Specialty Care

Specialists writing on KevinMD about their practices: what private equity does when it buys a specialty group, from dermatology roll-ups to staffing companies, and whether nurse practitioners and physician assistants belong in every specialty and on what terms. Two maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Keith Ablow on Chaz Bono and the outrage that follows

Ford Vox, MD

Physician

October 4, 2011

Dr. Keith Ablow is an assistant clinical professor at Tufts University School of Medicine. So am I. Ablow has a problem with transgendered people. I do not. I first learned about Ablow’s well publicized stance Wednesday via an email to the Tufts community, signed by the university’s president, the dean of the medical school and the chair of the psychiatry department.

The university reaffirmed its commitment to the complete inclusion …

Universal board certification can solve the Doctor Nurse controversy

Kevin Pho, MD

KevinMD

October 3, 2011

I’m going take on the Doctor Nurse controversy.

This isn’t a new issue, as the doctorate in nursing degree has been around for awhile. But a recent piece in the New York Times gave it new life.

The topic is a ripe invitation to “doctor bash,” with the predictable arguments about physicians protecting their turf, elitism, and the like.

Yawn.

To sample the …

Use a beginner’s mind in your medical practice

Philippa Kennealy, MD, MPH

Physician

October 2, 2011

As a mom and first-time parent, I marveled at my tiny daughter’s curiosity about and interest in the world. Her quest for knowledge was insatiable and her ability to sit absorbed in what she was doing and the moment enviable. Now that she’s 8 (“8 and a quarter, mom!”, said with a sigh and an attitude), she seems to have morphed into a smart, verging-on-sassy pre-tween who’s beginning to think …

The decision to pursue a rare illness

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

October 1, 2011

Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.

He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …

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The decision to pursue a rare illness

Physicians lack harmony in this age of health reform

Gary Oftedahl, MD

Physician

September 30, 2011

At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …

Bias in CME due to the presence of commercial support is overrated

Derek Warnick

Medical Education

September 30, 2011

So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.

I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look …

How to isolate problems in your scheduling system

Adam Alpers, DO

Physician

September 29, 2011

Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating …

The only anesthesiologist in this vast hospital

Felicity Billings, MD

Physician

September 29, 2011

His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.

I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.

Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves …

If you need to say you’re all about the patient, you aren’t

Sanford C. Sharp, MD

Physician

September 27, 2011

Sir William of Ockham has achieved a degree of mortality via the wide promulgation of an aphorism, now generally known at Occam’s Razor (I’ll use the more economical spelling). There are many iterations of the razor, but my favorite is this: “simpler explanations are, other things being equal, generally better than more complex ones.” That trips off the tongue more easily than, say, “plurality should not be posited without necessity.”

In …

See more patients with same day appointments

Neil Baum, MD

Physician

September 26, 2011

No one knows for certain what the future holds for American medicine. With cutbacks again on the horizon, we do know that reimbursements are going to decrease in the near future resulting in a decrease in income. An effective way to maintain our incomes is to increase the volume of patients seen but also to increase the income per patient that is seen in our offices. One of the best …

Why do doctors cling to continuous fetal heart monitoring?

Alexander Friedman, MD

Physician

September 25, 2011

My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.

So we gave medication to start labor, and the nurses placed …

Why a physician recruiter needs to consider the spouse of a doctor

Bo Claypool

Physician

September 25, 2011

Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit:

“You know, I just wanted to say that I really …

The day my mother became a saint

Neil Baum, MD

Physician

September 24, 2011

It was 1976 and I had just started my solo practice. I employed only a receptionist and a nurse. My nurse was absent because of an illness and I asked my middle-aged mother to come and serve as my chaperone for the afternoon.

The first patient was a young lady and I asked her to give a urine specimen and place it in the turnstile in the restroom. My mother, wearing …

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The day my mother became a saint

Elimination of industry support for CME is an urban myth

Thomas Sullivan

Medical Education

September 23, 2011

Urban myths come in all shapes and sizes. Recent medical scares include a rogue politician claiming that a vaccine is no good, based on someone they met in the audience who was not trained in medicine or science. How many physicians know patients who are scared of taking a medication or getting a needed procedure based on an Internet story or a friend of a friend?

Recently, there has been controversy …

Unintended consequences of standardizing physician practice

Steve Wilkins, MPH

Physician

September 22, 2011

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P), patient centered medical home (PCMH) requirements and so on.

Examples of …

Doctors are the true consumers of health care dollars

Ian Metzler

Physician

September 21, 2011

With computerized health systems, physicians can place orders as easily as they can shop online at Amazon.com. Just a few clicks and your physician can purchase a panel of blood tests, futuristic imaging and diagnostic procedures that will hopefully guide their path to solving your ailments.

Search. Click. Submit. Repeat.

Except, unlike online shopping, physicians don’t see the price tags and they never get the bill. Doctors are the true consumers …

Efficient billing in your medical practice

Rosemarie Nelson

Physician

September 21, 2011

Billing is way more than billing.

In a typical medical practice, more than 300 insurance cards cross the front desk every month. The variety of plans and coverage along with the complexities of coding and the difference among payers requires expertise and technology to effectively manage accounts receivable, regardless of practice size.

There are two basics required to manage your billing and accounts receivable — a practice management system and a clearinghouse.

The …

Elimination of industry support for CME

Daniel J. Carlat, MD

Physician

September 20, 2011

Something huge happened at the American Medical Association House of Delegates meeting. Although the meaning of what happened will be spun throughout the blogosphere, twittersphere, and schmuckosphere, the bottom line is that the AMA just voted most commercial funding of CME out of existence.

Specifically, the delegates voted to approve a report of the AMA ethics committee that calls for a near elimination of industry support for CME. The report is …

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Elimination of industry support for CME

Why doctors should be careful with Groupon and other social coupons

Adam Banks

Physician

September 19, 2011

I just received a Groupon for dental services. I have seen Groupon’s in the past for medical services and I can’t figure out how selling medical services via a social coupon (the generic name for Groupon like sites) is legal. This is dangerous, uncharted territory. Consult your attorney before running a Groupon.

As I run practices in New York, I will focus on the their statutes. New York has some of …

ADHD and the lack of quality sleep

Steven Y. Park, MD

Conditions and Diseases

September 19, 2011

As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults …

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ADHD and the lack of quality sleep