KevinMD

How to fix maintenance of certification: Here’s what I’d do

Kevin Pho, MD

KevinMD

December 16, 2014

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There’s a lot of angst when it comes to board recertification. The general consensus is that doctors find the requirements onerous, while a more cynical segment calls the whole process a money-making operation for our professional societies and those that profit from recertification courses and materials.

Cardiologist Wes Fisher has articulated the many criticisms against board recertification: “Does board recertification do …

The highest rated doctors may not provide the best care

Kevin Pho, MD

KevinMD

November 8, 2014

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A version of column was published in USA Today on September 14, 2014.

The public can rate and review most things today: books, hotels, and restaurants, to name a few. Even doctors. There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much …

Are American doctors paid too much or too little?

Kevin Pho, MD

KevinMD

August 15, 2014

A version of column was published in USA Today on July 2, 2014.

There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs. I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …

How physicians should respond to online ratings: Lessons from the Union Street Guest House

Kevin Pho, MD

KevinMD

August 6, 2014

What can physicians learn from the Union Street Guest House?

For those who don’t know, this hotel in New York threatened to fine those who dared write a bad review. The New York Post got wind of this, and needless to say, the fallout has been ugly. The hotel has hundreds of 1-star reviews of Yelp for its efforts.

This leads to a question I commonly …

Why the VA scandal is a red flag for single-payer advocates

Kevin Pho, MD

KevinMD

May 21, 2014

“I will not stand for it.”

That’s what President Obama said about the deepening VA health care crisis. It’s also a lightening rod for how partisans want to frame the ongoing health debate.

Some are eager to link the VA scandal to Obamacare, and more broadly, government-run health care.

Others extol the virtues of the VA, holding it as …

Pay me like a French doctor. You know you want to.

Kevin Pho, MD

KevinMD

May 8, 2014

Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France.

And on cue, Vox’s Sarah Kliff — normally an excellent health care writer, by the way — is uncharacteristically lazy in framing physician salaries through a biased lens.

After presenting the data, …

Why I’m not ready to prescribe mobile health apps

Kevin Pho, MD

KevinMD

May 4, 2014

A version of column was published in USA Today on April 2, 2014.

Patients in my clinic increasingly use health apps on their mobile devices. Many of these apps track various health metrics, such as weight or calories eaten, while others go a step further and help patients make sense of their symptoms or even suggest diagnoses. It’s estimated that 500 million people worldwide will use a health app by 2015, with the …

Why you need to hear from miserable doctors

Kevin Pho, MD

KevinMD

April 16, 2014

Is being a physician a good gig, or not?

In a piece that’s gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving …

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Why you need to hear from miserable doctors

Growing hospital networks create a tension for health reformers

Kevin Pho, MD

KevinMD

April 13, 2014

A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog.

To remedy our fragmented health system, reformers want to consolidate health care. President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform. To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices. Today, about 39% …

The alarming decline of internal medicine recertification pass rates

Kevin Pho, MD

KevinMD

April 9, 2014

Let’s talk internal medicine maintenance of certification (MOC).

I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I’m good until 2022.

Since then, the American Board of Internal Medicine has made maintenance of certification a more “continuous” process, and is sparking some outcry among physicians. Wes Fisher has multiple posts …

Electronic medical records obstruct patient interaction

Kevin Pho, MD

KevinMD

February 15, 2014

A version of column was published in USA Today on January 19, 2014.

Over half of physicians today use electronic medical records, thanks to the federal government spending more than $22 billion dollars incentivizing providers to transition away from paper charts. Supporters of digital records, including President Obama, say they improve patient care and reduce health costs. Having navigated a transition from paper charts to electronic records in my own practice, …

Mammograms: Breast cancer screening as an individual patient decision

Kevin Pho, MD

KevinMD

February 12, 2014

In a major cancer screening development, a study from the British Medical Journal found that an annual screening mammography didn’t result in a mortality benefit:

Women screened annually by mammography for 5 years had had a breast cancer mortality hazard of 1.05 compared with the control group during the screening period. During follow-up for a mean of 22 years, the mammography group …

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Mammograms: Breast cancer screening as an individual patient decision

Why Medicaid patients use the emergency department for primary care

Kevin Pho, MD

KevinMD

January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy …

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Why Medicaid patients use the emergency department for primary care

Herbal supplements may be natural, but that doesn’t mean they’re safe

Kevin Pho, MD

KevinMD

December 16, 2013

A version of column was published in USA Today on November 20, 2013.

I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin. When I saw him months later for follow-up, he admitted that he didn’t fill the prescription.

“I took red yeast rice capsules instead,” he said.

When I asked him why, he told me that he was wary of statins’ long list of side effects …

New cholesterol guidelines: The statin decision lies with patients

Kevin Pho, MD

KevinMD

November 13, 2013

The release of the new cholesterol guidelines from the ACC/AHA is big news. It represents a fundamental shift in how we prescribe statin drugs.

As with many sweeping changes, there are some good, and some controversial ideas.

I like removing non-statin cholesterol drugs from the recommendations, such as Zetia. Many haven’t been shown to save lives or decrease cardiovascular events.

Also, removing LDL targets can simplify …

Why I recommend LinkedIn to physicians

Kevin Pho, MD

KevinMD

October 31, 2013

When I talk to physicians about dipping their toes into the social media waters, I advise starting with LinkedIn. Spend about 45 minutes or so and create a LinkedIn profile, which is essentially a digital translation of your CV. LinkedIn profiles get ranked highest among the social media platforms, and can push down the influence of …

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Why I recommend LinkedIn to physicians

HealthCare.gov doesn’t need a tech surge, it needs better primary care

Kevin Pho, MD

KevinMD

October 25, 2013

The Affordable Care Act is off to a rocky start, to say the least.

Attention has been focused on HealthCare.gov, where those without employer-provided insurance can shop for health plans. Finger pointing abounds, with the Centers for Medicare & Medicaid Services and contractors blaming each other.

A story in the Wall Street Journal chronicles the debacle:

The contractors said each of their pieces worked more …

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HealthCare.gov doesn’t need a tech surge, it needs better primary care

Why doctors need to be more like Malcolm Gladwell

Kevin Pho, MD

KevinMD

October 17, 2013

In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath. I’m just about finished reading it.

Just as interesting as the book are its reviews. In a recent post from Slate, Gladwell himself responds to the criticism. He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”

He further elaborates on the power …

Corporate wellness programs fail both companies and patients

Kevin Pho, MD

KevinMD

September 19, 2013

This column was published in USA Today on September 9, 2013.

More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.

Coaching and financial incentives are often offered to help employees meet certain health metrics, …

Should doctors separate their personal and professional identities?

Kevin Pho, MD

KevinMD

August 17, 2013

Most social media guidelines for physicians, most recently from the American College of Physicians and Federation of State Medical Boards, suggest that doctors separate their personal and professional identity.

Until physicians are better educated on how best to act professionally on social networks, keeping their online personal lives private is more likely to keep them out of trouble.

But is it time for that recommendation to be revised?

In a recent JAMA perspective …