When private physician groups get acquired: Who loses?

Policy
June 1, 2018

In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists.

I will concentrate on anesthesia as it is my area of specialization, and I have some relevant …

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This doctor retired from clinical medicine. Here are his tax surprises.

Finance
June 1, 2018

Upon retiring from clinical medicine and becoming a full-time author/coach (I like to say I’m repurposed), I was uncertain as to the amount of taxes I needed to pay. I have a complicated tax return with several K-1s that don’t surface until March. My final return totals 32 pages for federal and 5 pages for state.  After making an estimate of my tax bill at year end, I figured I …

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Residents should not be mandated to do research

Physician
May 29, 2018

In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or …

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The Medicare merry-go-round in geriatric psychiatry

Physician
May 28, 2018

Martha (not her real name) was not an overly complex case in my field of geriatric psychology. But the case was complex enough to require multiple approaches and reliable follow up. And in rural Mississippi, follow up can be elusive. Soon it occurred to me that Martha’s case is emblematic of how caring for this vulnerable population often runs up against a huge problem — the Medicare merry-go-round.

A 78-eight-year-old with …

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We are sorry, you did not match to any position

Education
May 27, 2018

When I was in fourth grade, I won our school’s spelling bee. This meant that I went on to the next tier of the local spelling world — the sort of prestigious competition that takes place in a gymnasium somewhere with a makeshift stage and a bunch of flags.

I was the first kid disqualified. I misspelled veterinarian “veterenarian” and battlement “battlemint.” I remember feeling, in the moment the announcer said, …

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Your first meeting with a mentor

Physician
May 26, 2018

You extend a firm handshake and get ready to sit down at the table across from your mentor for the first time.

Woah, wait. Let’s back up to the legwork that should have happened prior to this meeting. First step, you found the mentor (see this post for practical ideas on how to find a mentor). Neither you nor the mentor have a lot of time — a frequent obstacle often …

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How to ask for a great letter of recommendation for residency

Education
May 25, 2018

Strong letters of recommendation are essential for supporting your residency application and matching well. This article details how to ensure you get great letters of recommendation.

Knowing what constitutes a great letter of recommendation is crucial to obtaining outstanding letters. A strong letter of recommendation clearly conveys knowledge of the medical student, how that student performed and qualities that predict excellent performance in residency. Strong letters of recommendation include the following:

What to do if you want to be a cruise ship doctor

Physician
May 25, 2018

In 2013 I began searching for ways I could change my career to reduce my workload, but not give up medicine altogether. During that time I took a cruise and looked at various jobs I could do on a cruise ship. One of the jobs I was qualified for, I thought, was to be a Cruise Ship Doctor.

After talking with the ship’s doctor to find out what it was like …

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The skinny on skinny health insurance

Policy
May 24, 2018

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health …

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How to deal with devastating criticism

Education
May 24, 2018

“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!”

I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the …

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The good, bad, and the ugly of being a medical expert witness

Finance
May 24, 2018

I have spent a good part of my career investing time and energy towards side hustles.  I generally categorize them into two distinct types of ventures.  The lazy side hustle involves starting a business or consulting in a field tangential to ones main hustle.  For example, an accountant who works normally as an auditor may do a few tax returns on the side during tax season.  I call his …

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Don’t be mean: Treat your team members with respect

Education
May 23, 2018

“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom.  I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming.

“Why the f*** would they think I need to be consulted for this? Only …

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Why the battle against being called a provider is probably lost

Physician
May 22, 2018

I recently needed to transfer my patient to a larger medical center for some urgent care. As I sat there in my relatively small hospital working out where they would be best served, a famous academic medical center that was not too far away, came to mind. I placed a call to the facility’s bed facilitator, who took the patient’s details from me, and was told to await a callback …

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The best medical specialty you’ve never heard of

Physician
May 22, 2018

The most common response when I introduce myself as a preventive medicine resident is an interjection, “You mean family medicine?” I have come to realize that the majority of the healthcare field has never heard of preventive medicine as a unique medical specialty. It’s a shame, because preventive medicine is truly the best medical specialty you’ve never heard of.

Preventive medicine practices at the intersection of public health and clinical medicine …

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Everyone needs someone to be a safe harbor

Physician
May 21, 2018

I met David on the internet. It was to become on of the closest, most intense relationships of my life.  For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started.  They had successfully traversed the waters that to me were completely unknown — and frankly terrifying.  On the pediatric brain tumor listserv, …

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Medical residents and academic due process: Know your rights

Education
May 20, 2018

I recently received a call from a physician resident in the Northeast U.S. who had been notified that she would be terminated from her residency program for a “weak knowledge base.” There would be no contract offered to her for the coming academic year. She reports that her scores are no worse than several of her colleagues and that her accredited program has a history of arbitrarily dismissing residents. She …

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I was accidentally accepted to an Ivy League medical school at 17

Education
May 20, 2018

Want to hear a crazy story?

Typical medical school students can relate tales of a college experience that includes summer research or hours spent reviewing for the MCAT. I didn’t even take the MCAT. Read on for the oddest medical school acceptance story you’ve ever heard.

I was driven in high school. I’d heard for years about smart kids going off to the Ivy League, and I wanted that experience — to …

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Personal finance lessons from Shaquille O’Neal

Finance
May 18, 2018

I’m always intrigued by those who earn millions of dollars per year or even per month. Some manage to blow all that money and then some. Others, like a select few NFL players, choose to spend wisely and save prodigiously.

Today’s Saturday Selection highlights the habits of one athlete who was among the highest paid NBA stars for many years. The headlines sadly feature athletes with similar …

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Too many things need physicians’ signatures

Physician
May 18, 2018

Just sign here.

How many times a day are we asked to do this? “Just sign here.” “Just put down your license number.” “We need a stamp with your doctor’s info on it.” “Give us your NPI.” “Initial here, here, and here.”

If we took the time to read all the things we’re signing, we wouldn’t have time to do any doctoring.

The other day I was asked to hand-write the date on …

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