P. J. Parmar, MD

This doctor doesn’t mind if your cell phone rings

Physician

March 25, 2016

Please turn on your ringer, you might get an important call!

From your case worker. Your housing coordinator. From WIC. A question about your SNAP or TANF or immigration papers or medical application. A potential client for your taxi business. Your boss telling you a shift is available. It could be something important. So please answer your phone!

All of these callers work from 9 to 5, with a lunch break, so …

I started a family medicine practice for $11,000. You can, too.

P. J. Parmar, MD

Physician

June 7, 2015

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I am presenting my startup costs here, to give some ideas for those providers who are considering starting their own family practice, or for those who say it can’t be done anymore.

To become a business, I spent $50 for the state LLC filing, and $12 for business cards. I already had my medical license and DEA from residency, so the only certificate …

Stop the arranged marriages between patient and provider

P. J. Parmar, MD

Physician

February 26, 2015

Assigning patients to doctors. Who still does this?

We don’t assign hungry people to restaurants, hairy people to barbers, or passengers to airlines. Even State Farm allows me to choose between Maaco or my local chop shop every time I crash my car. We do assign kids to teachers, but still, I don’t need too many analogies to tell me that assigning …

To remember who is the customer and who is the servant

P. J. Parmar, MD

Physician

January 26, 2015

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I’m a family doctor working in underserved medicine. My friend Pierre Wolfe was one of Denver’s top restaurateurs for decades. When we get together I often think of the parallels between our industries.

A postcard of Pierre’s Quorum Restaurant from the 1960s shows Pierre at the front door of his restaurant, holding a menu, and says “Pierre Wolfe himself greets you at …

A prescription to treat polyprovider syndrome

P. J. Parmar, MD

Physician

January 4, 2015

In the United States, we train health care providers on poor people. This is no secret — most medical schools and residencies are in lower income areas. If you have Medicaid or no insurance, you are more likely to find care in an office or hospital where medical students, residents, nursing students, and other trainees rotate; Blue Cross patients don’t let interns watch their childbirth. Even though my residency emphasized …

Hardly anyone is opening their own practice anymore. Why?

P. J. Parmar, MD

Physician

December 25, 2014

Young doctors are often progressive thinkers who like to support small businesses, buy locally grown produce from food shares, shop from individual merchants on Etsy, and never be seen in any chain store larger than Trader Joe’s. It seems every industry is recognizing the benefits of the personal service of a small business.

Decades ago, the majority of physicians owned their own …

Too many health coordinators means less care for patients

P. J. Parmar, MD

Physician

October 17, 2014

How many health coordinators does it take to screw in a lightbulb?

Four. But none actually do any screwing. One is your point of contact for screwing lightbulbs. One helps the bulb get screwed. One goes between those two. And one manages the other three, raises funds and writes reports.

My office strives to cut all barriers between the patient and provider. The patient calls me to schedule and comes in, or …

Do you want a culturally competent practice? Here are 15 tips.

P. J. Parmar, MD

Physician

October 11, 2014

Over the last few years I started a family practice serving refugees, and have seen 10,000 refugee patient visits. With regards to culturally competent medicine, medical schools teach about traditional remedies such as coining, and maybe role play with interpreters, but stop short of practice design ideas. The AAFP provides a checklist of qualities, which I feel could …

Who still uses faxes? The medical industry does.

P. J. Parmar, MD

Physician

October 2, 2014

Faxes!

Who still uses faxes? The medical industry does. Here is a picture from just today: 27 faxes received and about 20 sent, and that is only counting after noon. Some days are worse, with up to 40 faxes to handle in our small medical practice.

faxes

On the left are the 27 faxes received: We use e-faxing, so they arrive as pdfs. On …

I’m not worried about ICD-10. Here’s why.

P. J. Parmar, MD

Physician

August 1, 2014

It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has …

Conflicting state versus federal incentives confuse doctors

P. J. Parmar, MD

Policy

July 4, 2014

I get paid by Medicaid to see patients. How much?

Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 …

Medicaid cost shifting: The case of Denver Health

P. J. Parmar, MD

Policy

June 14, 2014

We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid.

The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or …

P. J. Parmar, MD

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