W. Ryan Neuhofel is a family physician and owner, NeuCare Family Medicine. He can be reached on Twitter @NeuCare.

Policymakers: Put down your carrots and sticks. They will not work.

Policy
April 5, 2019

As a family physician in the trenches, I routinely see blatantly poor medical care in the history of my new patients. Far too many people get unwarranted medications and tests, while important things go unrecognized or unaddressed. This paradox is maddening.

We must do better.

To this end, policymakers have developed programs to promote “quality” and “performance” among clinicians. The main approach has been altering payments to serve as financial incentives and …

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Policymakers: Put down your carrots and sticks. They will not work.

A radically patient-centered proposal to fix health care in America

Policy
September 4, 2017

An executive summary of “A radically patient-centered proposal to fix health care in America.”

The political theater over health care reform has quieted after yet another ugly show. A productive dialogue about big ideas seems impossible in our hyper-partisan climate. No matter which party holds power, any significant proposal is quickly met with fierce opposition from a variety of political and business interests.

So, for many decades, America has …

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A radically patient-centered proposal to fix health care in America

Direct primary care physicians are trying to rescue other doctors

Physician
September 2, 2016

In a recent interview, Dr. Farzad Mostashari (former national coordinator for health IT and current CEO, Aledade ACO) gave some advice to physicians on how to avoid burnout and “restore their role as caregivers”:

The key is two things. One, if you’re in a kayak in the rapids, you have to lean in and dig your paddle in and push ahead. If you lean back, you’re done. You’re going to flip …

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Direct primary care physicians are trying to rescue other doctors

Don’t deny access for vaccine skeptics. Here’s why.

Conditions
February 27, 2016

Potential patients — usually parents — occasionally ask me if I am “vaccine-friendly.” After having this question posed to me numerous times, I’m prepared for the conversation that follows. I’ve tried to ease into it in various ways, but none has proven universally comfortable.

The question’s phrasing is telling about a person’s perspective. It implies that their previous experiences with physicians were perceived as “unfriendly.” Also, my defensive side infers it …

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Don’t deny access for vaccine skeptics. Here’s why.

Direct primary care: Setting the record straight

Physician
December 15, 2014

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Since starting a direct primary care (DPC) practice nearly three years ago, I’ve become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it’s difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice.

Two common concerns about DPC have emerged during my conversations with fellow …

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Direct primary care: Setting the record straight

Building a concierge safety net practice

Physician
June 14, 2014

“So like a concierge doctor?”

That was the most common response upon explaining my future direct primary care practice while in residency. That perception and label really perturbed me. My vision was to care for a diverse group of people. I spent the majority of my residency clinic hours in an urban safety net clinic, but certainly didn’t want to swing the pendulum to the opposite 1%.

To avoid that stigma, I …

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Building a concierge safety net practice

I’m paying my patients cash to quit smoking

Physician
October 16, 2012

I am starting a prize-linked smoking cessation program for my medical practice. Like most family docs, I constantly remind my smokers about the risks of tobacco and my ability to help them quit when ready. And like most physicians I probably have a false belief that pestering “enough” will spur action. As an unofficial student of economics and official student of public health (MPH), I should know better.

Sure, I have …

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I’m paying my patients cash to quit smoking

Doctors and patients are both losing in our health system

Policy
June 28, 2012

Early in my medical training I envisioned myself as an old-fashioned family doctor. Marcus Welby, MD was well before my time, but he seemed like a good fictional role model for a naive student-doctor. (Especially considering Dr. Cox of Scrubs was my alternate choice.) After finishing my primary classroom studies, I was eager to leave the stacks of paper behind and to learn from real clinicians caring for real people. After donning my short white coat …

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Doctors and patients are both losing in our health system