Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. 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, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.
As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.
Most people …
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Thinking of starting a cash-based practice? Here are the pros and cons.
Taxes.
Doing taxes feels like a financial rectal exam. I hate doing taxes. Yeah, I don’t like getting rectal exams either.
It’s not that I resent paying the government for the fine services they render and the high quality of elected officials we have. It’s not the existence of taxes I hate; it’s just doing taxes make me feel extremely insecure. Sharing my personal and business finances with my accountant and the …
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How to change patient behaviors? Don’t lecture them.
Physicians play many roles in patients’ health care and lives in general.
In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision.
In the very next appointment, we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes.
We sometimes find ourselves in …
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Do doctors reveal too much about themselves?
As a fourth year student in her last few weeks of medical school, I recently found myself in an interesting new course: negotiation skills for graduating medical students. As part of a push from accrediting organizations like the LCME, the final weeks of our medical education are being devoted to lesser-taught subjects in medicine: licensure processes, malpractice, wellness and resiliency training, and contract negotiations. At the start of the lecture, a …
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Are female physicians really bad negotiators?
I would like to discuss how I achieved financial independence at age 39, and how it allows me the freedom to practice medicine in a way that keeps me happy.
Financial independence is defined as having enough money saved and invested in a way that would allow you to quit gainful employment and continue your present standard of living. The math, based on a 4 percent withdrawal rate, requires you to have …
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How this doctor achieved financial independence at age 39
We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …
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Your patient should get a health coach. Here’s why.
How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.
Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …
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Why the 15-minute doctor appointment is dangerous
For almost ten years now, family physicians have been the most recruited specialty in the medical profession, and that is not likely to change anytime soon. We face a huge shortage of primary care physicians that is only going to get worse because we aren’t training family doctors as fast as they are retiring.
Business training isn’t in the curriculum
What this means for me and my fellow family medicine residents is …
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What I learned from negotiating my first physician contract
You ask your patient to follow instructions and when they see you at their subsequent visit, they have not made the changes you suggested. We have all been there, often placing the blame on their lack of interest in their health. Have you ever thought to dig a little deeper?
The average American reads at a middle school level. There have been a series of studies trying to shed light and …
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Talk to patients in a language they can understand
Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café.
His maître d’ and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his …
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The story of a man who was a very good cook
In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?”
“Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming.
“You students are …
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How a patient gave this doctor his first coaching session
The changes to health care — not just in policy, regulation, and payment but also the tectonic shifts in how we define, evaluate, report and are paid for care — can make us all feel like we’re on a runaway train.
Alongside the runaway train are the significant improvement opportunities in health care we must somehow address — less variance, improved patient engagement, coordination of care, adherence to evidence, waste reduction …
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To make big heath care changes, think small
Sometimes before I go on a run, I take the laces of my jogging shoes and tie them together in a knot. I wear the pair around my neck with each shoe falling to opposite sides. The heels clunk against my chest as I make my last minute rounds. It’s as if running is my job and the shoes are the instrument I use to perform that job. Eventually, I …
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When practicing medicine is like running
The American Board of Internal Medicine has been under fire for the excessive testing requirements of physicians and they recently have been seeking clarity for the maintenance of certification process. In my opinion, the answer is to eliminate the examination completely and create a better, ongoing assessment using CME chosen by the physician that meets their needs, especially in a time where medical knowledge changes so rapidly.
Doctors are essentially tested …
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Why board exams are like Name That Tune
Recently during rounds on a busy inpatient teaching service at a county hospital, I led a group of medical students into a patient’s room. I asked the same question I have asked well over 10,000 times: “What do you see?”
Observation is a powerful tool at the bedside, and offers us an opportunity to learn from one another.
My student replied, “I see a white man sleeping in no acute distress.”
I repeated …
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A gentle reminder that healing begins with feeling
I’m a physician, part of the enormous all-consuming machine called modern health care. This machine is driven by value-based best practice and end results. Literal life and death decisions are required daily, so naturally I become impatient when my son can’t decide between chocolate and vanilla or which movie to watch.
My cultivated Achilles’ heel of impatience has a tendency to interfere with daily interactions or decisions because of the dreaded …
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The momentous power of sincerity and good communication
