Primary Care

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.

Primary care shortage solutions after health care reform

Toni Brayer, MD

Physician

April 27, 2010

The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor.

Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come …

Alternative medicine isn’t taught to doctors in medical school

Crystal Phend

Medications

April 26, 2010

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

ADHD needs more than drugs to appropriately treat

Claudia M. Gold, MD

Conditions and Diseases

April 25, 2010

I consider my most successful cases to be the ones that do not seem me any more. Not that they are “better”, but they and their families have come to realize the full complexity of the problems they are struggling with, and are getting appropriate help.

I inherited my “ADHD practice” from another pediatrician. He was wonderful man, a larger than life, toss babies in the air pediatrician with a hearty …

Op-ed: Health insurance doesn’t mean doctors will be available

Kevin

Health Policy

April 24, 2010

The following op-ed was published on March 30th, 2010 in AOL News.

Health reform has passed, and the United States is poised to join the rest of the industrialized world in providing most of its citizens with affordable health coverage.

But having health insurance doesn’t necessarily mean it will be easy to find a doctor. Even before reform, reports projected a shortfall of 40,000 primary care physicians over the …

Palliative care physicians confronting their own mortality

Lyle Fettig, MD

Conditions and Diseases

April 23, 2010

Dr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41.

Her story provides palliative care clinicians an opportunity to reflect on how our own personal mortality interacts with our professional lives.

I did not personally know Dr. Pardi. I write this post knowing that many readers did indeed know her, some …

Medicaid physician payment rates hurts primary care doctors

David B. Nash, MD, MBA

Health Policy

April 23, 2010

Across the country, state Medicaid health insurance programs serving low-income children and families, people with disabilities, and older adults are struggling in an environment of chronic underfunding.

Consider that, nationwide, at least one child in four relies on Medicaid for health coverage. Medicaid funds healthcare services for two out of every five births and fills in gaps in Medicare coverage for the elderly and disabled.

But inadequate payments and outmoded methods of …

Patient adherence to drugs is low and what doctors can do

Shantanu Nundy, MD

Medications

April 22, 2010

Frequently in preventive health we ask patients to take medications that will reduce the risk of a certain bad medical outcome years down the road: cholesterol-lowering agents that lower the risk of a heart attack, blood pressure-lowering agents that reduce the risk of kidney disease, glucose-lowering medications that reduce the risk of diabetes-related complications.

Sometimes these medications make patients feel better — for example, insulin in patients with symptomatic diabetes or …

Dementia affects the entire family

Emily P. Walker

Conditions and Diseases

April 22, 2010

by Emily P. Walker

My grandfather recently died of pancreatic cancer.

My grandpa was a WWII veteran, a nature enthusiast, an animal-lover, a chiropractor until the 1980s, and a firm believer in natural medicine. He helped my grandmother give birth to five children in her bed, and neither of them had ever taken any drugs except when both were hospitalized one winter with pneumonia.

As someone with a major respect for medical doctors …

Read more…

Dementia affects the entire family

High blood pressure treatment that patients need to know

Erin Marcus, MD

Conditions and Diseases

April 21, 2010

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.

“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.

Two years later, …

Top doctors may not always be the best physicians

Dr. Charles

Patient

April 21, 2010

I’m sure you’ve read through top doctor rankings and online physician ratings. It is only human to seek perceived leaders. But as sometimes seen in politics, those who have reached the pinnacles are often motivated by ambition, charisma, and gamesmanship instead of altruism, sincerity, and merit.

Beware the top doctors issues found in magazines and newspapers.

Some of these doctors are excellent, but many are simply “notable.” They may be well-connected, in …

Primary care needs better physical exam skills

Kevin

Physician

April 19, 2010

by Joseph Biundo, MD

Not long ago, primary care physician Rob Lamberts did a blog post about the economics of seeing Medicare and Medicaid patients, stating that doing so was bad business. While I agree with most of his points, I have a quarrel with his statement that primary care physicians keep down the cost of care by keeping people healthy, away from specialists, and out of the hospital.

That may be …

Health reform winners and losers, and how it affects doctors

Richard Reece, MD

Health Policy

April 19, 2010

I congratulate President Obama and the Democrats on their historic health reform achievement.

Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?

Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.

Now may be a good …

Patient appointment scheduling needs flexibility

Rosemarie Nelson

Physician

April 18, 2010

The daily appointment schedule is often a sore spot in everyone’s day:

* Patients aren’t completely satisfied because they can’t get an appointment when they want one.
* Physicians feel they’ve lost control of their day when the flow is not running smoothly and they fall behind and patients complain.
* Nurses and medical assistants are frustrated at the hodgepodge of types of appointments that get scheduled seemingly without any consideration for timing …

Health costs are high, and here’s why

Toni Brayer, MD

Physician

April 16, 2010

Health costs are high because the body is complicated and doctors and patients hate ambiguity. The cost is high because a missed diagnosis can lead to death and a large lawsuit. The cost is high because we have many specialists that view the body in tiny pieces and want to feel 100% correct about their piece.

Let me give you a real life example.

My patient, Rick, is a brilliant attorney. He …

Read more…

Health costs are high, and here’s why

Breastfeeding rates cost the country billions

Crystal Phend

Physician

April 16, 2010

by Crystal Phend

Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, …

ABIM: Maintenance of Certification – For the public

Chiduzie Madubata, MD

Medical Education

April 15, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The debate about recertification recently in the New England Journal of Medicine and highlighted earlier this week on KevinMD.com and in an Associated Press article brings to light some of the real challenges facing the future of the Maintenance of Certification (MOC) program.

I have been through …

Physicians are leaving medicine for alternative careers

Joseph Kim, MD, MPH

Physician

April 15, 2010

When physicians choose to leave clinical medicine to pursue alternative careers, what motivates them to make such changes? Is it money? More time with family? Scheduling flexibility? Avoiding litigation? To pursue new challenges? Maybe you’re getting bored with medicine.

Depending on that key motivating factor, physicians end up choosing all types of career paths. For instance, let’s take a look at some of these motivators:

Money. Let’s face it. Some physicians love …

Primary care doctors are saying farewell

Aldebra Schroll, MD

Physician

April 14, 2010

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.

As the economy faltered, I found my private office practice had simply become unsustainable. With the popularity …

Rural medicine won’t be helped by health reform

Kevin

Physician

April 14, 2010

by Rick Bendinger, MD

I am a rural health provider in Abbeville, Alabama and have been here almost 30 years. I originally went to school on a public health scholarship and took the private practice option. This was a program that existed in the 1980s that paid for tuition and a stipend with the obligation to go either to a prison, rural area, or Indian reservation.

Sadly the program no longer exists. …

Patients who visit the emergency department have insurance

MedPage Today

Health Policy

April 14, 2010

by Joyce Frieden

Most patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician, a review of the literature found.

“The uninsured represent only 15% of frequent users and are no more likely to be frequent users than they are to be occasional ED users (<4 visits/year),” Eduardo LaCalle, MD, MPH and Elaine Rabin, MD, of the Mount Sinai School of …

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