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.
by George H. Northrup, PhD
No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.
With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …
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How managed care caused the mental health care crisis
Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.
Hospitals can be for-profit, not-for-profit …
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Pros and cons of private or hospital owned practice
There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand.
The problem is that the word “sign” has a specific meaning in …
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Why pain cannot be a vital sign
by Doctor D, MD
A teacher asks Doctor D about a diabetic teenager in his class: “His sugar readings are often over 400. His mom says this is normal. Can this be normal?”
What is normal?
a) A state of harmony within the body and mind that leads to health and well-being.
b) The typical or status quo for a person; the way things usually are.
c) WTF? There is no such …
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What is normal for a teen with diabetes?
When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess.
I can’t tell you the number of times I’ve been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to …
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End of life care requires individual family decisions
Recently I wrote a blog about how the American Academy of Pediatrics (AAP) thinks that otherwise healthy children with ear infections should wait a couple of days before starting antibiotics, because many will get better without them.
Now there are two articles in the New England Journal of Medicine (here and here) saying that children with ear infections who are given antibiotics are more likely …
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Pediatrics is full of uncertainty, not unlike the practice of parenthood
The Theresa Brown furor has got me thinking. To be honest, I don’t think the doctor’s apparent offense was really that bad. I remember giving and taking worse.
When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition. Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job. But the …
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A tough disposition is required to endure physician training
by Andrew Schutzbank, MD
“He wants to go to Atlantic City for his research time?” must have been the question bouncing around my residency’s Area of Concentration (AOC) Committee.
Not that there is anything wrong with Atlantic City per se, but historically, our residency program generously grants three to six weeks of AOC time to allow residents to explore interests and …
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Observations of a primary care innovator in Atlantic City
I have had the pleasure as a medical student to complete my clinical clerkships in the Baltimore area community hospitals, the Johns Hopkins Hospital, and the National Institutes of Health.
I will forever cherish these experiences and lessons as I progress through my career. With an educated and wealthy suburban population and a large disadvantaged urban population; Baltimore is symbolic of the challenges and opportunities the healthcare field faces.
There are different …
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Primary care training and international medical graduates
Actually I’ll take a Ford Shelby GT500 Convertible, thank you very much …
Today’s stream of socially conscious thinking comes to you after having feasted on a tasty lunch paid for by a drug company (and no, it wasn’t Pfizer).
It has spurred me to contemplate the ever increasing scrutiny paid to the relationship between the pharmaceutical industry …
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Lunch money Pharma spends on physicians
The patient entered her private solo physician’s office and handed her medical ID card to the doctor. He put the card in his desktop reader and reviewed her medical history. All of her visits, vaccinations, medications, tests, x-rays etc from all providers were inscribed on the data chip in the card. The card also included insurance and billing information. At the end of the visit, he updated her information on …
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Implementation of a rational system of medical care
When I was a little girl, attending the circus was the highlight event of the year. I remember looking forward to it each year – perhaps because it was something fun, and each year something new. Never the same show twice. Very busy behind the scenes, yet at the same time, quite organized and appearing smooth on the surface.
In the same way, the clinic can be a truly hectic scene. …
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Be like a circus ring master when seeing a patient in the clinic
Primary care is a unique field of medicine.
Primary care physicians (PCPs) are the gatekeepers to specialized care, provide preventative care, and most importantly, they have the ability to manage patients with multiple chronic conditions. Thus, primary care physicians are in prime position to become the point men in the Read more…
The future of primary care in an ACO model
