for the sixth time in a row, women made up the majority of medical school applicants, matriculants, and total enrollment, according to new datareleased on January 9 from the Association of American Medical Colleges (AAMC).





In the 2024-25 academic year, women made up 57% of applicants, 55% of matriculants, and 5% of total enrollment, the AAMC found. Women matriculants rose 0.2%. Among men, there was a 1% increase in the number of matriculants in 2024-25. It was the third year in a row that male matriculants did not decline following 6 years of declines from 2016 to 2022, according to the AAMC report.


The number of women in medical schools this year is steady with that of the 2023-2024 academic year, when women made up 57% of medical school applicants, 55% of matriculants, and 54% of total enrollment, according to last year’s data.

Women have been entering medical school at higher rates since 2017, said Diana Lautenberger, AAMC director of gender equity initiatives.

“It’s not that women are only now interested in higher education, medicine, science, STEM fields,” Lautenberger said. “Women have always been interested in these fields. They have just not been socially accepted or allowed to go into them in such higher numbers.”


More social support, more women physician role models, and medical schools becoming less biased, have all fueled more women acting on their interests to pursue medicine, she said.

A broader AAMC analysis found that from 2004 to 2022, the number of women in the active physician workforce increased 97%, whereas the number of men increased 13%. Women accounted for 38% of active physicians in 2022 (a total of 371,851), a rise from 26% (188,926) in 2004, according to the report. Men meanwhile, accounted for 62% of active physicians in 2022 (613,974), a decrease from 74% (541,285) in 2004.

A particularly big jump of women entering medical school came after the pandemic. In 2021, about 6000 more women applied to medical school, according to Lautenberger. Men applicants increased too, but by about 2000.

“There’s a phrase called the ‘feminization of medicine’ in that we are seeing more women coming into it,” she said. “The result is almost this return of viewing medicine as this profession of healing and caring. This idea that physicians are not just in surgery in the operating room performing operations on patients, but that medicine really is about holistic care.”

More Women Undergraduates Tipping the Scales ​

Another factor contributing to more women entering medical school is that more women are now getting undergraduate degrees, leading to a larger pool of women graduates, said Rohr-Kirchgraber, who is a past president of the American Medical Women’s Association.

In 1995, men and women were equally likely to hold a bachelor’s degree, but the gap has widened since then, according to Pew Research Center. Today, 47% of US women aged 25-34 years have a bachelor’s degree compared with 37% of men, according to a 2024 Pew Research Center analysis.

Shifting cultural norms have also impacted the rise of women in medical schools, said Michelle (Shelley) Nuss, MD, campus dean for the Augusta University/University of Georgia Medical Partnership and associate dean for graduate medical education. Cultural norms once emphasized women staying at home and taking care of children and men working, she said. Today, there is more acceptance of women in the workforce and parents sharing childcare duties.

Women physician role models and senior women leaders have also played a role, Rohr-Kirchgraber said. Organizations like the American Medical Women’s Association and their leaders have helped pave the way for young women physicians, she said.


“Women today can see, ‘Oh, you can be a doctor and have a family. You can be a woman and be a neurosurgeon.’ It’s not so surprising as it used to be,” she said.

Multiple studies have shown that women physicians positively impact outcomes and public health.

Michelle (Shelley) Nuss, MD
Patients seen by women physicians for example, have better patient outcomes and lower readmission rates. A 2024 studyin Annals of Internal Medicine found that hospitalized patients in the United States had a lower chance of dying or being readmitted within 30 days when they were treated by female physicians rather than by male clinicians.


The death rate for female patients was 8.15% when treated by female physicians vs 8.38% when treated by male physicians, a clinically meaningful difference, the study found. Male patients treated by female physicians had a 10.15% mortality rate compared with a 10.23% rate for male patients treated by male doctors.

Women physicians also spend more time with patients, Lautenberger said.

“They’re more empathetic. They listen more,” she said. “The impact that we’re seeing is ultimately positive for public health, for society, and for the profession at large. Not to mention about half the entire population are women. Just having that representational workforce becomes really important and ultimately better for public health.”

Remaining Equity Gaps to Close​

While higher numbers of women physicians are coming into the workforce, women still represent only 38% of the practicing physician workforce, according to the AAMC.

At the same time, women physicians continue to face inequities in other areas of practice including salary and leadership roles.

Pay equity has been a continuing challenge for women physicians, said Rohr-Kirchgraber said. A recent study of female primary care physicians (PCPs) for example, showed that women PCPs generated 10.9% less revenue from office visits and conducted 10.8% fewer visits than their male counterparts. However, they spent 2.6% more time in visits than their male counterparts.

“When you look at the gender inequity and pay, in every single field of medicine except for anesthesia, women are paid less,” Rohr-Kirchgraber said.

Data also show women physicians are still primarily chosing the same three specialties: Pediatrics, obstetrics-gynecology, and dermatology.

“When we look at by specialty, in general, we are not diversifying the range of specialties that women are entering,” Lautenberger said. “Those same specialties that had the highest proportions of women and the lowest proportions of women are exactly the same today as they were 10 years ago.”

One area where women are gaining momentum after decades of dearth is academic medicine. Women faculty have now risen from 38% to 45% in the past decade, according to the AAMC’s 2023-2024 report on The State of Women in Academic Medicine.


Women now represent 27% of US medical school deans, 34% of division chiefs, and 45% of senior associate deans. However, the report noted that progress is still needed among department chairs where only 25% are women.

Nuss is optimistic that more women taking on academic leadership roles is on the horizon.

“We’re just now starting to see more women in medicine and working their way up,” she said. “It’s going to take a little longer to get where we need to be, which is more of a balance of leadership at the top in medical schools. I think you will see more associate deans, more department heads and chairs, and more deans over time.”