Physicians writing on KevinMD about running a practice: staffing and overhead, the payer paperwork that arrives with every patient, ownership and consolidation, the administrators and executives who now employ most physicians, and the models physicians have built to get out from under all of it. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Physicians and administrators: what physicians say about who runs medicine, in their own words, and Private equity and corporate medicine: what physicians say, in their own words.
With summer vacations over and school back in session, I should have gotten up earlier. The usually tough morning commute into Columbus was downright brutal, and I found myself getting repeatedly annoyed as I rushed to make it to clinic on time. Somehow, legally, I managed to make it right at 8 a.m., the start of my weekly asthma clinic. Though I arrived a bit later than usual, I still …
Read more…
Don’t to forget to walk in your patients’ shoes
1. This is a calling. Physicians do not typically start out undeclared, drink through a couple of semesters and randomly apply to med school. For many, they started dreaming in grade school. They started pushing themselves for straight A’s in third grade, fought for valedictorian, turned down frat party invites to study, and then essentially gave up four years of their lives to med school incurring an average debt of …
Read more…
10 things a doctor’s spouse wants you to know
How many times have you heard resident physicians say that they do not have time to exercise and get in shape? When looking at the numbers, it’s hard to blame them. An 80-hour work week is enough to make anyone realize that time is a precious commodity.
Take away six-to-eight hours for sleep each day, plus a couple of hours for eating, showering and studying, and you are left with approximately …
Read more…
Want to stay in shape during residency? Here’s how.
We all know what, in 1888, Rudyard Kipling pronounced to be the world’s oldest profession. But what’s the world’s second oldest? Hunter-gatherer? Nah, everybody did that. Primitive politician? That’s a tautology. Neolithic attorney? Nope. Too similar to the oldest.
I strongly suspect that the second oldest profession was healer/magician. Fire up Mr. Peabody’s Wayback time machine, and you’d probably find that the first healers were regarded as magicians, and the first …
Read more…
Physicians and magicians are not as different as you think
Rates of physician burnout are rising, and many physicians cite their electronic health record (EHR) as the primary culprit. That’s no surprise, since doctors spend twice as much time on electronic health record (EHR) systems and deskwork as they do directly interacting with patients. Let that sink in for a moment. Imagine if an airline pilot spent six hours documenting every detail of a three-hour flight. Such …
Read more…
How tech can get doctors back to seeing patients
Something very interesting happened to my patient visits when I changed my office attire.
My clean long cotton lab coats, hanging on the back of my office door, suddenly all seemed dingy when I set out to change lab coat about a week ago. I decided to pretend it was Saturday.
On Saturdays, I usually wear a pocketed button-down shirt instead of one of my usual Jermyn Street ones. I skip the …
Read more…
A doctor goes without a white coat. Here’s how his visits changed.
According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to …
Read more…
It’s time to ban productivity from medicine
The invitation was unexpected. Although I would attend the conference as a relatively new member of the community, I knew I was making inroads, so I accepted without hesitation. The prospect of meeting well-established players in the field at dinner with the planning committee was exciting. And, I was equally looking forward to spending more time with a fellow newbie who had already been tapped as a rising star the …
Read more…
Get up on your bed and stand up straight
We humans can’t help but shove as much as possible into one minute, one hour, one day. We’re rewarded for doing it, too. Society says that the more you check off your list, the more productive you are. And by default, then, the more productive you are, the more successful you are. So, we rush. We search for ways to skip steps and still get the same result. We fill …
Read more…
Gain time by slowing down with your patients
Most parents have been deeply distressed by the rising violence and streams of hate as a keynote in our national discourse. For a constructive response, I encourage parents to write to their school administrators and partner with the adults in their children’s community to stem the tide of vitriol that has engulfed our views on race, religion, and the study of history in our everyday lives. Here is an edited …
Read more…
An open letter about hate and how to fix it
That first paycheck as a new attending means so much more than what is direct-deposited into the bank account. The emotions of finishing medical school and training to finally seeing the fruits of your labor positively affect the bank account is something to be proud of. As a medical student (like myself) and resident, it is the light at the end of the tunnel. You’re probably asking yourself, “Why should …
Read more…
The key to financial freedom: Live and work like a resident
After almost fifteen years as a research physician, I grew tired of the relentless cycle of applying for grants, failing to obtain funding, and reapplying with variable success. Conducting clinical trials was rewarding, but the responsibility seemed endless. I began to feel burnt out, scorched. It was time for a change. I needed a hobby.
Around this time, I read Frank McCourt’s memoir, Angela’s Ashes. The author described it as a story …
Read more…
How a doctor turns life into story
Is the practice of medicine a different experience for male and female physicians? Two recent studies from athenahealth suggest that it is — in ways that should make us rethink what we value in health care.
The first study found that male physicians are more productive than their female counterparts. In an analysis of 47 million visits on the athenahealth network in 2016, male physicians generated 30 to 40 percent more …
Read more…
For women physicians, is there a connection between productivity and burnout?
I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time. During that time I stayed in a lot of hotels. But, occasionally, I had more unique accomodations. Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal. I actually like sleeping in airports occasionally. When you’re stuck, you’re stuck. Weather or …
Read more…
The surprising sleeping arrangements of an emergency physician
One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.
Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are …
Read more…
Take back our practices with physician cooperatives
Let me start by saying that I am a huge Dave Ramsey fan. When I completed residency and began my current position, The Total Money Makeover was the first personal finance book I read, and pardon the cliché, but it changed my life. It instilled in me a strong foundation in money management and offered me a road map to handle the situation I was in: hundreds of thousands of dollar in …
Read more…
Pay off debt, invest, or both: Advice to young physicians
When my husband Brian started first-year of medical school at the University of Miami Miller School of Medicine, I jettisoned off to Thailand to spend a year teaching English and traveling. We figured if we were going to date long-distance, why not go all in? Why not ensure that we were a full 12 hours apart, on literal opposite sides of the world. What can I say? We like a …
Read more…
5 keys to a successful long-distance relationship during medical school
In this current era of health care, patients are increasingly being labeled as “customers” to provide a landscape suggestive of the need to provide customer satisfaction. Many health care providers grow increasingly frustrated with that terminology. It demeans the relationship that is fostered in the patient-physician encounter; belittling it to a transaction that occurs as the exchange of goods for an expected outcome. Perhaps a more appropriate corollary to the …
Read more…
Why patients should be investors, not customers
Next month when our youngest child leaves for college, the biggest change may not be in his life but in ours.
We are done with dropping them off at school, or giving them driving lessons, or helping them with difficult homework assignments: We will officially become “empty nesters.”
My wife and I ponder sitting at the dinner table and standing by the kitchen counter, where exuberant political dialogue takes place, and common …
Read more…
How this physician transitions to becoming an empty nester
