Category: Physicians

QUALITY/PHYSICIANS: OBGYNs are scientists, scientists I tell you

Interesting long article in the New Yorker by Atul Gawande about How childbirth went industrial. Briefly it’s about how we stopped using all kinds of techniques for getting kids out that required a lot of skill because we started measuring the results on a universal scale. And the result is a lot, lot more C-Sections. In the UK they don’t use so many C-Sections, so I asked a recently retired British OBGYN I know rather well for his opinion. Here’s what my dad has to say about the article:
It shows yet again that the worst way to deliver a baby is by C/S following a long failed labour. If you could guarantee a normal labour then that would probably be best for mother and baby, at least at the time. This doesn’t allow for the increase in prolapse and Sphincter Weakness Incontinence (Stress incontinence)in later life. It also shows that female doctors are the poorest judge of how they should deliver!

The Great Balance Billing Scandal By Eric Novack

Novack_sm_2In California, the possibility exists that the unelected
department of insurance, under pressure from the insurance industry and
patient advocacy groups, may fundamentally alter the way medicine is
practiced. In an effort to get a work around the
disgraceful- yet very culturally sensitive- single payer bill recently
vetoed by Governor Schwarzenegger, there is a move afoot to ban the
practice of balance billing.
What is balance billing you say? Sounds very wonkish and unimportant. Sounds like those unethical, over-utilizing, quality-unconcerned doctors are just trying another technique to scam the ‘system’. (But I thought the familiar refrain is that we do not have a health system? …) I will explain with an example.

Continue reading…

PHYSICIANS/PHARMA: The oncologists’ chemo junket flies above the radar

You may have heard just a few things on THCB from Greg Pawelski, Matt Quinn, me and others about the oncologist prescribing franchise, and how it might just change physicians’ behavior a tad. Well Greg informs me that last Thursday the whole issue made it onto the NBC Nightly News.

Greg also notes that the community oncologists (well, he calls them something rather ruder, but he’s insulting the world’s oldest profession so I won’t use his language) have their own response. They are “outraged!”

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.


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