Breaking Down Student Loans by Profession

The continued growth of student loan debt in the United States has reached staggering numbers of more than $1.2 trillion and 40 million borrowers. After receiving a bachelor’s degree, many students continue to earn a graduate degree in order to improve their knowledge base and earning potential. Those pursuing a medical, dental, MBA or law degree have to deal with a serious price tag that is significantly higher than the national average undergraduate balance of $29,000. A recently graduated dentist, for example, will acquire an average of $240,000+ of student loans or 7.9 times more than those with a four year degree alone.

More Tuition Numbers by Graduate Degree Type: 

MBA: The average annual tuition for a two-year MBA program exceeds $60,000. If you attend one of the top business schools in the U.S., you can expect to pay as much as $100,000 or more in tuition and fees.

Law
: The average yearly tuition for a law degree is around $50,000. However, the average debt taken on by a law school graduate was $84,000 if you attend public schools and $122,158 if you attend private schools.

Medical
: The average yearly tuition for a medical student is $28,719 for resident students at public institutions, $49,000 for non-resident students at public institutions, and $47,673 for students at private institutions. The average debt a medical student graduates with is between $170,000 and $190,000.

Dental: The average yearly tuition in-state is $38,826 and out of state is $63,774. The average dental student graduates with $241,097 of debt.

These students have to pay off major tuition costs from graduate school and may need to pay off their undergraduate loans as well. It becomes an astronomical amount of money leaving many students with financial issues even after securing a high paying job. Plus, many of these working professionals are paying high-interest rates for their graduate student loans. As a good first step, they should research their options and consider refinancing their student loans to pay a lower rate and ensure that they start their professional careers on solid financial footing. Many working professionals don’t know that they can refinance their student loans and some who are aware don’t make the effort because they think it will take a good deal of their already limited time. But this is not true, as many student loan refinancers, including DRB, make the application process simple and easy with fast approval.

DRB recently announced a new product that will offer perspective MBAs the opportunity to finance their student loans while still in business school. This marks DRB’s first financing product for in-school borrowers. This product can change the debt numbers across the board as students will be able to finance their loans while they are still attending school. It will give students a head start as they begin to financially set up their lives after graduation and keep them from being buried in debt.

Aryea Aranoff works on strategy, marketing and technology at DRB Student Loan, a marketplace lender and FDIC-insured bank offering low rate student loan refinancing to working professionals and parents with PLUS loans. DRB Student Loan is a leader in this space offering some of the lowest rates in the country on its student loans.

Posted in Department of Education, Law, Medical Education, Student Loans

One Path to Debt-Free College

With college tuition costs at an all-time highDemos, a D.C.-based public policy organization, recently proposed a debt-free college initiative. “The Affordable College Compact” calls for state and federal partnership in higher education with the goals of substantially increasing public investment in higher education and reducing student debt.

In the current job market, a college degree continues to have tremendous value. As the New York Times noted in 2014, college graduates make 98 percent more per hour than people without a degree, and not obtaining a college degree costs about half a million dollars. Demos notes that “nearly two-thirds of all new jobs in the next 6 years will require some training beyond high school, and 35 percent will require at least a bachelor’s degree.”

Despite its value, the cost of a public college education has risen as state and federal investment in education has declined. Inflation-adjusted tuition and fees have increased 117 percent at public four-year institutions and 62 percent at two-year schools over the last two decades. Meanwhile, the average debt accumulated by students at public schools has increased by almost a third over the past decade. Not surprisingly, the debt load is heaviest for first-generation students, low- and middle-income students and students of color.

Demos intimates the consequences of college becoming less affordable are disastrous. The United States is only 12th in the world for college attainment among 25-34 year olds (we are first for those over 65). The gap in college graduation rates by race and class are widening. Student debt is an increasing drag on the economy as it reduces household formation and homeownership. The risks of delinquency and default are high for those who graduate with degrees, and even higher for the 29 percent of borrowers who drop out.

In response to this crisis, the Affordable College Compact proposes the federal government leverage funds to ensure that poor, working class and middle-class students can attend college debt-free. States would be required to treat higher education as a public good (which Demos defines as ensuring that tuition revenue does not exceed revenue appropriated) and in return would be eligible for 20 percent or 60 percent matching federal grants for every dollar they spent on higher education, depending on their level of commitment. States increasing their commitment over time would be eligible for an additional 40 percent match.

Demos’ estimate is that the Affordable College Compact would cost $29.5 billion if all 26 currently eligible states (those who meet the public good requirement) participated at their current funding levels and increased funding by 1.4 percent. Of course, these initial estimates would rise as more states and students respond to federal incentives, and it remains uncertain whether states, which are still recovering from the Great Recession, are prepared to shoulder these costs. However, this budget is still less than the federal government invests in Pell Grants, less than it invests in tax-based student aid and far less than the Department of Defense’s budget of $496 billion.

Debt-free education is not as radical as it might seem. Countries like Germany, Denmark, England, and Australia have all deemed education worthy of investment at approximately these levels. Whether we conceive of it as a public good or not, Americans need to consider making a similar investment. Kudos to Demos for sketching out one way to accomplish it.

Isaac Bowers is Associate Director for Law School Engagement & Advocacy, overseeing the Student Debt, Student Engagement and Law School Relations programs. He was previously responsible for the organization’s educational debt relief initiatives. In that capacity, he wrote a weekly blog for U.S. News; conducted monthly webinars for a wide range of audiences; advised employers, law schools and professional organizations; and worked with Congress and the Department of Education on Federal legislation and regulations. Prior to joining Equal Justice Works, he was a Fellow at Shute, Mihaly & Weinberger LLP in San Francisco, where he represented citizen groups and local agencies in environmental litigation and land use and planning issues. Isaac received his J.D. from New York University School of Law.

Lauren Hunter is a Communications Consultant for Equal Justice Works, and a full-time Ph.D. student in the Department of Communication at the University of Maryland. She studies rhetoric and public address with a focus on rights and public policy.

Follow Equal Justice Works on Twitter: www.twitter.com/EJW_Org

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Posted in Uncategorized

How lawyers can avoid burnout and debilitating anxiety

Posted Jul 01, 2015 06:00 am CDT

By Leslie A. Gordon

Soon after graduating from New York University School of Law and joining the corporate practice of a white-shoe Manhattan law firm, Will Meyerhofer gained 45 pounds, was sleep-deprived and was frequently sick. “I was a nervous wreck. I was shattered,” says Meyerhofer, who’d also graduated from Harvard. “Even though I got to the very top, I was treated like an idiot and I felt I didn’t belong in the field. I was a mess. At the end of the day, I really only looked forward to seeing my dog.”
Not surprisingly, this experience triggered major anxiety for Meyerhofer, who often found himself “curled up in a ball, crying, losing it.” Even after he left the profession, he had panic dreams about being back at the firm.

Meyerhofer’s experience is not unique. A 1990 Johns Hopkins University study examined more than 100 occupations for anxiety-related issues and found that lawyers suffer from depression at a rate 3.6 times that of the other professions studied. A National Institute for Occupational Safety and Health study—based on data from 1984-1998—concluded that white male lawyers are more likely to turn to suicide than nonlawyer professionals. Falling Through the Cracks, a 2014 survey of Yale Law School students, found that 70 percent of them have struggled with mental health issues during their time at law school.

“The official number is that something like a gazillion lawyers are stressed out, and that amounts to a bajillion percent of the profession,” observes Meyerhofer, who became a licensed clinical social worker after benefiting tremendously from therapy he himself underwent to “get a grasp on what happened to me in BigLaw.” Counseling stressed-out attorneys has since become a specialty for Meyerhofer, who’s also written a book, Way Worse Than Being a Dentist: The Lawyer’s Quest for Meaning. In his practice, lawyers complain frequently and primarily about depression and anxiety. “I see it like crazy.”

PERFECTLY NEGATIVE

Two character traits—perfectionism and pessimism—are prevalent among lawyers and may make them prone to anxiety, according to Gayle Victor, who worked as a consumer debt attorney for 25 years before becoming a social worker. “Perfectionism helps lawyers succeed in practice because the profession is excessively detail-oriented. In the Johns Hopkins study, optimism outperformed pessimism—except in the legal profession, because lawyers are hired to always look out for what can go wrong.” Stressed-out lawyers account for 75 percent of Victor’s practice, Care for Lawyers, which is based in Evanston, Illinois.

Taken to the extreme, perfectionism transforms into a feeling that nothing is good enough. “Attorneys develop an overdeveloped sense of control, so if things don’t go as planned, they blame themselves. They think they didn’t work hard enough or they were careless,” explains Tyger Latham, a Washington, D.C.-based psychologist who treats many lawyers and law students. “Paid worriers, lawyers are expected to predict the future, to anticipate threats and guard against anything that could arise. So they learn to see problems everywhere, even when they don’t exist. And they start to perceive threats as if they’re life-or-death matters. That’s the very definition of anxiety.”

Gayle VictorGayle Victor says two traits—perfectionism and pessimism—are prevalent among lawyers and may make them prone to anxiety. Photo by Wayne Slezak.

What can then happen is that looking for risk and problems moves beyond just being a job or a profession and becomes the way that lawyers approach life, says Alan Levin, who spent 34 years as a labor and employment lawyer before co-founding the Care for Lawyers therapy practice with Victor. Lawyers tend to perceive far higher stakes when they encounter adversity, Levin says. “It’s like coming home with four A’s and a B and only focusing on the B. Mistakes are not tolerated well. Plus, the atmosphere of law offers minimal support amidst the high pressure,” contributing to a profound sense of isolation for lawyers. As a result, “without a doubt, every lawyer I see has anxiety greater than the average population.”

Mental health disorders can profoundly affect attorneys’ daily functioning.Irritability, obsessive thoughts, feelings of inadequacy, difficulty concentrating, a sense of worry and impending danger, sleep disturbances, heart palpitations, sweating, fatigue and muscle tension are all side effects of anxiety and depression, according to Latham. Some attorneys withdraw from peers, friends and family or engage in “maladaptive coping behaviors,” such as self-medicating with alcohol and other substances.

Will Meyerhofer
Will Meyerhofer underwent therapy for anxiety while working at a corporate law firm. He now has a practice counseling stressed-out attorneys.

Meyerhofer, too, has seen “strange compensatory behavior” among lawyers eager to gain a sense of control over their lives, including “hair pulling, hand washing, food disorders and gym anorexia,” he says. “I’ve seen weird stuff—lawyers who stay up all night playing video games, guys who use prostitutes.”

What’s notable about lawyers’ unhappiness is that there’s a sense of acceptance rather than outrage, says Jeena Cho, a San Francisco bankruptcy lawyer who blogs about anxiety and mindfulness and is working on a book. “Why do we accept this as the norm? Why do we have to accept that our jobs have to be miserable?”

AVOIDING ANXIETY

The good news is that healthy coping mechanisms are available and are proven to reduce anxiety and depression among lawyers. Chief among them is meditation, which is not surprising given the media attention it has received in recent years. And the practice is gaining momentum in the legal profession. The law schools at Yale, the University of California at Berkeley and the University of San Francisco have begun offering mindfulness courses. In Northern California, Spirit Rock Meditation Center offers weekends solely for attorneys—the only profession-specific retreat the center offers.

In addition to her law practice, Cho teaches meditation courses for lawyers, coaches attorneys on stress and anxiety management, and produces the Resilient Lawyer podcast. She says a meditation practice will bring notable changes to stressed-out attorneys. “Start a daily meditation practice,” Cho says. “It doesn’t have to be long. It may just be a couple of minutes. It doesn’t even have to be a formal meditation practice: Just sit at your desk, close your eyes and breathe.”

Professionals such as attorneys can be resistant to meditation because of prevalent but erroneous stereotypes. Karen Gifford, a lawyer-turned-executive coach and co-founder of Broad Ventures Leadership in San Francisco, tries to demythologize meditation. “You don’t have to go to the top of a mountain or wear funny clothes” to bring mindfulness to your day, she says. “The territory you’re heading into is yourself, which is a very safe place to be. And it doesn’t involve giving up your logical mind.”

Criminal defense lawyer Brian Berson of San Francisco took Cho’s meditation course after experts at the Stanford Center for Sleep Sciences and Medicine suggested that he try meditation to help with his profound sleep disturbances. “I have a high-stress business. All of my clients are desperate. I’ve had various sleep disorders, including waking in the middle of the night thinking about work,” Berson says. “The meditation class was very soothing; and overall, it’s helped me with everything.”

The basic idea, according to Berson, is to just be in the moment. “All of us have a tendency to think about other stuff no matter what we’re doing. But it’s counterproductive and prevents you from enjoying life if you’re doing something pleasurable—or even if you’re doing something mundane that can be pleasurable, like taking a shower. You should stop and really feel the water instead of thinking about what you need to do when you get out. When you’re walking down the street, enjoy it. Smell the air, look at the surroundings instead of thinking about where you’re on your way to. Mindfulness is more than just meditation. It’s a whole different way of thinking.”

Berson continues to do online meditation sessions with Cho whenever he can fit it into his schedule. Because he has “trouble getting into that zone” on his own, he says, he likes the structure of a guided practice. “It’s a really good thing for anyone with a stressful job,” he says. “Most lawyers are under a lot of stress. We’re advocating for people who are desperate—not just criminal defense lawyers like me whose clients are in prison. Litigators, too, are warriors. We’ve got to fight people. The aggressive state of mind is hard to turn off. That’s stressful. It’s bad for your health and for your state of mind.”

Even if lawyers don’t want to take a class or begin a formal meditation practice, Cho suggests they at least try adopting what’s called the STOP approach to daily tasks: Stop. Take a breath. Observe. Proceed mindfully.

“Studies have shown that people literally hold their breath when they look at emails. It triggers the fight-or-flight response,” Cho says. She recommends simply taking one long inhale and exhale before opening your inbox.

Small changes like mindfulness can have huge implications, particularly for lawyers who tend to be incredibly disconnected from themselves, according to Gifford. “When you sit with your own mind every single day, you see what your thought patterns are. You soon realize that certain thoughts aren’t based on anything real or true—it’s just a pattern. So you learn not to take yourself so seriously, which is incredibly freeing. You learn not to always think that opposing counsel is this horrible human being set out to ruin your life. All of a sudden, negotiation with that person has so many more possibilities.”

FOCUSING ON THE PRESENT

Cho noticed a tremendous shift in her own law practice when she brought mindfulness and meditation into her life. For example, “You see your own role in the relationship with opposing counsel. You start to ask, ‘What am I doing to contribute to this relationship?’ Holding a mirror up isn’t easy, but meditation creates the space to do that,” she says. “Doing dishes, sitting in traffic, someone cutting you off—the knee-jerk reactions, the state of constant annoyance: That’s all gone away. Because of meditation, I’m able to do everyday things with more joy. I’m not living in the future, not living to cross things off a to-do list. I live more presently.”

From their first days of law school, lawyers are taught to vigilantly search the horizon for problems—to anticipate, prevent and resolve problems. But many attorneys lose the ability to choose when to approach the world that way, and a meditation practice can reverse that trend, according to Richard Carlton, acting director of the State Bar of California’s Lawyer Assistance Program, which helps lawyers and bar applicants grappling with stress, anxiety, substance abuse or career concerns.

“When I teach CLE programs throughout the state, I insist that thinking like a lawyer is a legal skill, not a life skill,” Carlton says. Adopting mindfulness, “just paying attention to the present moment,” is a great way to combat this tendency. A mindfulness practice can be as simple as closing your eyes and counting backward from 100, he says.

Experts insist that staying present is essential not just for mental health but also for effective law practice. In the Yale Law School study, 50 percent of respondents indicated that mental health challenges affected their ability to perform academically. Stressed-out lawyers make poor decisions, leaving them open to liability. As a result, the benefits of mindfulness have become a big topic of discussion and education among professional responsibility groups, according to Terry Harrell, chair of the ABA’s Commission on Lawyer Assistance Programs.

“Meditation and mindfulness are not just good for us the way things like fish oil are. They actually affect the quality of legal work,” Harrell says. “A mindfulness practice makes us better decision-makers, better ethical decision-makers. And that translates into better lawyering.”

Along those lines, the promotional materials for Spirit Rock Meditation Center’s weekend for lawyers say that “law students, law professors, corporate attorneys and public interest attorneys alike have found that incorporating mindfulness into their life and law practice leads to greater effectiveness in skills such as client interviewing, managing the stresses of oral argument or a complex trial, and cultivating greater equanimity within a challenging profession.”

In addition to meditation, eating both healthfully and mindfully should not be underrated as a method of combating anxiety, according to Cho. “Most lawyers eat at their desks or in front of the TV—there’s no rest or digestion. But it’s important to pause and do nothing but enjoy your meal. Eating properly, sleep and exercise are such foundational practices” for managing the stress of lawyering, she insists.

Exercise, too, is one of the best natural antidepressants and cures for anxiety, Meyerhofer notes. “I strongly urge everyone to find a physical activity: karate, yoga, swimming. Exercise releases endorphins. It will do wonders. The benefits are enormous.”

Even the busiest lawyers can incorporate more walking into their everyday routines as a physical boost, suggests Victor of Care for Lawyers. Yoga, with its emphasis on transferring attention to the body and to the breath, can help reduce anxiety while also releasing physical tension and restoring energy. Adequate rest, too, is essential for regulating mental health, she says. “Sleep deprivation and resulting tiredness can make you even more vulnerable to stress and anxiety.”

SACRIFICING HEALTH

Lawyers “intellectually know” that sleep, diet, meditation and exercise are important, according to Latham. “We know we feel better when we get a good night’s sleep. But attorneys sacrifice sleep and healthy habits to meet unrealistic expectations. They skip meals, eat out, skip exercising. It’s a snowball effect. Lawyers may also start to pull away from friends and family, to withdraw. But it’s important to feel connected to other people or the problem compounds with isolation and shame.”

In recalling his own experience with anxiety, Meyerhofer notes that one of his “profoundest regrets” is having remained so isolated from his peers at the firm. “It would have helped so much to have someone to talk to who understood.”

Despite the proven benefits of healthy habits like meditation, nutritious diet and exercise, there’s no blanket panacea for anxious lawyers, Latham cautions. “What may be helpful for one person may not be especially helpful for another. I always inquire about previous coping skills and what has proved helpful in the past.” That inquiry—in the form of therapy—may truly be the key to mental health for many lawyers.

Meyerhofer similarly notes that it isn’t that lawyers are unaware of wellness solutions like exercising and getting a good night’s sleep. “It’s that they are driven by financial considerations to earn as much money as possible by billing as many hours as possible, and that means they sacrifice other things—like time with friends and family, a healthy diet and exercise—to the almighty billable hour. How are you expected to get to the gym or yoga class or the pool when you’re billing 300-hour months?

“How are you supposed to get the recommended seven hours of sleep every night, which is critical to good mental health, when you’re expected to pull all-nighters and work weekends?” Meyerhofer asks. “People don’t need good advice on getting to the gym and eating their vegetables. They need a time out, to listen to themselves and process the static in their heads.”

Because medications treating anxiety and depression only do so much and can sometimes be addicting, Meyerhofer says, it’s far more effective to combat such conditions by getting to the root of a problem through therapy. Therapists can help lawyers reality-test common thoughts, such as “I’m not any good. I’m going to fail. Someone will criticize me.”

Expressing feelings of anxiety to another person who listens, cares and understands can be enormously therapeutic, “simple though it may seem,” Levin adds. Sadly, while attorneys are statistically the professionals most in need of therapy, they’re also deeply resistant to it, instead expending precious energy to hold everything in, according to Levin.

“Lawyers are a help-rejecting population,” he says. “They mistakenly believe that if you’re vulnerable, you’re weak. There’s this notion of being the rock of Gibraltar for your clients.” But lawyers who seek and get help “can be more effective helpers.”

Latham adds: “There are cultural variables that contribute to lawyers’ feelings of isolation from colleagues and prevent them from seeking help. There’s a stigma to any perceived weakness because it runs counter to the idea of attorneys being invincible and resilient.” In the Yale Law School study, a chunk of the students who considered seeking treatment for mental health challenges opted not to because they feared exclusion from faculty, administrators, peers and state bar associations, which sometimes request information about applicants’ mental health history.

Professional organizations, including the ABA and state and local bar associations, can educate lawyers about these issues, encourage them to seek help and, importantly, challenge the long-standing cultural factors that contribute to attorneys avoiding aid, Latham says. “These organizations can play a role in destigmatizing therapy, making it more acceptable for lawyers who are suffering to seek help and be able to talk openly,” he says. “There should be no shame in that.”

In a Psychology Today article, Latham wrote: “Just as any psychologist would consult an attorney when addressing legal issues outside of their area of expertise, so, too, an attorney should be prepared to consult a mental health worker if he or she feels ill-equipped to address the psychological stressors in his or her life.”

In California, all lawyers are entitled to at least two free counseling sessions with a professional who specializes in working with attorneys, says Carlton of the State Bar of California. But typically only about 200 lawyers out of more than 183,000 active bar members take advantage of this benefit at any given time.

KNOWING THERE ARE CHOICES

It’s important to note that no strategy should be touted as a cure-all. “The implication can become that you’re struggling with anxiety or depression because you’re not doing your yoga or not meditating or not eating right or somehow choosing to go without sleep,” Meyerhofer says, “that it’s your fault for not having mastered some ‘effective strategy’ that would make all these issues disappear.” The fact remains that law can be brutal, and most young associates are not equipped for what they find when they enter the profession, he says. “You’re not tossing and turning in bed, roiled by anxiety, because you’re choosing to eat badly or to skip your yoga class. It has a lot more to do with being thrown into the deep end in an extremely competitive, exploitive business driven not by compassion or collegiality or the desire to mentor, but by profit and money and competition for prestige.”

The perfectionist and competitive ideals are so entrenched in the profession that lawyers may be unaware of those questionable values and how damaging they are, Levin says. “It’s great to make $1 million a year but when all your competitors are making $1.1 million or $1.2 million, that’s hugely anxiety-producing,” he says. “What’s missing from all of this is the notion of quality of life, of feeling a connection and belonging in a common enterprise.” What’s needed is, essentially, a profound shift from the four-A’s-and-a-B attitude, he says.

Changing the culture of the profession can go a long way toward curbing the epidemic of lawyer anxiety and depression, according to Levin. He recounts a conversation he once had with a law firm partner who criticized a young associate for expressing lack of confidence when the associate was about to do something for the first time. The partner worried that the associate would express that insecurity to the client.

“I thought: ‘Give the associate some credit for being smart enough to know the difference.’ And if an associate can’t get support from an older mentor in private, then where will he get it? That associate needed to hear: ‘It’s natural to be afraid.’ An associate who hears that is going to do a much better job, as opposed to someone simply working just to avoid a mistake. Lawyers need to be willing to let go of the belief, endemic to the profession, that expressing vulnerability is weakness.”

Meyerhofer, too, laments the “hypercritical environment” of law firms. “Lawyers don’t understand proper management and the value of praise,” he says. “You don’t beat the horse or else the horse turns into a shaky mess.”

In his own case, anxiety disappeared once Meyerhofer left BigLaw and found a supportive mentor at his next job.

“Often, frankly, the ‘solution’ to lawyers’ anxiety is to take a pay cut and work at a smaller, less hectic job, whether at a smaller firm or in-house or in a different field.” Meyerhofer tells his clients that everyone has a right to look forward to what they’re going to do each day.

Lawyers need to understand that they’re not trapped, and that changes are possible, Levin adds.

“They can go to a smaller firm, create their own practice, teach, go to a corporation,” he says. “We do a lot of work in our practice about getting lawyers to realize they have choices. Lawyers don’t ask themselves ‘What do I really want?’ They’re not used to it.”

This article originally appeared in the July 2015 issue of the ABA Journal with this headline: “Stressed Out: How to avoid burnout and debilitating anxiety.”


Leslie A. Gordon, a former lawyer, is a legal journalist based in San Francisco.

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Posted in ABA, Law, Legal Education, mental health

Armies of Expensive Lawyers, Replaced by Cheaper Software

Source:The New York Times
By JOHN MARKOFFMARCH 4, 2011

When five television studios became entangled in a Justice Department antitrust lawsuit against CBS, the cost was immense. As part of the obscure task of “discovery” — providing documents relevant to a lawsuit — the studios examined six million documents at a cost of more than $2.2 million, much of it to pay for a platoon of lawyers and paralegals who worked for months at high hourly rates.
But that was in 1978. Now, thanks to advances in artificial intelligence, “e-discovery” software can analyze documents in a fraction of the time for a fraction of the cost. In January, for example, Blackstone Discovery of Palo Alto, Calif., helped analyze 1.5 million documents for less than $100,000.
Some programs go beyond just finding documents with relevant terms at computer speeds. They can extract relevant concepts — like documents relevant to social protest in the Middle East — even in the absence of specific terms, and deduce patterns of behavior that would have eluded lawyers examining millions of documents.
“It’s a means of showing who leaked information, who’s influential,” said Elizabeth Charnock, founder of Cataphora, an information-sifting company. Credit Béatrice de Géa for The New York Times
“From a legal staffing viewpoint, it means that a lot of people who used to be allocated to conduct document review are no longer able to be billed out,” said Bill Herr, who as a lawyer at a major chemical company used to muster auditoriums of lawyers to read documents for weeks on end. “People get bored, people get headaches. Computers don’t.”
Computers are getting better at mimicking human reasoning — as viewers of “Jeopardy!” found out when they saw Watson beat its human opponents — and they are claiming work once done by people in high-paying professions. The number of computer chip designers, for example, has largely stagnated because powerful software programs replace the work once done by legions of logic designers and draftsmen.
Software is also making its way into tasks that were the exclusive province of human decision makers, like loan and mortgage officers and tax accountants.
These new forms of automation have renewed the debate over the economic consequences of technological progress.
David H. Autor, an economics professor at the Massachusetts Institute of Technology, says the United States economy is being “hollowed out.” New jobs, he says, are coming at the bottom of the economic pyramid, jobs in the middle are being lost to automation and outsourcing, and now job growth at the top is slowing because of automation.
“There is no reason to think that technology creates unemployment,” Professor Autor said. “Over the long run we find things for people to do. The harder question is, does changing technology always lead to better jobs? The answer is no.”
Automation of higher-level jobs is accelerating because of progress in computer science and linguistics. Only recently have researchers been able to test and refine algorithms on vast data samples, including a huge trove of e-mail from the Enron Corporation.
“The economic impact will be huge,” said Tom Mitchell, chairman of the machine learning department at Carnegie Mellon University in Pittsburgh. “We’re at the beginning of a 10-year period where we’re going to transition from computers that can’t understand language to a point where computers can understand quite a bit about language.”
Nowhere are these advances clearer than in the legal world.
E-discovery technologies generally fall into two broad categories that can be described as “linguistic” and “sociological.”
The most basic linguistic approach uses specific search words to find and sort relevant documents. More advanced programs filter documents through a large web of word and phrase definitions. A user who types “dog” will also find documents that mention “man’s best friend” and even the notion of a “walk.”
The sociological approach adds an inferential layer of analysis, mimicking the deductive powers of a human Sherlock Holmes. Engineers and linguists at Cataphora, an information-sifting company based in Silicon Valley, have their software mine documents for the activities and interactions of people — who did what when, and who talks to whom. The software seeks to visualize chains of events. It identifies discussions that might have taken place across e-mail, instant messages and telephone calls.
Then the computer pounces, so to speak, capturing “digital anomalies” that white-collar criminals often create in trying to hide their activities.
For example, it finds “call me” moments — those incidents when an employee decides to hide a particular action by having a private conversation. This usually involves switching media, perhaps from an e-mail conversation to instant messaging, telephone or even a face-to-face encounter.
“It doesn’t use keywords at all,” said Elizabeth Charnock, Cataphora’s founder. “But it’s a means of showing who leaked information, who’s influential in the organization or when a sensitive document like an S.E.C. filing is being edited an unusual number of times, or an unusual number of ways, by an unusual type or number of people.”
The Cataphora software can also recognize the sentiment in an e-mail message — whether a person is positive or negative, or what the company calls “loud talking” — unusual emphasis that might give hints that a document is about a stressful situation. The software can also detect subtle changes in the style of an e-mail communication.
A shift in an author’s e-mail style, from breezy to unusually formal, can raise a red flag about illegal activity.
“You tend to split a lot fewer infinitives when you think the F.B.I. might be reading your mail,” said Steve Roberts, Cataphora’s chief technology officer.
Another e-discovery company in Silicon Valley, Clearwell, has developed software that analyzes documents to find concepts rather than specific keywords, shortening the time required to locate relevant material in litigation.
Last year, Clearwell software was used by the law firm DLA Piper to search through a half-million documents under a court-imposed deadline of one week. Clearwell’s software analyzed and sorted 570,000 documents (each document can be many pages) in two days. The law firm used just one more day to identify 3,070 documents that were relevant to the court-ordered discovery motion.
Clearwell’s software uses language analysis and a visual way of representing general concepts found in documents to make it possible for a single lawyer to do work that might have once required hundreds.
“The catch here is information overload,” said Aaref A. Hilaly, Clearwell’s chief executive. “How do you zoom in to just the specific set of documents or facts that are relevant to the specific question? It’s not about search; it’s about sifting, and that’s what e-discovery software enables.”
For Neil Fraser, a lawyer at Milberg, a law firm based in New York, the Cataphora software provides a way to better understand the internal workings of corporations he sues, particularly when the real decision makers may be hidden from view.
He says the software allows him to find the ex-Pfc. Wintergreens in an organization — a reference to a lowly character in the novel “Catch-22” who wielded great power because he distributed mail to generals and was able to withhold it or dispatch it as he saw fit.
Such tools owe a debt to an unlikely, though appropriate, source: the electronic mail database known as the Enron Corpus.
In October 2003, Andrew McCallum, a computer scientist at the University of Massachusetts, Amherst, read that the federal government had a collection of more than five million messages from the prosecution of Enron.
He bought a copy of the database for $10,000 and made it freely available to academic and corporate researchers. Since then, it has become the foundation of a wealth of new science — and its value has endured, since privacy constraints usually keep large collections of e-mail out of reach. “It’s made a massive difference in the research community,” Dr. McCallum said.
The Enron Corpus has led to a better understanding of how language is used and how social networks function, and it has improved efforts to uncover social groups based on e-mail communication.
Now artificial intelligence software has taken a seat at the negotiating table.
Two months ago, Autonomy, an e-discovery company based in Britain, worked with defense lawyers in a lawsuit brought against a large oil and gas company. The plaintiffs showed up during a pretrial negotiation with a list of words intended to be used to help select documents for use in the lawsuit.
“The plaintiffs asked for 500 keywords to search on,” said Mike Sullivan, chief executive of Autonomy Protect, the company’s e-discovery division.
In response, he said, the defense lawyers used those words to analyze their own documents during the negotiations, and those results helped them bargain more effectively, Mr. Sullivan said.
Some specialists acknowledge that the technology has limits. “The documents that the process kicks out still have to be read by someone,” said Herbert L. Roitblat of OrcaTec, a consulting firm in Altanta.
Quantifying the employment impact of these new technologies is difficult. Mike Lynch, the founder of Autonomy, is convinced that “legal is a sector that will likely employ fewer, not more, people in the U.S. in the future.” He estimated that the shift from manual document discovery to e-discovery would lead to a manpower reduction in which one lawyer would suffice for work that once required 500 and that the newest generation of software, which can detect duplicates and find clusters of important documents on a particular topic, could cut the head count by another 50 percent.
The computers seem to be good at their new jobs. Mr. Herr, the former chemical company lawyer, used e-discovery software to reanalyze work his company’s lawyers did in the 1980s and ’90s. His human colleagues had been only 60 percent accurate, he found.
“Think about how much money had been spent to be slightly better than a coin toss,” he said

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Posted in Law, Technology, Wage

The digital doctor is in: Next wave in health care

There are countless tricks in the book that patients can use to cure themselves right at home: gargle salt water to curb a sore throat, prescribe Advil for a headache, settle an upset stomach with some bread and rice.

But there are also many other things that often warrant a trip to the doctor: A painful ear infection, an accurate diagnosis of a concussion, peace of mind over an unfamiliar mole.
In today’s digitally focused world, there are some cases where a trip to the doctor can be easily replaced with the download of an app or the power of a text message.
The health care industry is in the midst of a technological boom, a transition which physician Bob Wachter, author of The Digital Doctor, says is necessary – but no one has gotten it completely right yet.
“There are many things that patients can do to help themselves … if armed with good algorithms and good backup plans,” he said. “But the trick here is that you need to draw a line, and know how to tell when a patient needs to see a human, versus when they do not.”
Investment in digital health startups was more than $2 billion in 2014, says Ahmed Albaiti, founder and CEO of Medullan, a digital health innovation lab in Boston. Many databases, he said, such as RockHealth, CBInsights and McKinsey & Company, say they’ve found more than 2,000 startups with the key words “digital health” and “new health care technologies.”
Among the hundreds of companies focused on digital technologies, CVS Health is one of the latest businesses looking to bolster its image as a digital health care powerhouse.
CVS Health recently opened up its Digital Innovation Lab, a warehouse-size space where innovators and entrepreneurs can come together, test new products and hash out ideas with each other, says Brian Tilzer, CVS’ chief digital officer.
CVS’ lab work includes:
• Connected otoscope: Looks into the ear canal and turns phones into a remote diagnostic device. Users can send videos and still images of the ear to medical professionals who can promptly address any issues and prescribe a treatment.
• Connected blood pressure monitor: Allows data to be shared with medical professionals, caregivers or other apps to help customers better manage their health.
• Apple Watch Integration: Improves access to prescription notifications and other health care information through the Apple Watch app.
Connected otoscope looks into the ear canal and turns

Connected otoscope looks into the ear canal and turns phones into a remote diagnostic device. (Photo: CVS Health)
The lab’s opening follows CVS’ announcement last month that it bought Target’s pharmacy business for $1.9 billion. With this deal, more than 1,600 Target pharmacies in 47 states will be re-branded as CVS/Pharmacy.
Wachter, a professor and interim chairman in the department of medicine at the University of California, San Francisco, said companies that aren’t stuck in their traditional values are the ones in the most advantageous place in the digital health care sector.
However, regardless of how forward-thinking the companies are, that doesn’t change the fact that the digital health care industry is both extremely competitive and incredibly complex.
Wisconsin-based health care provider, Aurora Health Care, announced last month that it is taking a lead investor role in StartUp Health, a long-term program focused on assisting new companies navigate through the fledgling digital health care market. According to StartUp Health’s 2015 midyear report, more than 7,500 startups around the world are developing solutions in digital health based on the company’s insights and data.

Unity Stoakes, co-founder of StartUp Health, talks about the revolution of health care through technology. Trisha Thadani, Collin Brennan
Unlike more traditional hospitals and doctors, Wachter said, emerging startups and companies such as CVS have “more degrees of freedom to think what a new model of healthcare looks like.”
Although the goals of health care will always be the same – to diagnose, treat and prevent sicknesses in the best way for the best price – the line of what a patient can or cannot do without a doctor is getting increasingly blurry, Wachter said.
“As long as businesses are aware that it is possible to take this transformation of the health care industry too far, it is a good move that more and more entrepreneurs and innovators are looking to push the boundaries and think up new models of care,” he said.

source: USA Today

Follow Trisha Thadani on Twitter: @TrishaThadani

Posted in Healthcare, Innovation, Productivity, Start-Up, Technology

Secrets of NYU

At 174 years and counting, New York University

Secrets of New York
By FELIPE DE LA HOZ

May 14, 2015

New York University is centered around the iconic Washington Square Park in Greenwich Village.

As the largest private research university in the United States, however, its reach extends far beyond Manhattan into Brooklyn to Shanghai and Abu Dhabi. Though it has far-flung foreign outposts, NYU’s strongest presence is certainly in the city, with over 50,000 graduate and undergraduate students and dozens of buildings, including 23 residence halls, throughout the city. And with the university pushing a polarizing plan to expand its main campus in Greenwich Village, its footprint in the historic neighborhood could grow by up to 2 million square feet in the coming years.

At 174 years and counting, the university has its fair share of fascinating details and hidden gems. Here are just nine of them.

Felipe De La Hoz is studying journalism and politics at NYU, set to graduate in 2017. He is a freelance journalist and senior editor at the Washington Square News, the student daily. Follow him at @FelipeDLH.

Pioneer of gender neutral housing for students

NYU was one of the first universities in the country to adopt protections for students with different gender identities.

According to Monroe France, assistant vice president for student diversity, the university first included gender identity and expression in its nondiscrimination policy in 2002. “Gender expression for me is important because it includes not only how you identify but how you choose to express yourself,” he said.

As of 2012, the school also allows students to live in gender neutral housing, which is available by request.

Cian Compton-Lujin, a transgender junior who lived in gender neutral housing, said he appreciated the practice, though there was still work to be done: “It’s not perfect, but there’s a lot of places where these policies don’t exist at all.”
The cemetery under Washington Square Park
Washington Square Park is built atop as many as 20,000 burials, according to the park’s 2005 archaeological assessment. Historically, it was “the site of at least one church cemetery,” and a city potter’s field, or public burial site, starting in the late 18th century.

In 1965, Con Edison workers discovered 25 individuals inside of a vault under Washington Square Park, which “not only documents that burials still remain, but also that rather than individual burials, or burials in pits or trenches, the church plots may have comprised large vaults.”

The park was first established as a public space in 1826, and named the Washington Military Parade Ground, to host the national jubilee of the 50th anniversary of the Declaration of Independence. It was named, of course, for George Washington. Since its creation, the park has undergone various renovations, including the addition of a park house, comfort station, play area, and dog run in 2013.
The mysterious ‘Timekeeper’
Remembered fondly by students and Greenwich Village residents alike, John Votta a.k.a. The Timekeeper, was as much a Washington Square Park staple as the arch.

An elderly man who seemed to have no obligations or desires but to look after students, he was known as The Timekeeper because he would yell the time left until class, relying on one of four watches he would wear on his wrists. He would also direct traffic and scold students who were late.

Though he passed away in late 2012, he remains a part of NYU folklore.

“I think it was because he was always there, it was that consistent thing, you knew that going to class you were going to see The Timekeeper,” said Melody Ladd, an undergraduate student. “He was almost like an authority figure. You wanted to get to class on time.”
The fatal fire that sparked reform
NYU’s Brown building, located at 29 Washington Place and now home to the chemistry and biology departments, was the site of the infamous Triangle Shirtwaist Factory fire.

On March 25, 1911, a fire started on the eighth floor of the building, which housed the Triangle Waist Company garment manufacturer, and ripped through the structure. A total of 146 people — mostly young immigrants — died in the blaze. The tragedy led to widespread shock and eventual workplace safety reform across the country.

Vincent Alvarez, president of the NYC Central Labor Council, said, “They got together, and they massed in the street, thousands and thousands of workers, immediately following this accident, and they changed the industry for the better.”
The ultimate global university
NYU is currently the only United States university with degree-granting campuses in Asia and the Middle East, according to Mattie Bekink, deputy director of public affairs for NYU Global Programs and Sites. These are the university’s campuses in Abu Dhabi, U.A.E., and Shanghai, China, which prospective students can apply to directly and graduate from.

The university has study abroad sites in 11 other cities around the world, which Bekink said offer students the opportunity to continue to work towards their degrees while studying overseas.

She cited how “pre-med students can study biochemistry in Tel Aviv, or organic chemistry in London; psychology students can take courses in Florence, Sydney, Berlin or Accra.”

After The New York Times published an article in May 2014 detailing abuses like beatings, deportations, poor living conditions and passport confiscation of workers at its Abu Dhabi campus, the university commissioned a study of its own. This study found that around 10,000 workers were not treated up to the standards NYU had set.

NYU President John Sexton has promised to “take responsibility for the lapses that occurred,” and to try to address them.”
“Twentysomething,” the class for twentysomethings
NYU, like many large universities, offers an array of classes that range from the common and straightforward — political theory, calculus — to the bizarre and idiosyncratic. There are classes on the video game Starcraft, the science of happiness and performing comedy.

Professors Ursula Diamond and Yamalis Diaz teach the class “Twentysomething,” which Diamond describes as addressing the “hole in the literature right now about what happens between being an adolescent and becoming an adult.”

Diaz adds that, given that the students are in the stage which the class is meant to examine, the professors are able “to watch them shift and change over the course. It’s like you watch them develop into mini-emerging adults.”
The only Chick-fil-A in NYC
NYU currently houses the only Chick-fil-A in the city. Though the restaurant chain has announced that it will be opening up a full restaurant on West 37th Street, as of now, anyone looking to fill up on the chain’s food will have to seek it out at the Weinstein Residence Hall, on University Place, in the upstairs food court known as “Upstein.”

Some students called for a boycott of the eatery in 2012 because of its financial ties to anti-gay groups. But a student council declined to ban Chick-fil-A and NYU officials said the company was licensed through its restaurant vendor.

NYU has the only graduate student employee union

NYU has the only graduate student employee union among private universities in the United States. GSOC-UAW Local 2110, as the union is called, is affiliated with the United Automobile Workers and has been around since 1998.

They’ve had ups and downs with the university, failing to gain approval for a new contract in 2005, but renegotiated a contract in 2013, and have been in deliberations with the university since then. In April, following a strike, they reached an agreement with the university involving points like minimum wage and healthcare subsidies.

Jessica Feldman, a spokeswoman for GSOC, said that they hope to be “a model for future unions at other private universities,” adding that the struggle had taught them lessons like “the importance of union democracy.”

Near NYU’s main Washington Square location, running between

Near NYU’s main Washington Square location, running between University Place and 5th Avenue just north of the park, is a little cobblestoned street known as the Washington Mews. It’s owned by the university, and most of the small buildings that line it are faculty offices.

If the street looks like a horse-and-buggy wouldn’t be out of place, that’s because in the 1830s the Mews housed stables for horses and coachmen serving wealthy residents in the townhouses lining the northern edge of the park. It looks much the same 140 years later.

The university’s French center, La Maison Francaise, sits on the south side of the street’s University Place entrance, while the German center, Deutsches Haus, sits on the north side. For students, the Mews can sometimes provide a break from the energy of the classroom.

After all, stepping onto its cobblestones is like stepping into another time.

Posted in Uncategorized

Daily Report: Uber Ruling Spurs Debate Over Workers

In a ruling that fuels a long-simmering debate over some of Silicon Valley’s fastest-growing technology companies and the work they are creating, the California Labor Commissioner’s Office said that a driver for the ride-hailing service Uber should be classified as an employee, not an independent contractor, Mike Isaac and Natasha Singer report.
The ruling ordered Uber to reimburse Barbara Ann Berwick $4,152.20 in expenses and other costs for the roughly eight weeks she worked as an Uber driver last year. While Uber has long positioned itself as merely an app that connects drivers and passengers — with no control over the hours its drivers work — the labor office cited many instances in which it said Uber acted more like an employer. Uber is appealing the decision.
The ruling does not apply beyond Ms. Berwick and could be altered if Uber’s appeal succeeds. Uber has also prevailed in at least five other states in keeping its definition of drivers as independent contractors. Yet the California ruling stands out because officials formally laid out their arguments for why Uber drivers are employees. That could bolster class-action lawsuits against the company in the state. California law expressly requires employers to reimburse employees for business expenses and several suits proceeding against Uber are based on that state law.
Companies like Uber and its rival Lyft, and Instacart, a grocery delivery service, have long faced questions about whether they are creating the right kind of employment opportunities for both the economy and for workers. The technology companies have contended that their virtual marketplaces, in which people act as contractors and use their own possessions to provide services to the public at the touch of a smartphone button, afford workers flexibility and freedom. Read more »

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Anesthesiologist trashes sedated patient — and it ends up costing her

Anesthesiologist trashes sedated patient — and it ends up costing her
Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.
But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.
In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.
“After five minutes of talking to you in pre-op,” the anesthesiologist told the sedated patient, “I wanted to punch you in the face and man you up a little bit,” she was recorded saying.
When a medical assistant noted the man had a rash, the anesthesiologist warned her not to touch it, saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.”
When the assistant noted that the man reported getting queasy when watching a needle placed in his arm, the anesthesiologist remarked on the recording, “Well, why are you looking then, retard?”
There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.
The plaintiff, identified in court papers only as “D.B.,” wanted to maintain his anonymity and did not want to comment about the case, said his attorneys, Mikhael Charnoff and Scott Perry.
The anesthesiologist, Tiffany M. Ingham, 42, could not be reached for comment, and her attorney, D. Lee Rutland, did not return messages seeking comment. Ingham worked out of the Aisthesis anesthesia practice in Bethesda, Md., which the jury ruled should pay $50,000 of the $200,000 in punitive damages it awarded. Officials there did not return a call seeking comment. Ingham no longer works there, an Aisthesis employee said, and state licensing records indicate that she has moved to Florida. An anesthesiology practice in Tavares, Fla., said she no longer worked there. Calls to a number believed to be Ingham’s were not returned, and there was not an answering machine or voicemail at that number.
On the opening day of the trial last week, the gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case. Court documents state Shah also made some insulting remarks — “As long as it’s not Ebola, you’re okay,” Shah was recorded saying during the rash discussion — and did not discourage Ingham from her comments or actions, which included writing on the man’s chart that he had hemorrhoids, when he did not.
Neither Shah, who did not return a message left at his office, nor the lawyers on either side would comment.
The lawyers also would not discuss whether Ingham or Shah faced disciplinary action from the Virginia Board of Medicine. No actions are listed against either on the board’s Web site.
The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not.
“I’ve never heard of a case like this,” said Lee Berlik, a Reston lawyer who specializes in defamation law. He said comments between doctors typically would be privileged, but the Vienna man claimed his recording showed that there was at least one and as many as three other people in the room during the procedure and that they were discussing matters beyond the scope of the colonoscopy.
“Usually, all [legal] publication requires is publication to someone other than the plaintiff,” Berlik said. “If one of the doctors said to someone else in the room that this guy had syphilis and tuberculosis and that person believed it, that could be a claim. Then it’s up to the jury to decide: Were the statements literal assertions of fact? The jury apparently was just so offended at this unprofessional behavior that they’re going to give the plaintiff a win. That’s what happens in the real world.”
One of the jurors, Farid Khairzada, said that “there was not much defense, because everything was on tape.” He said that the man’s attorneys asked for $1.75 million and that the $500,000 award was a compromise between one juror who thought the man deserved nothing and at least one who thought he deserved more.
“We finally came to a conclusion,” Khairzada said, “that we have to give him something, just to make sure that this doesn’t happen again.”
The colonoscopy took place in Shah’s surgical suite on April 18, 2013, according to the man’s lawsuit. While being prepped for the procedure, the man apparently told Ingham that he had passed out previously while having blood drawn and that he was taking medication for a mild rash on his genitals.
Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning that only one person involved in a conversation need agree to the recording.
The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states, and Shah then commented that another doctor they both knew “would eat him for lunch.”
The discussion soon turned to the rash on the man’s penis, followed by the comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke, and Shah reportedly told an assistant to convince the man that he had spoken with Shah and “you just don’t remember it.” Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states. “Round and round we go. Wheel of annoying patients we go. Where it’ll land, nobody knows,” Ingham reportedly said.
Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.
After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”
Shah replied, “I call it the Northern Virginia syndrome,” according to the suit.
The doctors argued that the Vienna man did not suffer any physical injury or miss any days of work. The man’s complaint said that he was “verbally brutalized” and suffered anxiety, embarrassment and loss of sleep for several months.
“These types of conversations,” testified Kathryn E. McGoldrick, former president of the Academy of Anesthesiology, “are not only offensive but frankly stupid, because we can never be certain that our patients are asleep and wouldn’t have recall.”

Editor’s note: a clip of the recording is available online.

Source: WSJ

June 24, 2015

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Posted in Law, Medical Education, Uncategorized

Young Lawyers Could Face ‘Tax Bomb,’ Says Professor

Source WSJ

Associated Press
Thousands of recent law-school graduates have taken advantage of a pair of programs aimed at easing student-debt burdens.

The plans require federal student-loan borrowers to pay back as little as 10%-15% of their discretionary income each month over 20 to 25 years. After that period, any remaining balance is forgiven.
As attractive as the terms may be, some law-school graduates enrolled in the programs could be facing what one law professor dubs a “tax bomb” down the road.
Specifically, it’s set to go off in 2032, the first year when the loans qualify for debt forgiveness. At that point, the forgiven debt turns into “cancellation of debt” income under the tax code, taxed as ordinary income, says Southern Methodist University law professor Gregory S. Crespi.
In a draft paper published online, highlighted by Paul Caron’s TaxProf Blog, the professor estimates what that could mean for a lawyer who wraps up the repayment period with a hefty amount of unpaid debt:
[A] large proportion of those enrollees who have incurred loan debts to finance law school studies will as a result have over $150,000 and perhaps even in some cases as much as $300,000 or more of unpaid principal and accrued interest still owing and then forgiven at the end of the applicable 20- or 25- year repayment period. With such a large amount of forgiven debt included in their income along with their other earnings for that tax year these persons will almost all be paying taxes on that forgiven debt at at least a 28% marginal federal income tax rate, and often closer to a top-bracket 39.6% marginal federal income tax rate, on this additional attributed income. In addition, many states also impose a state income tax on the income recognized by the federal government, in some instances with relatively high upper-bracket marginal rates that would usually here apply given the large size of the debt forgiven.
For an IBR or PAYE law graduate enrollee with a $200,000 or larger unpaid debt at the time of their debt forgiveness this may well mean a combined federal and state income tax bill on this additional attributed income of at least $50,000 up to perhaps $100,000 or more, and an enrollee with $300,000 or more of forgiven debt may owe additional income taxes in the neighborhood of $125,000 or even more!
The two loan programs he’s referring to — the “Income-Based Repayment Plan” and the newer “Pay As You Earn” program — don’t treat law school students differently than other graduate school borrowers. But Mr. Crespi says the high cost of a legal education combined with uncertain future salary prospects for lawyers these days make law school students more vulnerable.
He says a revised Pay As You Earn program expected to launch in December greatly diminishes the impact of the tax “bomb” because of its less generous terms. Under the proposed “REPAYE” program, spousal earnings are now included in the calculation of discretionary income.
So, he’s talking about a four-year window — roughly 30,000 borrowers who left law school between 2012 and 2015.
In his paper, Mr. Crespi says those graduates shouldn’t expect Congress to eliminate their tax obligations before they explode years from now. If there’s a bailout, a more likely, and in his view preferable option, would be a tax-code adjustment that allows borrowers to stretch out the IRS payments over several years without a penalty.
A Department of Education spokesman did not have an immediate comment about the paper.

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Posted in Department of Education, forgiveness, IRS, Legal Education, Statistics, Student Loans

GAO: CMS Too Reliant on Doctors When Setting Medicare Pay Rates

CMS is too reliant on the American Medical Association when setting provider reimbursement rates, according to a recent Government Accountability Office report, the New York Times reports.

The report focused on CMS’ process to set provider payment rates that account for more than $70 billion in federal spending each year. CMS uses a fee schedule to set the rates, which are determined based on the “relative value” of each provider service. Services determined to be more time-consuming or difficult are reimbursed at higher rates than those that are less demanding. For example, hip replacements are reimbursed at higher rates than cataract surgeries or regular office visits. When setting the rates, CMS takes into account the amount of time it takes to perform the services, the physical and mental efforts required and the technical skills needed.
According to the report, CMS uses a panel of 31 providers formed by AMA and medical specialty societies, called the Relative Value Scale Update Committee, to help inform their payment rate decisions. The group’s meetings are open to the public, but attendees must sign confidentiality agreements prohibiting them from disclosing any information about the meeting’s considerations.

Panel Might Be Biased

The report noted that the panel could be biased when helping CMS to set the rates because the provider group could have conflicts of interest. According to the report, provider groups “donate [more than] $8 million” annually in services to the committee and “hundreds of physicians” volunteer for the panel.

Further, the report found that along with AMA’s influence, flaws in data collected by AMA “could result in inaccurate Medicare payment rates.” According to the Times, medical societies collect information about their physicians’ work through member surveys. The data are intended to help determine the time and intensity required to perform certain services, as well as the costs associated with them, including expenditures related to:

-Equipment;

-Malpractice insurance;

-Office space;

-Supplies; and

-Wages.

However, the surveys usually have low participation rates, which spur questions about the data’s accuracy. Further, CMS does not have a means to verify the data, according to GAO. The report noted that such weaknesses “could lead to inflated Medicare payment rates” in some instances.

Overall, the report noted that CMS “does not fully disclose information upon which its decisions were based” and does not use a “standardized process” for determining the relative value of services performed by providers.

Medicare Rates Influence Rest of Health Care Industry

According to the Times, the payment rates set for Medicare often have a ripple effect on the rest of the health care industry and a direct effect on consumers. Medicare beneficiaries usually pay for around 20% of the provider reimbursement fees. Further, many private health insurers use Medicare’s fee schedule to help determine how much they will reimburse providers for specific services. In addition, physicians might be more likely to perform more of services that are overvalued by Medicare.

Reaction

Barbara Levy, who has chaired the RVSUC for the past six years, said she did not see the conflicts of interest on the panel. She noted that the committee does “not tal[k] about dollars or money,” but “about the time and resources that are necessary to perform a procedure.” She said, “I can’t imagine how anyone other than a group of physicians could provide that kind of expertise.”

However, Rep. Jim McDermott (D-Wash.), a member of the House Ways and Means Committee’s Subcommittee on Health, said that while “Medicare certainly needs clinical expertise to appraise the value of doctors’ services,” CMS “give[s] medical specialty societies an undue influence on their own payments.”

Meanwhile, the American Academy of Family Physicians has long called for including more primary care physicians on the RVSUC, as well as consumer advocates, employers and health economists.

The Obama administration said it is seeking more information on the issue so that it can determine more accurate Medicare payment rates. Under the Affordable Care Act, CMS is required to reassess the value of physician services. Congress in 2014 allocated $2 million for the agency to collect its own data to help inform Medicare reimbursement rates. However, GAO noted that the agency “does not have a specific timeline or plan for using these funds” (Pear, New York Times, 5/31).

Source: California Healthline

June 1, 2015

Posted in Conflict of Interest, Economics, Ethics, Healthcare, Medicare, Policy
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