Physicians writing on KevinMD about the rules they practice under: prior authorization and the algorithms now deciding it, gold card laws, scope of practice and who may practice without supervision, Medicare and Medicaid, the Affordable Care Act, drug pricing, rationing that is done and not named, and the policies that decide which patients get care. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Race and medicine: what physicians say, in their own words, and Medical ethics: what physicians say, in their own words.
Often the key to solving a troublesome problem is approaching it from a different direction. As 19th-century mathematician Carl Gustav Jacob Jacobi wisely noted (and as popularized by renowned investor Charlie Munger), “Invert, always invert.”
Therefore, when we consider ways to transform our current health care system in the U.S. to deliver more reliable, equitable, cost-effective value, we should explore the factors that perpetuate a continued unreliable, wasteful system that propagates …
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How value-based care can address health inequities
A new health crisis is looming on the horizon in the United States, and it will affect the most vulnerable people. I am not talking about another pandemic, the downstream impact of delayed preventive screenings, or even the ongoing substance use crisis. I am talking about the endangerment of America’s health care safety net, including the providers that serve marginalized communities.
Safety net providers are primarily in unserved and underserved communities, …
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America’s health care safety net is in danger
It is not breaking news that we are currently in the midst of a mental health and substance use disorder crisis. We saw a record number of overdose deaths in a 12-month period from May 2022 to May 2023. According to the CDC, overdose deaths totaled more than 112,000 during that period. There has been an all-hands-on-deck effort to curb these deaths with efforts aimed at decreasing supply, educating the …
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Are convenience stores making addiction convenient?
Health care and how individuals receive it has been at the forefront of public concern for many years. Now, more than ever, a priority should be placed on discovering amenable solutions to address the incomprehensible challenges impacting this nation’s health care system. I believe that direct primary care (DPC) holds the potential to improve the way Americans access and experience health care. An article published by Medical Economics says …
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The rise of direct primary care in America
At the peak of the coronavirus crisis in 2020, American policymakers were faced with the critical challenge of how to encourage as many Americans as possible to be tested for and vaccinated against the COVID-19 virus. Fortunately, Congress rose to this challenge by passing legislation that, in addition to providing these services to the uninsured, required private insurance plans to eliminate all out-of-pocket costs associated with getting vaccinated or tested. …
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High-deductible health plans: a barrier to care for chronic conditions
The nurse and clinician workforce crisis in the United States is a complex issue with multiple contributing factors that include clinical staff burnout, unmanageable workloads, the departure of nurses reaching retirement age, and the pandemic’s lingering impact on health systems. A 2023 study by the American Hospital Association (AHA) found that the U.S. will face a physician shortage of as many as 124,000 by 2034 and will need to hire …
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Post-pandemic nursing workforce challenges continue to mount
Representatives of a battered and stressed Canadian medical profession gathered in Montreal and virtually last week for the 7th annual Canadian Conference on Physician Health (CCPH) – the first such meeting in four years and the largest to date. One of the main pain points identified as facing individual physicians is the burden of administrative work, and this was the focus of a special cross-border plenary session featuring Canadian Medical …
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Physician well-being: Overcoming administrative hurdles
My son’s favorite thing to do is fish. I bought him a brand-new Mickey the Mouse fishing pole and a tackle box for his birthday. His favorite spot was on a small inland lake in a state park. On the bank of the lake, we would fish underneath a large cottonwood tree decorated with bobbers and lures that had become snagged in the branches.
The tree was tall and old and …
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From fishing licenses to gun control
The NFL season is now in full swing, with TV screens ablaze in households across the nation, eyes glued to an elliptically-shaped ball being thrown and kicked far distances. This reminds me of an incredibly rare case that happened to a male patient I saw in the ER many years ago, whose right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway. My …
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How the NFL offers a window into health care solutions for our country
In the complex world of health care, doctors and nurses often take center stage. But behind them is a much larger team supporting the delivery of exceptional care. Allied health professionals – like radiology and surgery technicians – play an essential role in health care, and it’s time we shine a brighter light on the importance of these roles and the tremendous opportunities they present for those seeking a career …
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Unlocking the potential of allied health roles for a thriving health care system
Although the health care workforce has begun to normalize following the historic lows of the pandemic, according to Staffing Industry Analyst’s most recent Healthcare Staffing Report, health care employers across the board still struggle with a tight labor market, high turnover, and continued attrition.
In fact, the health care sector continues to rank last for overall employee satisfaction, with low scores in areas such as engagement, intent-to-stay, and employee experience …
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Efficient staffing partners for health systems
The practice of medicine involves a delicate interplay between medical expertise and the unique needs of each individual. Ideally, medical decisions should prioritize the health and well-being of patients while being rooted in science and evidence-based practice. However, this noble mission inevitably becomes challenging in the context of reimbursement structures that inadvertently incentivize unnecessary procedures rather than focusing on the quality or necessity of care provided.
In an all-too-common scenario …
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In the crosshairs: The False Claims Act’s new targets in health care
Regressive legislators in a Southwestern state discovered that doctoral-level nursing students, future nurse practitioners at the state university, were receiving education in human sexuality. As watchdogs of public morality, and with a conviction that these students were being educated to “groom” children to become transgender individuals, they did not pause to verify the information, review course materials, or speak with the instructors. Instead, they immediately began complaining to the media …
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Challenging misconceptions in nursing education
I have been representing physicians for over 40 years, and the vast majority of the people I work with are genuinely nice. Overworked, stressed, sometimes distracted – yes, but most physicians entered the profession because they were sincerely concerned about people and wanted to help. Medicine can be a truly thankless job, and the vast majority of physicians don’t pursue it solely for the money.
Unfortunately, this characterization of physicians is …
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Not all physicians are nice
I was having a conversation with a colleague about a state-funded Medicaid managed care organization (MCO). She told me that the mental health performance measures used by the state to evaluate the MCO were all “placement and provider issues,” such as the amount of time children spent sleeping on the floors of social services offices or languishing in emergency departments (ED) before they were transferred for treatment or placed into …
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Medicine has become the new McDonald’s of health care
Have you ever wondered what it’s like to have a heart attack? Or maybe you’ve had one. What about that same heart attack on a single-lane, pitted road flanked by cornfields on both sides, two hours from the nearest city? This is the reality for rural Americans, and it becomes more extreme by the day. Rural hospitals are sometimes the only tertiary care centers for hundreds of miles, and they’re …
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The alarming problem for rural medicine
