Like prep sports or prime-time television, medical meetings have seasons.
In the spring and fall, my calendar fills with invitations to speak. I try to get to the venue a few hours before I’m scheduled to speak, so I can “take the pulse” of fellow doctors, asking them about their practices, patients and the future of medicine.
Figuratively speaking, the industry’s pulse is racing with fear. I’ve observed that in just the past …
An excerpt from Prescription for Bankruptcy: A doctor’s perspective on America’s failing health care system and how we can fix it.
Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue …
How health insurance contributes to our failing system
Will physicians go extinct? Artificial intelligence, legislation, profit motives in the health care industry, and clever lobbying by non-physician providers may all contribute to our demise. However, I believe the existential threat to our profession stems from the ranks of physicians themselves.
1. Unwillingness to embrace activism
Pathologist and writer Rudolph Virchow once said: “The physician is the natural attorney of the poor.” Like most physicians, my goal is to provide evidence-based …
4 reasons why physicians will become extinct
From 2009 to 2012, I directed the graduate course “Fundamentals of Clinical Preventive Medicine” at Johns Hopkins University’s Bloomberg School of Public Health. It was a required course for Hopkins preventive medicine residents, and also usually attracted other master’s level public health students and undergraduates with a strong interest in medicine. The class size was 15 to 25 students. In that setting, with a small group who generally believed that …
Why this physician teaches health policy in medical school
I’ve written previously that financial independence is plan B. Plan A, of course, is life. Your work and time are precious, and life is too short to be wading through a morass of unhappiness only to get to some endpoint or goal. While I definitely believe in front-loading the sacrifice, the cost should not have to be misery. Physicians, in particular, tend to look at their …
Every doctor should have a plan B. Here’s why.
Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work?
Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for.
A patient with an ugly skin lesion can have it removed if it might …
Balancing stewardship and entitlement in health care
The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill. They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.” The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of …
Medicare’s historic proposal to change how it pays physicians
Author’s note: My personal reflection about the Sutherland Springs mass shooting was written before the horrific events at Stoneman Douglas High School and Santa Fe High School. The chorus of voices has only increased in amplitude regarding the calls to responsible action on firearm safety. While a larger debate continues in Washington, DC, I ask myself again: What can I do now as a medical provider to make a difference? …
Make a commitment to ask patients about firearms
Medicaid — the program that provides funding for adults, seniors (along with Medicare), children and people who are blind or disabled who can’t pay for their own health care — is expensive. It is painfully expensive. The program, along with CHIP (the Children’s Health Insurance Program), marketplace subsidies and Medicare is responsible for 25 percent of the federal budget. Total Medicaid costs in 2016 were …
To give good value, Medicaid needs help
On May 15, President Trump attempted to kill not just two, but three birds with one tweet, simultaneously denouncing the Media and the Mueller investigation, and crowing about his approval ratings. “Can you believe that with all of the made up, unsourced stories I get from the Fake News Media, together with the $10,000,000 Russian Witch Hunt (there is no Collusion), I now have my best …
Political polarization is harming America’s health
A relative taught me to drive in a burgundy Lincoln Town Car in an empty Long Island parking lot in the 1980s. After emphasizing the need to practice driving in reverse, he also warned: “A car is a weapon. You can kill someone, or get killed, in an instant.” I am a safer driver (forwards and backwards) thanks to his warning.
This relative had purchased several handguns over the years. He …
Why guns should be tracked and studied
Fair and just societies protect children. The Trump administration’s unconscionable practice of separating children from their families at the border between Mexico and the United States is making me rethink what kind of society I live in.
The images and the stories are heartbreaking.
In an effort to deter families from migrating to the United …
Separating children at the border is a danger to their health
We’ve all seen the news and heard the stories about children being separated from their parents as they cross over the U.S. border. The pictures of human beings, including very young children, behind wire mesh (some argue that they are not really cages) is simply horrifying. Over the past decades, we have seen atrocities happening in many other countries around the world. And we sit and wonder why the citizens …
Bullying immigrant children in the name of politics
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The following are intended to inspire to medical students and residents to learn more about organized medicine. Whether it be at the national, state, county, or specialty level, there are numerous societies with opportunities for contribution.
1. To pull back the curtain. Many physicians are innately curious and like to “see how the sausage is made,” so to speak. There is a great deal of policy behind the scenes of our …
5 reasons to get involved in organized medicine
You are a child of Thanos.
“Hear me and rejoice!”
“You have had the privilege of being saved by the American College of Cardiology and the American Heart Association. (Yeah, I know we said the same thing when we prescribed low-fat diets to decrease the risk of heart disease, but you gotta give us a pass on that one.”)
“Based on our research, we have found 100,000,000 of you are ill.”
“But we can …
How our health system is like the Marvel supervillain Thanos
When I hear pundits going on about the Medicaid work requirements, I think of my father.
He has worked in the United States for twenty-four years, taking on the role of a handyman, migrant farmer, truck driver, construction roofer, dialysis patient transporter, and elder transporter. His limited English and third-grade education land him in low-paying jobs with limited hours and an oversupply of workers — resulting in frequent periods of unemployment.
For …
A bipartisan solution for Medicaid work requirements
I am a hospitalist at a safety-net hospital. Through my work, I have come to understand how our daily decisions — filtered through our own biases — influence how health care is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K. He was in his 40s, well-kempt, soft-spoken and had the good habit of looking people …
More equitable health care starts with you
Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs — either with no insurance or insurance that is out-of-network — they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.
After the post, I was inundated with angry tweets and emails, mainly from emergency medicine …
Don’t blame doctors for outrageous emergency department prices
Less than one year ago, on an early fall evening in Las Vegas, 59 people were killed at the outdoor Harvest music festival. A single shooter injured hundreds more, using firearms purchased through lawful channels.
There have been many mass shootings in our country, before and since, and in 2015, deaths from gun violence eclipsed for the first time deaths from motor vehicle accidents.
Not long after Las Vegas, discussion emerged in …
Limiting access to guns may not be the best solution to the present crisis
I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.
It wasn’t that …
Physicians have become devalued in modern health care
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