Physicians writing on KevinMD about policy as it reaches the exam room: prior authorization and the state and federal rules now written for it, scope of practice laws state by state, the CDC opioid guideline and what forced tapers did to patients, and public health from vaccination to the pandemic. 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, Opioids: what physicians and pain patients say, in their own words, and Vaccines: what physicians say, in their own words.
There is growing recognition that the broken American health care system is taking a toll, not just on patients and their families, but on health care professionals as well. Nearly half of all physicians in various surveys now report that they are burned out. Inevitably, the experts are lining up to further study the issue and to teach doctors better coping skills.
In terms of the need for further study, I am but a simple country doctor, but I think the …
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Therapy and self-help strategies aren’t the answer to solving physician burnout
I can’t help but wonder …
Every day I find myself driving against traffic to get to work. I am the kind of person that generally always worries about making it to work on time, so I tend to leave my home a few minutes early. Even at these early hours, I can already see a line of cars trying to merge on to the highway going the opposite direction as …
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A roller coaster of emotions at my community clinics
I have worked with some great nurse practitioners (NPs) who I consider to be friends. They play a vital role in team-based practice. This is not about NP bashing. Nor is it a turf war; now that I’m retired, I have no turf to protect. I am a member of Physicians for Patient Protection out of real concern for the future of medicine in this country.
I want there to be …
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Are diploma mills hurting the nursing profession?
2018 is looking to be the year of the woman. In the last few months, there have been several groundbreaking movements that have propelled women into the spotlight. The #TimesUp and #MeToo movements have recently harnessed the collective voice of women who have suffered in silence for too long, revealing the frequency of sexual harassment, systemic sexism and exposing the severity of this widespread issue. Compounding on the tremendous momentum …
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The year of the woman physician
During his 2004 stand up “Never Scared,” Chris Rock said, “I love rap music, but I am tired of defending it.” That statement, for me, holds true more today than ever before. Mumbling about nonsense is already hard to defend and only gets worse when the first line to every song these days has a reference to drugs.
Drugs, sex, and money have always been an important part of music, and …
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Rappers: Stop glamorizing prescription drug use
The state of medicine in America is a highly discussed topic today. The reports are rarely positive. Politicians battle for control over their vision for health care and predict doom and gloom if the other side “wins.” The cost of health care continues to rise for employers and employees. Physician burnout and dissatisfaction are on the rise. We hear from politicians, media outlets, and others on how to fix the …
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The patient-physician relationship is in critical condition
Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December.
CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise — a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company …
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The CVS-Aetna merger is still the one to watch in 2018
I keep reading about how physician’s rightful bitching and moaning is peaking at an all-time high. It’s time they do so before the bow breaks, and let me tell you — we’re almost there. The worst problem that persists is “the enemy within ourselves.” This voice of doubt keeps us from the next logical step: stop what we’re doing, revolt and disable a broken runaway system lest we all soon …
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Physicians have had it. What do we do now?
Remarkable improvements in advanced life-saving therapies have brought chronic disease management to the forefront of American health care. Today, we see more patients that have complicated conditions. Often, these patients are admitted to the hospital with acute symptoms related to chronically managed conditions such as heart failure, lung diseases or cancer.
These patients can end up in the intensive care units and require critical care such as ventilators, dialysis and other …
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Chronic disease is making medical education worse
Anyone who has ever tried to buy health insurance in the open marketplace knows how difficult and expensive it can be. I spent years working at jobs that did not provide health insurance, and I remember the annual feeling of dread when I received notice of the new premium increase. The only way I could keep the cost affordable was by continually raising the deductible until eventually, I was paying …
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Here’s why health insurance is different from other insurance
The recent announcement that Berkshire Hathaway, Amazon, and JPMorgan have joined forces to pare down health care costs has sent ripple effects across the health care space. The announcement sent stocks tumbling due to the uncertainty of what influence these companies will have on a deeply complex, unruly and wasteful health care system.
Said Berkshire Hathaway chair and CEO Warren Buffett: “The ballooning costs of health care act as a hungry …
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Will Buffet, Bezos, and Dimon be able to control health care costs?
CNN recently posted an article online, asking this very question. It was posed in the guise of our leading mega-billionaires, Warren Buffet, Jeff Bezos, and Jamie Dimon, “fixing” our broken health care system. In actuality, these three industry giants announced plans to combine resources to create their own insurance system for their combined 850,000+ employees. A nice gesture, to be sure, but not really a panacea for a nation of …
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Why is health care so expensive in the United States?
It’s February 15, and our country has had yet another school shooting. Seventeen more kids are dead, despite multiple warnings that the perpetrator was high risk. No one wanted this to happen. Across the political spectrum, Americans are appropriately asking what they can do to prevent another shooting. Yesterday many asked for a day to mourn. They said, “tomorrow we take action.” Today is tomorrow.
My liberal friends are calling to …
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5 things America can do today to reduce gun deaths
On September 5th, 2017, the Trump administration denounced the further implementation of Deferred Action for Childhood Arrivals (DACA) and called for its revocation in 6 months. Opponents quickly voiced their concerns towards the unjust decree. Now, the deadline is near and a heightened urgency to act is imperative. To encourage advocacy and help legislators understand the vitality of DACA-recipients, the following displays the power of the undocumented.
Days after news of …
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Ending DACA is a travesty
The way doctors and hospitals are paid is undergoing a quick and quiet revolution in an attempt to control costs and improve health outcomes. Federal payers are driving this change from fee-for-service payments to reimbursements based on quality outcomes and measurements of clinical processes. This focus on clinical outcomes does not account for the deep inequities that drive poor health outcomes in the United States. Without measuring and paying for …
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Health equity is the missing value in value-based payments
What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people’s lives? You get the carnage that is the American health care system.
You get my week as a family doctor in the worst health care system in the world.
This week a diabetic patient who …
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A week in the worst health care system in the world
The costs of many generic drugs have skyrocketed. In some cases, the price of a single pill has increased over 500 percent.
But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.
Why has the price of generics skyrocketed?
Some large drug companies have purchased …
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How hospitals can impact generic drug companies
Early this month, it was reported that President Donald Trump, having grown frustrated from discussions regarding a bipartisan deal on immigration, asked why proposals continued to provide special protections for immigrants from the countries of El Salvador and Haiti, and the continent of Africa. He reportedly exclaimed, “Why are we having all these people from sh*thole countries come here?” The statement has been largely denounced both at home and abroad, and …
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Immigrant health care workers serve a vital function within the American health care system
The most profound health care legislation enacted since the Affordable Care Act, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a huge mistake. It adds another vast layer of bureaucracy to a health care system already overburdened by such things, and penalizes physicians who take care of the most complicated patients. The head of the Centers for Medicare and Medicaid Services (CMS), who administer the program, admits …
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Doctors must take a stand and force the government to cancel MACRA
