Source: Northern Echo Publication date: 2008-12-30Want to get fit but don’t want to splash out on expensive gym membership? Julia Breen looks at ways to battle the bulge and beat the crunch

IT’S definitely time to start thinking about a New Year fitness regime to shift those Christmas pudding pounds.

But research has shown that the credit crunch means fitness fanatics are throwing in the towel on expensive gymmemberships and instead investing in home fitness equipment.

It has been shown that there is a growing trend in the purchase of treadmills, exercise bikes and other home fitness machines.

Connection Fitness, based on the George Reynolds Industrial Estate in Shildon, is one of the largest online retailers of fitness equipment in the UK.

Managing director Dan Foskett, 20, says: “There are many reasons people turn away from the gym to buying home fitness equipment, but a lot of my customers have mentioned they want to find ways of reducing their outgoings and giving up their gymmemberships in exchange for a one-off payment for a piece of equipment for home use is one of them as the credit crunch sets in.

“Home gym equipment used to be really expensive and too large to fit in most homes. Over the years costs have been going down and the quality has really improved. There are also a lot of treadmills and crosstrainers that have folding designs to save space around the home. ”

Connection Fitness has five top tips for people wanting to burn fat in the New Year:

Use interval training on a treadmill to burn fat

Interval training is a great way to get fit. You can do this on a treadmill by walking for 30 seconds and then jogging for 30 seconds, or even jogging slowly for 30 seconds and running fast for 30 seconds - it just depends on your fitness level and what you feel comfortable with. Studies have shown that interval training will not only help increase your cardio fitness by 13 per cent, but your fatburning potential is also increased by 36 per cent when compared with a moderate workout.

Weight training burns calories

Cardio training is an excellent way of burning fat, but by adding a little strength training to your workouts you can burn extra calories each day and get even better results. For every additional pound ofmuscle you gain, your body burns around 50 extra calories every day of the week. A set of weights and a small utility bench is a good starting point if you want to add an extra dimension to your home workouts.

Cross trainers provide a full body workout

A cross trainer is a great piece of fitness equipment that can help burn calories and tone your full body at the same time. Cross trainers work your upper body and lower body - unlike an exercise bike that mainly focuses below the waistline. A cross trainer is also an excellent piece of equipment to get you in your fat burning zone and you can often burn as many calories as running on a treadmill.

Keep the workout varied with different equipment

By keeping your workout varied you can achieve better results. Combining both strength training and a cardio-vascular workout you can reach your fitness goals in record time. A varied workout plan keeps it interesting - and the more fun it is, the easier it is to keep up.

Combine with a healthy diet to get results

This may seem like an obvious one but it is really important to stick to a healthy diet to get the results you are looking for. The customers who get the most from their equipment are often those who make a lifestyle change and stick with it. By making changes to your eating habits and exercise regimes and sticking to them, you can get the results you want in 2009.

WIN A NORDIC TRACK TREADMILL WORTH [pounds]1,000

THE Northern Echo has teamed up with Connection Fitness to offer one lucky reader the chance to win a Nordic Track C2000 treadmill, below left.

The treadmill allows you easily to plug in your iPod or MP3 player and listen to your favourite music while you work out. DuraSoft III adjustable premium cushioning provides an impact- reducing workout for your joints.

The C2000 hosts 15 personal trainer workouts which automatically adjust the incline and speed of your treadmill, offering five weight loss, five aerobic and five performance workouts. A console displays either your heart beat, or an animated figure to walk, jog or run through the workout with you.

An autobreeze fan will keep you super cool throughout, with 0-12 per cent incline to add a degree of difficulty.

The space-saving C2000 also folds away with a self-locking latch.

For your chance to win, just answer this simple question: Where is Connection Fitness based?

Answers, along with your name, address and a daytime telephone number, on a postcard or back of an envelope, by January 5, 2009, to: Treadmill Competition, Features, The Northern Echo, Priestgate, Darlington DL1 1NF. Only one entry per person. Usual Newsquest competition rules apply.

(c) 2008 Northern Echo. Provided by ProQuest LLC. All rights Reserved.

A COMMON gene mutation has been identified that may be an important cause of high blood pressure.Around 20% of the white population are thought to have the gene variant, which affects the way the kidneys process salt.

Scientists believe a number of genes play a role in hypertension, or high blood pressure.

But identifying them is difficult because so many other factors influence blood pressure, including diet, exercise and stress levels.

The new discovery was made by analysing the DNA of 542 members of the Old Order Amish community in Pennsylvania, US.

The Amish are a Christian group who choose to live without electricity, motor transport or other trappings of modern life. Because they do not marry outside their community the Amish are genetically homogenous.

They also share a similar diet and rural lifestyle. For this reason they are ideal subjects for studies looking at the genetic causes of disease.

Dr Yen-Pei Christy Chang, of University of Maryland School of Medicine, Baltimore, said the discovery would enhance the ability to tailor treatments to the individual and to more effectively manage patients with hypertension.

(c) 2008 Belfast Telegraph. Provided by ProQuest LLC. All rights Reserved.

Source: The Times of India Publication date: 2008-12-31NEW DELHI: Thinking of adding a few more yards to your daily run? Sports medicine experts warn that taking part in longer runs like marathons without proper preparations could lead to related injuries.

Marathons where many runners are those who don’t exercise regularly or are not fitness freaks, are at a greater risk of suffering injuries as their bodies are not toned to deal with high- level physical stress.

The most common injuries which participants suffer during strenuous events like marathons are ankle and knee sprain, ligament tear, muscle pull among others. “A toned muscle provides support to ligaments and prevents it from rupturing. Those who don’t exercise on a regular basis develop weak muscles and more pressure is exerted on the ligaments when they participate in such events. They should wear knee or ankle braces before taking part in physically demanding tasks like these,” said Dr P K Dave, head of orthopaedics department, Rockland Hospital.

Experts also say that taking part in stressful exercise after a long period of time can result in cardiac arrest as the heart is not able to pump sufficient amount of blood to the organs. “The heart has its own need for oxygen and glucose apart from other organs to which it supplies blood. And when we exercise after a long gap, it is not able to meet the requirement. Thus, it can lead to sudden cardiac arrest or cardiac arrhythmia due to disturbance in heart rhythm,” said Dr R K Khetrapal, head of sports medicine unit at Indian Spinal Injuries Centre.

Among important factors like physical exercises, diet also plays a key part in building stamina. “Water is very important, as lack of it can lead to dehydration or disturb the electrolyte balance in the body. It is important drink water at regular intervals while running in a marathon so that the fluid content is balanced. Also, one should eat a lot of carbohydrate-rich food a day before the marathon in order to stock up energy,” explained Priti Rishi Lal, former nutritionist with Sports Authority of India and currently a lecturer with Delhi University.

Even lungs get affected during rigorous exercise like running and can lead to breathlessness. Said Dr Khetrapal: “The oxygen carrying capacity of lungs of an athlete and of an normal person are different. In some cases, the ones who are not used to any physical exercise can suffer from asthma and it can prove to be fatal in others. So, the preparation of any marathon or similar event should start at least a week in advance so that the body is conditioned to take the stress.”

risha.chitlangia@timesgroup.com

(c) 2008 The Times of India. Provided by ProQuest LLC. All rights Reserved.

Dec. 31–Chances are many of us will wake up bleary eyed Thursday after a night of New Year’s Eve revelry and resolve to do better in 2009.One of the main targets for improvement: our waistlines, with good reason.

According to the U.S. Centers for Disease Control and Prevention, more than 30 percent of American adults are obese, a condition that increases the risk for a variety of health problems including heart disease, diabetes, high blood pressure and strokes.

So how can you lose weight effectively? A dietitian and an exercise physiologist agree that much like any other long-term goal, the answer is a little bit at a time, not all at once.

“All the lifestyle changes we talk about, the question we tell people to ask is, ‘Can I do this long term?’ We try to teach lifestyle changes versus diet,” said Pam Ward, a dietitian with Western Baptist Hospital. “You’re much more likely to make long-term changes gradually as opposed to taking a gung ho approach.”

Kyle Miller, an exercise physiologist with Lourdes cardiac and pulmonary rehabilitation, said the key is simply doing something.

“I’ve been doing this since 1979, and I’ve heard all the excuses not to exercise, but I have yet to hear a reason not to exercise,” Miller said. “A lot of patients will say, ‘I’m active,’ or ‘I lead an active lifestyle.’ Well, exercise is an activity, but activity is not exercise.”

Both diet and exercise play key roles in weight loss and, more generally, a healthy lifestyle. Both Ward and Miller said jumping into an unsustainable program does little good because people will slide back into bad habits. Instead start small and build up to bigger goals.

“The old adage of no pain, no gain does not apply,” Miller said. “The goal is losing weight, and you can do so with moderate levels of activity. Moderation is key. Even a machine can’t handle extremes over a long period of time. It’s going to break down. The human body is the same way.”

Ward said even small changes in our perceptions of food can pay big dividends.

“The first thing I tell people is to gradually add more fruits,” she said. “They’re high in fiber and low in fat, so you’ll be more full and make fewer poor choices. Eat a variety of colors; the bigger the variety of colors you have, the more balanced it will be.”

Ward also suggested splitting meals at restaurants, or getting a to-go box for half of the increasingly oversized restaurant meals.

“If you’ll notice, the silverware has gotten bigger, the plates have gotten bigger, all to stay in proportion,” she said. “With chips and salsa and bread, a lot of those meals can easily be 1,500 to 2,000 calories.”

That’s basically a full day’s worth for those seeking to lose weight, she said. Ward suggested men target 1,800 to 2,000 calories a day to start, while women should shoot for between 1,300 and 1,500 calories a day. Going below 1,200 calories a day should be avoided, she said: “It becomes very difficult to get vitamins and minerals you need.”

A variety of small lifestyle changes can pay off in the long run, both said, but it’s crucial to realize there’s no quick fix.

“Everybody wants to lose 30 pounds, 40 pounds, 50 pounds,” Miller said. “Nobody sees monumental success in losing two or three pounds. But if you do that, and you lose another two or three pounds, and another two or three pounds, in due time you will have lost that 30 or 50 pounds.”

C.D. Bradley can be contacted at 575-8617.

——

Diet

–Add more fruits and vegetables to your routine, aiming for a variety of colors.

–Drink diet soda rather than regular, and also plenty of water.

–Watch portion sizes; many restaurant meals are enough for two.

–Make healthier choices: low-fat dairy products, the vegetable of the day rather than a loaded baked potato, grilled rather than fried.

Pam Ward, Western

Baptist Hospital dietitian

Exercise

–Some is better than none, even if you start small: walking five to 10 minutes three times a week.

–Gradually add to your routine, extending exercise to 15 minutes, then 20, then 30; then add a fourth day each week, then a fifth.

–Find someone to exercise with: the camaraderie offers encouragement and provides accountability.

–Choose an activity you enjoy: walking, cycling, swimming.

–Aim for a moderate level of activity: on a scale of 1 to 10, an effort between 3 and 5 can produce results.

Kyle Miller, Lourdes

exercise physiologist

—–

To see more of The Paducah Sun, or to subscribe to the newspaper, go to http://www.paducahsun.com.

Copyright (c) 2008, The Paducah Sun, Ky.

Distributed by McClatchy-Tribune Information Services.

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CONTROLLING blood sugar levels may help avoid memory lapses that occur in older age, according to a study that has linked raised glucose levels with “senior moments”.Researchers from Columbia University in the US found a direct link between blood sugar levels and activity in the part of the brain associated with memory lapse, which was true even for people who do not suffer degenerative brain disorders such as Alzheimer’s.

The research suggests that even in healthy individuals keeping blood sugar under control could be the key to preventing memory lapses.

Regular physical exercise and the right diet are two strategies to help achieve this, say the scientists. If necessary, blood sugar levels can be lowered with drugs.

Some degree of mental decline, marked by forgetfulness, is a part of normal ageing and does not always herald the onset of dementia.

Both the problems of normal ageing and dementia involve the hippocampus, the brain’s centre of memory.

In the study, Dr Small’s team conducted brain scans of human volunteers and animals to find out what was affecting the dentate gyrus. The scientists discovered that reduced activity in this part of the brain was closely correlated with higher levels of blood sugar. The same association was seen in humans, rhesus monkeys and mice.

Dr Small said: “There have been many proposed reasons for age- related hippocampal decline. This new study suggests that we may now know one of them.”

The findings were published in the December issue of Annals of Neurology.

Top health tips

Eat a healthy balanced diet that is low in fat, high in fibre, low in salt and includes plenty of fruit and vegetables

Make sure your weight stays within the recommended range for your height

Improve your level of all-round fitness by participating in regular moderate physical activity

Maintain normal blood pressure levels . Your doctor can advise you on diet and exercise.

Make sure that your cholesterol is kept low - your doctor will be able to advise you.

Give up smoking euros Reduce the amount of alcohol you drink

Originally published by Newsquest Media Group.

(c) 2008 Herald, The; Glasgow (UK). Provided by ProQuest LLC. All rights Reserved.

Winter running tips from University at Buffalo cross country coach and elite runner Vicki Mitchell:>Outside running

*Clothing

Wear bright clothes, wear reflective gear in the dark.

Dress in layers: Invest in one good dry-fit top. Have a pair running tights or pants, which come in a variety of weights. Wear a hat or headband and good mittens or gloves.

*Weather

If it’s windy, start your run into the wind, with the return trip with the wind. If you do the reverse, the return trip into the wind when you are sweaty can cause you to become cold.

Using a layer of Vaseline or similar product on the exposed parts of the face is a great skin protector.

If the wind chill is below zero, consider moving indoors.

*Road conditions

Always assess road conditions before going out to run. If icy, it is not worth the risk. If there are whiteout conditions, cars and snowplows cannot see a runner.

***

>Workouts for treadmills

*Easy and long runs

The general principle is to set the grade of the treadmill to 1- 1.5 percent to make up for the lack of wind resistance while running on the treadmill.

Speed workouts

Treadmills can serve as a great training aid in the winter months because you can get quality sessions in without the risk of icy roads or sacrificing the quality of your workout due to cold temps.

*Tempo runs

Perfect for treadmills because you can focus on the actual run, “feel” the pace, and work on mental focusing skills that are needed in distance running

Interval workouts

Faster running interspersed with slower jogging recovery segments. You can do endless variations on interval sessions by changing the speed and length of the interval and recovery period.

*Spring marathon training

Do your long runs and goal pace runs on the treadmill. You can have your water bottle right there, gels to refuel, and can practice your hydration — refueling at regular intervals. It also helps to train the mind to be at peace for a long period of time.

*Fighting the boredom factor

Use an iPod or mp3 player with your favorite music. Make a new music mix before a longer run, space out your favorite “energizing” songs throughout the mix. This will help keep you focused, and keep up a good rhythm.

– Amy Moritz

(c) 2008 Buffalo News. Provided by ProQuest LLC. All rights Reserved.

Marie Altman was feeling achy, sore and tight. Her back hurt constantly. Her body felt worn down. She needed a change in her life, a new outlook and a healthier perspective.That was Altman 25 years ago, before she discovered the benefits in healthy living. Today, Altman is strong and limber, agile and moves with ease. After more than two decades of practicing pilates, an exercise regimen that focuses on breathing and muscle control, she has more than reaped the benefits of a well-balanced life. She is, in short, the model of health.

“I just feel so much better,” Altman said. “That desire to be healthy really became a contagious way of living.”

For 11 years, Altman has been working to bring that sense of a whole, balanced lifestyle to her Glynn County neighbors, through her studio, The Pilates Loft.

At that facility on St. Simons Island, Altman trains her more than 200 clients to find their own sense of inner well-being. These are individuals, young and old, both new to or well-trained in the ways of physical fitness.

“Some of my clients are in middle school, and some are in their 80s,” Altman said. “That just goes to show that it is never too early or too late to start living a healthy lifestyle.”

As the calendar turns the page and another year lies on the horizon, many residents of the Golden Isles are looking to start living out resolutions of healthy living.

Pilates, Altman said, is an ideal way to kick-start those vows of well-being. After just one session, a physical shift and difference can be felt. After 10 sessions, that difference can be seen. And after 20 sessions, clients can expect an entirely new body and outlook on life, Altman attests.

“I’d say you need one or two sessions a week,” Altman said. “This is a very quick way to start getting in shape. Pilates elongates your muscles, increase strength and flexibility, while working in elements of breathing, relaxation and meditation. It really works the whole body, physically and mentally, and gets you ready for starting a healthy life.”

Pilates is far from the only option for jump-starting personal fitness. This time of year, sidewalks and health clubs become focal points for runners looking to get in shape. And while lacing up running shoes may be a good way to get heart rates up, it’s not the only exercise to launch a new, healthy way of living.

Cliff Caldwell, a personal trainer and program coordinator at the YWCA, has found walking to be an ideal gateway exercise.

Swimming and cycling, also, are easy, low-impact exercises that can shape and tone the body, without hurting the knees, Caldwell said, adding that lifting free weights and adding resistance training to an exercise routine are also keys to feeling and looking better.

But, Caldwell warns, an exercise routine should never be just that — don’t let it get routine. Exercising should be a fun experience, something that individuals look forward to doing, he said.

“Make it work for you. Listen to music, or exercise outside. Exercise with a buddy, or alone if you like that better. It needs to be about you,” Caldwell said. “People sometimes get this idea that exercise is a chore, but it shouldn’t be. There is no right or wrong.”

The true key to living a healthy lifestyle is not about having set days at the gym or a list of foods to eliminate from your diet, Caldwell said. Instead, his advice is simple: Eat less and move more.

“That’s all there is to it,” Caldwell said. “Just get that momentum going.”

For Patrick Kent, a personal trainer at St. Simons Health and Fitness, healthy living revolves around three elements: Getting plenty of rest (”You need at least seven to eight hours a night,” he said) exercising at least three times a week (”You’ve gotta get that heart rate up,” he said) and getting lots of sunshine (”Turn off the TV and go outside. You need that sunlight, I’m a big believer in that,” he said.)

Of course, being healthy is more than working the body. It also entails stimulating the mind and spirit. Taking time to relax, unwind and center your consciousness is as important to well-being as daily exercise, said Susan Turner, owner of Island D Spa.

Doing good things for others also pays off. Volunteering and lending a helping hand to neighbors can have as much of an impact on good health as anything, said Jordan Griffis, volunteer coordinator with United Way of Coastal Georgia.

Offering time and aid to others generates a sense of calm and wholeness, Griffis said, as well as giving individuals a greater understanding of the world at large.

“Helping others creates this whole positive energy about life,” Griffis said. “It’s a catalyst for opening your mind, and helps you see the forest for the trees.”

One of the biggest challenges faced by those new to the world of healthy living is the struggle to stick with it, Kent said. Altman sees it, too. A few weeks into the new year, and those resolutions have fallen by the wayside.

“It happens all the time,” Altman said. “People just get busy or get out of the mindset.”

So how do you stay on the path of health?

It’s easy, Kent said. The first place to start is by setting reasonable goals.

Often, would-be exercisers vow to make major changes, but a week or two in, it becomes too much of a struggle to stick with it. Kent advises setting easy and attainable goals, and once those have been achieved, inching up the resolutions in small increments.

At the YWCA, Caldwell often encourages clients to keep a log of their achievements. Maybe an immediate physical change is not evident, but seeing how hard you’ve work and how far you’ve come over time can be extra motivation to keep going, Caldwell said.

“Stick with it for three weeks,” Kent said. “After that, two things happen. First, you get into the habit of healthy living. Then, two, you get addicted to endorphins (released in your brain during exercise) and to feeling better. And that really is the most important thing. You feel better all over.”

Where to get fit

You say it every year. When the new year comes around, resolutions for healthier living fly. Eat better. Exercise more. Take time to unwind. Lend a helping hand. Luckily, in the Golden Isles, there are plenty of place to help you keep those healthy living resolutions. Among them:

Fitness Center:

YWCA Family Center: 144 Scranton Connector, Glynn County 265-4100 www.ywcabrunswick.org

St. Simons Health and Fitness: 2929 Demere Road, St. Simons Island 638-5600 www.stsimonshealthclub.com

Pilates Loft: 60 Cinema Lane, Suite 230, St. Simons Island 638-0101 www.pilatesloftssi.com

341 Fitness: 60 Town Village, Glynn County 279-1341

Anytime Fitness: 24 Canal Road, Glynn County 275-8005 www.anytimefitness.com

Pilates and Yoga: 805 Mallay Street, St. Simons Island 242-2149

Healthy eating

Island Natural Market: 204 Retreat Village, St. Simons Island 634-0394

Feelin’ Great Cafe and Wellness Center: 718 Mall Blvd., Glynn County 265-1552

Volunteer opportunities

The United Way of Coastal Georgia: 265-1850 www.uwcga.org

Salvation Army: 265-9381 www.salvationarmy.org

American Red Cross: 265-1695 www.redcross.org

Habitat for Humanity of Glynn County: 265-7455 www.habitatglynncounty.org

—–

To see more of The Brunswick News or to subscribe to the newspaper, go to http://www.thebrunswicknews.com/.

Copyright (c) 2008, The Brunswick News, Ga.

Distributed by McClatchy-Tribune Information Services.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Joi Harper had been working out at Champion Fitness for about four years, but it was an on-and-off kind of thing.She says she knew she wasn’t consistent and was concerned about getting an injury as she grew older.

So, she chose certified trainer Kim Stephens to help her.

It made a difference.

“Definitely I pushed myself farther than before; she motivates me,” said Harper, 32. “One thing about Kim is she really makes it fun. I think her personality makes her clients want to work out.”

Harper said Stephens has been her trainer for about 1 1/2 years. She has three sessions a week. They are preceded and followed by a warm-up and cool-down that she does on her own, but the core of each session is 30 minutes with Stephens.

“We do squats and lunges, and we do a lot of abdominal exercises,” Harper said. “The biggest thing Kim has done for me is get me to where I enjoy running. We do free weights for my arms and upper body, and push-ups.”

Harper said having a personal trainer improved her consistency to where she is now regular in showing up at the gym.

“I would definitely say I’ve gotten stronger in my endurance,” she said. “I’ve done things I didn’t know I could do before.”

Stephens said being a personal trainer is a process of educating, motivating and holding the clients accountable for their success.

“I have quite a range of clients from age 19 to 70,” she said. “A lot of people want to change the shape of their body or improve their cardiovascular capacity. I design a program for them that takes into account their individual differences, like diabetes or a bad shoulder. Someone with a disability or disease has to be treated right.”

At Muskogee Swim and Fitness Center, certified personal trainer Jessica Smith, 27, has seen that having a personal trainer may make the difference between staying on an exercise program or getting no exercise at all.

“A lot of people who don’t have a personal trainer won’t even come in,” she said. “It’s a dramatic difference. A personal trainer will encourage you, whereas if you were on your own, you might give up.”

Smith said starting with a personal trainer involves filling out a questionnaire and doing an evaluation.

“The questionnaire asks them things like whether they have diabetes, high cholesterol, or injuries in the past,” she said. “We also find out their long-term fitness goals, how many hours they sleep, their eating habits, and whether they have an physical restrictions.”

Next is a physical fitness evaluation to see where the client is at their starting point.

“We check their body composition, their strength, their flexibility, their endurance and their cardiovascular output,” she said.

Smith said the combination of the questionnaire and the evaluation helps her design an “exercise prescription.”

“We slowly work them out,” she said. “For example, if they’re doing crunches, we increase them by two or three each time they come in. If they’re doing 20 sit-ups at the time of their evaluation, we may aim for 40 sit-ups by the end of their next evaluation. And we log every exercise.”

Smith said the No. 1 reason people sign up for a personal trainer is weight loss. But she added that the money spent on a trainer translates into savings later on.

“It’s an investment now that doesn’t compare to doctor’s bills and medicines down the road,” she said. “It’s prevention.”

—–

To see more of the Muskogee Phoenix or to subscribe to the newspaper, go to http://www.muskogeephoenix.com.

Copyright (c) 2008, Muskogee Phoenix, Okla.

Distributed by McClatchy-Tribune Information Services.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Health care reform always ranks near the top of politicians’ short lists of major problems facing the nation, but it seems that rhetoric hasn’t been backed by action. In Vermont, a shortage of primary care physicians (PCPs) such as family doctors and pediatricians is one of the biggest challenges facing the state’s health care system.The common problems cited by primary care doctors crushing paperwork loads, lack of adequate time with patients, unsatisfactory compensation, and fear of malpractice lawsuits have been increasing in recent years. These disadvantages are discouraging new medical school graduates from pursuing careers in primary care.

Many of these problems are national trends. The typical medical student graduates with about $140,000 in loans, from both undergraduate and medical degrees. Paying off that debt is an important consideration, and many graduates eschew primary care for a more lucrative specialty, such as anesthesiology. In 2007, family doctors in Vermont made just under $130,000, while anesthesiologists made around $175,000, according to state’s Department of Labor statistics.

Why are primary care physicians paid less when their services are so important to the general health of the patient?

The answer is complex, but is rooted in the fact that primary care doctors are paid solely for the time they see patients, not for administrative duties they perform. Under the current payment structure, there is no billing system for time spent writing referrals, doing consultation work, and completing insurance forms. This is work that a specialist often avoids. “A surgeon is billed for the entire operation, but a primary care doctor is only billed for the time they see the patient,” said Dr Ted Epperly, president of the American Academy of Family Physicians.

“Anything that starts to standardize forms will free up time for doctors,” said Epperly, “Different organizations want all the patients’ information to be repeated. Forms should be streamlined and put online.”

Tweaking the ratio of doctors is essential to fix the problem, Epperly added. But if primary care is an area where the new doctors see inadequate compensation and unsatisfactory professional lives, it will continue to be difficult to satisfy the growing need.

In fact, the federal government has mandated that patient information be stored electronically, in an Electronic Medical Record (EMR). Hospitals and practices will have until 2009 to comply with the legislation.

Marvin Klikunas, MD, practices at the Given Health Center in Williston. He agrees that such measures will help, but contends that the problem still lies in how physicians are billed, and, equally important, added burdens of the job.

“Primary care has gotten harder as more regulations have been imposed,” Klikunas said. “A lot of it has to do with billing. Everything we do is scrutinized. There’s some reasons for what’s been done, but you’re always having to justify the test.”

An MRI can cost $2,000, so recommending one that isn’t absolutely necessary is a big profit loss in the eyes of the insurance company.

Such micromanagement is one of the reasons why fewer medical school graduates become PCPs. The shortage is expected to get worse: Currently, 36 percent of practicing physicians the United States are in primary care. In 2005, only 13 percent of internal medicine residents planned careers in primary care.

Many studies show that a primary care-centered health care system leads to superior patient health at a lower cost. Indeed, most western nations have about the same number of PCPs as specialists, but in the United States only 36 percent of doctors are in primary care. That number is slightly higher in Vermont (at 39 percent), but still not high enough to meet the demands of the state.

A survey of 1,200 general practice physicians conducted by the Physicians’ Foundation and released in November found that 60 percent of such doctors would not recommend medicine as a career. The survey also found that 78 percent believe there is a shortage of primary care doctors. Other findings revealed that 90 percent stated that their non-clinical paperwork has gone down, and 63 percent said that paperwork has resulted in a decrease in patient time.

Overall, the consensus (76 percent) of the primary care doctors in the survey said that they are either at full capacity or overworked. Almost half in the study said they plan to either reduce patient loads or quit medicine.

Vermont ranks near the top of the nation in care provided, but is the second most rapidly aging state, it needs to prepare itself for an influx of older patients who may not be in the best health. According to Paul Grundy, director of healthcare technology and strategic initiatives at IBM, primary care needs to play a bigger role. “Our premise is that primary care is the only natural locus of control of health care quality and costs, Grundy said. ” It is the only entity whose job it is to consider the whole patient, the health of the whole person, including mental and physical.”

One development helping ease the burdens of PCPs are hospitalists, defined as those who spend over 25 percent of their time providing primary care in a hospital setting. By taking over primary care when a patient enters a hospital, they help to normalize the hours of the primary care doctor by eliminating the need to shuttle from the clinic to the hospital.

“Hospitalists limit doctors’ time on call, and provide a reduced schedule while still meeting patient needs,” said Mike Simpson, director of human resources at Northeastern Vermont Regional Hospital in Saint Johnsbury. However, some feel that use of hospitalists interrupts the continuity of care so important in medicine.

Dr Klikunas is one of those people. He doesn’t use a hospitalist with his patients, but sees it as an option for some doctors.

“It’s more accepted by younger physicians looking for more balance between their professional and personal lives,” he said. It also allows physicians who might otherwise retire to continue practicing.

Loan repayment assistance is one way to entice more medical school grads into PCP. In partnership with the Vermont Department of Health, the Vermont Area Health Education Center (AHEC) offers up to $20,000 (out of a total of $370,000) to primary care doctors promising to stay in the state and practice in the areas of greatest need.

Those tend to be in the rural sections of Vermont, according to AHEC studies. Data gathered by the center 2006 revealed that over half of primary care providers in Lamoille, Washington, and Orleans counties were not accepting new patients.

Many applaud loan repayment programs like the one managed by AHEC, but say that more needs to be done.

“The funding provided in for the loan repayment program is inadequate,” said Paul Harrington, executive Vice President of the Vermont Medical Association.

Harrington does have a point: the average award granted by the program in 2006 was just over $4,000, which may not be enough to influence new doctors with debts two dozen times that.

As the state budget is picked apart and funding slashed, lawmakers have continued to fund loan repayment. Like Harrington, AHEC program director Liz Cote would like to see funding increased, but concedes that might not be possible in the current economic climate.

Cote sees payment reforms as the main issue.

“You can’t just throw money at the system,” she says. “Vermont is a unique environment to impact change,” Cote said. “It’s a small state and legislators are accessible, so if any state can get [payment reform] done, it’s Vermont.”

Copyright Boutin-McQuiston, Inc. Dec 2008

(c) 2008 Vermont Business Magazine. Provided by ProQuest LLC. All rights Reserved.

Heart disease is the leading cause of death for women in the U.S., yet a wealth of data shows female cardiac patients receive inferior medical care compared with men.Too many physicians still discount the idea that a woman could be suffering from heart disease, delaying or denying needed medical interventions, experts note. Most community hospitals in the U.S. still are not following guidelines for treating women with heart attacks. And primary care doctors don’t do as much as they could to emphasize prevention.

As a result, women are failing to reap the full benefits of enormous advances in cardiovascular medicine.

The point was underscored this month by a study published in the journal Circulation finding that women who have heart attacks receive fewer recommended treatments in hospitals than men, including aspirin, beta blocker medications, angioplasties, clot-busting drugs and surgeries to re-establish blood flow. Women with the most serious heart attacks, known as STEMIs, were significantly more likely to die at a hospital than men.

“We need to do a better job of defining women’s symptoms and treating them aggressively and rapidly, as we do for men,” said Dr. Hani Jneid, the study’s lead author and assistant professor of medicine at the Baylor College of Medicine in Houston.

In Israel, when guidelines have been applied much more rigorously, the mortality difference between the sexes all but disappeared, according to a July study in the American Journal of Medicine.

Outside hospitals, too few internists, family doctors, obstetricians and gynecologists are implementing recommendations for preventing heart disease in women, experts say. Eighty percent of heart attacks in women could be prevented if women changed their eating habits, got regular exercise, managed their cholesterol and blood pressure, and followed other preventive measures.

Although death rates from cardiovascular disease have fallen, the condition killed 455,000 women in 2006, according to data from the American Heart Association. Heart disease causes about 72 percent of cardiovascular fatalities; the rest are strokes and other related conditions.

The next decade could see major advances as scientists better understand how the biology of heart disease differs in women, said Dr. Joan Briller, director of the Heart Disease in Women program at the University of Illinois Medical Center at Chicago.

Already, for example, researchers have learned that plaque deposits tend to be spread more widely in women than in men, resulting in fewer big blockages in the arteries. That means standard therapies such as angioplasty are often less effective in women. Also, woman metabolize certain heart drugs at a different rate than men.

Women should learn about the symptoms of acute heart disease — which can differ from those in men — respond promptly if they sense something is wrong, and “find physicians who care about them,” said Dr. Annabelle Volgman, medical director of the Heart Center for Women at Rush University Medical Center.

“Ask your doctor: Are you familiar with the guidelines for the prevention of heart disease in women published in 2007? Do you follow them? If they say ‘no,’ find yourself another doctor,” she said.

These Chicago-area women learned the importance of that advice the hard way:

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