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.
I still remember the exhilaration I felt upon learning that my peers and I could finally return to our in-person classrooms. After a year of Zoom lectures, asynchronous exams, and more, the prospect of seeing each other again thrilled us.
However, we had not anticipated the constant fear and uncertainty that would accompany this transition. Despite implementing safety measures like masking and one-way hallways, the number of COVID-19 cases continued to …
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Let teens self-consent to vaccines
Health care is growing hard to come by in rural America.
Three-quarters of rural counties suffer from doctor shortages. More than 200 rural hospitals are at risk of closing due to financial hardship within the next two to three years, according to a study published this spring. And while 20% of the U.S. population lives in a rural region, just 10% of physicians practice in these communities.
Fortunately, there’s a group of …
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Doctors trained abroad will save rural health care
“To serve the art of medicine as it should be served, one must love his fellow man.”
– William Osler
There is sadness in my heart and my mind. With so many advances in the treatment of illnesses of the mind and body, why have we let our diseased health care system go untreated?
Hospitals in rural areas are being closed down and deemed non-profitable, forcing their patients to seek alternatives; those alternatives …
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Why have we let our diseased health care system go untreated?
When I transitioned into a new role as a training faculty member at an academic medical center a few years ago, it didn’t take long to realize that the program had a problem with psychological safety. There wasn’t much.
As I got to know the trainees and heard specific feedback, I began to understand why. The trainees felt criticized and unsupported by the training faculty. And every time there was a …
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Leaders who elevate diverse employees create psychological safety
In a report published by the Commonwealth Fund and released in August 2021, the performance of the U.S. health care system was compared to that of other high-income countries. The results were stunning: despite investing far more of its gross domestic product in health care, the U.S. ranks dead last overall and last on access to care, administrative efficiency, health equity, and health …
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The solution to a crumbling primary care foundation is direct primary care
“Inflation hit 8.2 percent for the month of September.” The sound of the newscaster’s voice was grim.
Tuning into the nightly news, many Americans have become seasoned pseudo-economists. It has become common practice to crunch numbers to prepare next month’s budget as food, oil, and housing prices reach all-time highs. The ever-foreboding question of “Are we in a recession?” has become as frequent and a juxtaposition to the innocent pestering …
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The hidden health complications of inflation
Canada needs trauma-informed aged care, training, and strategies in long-term care homes across the country.
“Trauma” is a heavy word, but it’s the right word.
“Trauma” describes what has been happening in long-term care facilities across Canada during the pandemic, where the majority of COVID-19 deaths have occurred and where highly restrictive visitor policies and short staffing have meant extreme isolation and deprivation for the residents who live there.
But there are often …
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We need trauma-informed care in long-term care homes
With the Christmas holiday rapidly approaching, it has me thinking about what the family of faith should think about health care in America. As a physician, I’ve spent over a decade of my life trying to use my faith in science and evidence to inform people about an optimal way to practice medicine and, as someone trained in health policy and management, how to structure the United States’ health care …
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A theological answer to our health care crisis
Despite the aggressive marketing, Medicare Advantage plans offer little benefit for poor and vulnerable patients.
Consider my patient C, who was in pain from her knee arthritis. She was often in pain, but now her new pain medication helped her less than her previous one. She also wanted her old asthma inhaler back as the new one was harder to use. We had changed all her medications since her new Medicare …
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Medicare “Advantage” for my indigent patients
For diabetics, insulin matters as much as H2O. Unfortunately, insulin’s a hell of a lot more expensive than bottled water. High insulin prices force approximately nine million Americans to balance their wallet and well-being.
The American Action Forum reported that a type-one diabetic’s average yearly expense for insulin was $~6000 (i.e., $500/month). It’s easy to lambast Big Pharma companies for the current state of insulin’s affairs, but history and market behavior …
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Don’t blame Big Pharma for insulin’s problems
The American Medical Association (AMA) would have you believe that the biggest threat to the medical profession is “scope creep” – the intrusion of advanced practice providers into medical practice.
The way I see it, this is no big deal; the movement will reach equilibrium, and everyone will play nicely in the sandbox.
In my opinion, the biggest threat to the medical profession is “political creep” – the increasing government …
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Political creep: government intrusion in health care
The recent Dobbs decision has led to strong reactions from many major medical associations arguing that limiting abortion options will significantly harm women with unexpected pregnancies. This needs to be acknowledged, and the desire to do what is best for women is to be commended and shows a true passion for providing what these organizations deem to be the best possible care.
However, there are many medical providers who are as …
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It is time that medical societies acknowledge that pro-life views are legitimate
As a physician, do you know the average salary for your specialty and location? What about the average signing or relocation bonus? If you don’t know or are unsure of how to get that information, you are not alone.
In a society where most employees hesitate to openly share compensation numbers, it can be difficult to determine what you should be earning, physician or otherwise. Unfortunately, employers benefit much more from …
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Negotiating a raise with the right compensation data
“We use a punishment mindset that exacerbates the trauma (people have already suffered). We have to change that.”
– Bryan Stevenson, Director of the Equal Justice Initiative
In the months preceding the COVID-19 pandemic, our quality improvement team was discussing the safety of providers and staff on a weekly basis. This was not in the context of a communicable disease or sufficient personal protective equipment but instead related to another insidious health …
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Breaking the cycle of violence in hospitals: the role of trauma-informed care
Once again, it’s time to consider universal health care. What are the implications? Could it happen?
After something of a hiatus during the passage of the Affordable Care Act and the battles over its implementation, legislative committees in Oregon and Washington are looking at new proposals for state-based universal health care. Oregon’s task force report was completed in September, while Washington’s “baseline report” was finished this month.
While there’s a fair amount …
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New proposals for universal health care in Oregon and Washington
When I was in high school, I read George Orwell’s 1984, a novel about a dystopian future where the government (a.k.a. Big Brother) monitors everything the citizenry says or thinks. Anyone deviating from government “doublespeak” is swiftly and severely punished. I recall my horror as the main character, Winston, a former government official who joins the anti-Big Brother underground, is arrested by the “thought police.” His mind is then reprogrammed …
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Punishing doctors for spreading misinformation
Buying health insurance is a lot like renting an apartment. Finding the perfect place is hard, and the price is always higher than you expect. But if it is conveniently close to your employer and there are few other affordable options, you sign the lease and agree to all of the terms. Only after a few monthly payments do you realize electricity, heat, water, and snow removal are not included. …
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Building individual health equity
A medical malpractice process is a lot like running a marathon.
The analogy makes it easy to understand why physicians are emotionally unready to go through years of litigation and often find themselves struggling.
To successfully make it through the grueling 26.2 miles, a runner has to be well-prepared.
It’s common for runners to join a running group. Sometimes, engage a coach who can help to train smart.
Runners will spend months building up …
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Medical malpractice is a lot like running a marathon
