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Category: Medical Practice

PHYSICIANS: Dr. Mom sounds off

Angela Heider is no longer practicing as an OBGYN, and has written a book about why not, called The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future. What went wrong? Well she starts to explain in this piece:

Wanted.  Part-time.  Private practice seeks obstetrician and gynecologist.  Forty hours a week, some nights and weekends.  Pretax income $70k/yr and falling.  Life-altering medical malpractice claims average only 1/3 years.  Electronic medical record – partially functioning.  Administrative skills required.  Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above plans.  Keep up with this ever-changing medical field and all technical skills on your time.  $80k exit fee due at termination of employment.  Expect childcare expense approaching $35k/yr.     Fortunately, I vacated the above position before the required $80k in malpractice tail coverage took effect.  Unfortunately for all of us, many female obstetricians are forced to make the same choices.  In my practice alone, five of nine female partners elected to retire within the past two years.  I left the practice after only three years when my inability to balance work and family life became obvious.  I was clearing less than $20k a year – and money wasn’t even the biggest problem.  Clearly, my case is only one example; my concern is that it is not the only example, but a nationwide trend for women in private obstetrical practices.

Much has been said about physicians and the part their greed plays in the current health care crisis.  Admittedly, many examples can be found of physicians who have milked the system, over-billed, over-treated, and committed outright insurance fraud in order to make more money.  On the other hand, some physicians have been praised for their utter selflessness, physicians who devote all of their time and resources to charitable care.

Most, myself included, do not fit the description of either extreme.  Like many Americans, we want to excel professionally, enjoy our work, have others appreciate the contributions we make, and raise our families comfortably.  As a physician, I would have been happy with my salary minus the bureaucratic nightmare the practice of medicine has become, the constant threat of catastrophic legal action, the ingratitude, and the long hours away from my young children.  Some physicians long for the honor that once accompanied the profession.  Others miss the joy associated with personal doctor-patient relationships.  Still others enjoy their work, but also want to enjoy their families.  Money is not always the bottom line.

My current job – wife, mother of three small children, new author of the book, The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future, and advocate for health care reform – doesn’t generate any income, but the benefits are better.  I hope to be a part of needed change in our health care system simply by telling my story.  The compensation is not important; the fact that I can enjoy and am proud of what I am doing is.  We can raise awareness by examining the effects the system has on individual doctors, patients, and communities.

We all depend on our physicians to provide quality medical care, to take our lives into their hands.  If for no other reason, should we strive towards health care reform so we can restore their job satisfaction?  Do we not want them to be happy when they are guarding our lives?  Do we not want the best and the brightest to continue to sign up for careers in medicine?  And how much should they earn anyway?

In my opinion, reform will be required in order to retain a qualified, diverse pool of primary care obstetricians and gynecologists for women across the country.  Such reform must include medical malpractice reform, as current rates make the cost of less than fulltime practice prohibitive.  Changes in the training of obstetricians and gynecologists could be made to allow for women to focus on either obstetrics or gynecology, thus improving their odds of being able to keep abreast of changes in practice patterns.  Finally, the enactment of a national health care plan with health care coverage for all would reduce the administrative costs and barriers to practice and improve physician job satisfaction.      

PHYSICIANS/PHARMA/TECH: A take on the news, sort of

Things we already knew:

Doctors are poor at judging their own abilities. It’s a bit like everyone says they’re a good driver, but that 75% of drivers are terrible.

Merck earnestly believes that it was as pure as the driven snow over Vioxx and never knew that it was dangerous until it took it off the market(who knew about Dodgeball, eh — let alone what Kaiser knew several months earlier).

Little girls don’t really cry tears of stone

Things that I don’t think we did know

Online PHR use is up to 7% by July. Which is about 6% higher than they said it was 2 years ago.

According to the survey, commissioned by UnitedHealth Group and conducted by Harris Interactive ® , only 7 percent of U.S. adults use online personal health records and 35 percent of people surveyed were not even aware this resource technology exists.

PHYSICIANS: Ed Goldman podcast transcript

This is the transcript from the interview/podcast I did with Ed Goldman from MDVIP a week or so back. (The transcript was done very well and very affordably by castingwords. I just gave it a light readability edit)
Matthew Holt: So this is Matthew Holt from the healthcare blog and I’m doing yet another podcast and this one is from Ed Goldman president and CEO of MDVIP. MDVIP is a concierge physician franchise company which is helping physicians setup in the concierge market. Ed is it correct to say you’re a retired physician or are you still practicing?

Ed Goldman: No I’m a full time administrator these days.

Matthew: Ed has crossed over to the dark side but is doing something that is very interesting. Those of you who have read the healthcare blog know I’m not a big fan of multi different tiers of medicine—I’m all for universal health insurance and all the rest of it. You may wonder why I’m featuring someone from the “other end”. The reason is I had a conversation with Ed a while back in doing some private consulting work. There were some really interesting outcomes and approaches that MDVIP is using. So Ed a) thank you very much for agreeing to coming on the podcast and b) why don’t you give me a touch about the background of MDVIP how you work with physicians where you are as an organization and a little bit about how you got into this just a little bit of introduction I don’t know much about the company. 

 

Continue reading…

PHYSICIANS: Patient comments on overuse

The NY Times asked. Have you ever suspected that a physician had financial incentives for recommending a medical treatment to you? One day later they have 236 comments from readers. almost all uniformly going after doctors and dentists for overtreatment.  If you think some TCHB regulars are susicious of doctors…well they’ve got nothing on this bunch!

Meanwhile I have a gem of a story about psychotherapists overcharging desperate parents that I’ve been dragged into which I’ll share with you later.

PHYSICIANS/POLICY: Concierge Medicine-Interview with Ed Goldman MDVIP

Does primary care have a future? And is that future a version of concierge medicine? It’s very early days, but yesterday I had a great conversation with Ed Goldman, CEO of MDVIP, a franchise concierge medicine company. He has some very interesting things to say about how concierge care may not just be for the worried wealthy.

The conversation is in this podcast
.
There’ll be a transcript available in a couple of days.

PHYSICIANS: The sky is falling

Capitol2Mark McClellan says that Medicare payments to physicians are going down 5%. This of course is leading to political pressure, with the President of the AMA writing op-eds showing that the sky is indeed falling on the heads of seniors. And don’t let any of those pesky researchers at HSC tell you that cuts in Medicare reimbursement actually don’t lead to doctors dropping out of Medicare.

Oh well, perhaps the doctors will make their money back by investing in more specialty hospitals–after all, that moratorium is over. Let the self-referrals begin.

CODA: The AMA Pres uses this sentence "In 2006, Medicare is reimbursing physicians about the same as it was in 2001 — that’s in real terms, not adjusted for inflation." Someone needs to take him to a very basic economics class. "Real" means that it is adjusted for inflation. He means "nominal". And of course someone else needs to explain the P x V = I phenomenon.

 

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