Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Cannabis card-mills have conflicts of interest

Jill Becker, MD
Physician
April 1, 2021
Share
Tweet
Share

Two weeks ago, my piece, “Cannabinoids are medicine, but patients aren’t getting the care they need,” was published. Since that time, I’ve heard from quite a few physicians who admitted that they did not know card-mills existed or, if they did, how they were different from Cannabis Specialist Physicians. From their collective perspective, pot was pot. I am grateful to have had the opportunity to provide them with information and with education. When the case below presented itself, it seemed a wonderful opportunity to delve a bit deeper and to point out the fact that not only are card-mills inconsistent with good patient care but that they often have significant conflicts of interest.

This past week I was asked to add a new patient to my schedule at the last minute. I was told that she was coming to see me hoping that medical cannabis would offer some relief of chronic migraine headache pain. The patient’s details have been changed to protect her privacy, but the facts remain the same.

Patients don’t always know what is important to share with their physicians and what is not. It is for this reason that physicians are trained to take full medical histories. We ask about current symptoms, past episodes, what makes the symptoms better, and what makes them worse. We ask about medications and tests and family histories and social histories. We learn that when one “hears hoofbeats, they should look for horses, not zebras” – meaning that common things are common. It is only with adequate time and sufficient inquiry that physicians can determine whether the patient in their office is, in fact, presenting with something common.

After the first 30 minutes with my new patient, I was concerned that there was more going on with her than typical migraines headaches. As we got deeper into her history, I became more certain that I needed to examine her medical records. Typically I have the opportunity to do so before new patient appointments. Because she was added to the schedule last minute, I had not had that chance. I told my new patient, who thought she might find relief from her chronic headache pain, that I was concerned about her symptoms – that, perhaps, we were looking at a zebra rather than a horse. I was not at all comfortable potentially masking her symptoms with medical cannabis. I told my patient that I needed to consult with my practice partner and review her primary care physician’s records. I expected her to be disappointed, if not downright angry. Instead, she said, she finally felt hope – that someone was actually listening to her. We agreed that I would call her the following morning with a plan. She understood it was unlikely that I could get all of the information together in less than 24 hours, but she trusted that I would get in touch and that we would move forward together.

It was at this point that I found myself, once again, grateful for having declined the invitations I’ve had to join medical cannabis card-mills. Had this patient presented to me at one of those ever-proliferating establishments, I would have had only the allotted 15 minutes to determine whether medical cannabis would have been an appropriate treatment for her. And, in our initial 15 minutes, it appeared that such treatment would likely have been fine. However, with further discussion, it became apparent that it might not have been fine. In fact, it might actually have been harmful. And, had I had adequate time, I would have been faced with a conflict of interest.

Card-mills pay their physicians approximately $45 to $50 per patient, with patient after patient scheduled for 15-minute slots. They then boast that physicians who work with their companies earn $180 to $190 per hour with no overhead. It is true that these physicians earn such income, but only if they certify patients for medical cannabis cards. If they certify for medical cannabis only when appropriate, they don’t necessarily earn an income; they’re paid only if they certify the patient. That is the very definition of a conflict of interest, isn’t it?
Back to my patient: I looked through her medical records but didn’t see the test I was looking for. I called the office and learned that the patient’s PCP was on vacation, so I spoke with the covering doc. She looked through the records and came to the same conclusion. She told me she would follow up with the patient and make sure the test had been ordered. I called my patient who, tearfully said, “This is the first time I feel like someone has heard me in twenty years.”

I don’t believe this would have occurred at a card-mill.

In my current practice, I have an hour scheduled with each new patient and thirty minutes scheduled for each follow-up. I’m also available via email or telephone, as needed.  I am compensated not because of the amount of time I spend nor by the number of medical marijuana cards I give out, but by the patient care I provide.

Once again, I find myself thinking: Don’t real patients deserve real patient care?

Jill Becker is a physician and can be reached at her self-titled site, Jill Becker, MD.

Image credit: Shutterstock.com

Prev

Telemedicine is the new house call

April 1, 2021 Kevin 0
…
Next

Keep insulting doctors, and good luck finding a physician [PODCAST]

April 1, 2021 Kevin 0
…

Tagged as: Medications

Post navigation

< Previous Post
Telemedicine is the new house call
Next Post >
Keep insulting doctors, and good luck finding a physician [PODCAST]

ADVERTISEMENT

More by Jill Becker, MD

  • A doctor’s genuine approach to medication-assisted therapy patients

    Jill Becker, MD
  • Federal legalization of cannabis: What does it mean for patients?

    Jill Becker, MD
  • A case for changing the way we talk about obesity

    Jill Becker, MD

Related Posts

  • The can and can’t of cannabis

    Eunice Zhang, MD
  • Cannabis stigma continues to impede patient care

    Jill Becker, MD
  • Federal legalization of cannabis: What does it mean for patients?

    Jill Becker, MD
  • Clearing the misinformation surrounding medical cannabis

    Samoon Ahmad, MD and Kevin Hill, MD
  • Cannabis is ground zero in the fight for racial justice in America

    Peter Grinspoon, MD
  • Are diploma mills hurting the nursing profession?

    Patricia Anne Aronin, MD

More in Physician

  • Why “the best physicians” risk burnout and isolation

    Scott Abramson, MD
  • Why real medicine is more than quick labels

    Arthur Lazarus, MD, MBA
  • Stop blaming burnout: the real cause of unhappiness

    Sanj Katyal, MD
  • Breaking the martyrdom trap in medicine

    Patrick Hudson, MD
  • What a Nicaraguan village taught a U.S. doctor about true care

    Prasanthi Reddy, MD
  • Public health under fire: Vaccine battle hits federal court

    J. Leonard Lichtenfeld, MD
  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Cannabis card-mills have conflicts of interest
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...