Michigan podiatrists skipping out on CE?

Two Michigan Podiatric Medical Association employees blew the whistle on their own organization's practices, were fired, and now have filed a lawsuit against the association. From the Lansing State Journal:

The suit against the association and seven board members alleges some podiatrists would get credits at a major annual conference without attending the lectures. Continuing education credits are required for podiatrists to renew their medical licenses.

"People would sign in and either not attend the lectures or leave and go back to their offices and work and come back at the end of the day, sign in and get full credits," said former executive director Mark Dickens said. "There were instances where the lecture never occurred, and there was no one there."

Dickens and former marketing director Meghan Webber claim the association board of directors resisted their efforts to fix the system and fired them after they filed complaints with the state.

Last week, state community health officials got the go-ahead to launch a formal investigation.

Click here to access the article.

Survey on Impact of Senate Finance Committee Report

My friends over at Medical Meetings magazine took me up on my suggestion to post an online survey on this topic. What impact do you think the recent Senate Finance Committee Report will have on the world of CME? -- click here to access this short survey and tell MM what you think (Thank you, Medical Meetings magazine!). Click here to access the Senate Finance Committee's Report.

Physicians and industry survey results

The results of a 2003-2004 survey of 3,167 physicians representing six specialties have just been published in the New England Journal of Medicine:

Most physicians (94%) reported some type of relationship with the pharmaceutical industry, and most of these relationships involved receiving food in the workplace (83%) or receiving drug samples (78%). More than one third of the respondents (35%) received reimbursement for costs associated with professional meetings or continuing medical education, and more than one quarter (28%) received payments for consulting, giving lectures, or enrolling patients in trials. Cardiologists were more than twice as likely as family practitioners to receive payments.

Click here to access the abstract.

Short sightedness?

Jerry Avorn, MD, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, gives his perspective on the Prescription Drug User Fee Act (PDUFA) in the New England Journal of Medicine:

There were problems with the user-fee approach from the beginning. The original legislation required that no portion of companies' fees (about half a million dollars per drug reviewed) could be spent to evaluate drug side effects after approval — the time when many important safety concerns become apparent. The new law mandated strict deadlines for approval decisions. To comply, the FDA reassigned staff scientists to work on new drug applications, pulling the scientists from other regulatory activities. Several were taken from the Office of Drug Safety, which conducts adverse-effects surveillance — a move that helped to shrink and demoralize that unit.

Click here to access (registration required; NEJM is offering as a free text article). Please note there are a couple of other free text articles on FDA reform in the same issue.

Senate Finance Committee issues report on educational grants from industry

Well, here it finally is -- "Use of Educational Grants by Pharmaceutical Manufacturers" -- an excerpt from the Executive Summary of this report:

Indeed, ACCME’s records reveal numerous cases over the past 3
years in which companies had too much influence over the content of supposedly independent educational programs. In one case, a CME provider was cited for allowing a company to help select presenters; in another, the company allegedly influenced the setting and frequency of educational events. One CME provider was cited for promoting the ‘‘proprietary business interests of a commercial interest’’ during an educational program. During 2005 and 2006, 18 of the 76 CME providers reviewed by ACCME—or 24 percent—did not comply with at least one of the standards meant to ensure independence.

Another continuing concern for the Committee staff is the lack of proactive or real time oversight for educational grant programs. CME providers are not required to run prepared text by the FDA, ACCME, or any regulatory authority in advance of CME programs, and the FDA and ACCME do not routinely place monitors in CME audiences to assess what information is presented. Both the FDA and ACCME have intervened after the fact when presented with evidence that abuse occurred in educational grant programs. They do not, however, pre-approve or directly monitor educational grant programs and oversight actions may occur long after the problematic educational activity occurred. Even when ACCME determines that the CME providers repeatedly failed to distance themselves from the drug companies that sponsor them, ACCME can take years to impose penalties. Based on ACCME policies, it can take as long as 9 years from the date of a non-compliant educational activity for an educational provider to lose accreditation.

Click here to access the report.

Do drug reps "play" doctors?

Interesting article over at PLoS: "Following the Script: How Drug Reps Make Friends and Influence Doctors." Click here to access the article; if you read it, let me know what you think.
:)

Public Library of Science (PLoS)

A quick post to let readers know about this peer-reviewed open-access online journal. From the PLoS website:

PLoS is a tax-exempt, 501(c)3, nonprofit corporation headquartered in San Francisco, California (Federal Tax ID 68-0492065). PLoS is governed by a Board of Directors chaired by PLoS co-founder Harold Varmus.

PLoS received a $9M start-up grant from the Gordon and Betty Moore Foundation and has received support from the Sandler Family Supporting Foundation, the Open Society Institute, the Irving A Hansen Memorial Foundation, the Doris Duke Charitable Foundation, the Ellison Medical Foundation, the Burroughs Wellcome Fund, and many other foundations, universities, and other organizations and individuals.

Click here to access this online journal.

Are we too used to seeing overweight children?

As reported in the Wall Street Journal, heart researchers at Cincinnati Children's Hospital Medical Center have "found that a number of kids viewed as normal, healthy children by their parents and even the medical staff at the hospital were later found to have enlarged hearts -- a thickening in the wall of the main pumping chamber. Even some children under 10 years old showed signs of the condition, known as left ventricular hypertrophy, or LVH." From the article:

Given the attention on childhood obesity today, how could doctors not notice that these kids were heavy? One argument is that there are so many of them.

"We've grown so accustomed to an overweight child walking into the exam room that we've lost our visual representation of what a normal child is supposed to look like," says Tom Kimball, a pediatric cardiologist at the hospital. In short, overweight is the new "normal."

Click here to read the entire article (subscription required).

Delivering bad news

Is there a good way to tell a mother that her daughter has died? Let's say there is a compassionate way to do so and doctors in training at Emory University School of Medicine get to practice delivering bad news in a simulation workshop:

"They might not remember your name, but they will remember exactly the phrasing you used, how you said it, if they were confused," she tells the doctors. "People can recall that event very, very vividly. People can relive that and replay that." To avoid any confusion or misunderstanding, she advises the doctors to choose their words carefully. Instead of saying "passed on" or "not going to make it," she tells them to be straightforward. "I've seen family members be confused when someone goes in to talk about the news of death and (the doctors) can't actually say the person has died."

Click here to access the CNN.com article.

Medinnovation Blog

Although the writings of Richard L. Reece, M.D. are certainly not new to me, I've just discovered he has his own blog! And, I'm very happy to report, I have his permission to link from my blog to his! (Now if only Sam Elliott will contact me, life will be complete).
:)
Click here to access Doctor Reece's blog; interesting, interesting stuff!

Freaky Friday?

This New York Times article caught my attention "Doctors Try New Surgery for Gallbladder Removal." Apparently some surgeons in New York removed a woman's gallbladder through her vagina as part of a study! Dude, count me out on that approach; if I ever need my gallbladder out I'm going with the current standard of care. Click here to access the article.

New Safety & Quality Proposal from America's Health Insurance Plans

The AHIP's Board of Directors issued a press release on its proposal "Setting A Higher Bar":

The plan calls for the development of a new entity to compare the safety and efficacy of medical procedures and technologies, advocates steps to promote transparency of health care information and speed the adoption of best practices, and calls for the creation of a new patient-centered dispute resolution mechanism.

“Improving the safety and quality of care will allow the nation to more quickly provide coverage to all Americans,” said Karen Ignagni, President and CEO of AHIP. “We can enhance the value of the nation’s investment in health care and ensure that patients receive the right care at the right time in the right setting.”

Read their proposal and let me know what you think. Click here to access the press release and the proposal.

Will the case of Ketek lead to reform?

Check out "The FDA and the Case of Ketek" written by David B. Ross, M.D., Ph.D. and just published in the New England Journal of Medicine. Click here to read this important article (registration required).

The American College of Lifestyle Medicine

First that I've heard of this organization but better late than never... From the New York Times article:

The Centers for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s. The American College of Lifestyle Medicine has 150 members in a wide array of specialties — nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer-reviewed research on the way daily habits affect health.

Click here to read the news article. Click here to access the college's website.

Canadian open-access medical journal goes live!

Just learned that a new open-access online medical journal has gone live. From the cta.ca news article:

Open Medicine, to be officially launched Wednesday, was conceived in the bitter aftermath of the February 2006 firing of the editor and deputy editor of the Canadian Medical Association Journal.

The publication's business model differs greatly from standard medical journals. It will be available online only, will have no subscription fees, and no corporate or medical association ownership.

Click here to access the news article. Click here to access Open Medicine.

New IT consulting company launched!

I'm delighted to announce the launch of a brand new company, The Chimera Partnership, LLC. The company was started by the husband, Samir D. Mehta, MCP, of my friend and colleague, Ann Lichti (whom many of you might know from her articles in Medical Meetings magazine).

The Chimera Partnership, LLC states that it is a full-service IT consulting company with a mission to provide clients with reliable, stable and secure IT solutions to whatever technology issues they face. Core capabilities include: Data analysis (including CME/CE outcomes data analysis and report generation); Custom applications (including CME/CE participant databases, patient registries, and clinical trial management systems); Comprehensive network security; Disaster recovery services; Project management; IT manager/staff competency analysis; and comprehensive staff training programs. Click here to access the Chimera Partnership's website.
Disclosure: I have no financial interest in this company.

FDA Seizes All Medical Products From N.J. Device Manufacturer for Significant Manufacturing Violations

Click here to access this FDA alert.

Start low and go slow...

This old adage regarding prescriptions might end up with a new meaning if a bill limiting DTC advertising is passed by Congress:

Pharmaceutical companies could be prohibited from advertising new drugs directly to consumers for the first two years they are on the market under a bill moving through Congress this week.

The goal, supporters say, is to ensure medicines are safe before allowing industry to promote them to consumers in the hopes they will request prescriptions from doctors.

But a reduction in TV and print advertising, which helped transform medications for heartburn and arthritis into blockbusters, would be a serious financial blow to drug makers. According to one study, every $1 spent on pharmaceuticals advertising often adds more than $2 in sales.

Click here to read the WTOPnews.com article. If this bill is passed, would that mean more funding for CME?

Silence is not golden...

An article in today's New York Times points out that, historically, doctors in training learn in an environment that doesn't always welcome their input. From the article:

Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And students were all too easily intimidated. In a 1993 article in The New England Journal of Medicine, a Harvard medical student reported that although her resident routinely made derisive remarks about her patients on rounds, the rest of the team laughed nervously rather than confront her.

Similarly, as Dr. Adam J. Wolfberg wrote in the same journal last month, for years medical students performed pelvic examinations on anesthetized women who had not given consent because senior obstetricians said it was the best way to learn internal anatomy. Although this practice made many students uncomfortable, most were afraid to speak up.

The good news is that things are changing in this regard. Click here to read this article.

Smart tool aids in triage of emergency room patients

Do patient-centered (or "centred" as they spell it in Canada) information systems assist in the triage of Emergency Room patients? The Scarborough Hospital, Canada's largest urban community hospital, and Canada Health Infoway have launched such a new system:

The user-friendly kiosks are available in English, but will also feature interfaces in seven different languages including English, French, Chinese (Cantonese and Mandarin), Tamil, Punjabi, Farsi, Hindi and Urdu. Patients are asked a number of questions in their native language and can choose answers from a comprehensive list. The system then translates the information into English for use by the care providers. It is estimated that approximately half of the patients at the Scarborough Hospital speak English as a second language.

It will be interesting to see how successful this system will be in the ER setting. I would love to see such a system utilized for office visits. Click here to read the news article.

Surgical infection prevention

Check out this article just published in the Archives of Surgery: "Enhancing Compliance With Medicare Guidelines for Surgical Infection Prevention: Experience With a Cross-disciplinary Quality Improvement Team." What were the measures?:

(1) percentage of patients receiving antibiotics within 1 hour of incision,
(2) percentage of patients with appropriately selected antibiotics, and
(3) percentage of patients with antibiotics discontinued within 24 hours of operation end time.

And the results:

One thousand seventy-two patients were monitored. Measure 1 compliance improved from 72.25% to 83.78% (P<.001, Cochran-Armitage trend test); improvement or high performance (>90% compliance) was demonstrated in 5 of 7 services. Measure 2 compliance remained uniformly high (approximately 98%). Measure 3 compliance improved from 54.5% to 87.16% (P<.001); improvement was seen in 5 of 7 services.

How did that do all that? They formed a multidisciplinary team comprised of "a surgeon, an anesthesiologist, nurses (preoperative, operating room, and floor), a pharmacist, a hospital infection control committee member" and quality improvement specialists. They defined the hospital guidelines for surgical infection prevention, they defined personnel roles, they standardized processes and enhanced communication/education for their health care professionals. Did their CME folks certify their improvement activity for credit? Don't know, but they could've! Click here to access the abstract.

No Free Lunch?

Most of us are familiar with the organization "No Free Lunch"; well, they've just gone live with an online searchable database so that interested patients can locate physicians who do not accept freebies from industry. Click here to access the organization's website.

CME in the theater

I subscribe to various news alerts and thought I'd share this one on Military CME. Whenever you are buried by paperwork and anytime you doubt how important CME really is, think of this conference, the Multi-National Corps-Iraq Physician Assistants Conference, “Healthcare in a Deployed Environment,” which was not only for PAs but other medical professionals:

“Bringing us together allowed us to learn about treatment procedures, emergency medical gear and new innovations that other physician assistants have developed,” said Col. William Tozier, Task Force 3 Medical Command senior physician assistant.

“The scope and severity of many of the injuries we see in theater on a daily basis are unlike those experienced at trauma centers (in the U.S.) — even very busy ones,” said Lt. Col. William Magdycz, M.D., Task Force 3 surgical consultant. “Our providers have developed a very unique expertise. Sharing their experience with other providers helps to generalize that knowledge in theater. This can only improve the timing and quality of care for our service members,” he said.

Once assigned in theater, many PAs find themselves in remote areas and without consistent communication due to limited phone and network access, Tozier said.

“This meeting allowed them to talk about topics that currently impact their practice,” Tozier said. “I expect that many will change the way they practice medicine as a result of this conference.

That is what is important — not the review of old medical information, but the creation of new information and practices as a result of what they learned here.”

Click here to read the entire article.

The beginning of the end for prescription data mining?

Looks like lawmakers are taking a close look at companies that sell physician prescribing data to pharmaceutical companies:

Data-mining companies strongly defend what they do, saying the information they provide makes marketing less wasteful, more profitable and less annoying to doctors.

New Hampshire last year became the first state to ban such use of the data.

"I would say most doctors are shocked when they hear that drug reps really know everything they've written," said New Hampshire state Rep. Cindy Rosenwald, who sponsored the legislation.

The nation's largest health data-mining company, IMS Health of Norwalk, Conn., is challenging the New Hampshire law in federal court. IMS is also fighting a 2001 ban in the Canadian province of Alberta on releasing doctors' names.

States that have considered similar bills include Arizona, Illinois, Kansas, Maine, Nevada, New York, Massachusetts, Rhode Island, Vermont, Washington, West Virginia and Texas. A federal bill was proposed last year but died in committee.

Click here to read the news article.

FDA Urgently Warns Consumers about Health Risks of Potentially Contaminated Olives

The U.S. Food and Drug Administration (FDA) is alerting consumers to possible serious health risks from eating olives that may be contaminated with a deadly bacterium, Clostridium botulinum. C. botulinum can cause botulism, a potentially fatal illness. The olives are made by Charlie Brown di Rutigliano & Figli S.r.l, of Bari, Italy and are being recalled by the manufacturer. No illnesses have been reported to date in connection with this recall.

Click here to see the full FDA Safety Alert.

DTC medical device ads

Interesting article in the Wall Street Journal on direct-to-the-consumer medical device ads. Will they become as big as the DTC pharma ads? From the article:

To be sure, ad spending on medical devices isn't likely to become quite as significant as the money poured into pharmaceutical drugs, which more than doubled to $5.3 billion last year from 2000, according to TNS Media Intelligence. The device market is worth about $50 billion in sales right now, estimates Milton Hsu, a medical-devices industry analyst for Bear Stearns, compared with $320 billion for pharmaceuticals. TNS doesn't break out spending by medical-device makers. Most TV ads for medical devices air in the so-called spot market in limited regions of the country, rather than on national networks where airtime is more costly.

Click here to read the entire article (subscription required).

Do physicians consider your out-of-pocket costs?

A study conducted by the Center for Studying Health System Change (HSC) and the University of Chicago Hospitals indicates that:

While almost 80 percent of physicians consider patient costs when prescribing a generic over a brand-name drug, far fewer consider patient costs when deciding what diagnostic tests to recommend (40.2%) or deciding whether to hospitalize a patient when outpatient treatment is an option (51.2%), the study found.

Click here to read the news release.

Smoking stats from the CDC

The Centers for Disease Control recently published its 2005 smoking statistics -- some highlights:

The annual prevalence of current smoking among U.S. adults declined from 24.7% in 1997 to 20.9% in 2005.

For both sexes combined, the percentage of adults who were current smokers was lower among adults aged 65 years and over (10.4%) than among adults aged 18–44 years (24.0%) and 45–64 years (21.7%). This pattern in current smoking by age group was seen in both men and women.

Non-Hispanic white adults and non-Hispanic black adults were more likely than Hispanic adults to be current smokers.

Click here to access all of the smoking data from the January-September 2006 National Health Interview Survey.

"Sick" a new book

Yes, that's the title of a new book written by Jonathan Cohn, a senior editor at The New Republic. The book is reviewed in the New York Times by Sally Satel, who is a physician and a resident scholar at the American Enterprise Institute. An excerpt from this excellent review:

“Sick” does not offer a prescription for our ailing health care system, but it does include a closing chapter on what to do. Here the argument turns tendentious. Critics of universal coverage, Cohn writes, often traffic in alarmist tales “about rationing and waiting lines, followed by a horror story from Britain or Canada.” Those complaints are “wildly exaggerated” and also unfair, he says, because the problem is not the result of universal health care but “of universal health care on the cheap.” But Cohn is himself being unfair when he sweepingly denounces “the principles of modern conservatism” for being “conspicuously short on ... comfort or hope.” In truth, there is nothing inherently pessimistic in choice, self-reliance or limited bureaucracy — the values that underlie a market-based proposal like the one introduced by Senator Ron Wyden, an Oregon Democrat. In this plan, employers would no longer provide insurance and would instead convert those costs into a bigger paycheck, enabling workers to buy private insurance from providers who would then be forced to compete for business by offering better plans. (Wyden’s proposal also offers subsidies for the unemployed.)

Click here to read the entire review (registration required).

Hatfield-McCoy Feud possibly explained?

Just couldn't pass up posting this news item! Seems the McCoy clan might have an underlying genetic predisposition to having, well, a poor disposition:

No one blames the whole feud on the disease, but doctors say it could help explain some of the clan's behaviour.

"This condition can certainly make anybody short-tempered and, if they are prone because of their personality, it can add fuel to the fire," said Dr Revi Mathew, a Vanderbilt University endocrinologist treating a McCoy.

Von Hippel-Lindau disease can cause tumours in the eyes, ears, pancreas, kidney, brain and spine.

Roughly three-quarters of the affected McCoys have tumours of the adrenal gland.

Click here to read the Daily Telegraph article.

Reduction in Childhood Pneumonia Cases

From the Medical News Today article:

Since the introduction of the PCV7 pneumococcal conjugate vaccine, which began in 2000 in the USA, there has been a significant fall in the number of hospital admissions for pneumonia, according to a new report by researchers from Vanderbilt University School of Medicine, Nashville, USA.

Click here to read the entire article.

Pet food recall

A quick post to share this resource with y'all who have pets and are concerned about the pet food recalls (which seem to be mounting every day). Click here to access the FDA's website for the latest information.

Fourth Annual HealthGrades Patient Safety in American Hospitals Study

From the Washington Post article on this study:

The excess cost to Medicare associated with patient safety incidents was $8.6 billion from 2003 to 2005.Ten of 16 types of patient-safety incidents increased over the three years of the study, by an average of almost 12 percent. The greatest increases were in post-operative sepsis (about 34.3 percent); post-operative respiratory failure (18.7 percent); and selected infections due to medical care (about 12.2 percent).

Click here to access the WP article.

CMS releases 2007 Physician Quality Reporting Initiative Measures

There are 74 measures in the initiative, a fair amount of them relate to diabetes, antibiotic prescription, perioperative care, stroke, osteoporosis, CAP, and GERD. A few from the list:

20. Perioperative Care: Timing of Antibiotic Prophylaxis - Ordering Physician
Description
Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic parenteral antibiotics, who have an order for prophylactic antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)
21. Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin
Description
Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic, who had an order for cefazolin OR cefuroxime for antimicrobial prophylaxis
22. Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures)
Description
Percentage of non-cardiac surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic antibiotics AND who received a prophylactic antibiotic, who have an order for discontinuation of prophylactic antibiotics within 24 hours of surgical end time
23. Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Description
Percentage of patients aged 18 years and older undergoing procedures for which VTE prophylaxis is indicated in all patients, who had an order for Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after surgery end time

Click here to access the CMS release; click here to access the list of 74 measures. What percent of your CME Program will address these measures? Will you be able to link your CME activities to these measures in your CME database?

No more free CME dinners at the local steak house?

Check out the March 2007 Medical Meetings article "Stark II Update" authored by Sue Pelletier. Sue relates that the AMA wrote a letter to CMS asking that CMS make an exemption "'that permits physician compensation without financial limit in the form of continuing medical education that is offered for the purpose of ensuring quality patient care.'" And how did CMS respond?:

In a letter the AMA received in March of last year, Mark McClellan, administrator, Centers for Medicare and Medicaid Services, said, “After careful review, we do not think that a broad exception is consistent with our statutory mandate to create by regulation only those exceptions that pose no risk of program or patient abuse. In our view, CME provided at no or reduced cost — particularly CME off-site from the hospital — may pose a risk of program abuse.” The good news, however, is that CMS did agree that traditional on-site hospital CME programs, such as grand rounds and tumor boards, don't constitute remuneration to physicians and so should not fall under Stark II rules, Aparicio said.

Click here to read the entire article. CMS should be out with a final rule sometime very soon.

Alliance announces new executive director

From an announcement from the Alliance President, Sue Ann Capizzi, MBA:

On behalf of the Board of Directors of the Alliance for CME, it is my pleasure to announce that Paul D. Weber has been named the new Executive Director of the Alliance for CME effective April 27, 2007. Mr. Weber is the fourth Executive Director in the Alliance's thirty-two year history.

Click here to access the full announcement. Congrats to Mr. Weber!

Both sides now?

Interesting article in USA Today on unapproved drugs and the terminally ill:

Frustrated with the cumbersome process for obtaining experimental drugs — which requires dealing with the FDA bureaucracy as well as drugmakers and research institutions — a patient advocacy group has taken the FDA to court. The group argues that mentally competent terminally ill patients have a right to get such drugs.

Howard Fine, chief of the brain cancer branch at the National Cancer Institute, says he understands both sides of the debate over experimental drugs.

"Ethically speaking," Fine says, noting that he's talking only for himself, "who has the right to say to a patient: You have no right to try this medicine even though you're dying, even though you're well informed?"

On the other hand, he says, giving unapproved drugs to anyone who wants them would be a logistical nightmare: "Where are (drugmakers) going to send these drugs? The local doc down the street? And who's going to educate the doctor?"

Click here to read the entire article.

Why physicians leave a practice...

In a nutsell, it's the ole "not-a-good-fit" reason. According to a survey conducted by Cejka Search and published in STLToday:

More than half of the practices surveyed said "poor cultural fit" was No. 1 among the top three reasons given by departing doctors before they left. Cultural fit could include differences in clinical approach, bedside manner or management style. The other two top reasons for leaving were relocating closer to family and seeking higher compensation.
...
Statistically, most doctors leave a practice between years one and three.
...
Turnover rates were about the same among men and women. Among female physicians, however, the rates declined by about a percentage point versus the previous year. The rates among male physicians rose by about a point.

Click here to read the entire article.

FDA Announces Voluntary Withdrawal of Pergolide Products

From the 3/29/07 FDA release:

In 2006, an estimated 12,000 patients received prescriptions for pergolide from retail pharmacies in the United States. Patients taking pergolide should contact their doctors to discuss alternate treatments. Patients should not stop taking the medication, as stopping pergolide abruptly can be dangerous.

There are alternative therapies available for Parkinson’s disease, including three other dopamine agonists that have not been associated with valvular heart disease. The removal of pergolide products is not expected to adversely affect patient care because of the alternative therapies available.

Click here to read the entire release.