The Paradocs Podcast with Eric Larson: Recent Episodes
We Are Libertarians
The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, other times lighthearted, and accidentally informative. A show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face. Part of the We Are Libertarians Podcast Network.
History is a funny thing. Often, we think we know what happened either as we experience it personally or have trusted sources that give us an account. However, it depends on who is relaying the information, and the prior biases and perspectives. The goal of a good historian is to gather information from multiple sources and figure out what happened and why it played out the way it did. In today's episode we focus on why the US ended up with a third party payer system left to the insurance companies to dictate payment and generally how physicians can practice medicine. It Begins with InsuranceDr. Christy Chapin has focused her research on the history of health care which includes insurance and finance. She believes that you must understand how we got to where we are today with insurance (private and public) dictating how medicine is practiced through payment mechanisms. It's easy to look at Medicare and Medicaid and assume that there was always a large influence on health care's practice through insurance reimbursement - but that's not the case. In fact, most doctors assume it was the decade or two before the creation of Medicare in 1965 that insurance really came to be a big player in health care. Actually it Begins with the AMAThe standard story is that wage controls coming out of WW II left employers with limited ways of attracting top talent since they couldn't adjust employee incomes easily so they resorted to offering benefits like health insurance to entice the ones they wanted. Although that story is a handy explanation, it isn't really borne out by the evidence either in uptake in the frequency of health insurance being offered to employees or its use more broadly in the marketplace. In fact, the creation of health insurance product came from the AMA as they looked to thread the needle and avoid corporate interests taking over medicine (worked out great, huh?) and a federal nationalization. Unfortunately, the AMA, by squashing all other physician led ways of organizing the delivery of health care, removed all other alternatives to their preferred method - insurance. Initially, the insurance companies agreed to not limit any claims, pay in full whatever charged by the physician, and pay wherever the charges originated (ie, the physician's own lab, etc.). This led to cost over runs and then the endless government fixes including governmental insurance (Medicare/Medicaid) and the resulting changing of the landscape of medicine. Learn more about your ad choices. Visit megaphone.fm/adchoices
It's been a while since I've done an episode and it's mainly because I've had a COVID rant percolating for some time. So I just had to let it out now that the president (accidentally?) mentioned that the pandemic of COVID-19 is over. In this episode, I cover mandates, vaccines, public health policy and much more. A frank discussion with you about where we are and where we need to go as a country with this irritating virus and resulting policies. This is an expansion on my speech from episode 156 and a broader discussion with Dr. David Graham in episode 143. Learn more about your ad choices. Visit megaphone.fm/adchoices
In survey after survey, the number one satisfier for physicians - by a long way - is their relationship with patients. Anything you can do to improve or deepen that relationship makes the work better and decreases the incidence of burnout. Obviously, barriers put in the way that detract from creating a deeper relationship with patients makes the job of medicine less desirable. One way a lot of doctors have gone is to practice using a direct care model which removes many of the obstacles in place within modern medicine from forming that all important bond with their patients. Getting Help to Start a DPC PracticeUnfortunately, doctors don't usually receive training in how to run a business and set up a practice like this. Even if they have heard about direct primary care (DPC) there are a lot of things to overcome to start up. First, they need to understand how the model works and what space, supplies, and equipment they need to begin. Second, they need to find ways of bringing patients in the door which requires marketing and sales. Finally, there is a lot they need to learn as far as running the practice since most of their training probably came in an academic setting or at the very least, an insurance based model for providing care. That's where today's guest, Chris Habig of Freedom Healthworks, comes in. He and his brother started the business initially to help their parents (who are primary care physicians) rekindle their love of medicine. What they've built is a company that helps doctors at every stage of the process setup, start, and run a DPC practice. Doctors can use as little or as much of their services as they feel they need but essentially Chris and his team take away a lot of the unknowns and help navigating medicine in this space. Learn more about your ad choices. Visit megaphone.fm/adchoices
Occasionally, you come across an interview or subject that blows you away with incredible claims that are both out in the open - and yet invisible. Today's guest is an author and expert witness for some of the biggest pharmaceutical cases of this century, Dr. John Abramson. He reveals the rot that centers not only in the pharmaceutical industry but also the institutions that are constructed to serve as its guardrails - the medical journals, federal agencies, and guideline committees. In some What Would Physicians Say if They Knew Medical Journals Had No Access to Data for Peer Review?The most stunning aspect of the whole conversation centered around how the most prestigious medical journals conducted peer review without all of the clinical data. This means if anything was misrepresented or omitted there is no check on the truth of the claims from the study. Essentially, the journal and its reviewers are relying on the good faith submission of all important details from the study designers who are usually paid employees or have research paid for by the pharmaceutical manufacturers. The most famous landmark case was with Pfizer withholding adverse event data (or misclassifying them to avoid statistical significance) on cardiovascular events (heart attacks and strokes) with their medication, Vioxx. Only when Pfizer was sued in a huge class action lawsuit did the actual clinical data get revealed showing that they had seen a signal for adverse events but intentionally did not disclose it (or the raw data) to the medical journal reviewers. Worse yet, once the error was presented, the medical journals spent very little time discussing the error. According to Dr. Abramson, this is in large part because up to 40% or more of medical journal revenue comes from study reprints. This financial incentive to find positive results and publish makes for a twisted system that incentivizes the promotion of new medications and devices when they may not be safe or very useful. Learn more about your ad choices. Visit megaphone.fm/adchoices
What is one common difference between the hiring process of most professionals with advanced degrees and those in sports and talent industries? The use of talent agents. People dedicated to finding their clients jobs, negotiating the terms, and essentially doing all of the analytical work to determine market value for the "talent." What if the Talent were Physicians?Raised by a physician mother, my guest today is Ethan Nkana, who didn't enter the world of medicine as a doctor but instead got his JD and MBA to enter the world of hospital administration. Ethan cut his teeth negotiating physician contracts, running operations, and more for hospitals. But he decided to get out and start a business working on the other side of the table with physicians in the negotiation process. His model is simple in that he uses the same as talent agents for musicians, artists, and athletes except his clients are doctors. Ethan brings his knowledge at the Rocky Mountain Physician Agency of what hospitals want, where their pain points are, and what they worry about to help doctors maximize their compensation or work situation. Fortunately for Ethan, there are plenty of physicians now employed and looking for more. Learn more about your ad choices. Visit megaphone.fm/adchoices
I confess that I hold a lot of biases when it comes to various surgical specialties. One such bias is that orthopedic surgeons - especially trauma - are not deep thinkers. My guest today completely turns that prejudice on its head as we discuss the role of nutrition and vitality in disease and recovery rates. Setting the Hammer DownObviously, an orthopedic trauma surgery focuses their care on treating patients with fractures sustained in injuries. However, Dr. Miller now looks beyond the obvious mechanical or lab-based problems that patients present with. He uses some principles of functional medicine to seek the answers to what might afflict his patients. For instance, perhaps the pain in their joint isn't from arthritis but from a dietary problem. Learn more about your ad choices. Visit megaphone.fm/adchoices
In 1973, the US Supreme Court ruled on the Roe v. Wade case and concluded that Americans have a constitutional right to an abortion up to viability of the fetus. That has been the law of the land... until now (or at least very soon). Roe v. Wade OverturnedA few weeks ago, a draft majority decision by the Court was leaked which showed that there was a majority of justices on the Supreme Court who were going to rule in favor of the state of Mississippi in their challenge to the Roe decision from nearly 50 years ago. Effectively, overturning the Roe decision would revert back the power to regulate abortions from the federal to the state level. Many states have been anticipating or preparing for the eventuality of this decision and have created 'trigger laws' which go into effect if and when Roe is reversed. Most of those states make abortion more restricted or outright illegal. However, some states have liberalized abortion making it legal right up until birth. Challenges for the StatesElizabeth Nolan Brown, Senior Editor at Reason magazine, lays out a few of the problems with this ruling coming back to the states. Primarily, although the states can regulate what happens in their borders, it is very difficult for them to restrict what people do in other states. For instance, can states really stop women from crossing the state line and getting an abortion? Can they prevent mail order morning after pills? Learn more about your ad choices. Visit megaphone.fm/adchoices
What would you do if you were fired by your employer over something you had said on social media? Would you be able to survive or would you have to scramble to find work? That scenario is exactly what was faced by today's guest, general surgeon Dr. Buck Parker. And his solution was a surprising one. Seeds of an EntrepreneurIt doesn't appear that Dr. Parker never set out to find ways to be financially secure outside of medicine. His path through medical school and his general surgery residency seemed fairly traditional. However, there were signs that he had an entrepreneurial streak about him as he began a very small online business selling gym equipment. Following that, he landed a role on a reality TV series which led to another starring role on a second show. Aside from practicing clinically as an acute care and trauma surgeon, Dr. Parker leveraged his appearances on TV and built up a following on social media through Instagram and YouTube. And that's where the trouble began. Losing Your JobDr. Parker's termination within his hospital system in 2020 happened a lot like the old joke in bankruptcy. "How do you go bankrupt? Gradually and then suddenly." Parker's CMO had been very upset with his YouTube channel and social media presence for some time and when Parker published a video stating that the highest risks for COVID are those who are obese, elderly, and with medical co-morbidities, it was the final straw. Perhaps it was because the video went viral and the light it shone on an institution that didn't want any attention paid to it. No matter the reason, it was the end of the line for Dr. Parker's Salt Lake City surgical career. Overcoming Job Loss as a MinerPerhaps by happenstance, Dr. Parker had researched and eventually took the plunge to mine bitcoin. Fortunately for him, the price of bitcoin exploded from a few thousand a coin to tens of thousands from the time he started to the time he had been let go. It more than supplemented his income lost as a surgeon and gave him the financial freedom to be able to walk away and not worry about scrambling to get another job. It's now been almost 18 months since being let go and the CMO has been replaced and the hospital has been busy. So busy they actually asked him to return but he declined. For right now, Dr. Parker doesn't see himself going back to medicine but time will tell. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Jay Bhattacharya returns today to further our discussion on the dysfunction within the scientific community around COVID-19. Specifically, we discuss what exactly happened to Dr. Bhattacharya after he co-authored the Great Barrington Declaration where he and two other prominent academicians laid out a case for a more focused protection plan for the elderly than the widely adopted general lockdowns and mandates at the time. Dr. Bhattacharya was not surprised to face opposition to their plan - but the way it formed and by whom did. A Government Bureaucratic Cabal?After the publishing of the GBD, the attack against Dr. Bhattacharya and his co-authors was blistering, numerous, and seemingly coordinated. Those on the outside, and even Dr. Bhattacharya himself, believed that the scorn from media, government, and academia was due to a general disagreement with their position - not a coordinated attack. It turns out that FOIA documents of emails from Drs. Fauci (head of NIAID) and Collins (head of NIH) prove that they worked in tandem to discredit the GBD through their contacts within the scientific, media, and government communities. Learn more about your ad choices. Visit megaphone.fm/adchoices
The US health care system is fraught with all sorts of problems. Many of these have to do with consolidation in the market and scores of rent-seekers (those using legislation and regulation to maintain their market share. Those issues can probably be best resolved with fundamental changes within the halls of government. However, some of these problems can be addressed with new technology which offers solutions not even dreamed possible a few years ago. And the driver of much of this innovation rests on block chain technology. Block Chains to the Rescue? The basics of block chains have been discussed on this show where we explained the basic concept of what it is and how it works (here and here). We also looked at some helpful business applications such as decentralized finance and how that could unlock capital and make for opportunities for small medical practices. However, the real allure of block chain is whether it can solve some of the bigger problems in health care and bring about real structural change to the problems that plague doctors and patients alike: information sharing, supply chains, and payment processing. Patient Information Sharing and Storage Big Data is big money and there is no more valuable data set than patient health information. Companies pay millions of dollars for this data to develop health processes and businesses to manipulate the data to change patient behavior, physician behavior, and new businesses. However, the biggest problem is that the patient has no ownership of their information meaning that they cannot decide if the data is used or be compensated if it is. The possibilities of the block chain allow for patients to control their information and dictate those to companies - not the other way around. Additionally, patients owning and securing their own data would allow for more accurate and safer transfer of their personal medical information when traveling between medical systems, EHRs, or even health providers within the same system. In essence, a patient could only transfer the information they want and deem important to a particular provider and no more. A quick example would be to just provide personal demographic information to an imaging center and not all their health history. Learn more about your ad choices. Visit megaphone.fm/adchoices
There's no shortage of an alphabet soup of government agencies but the same exists within the nebulous public-private sphere of medical education and credentialing. These non-profit organizations were created to ensure a baseline within medical education institutions across the entire country for medical students, foreign medical graduates and residencies. However old and established these institutions are, they are still staffed by people who make decisions and are charged with maintaining the organizations financial stability. But, since they don't have any real competition, they can make financial decisions that are not always the best for the long term viability of the organization which can lead to problems in the future. Sometimes those futures become the present and people paying for their services, ie, medical students, residents, and foreign medical graduates take the brunt of their poor fiduciary planning. The real financial risk to many of these organizations is similar to what threatens governments at the local, state, and federal level: pensions. The Sorry State of NBME's Pension ProgramCharles Kroll is a forensic accountant which means he is adept at parsing financial reports and determining where money is flowing and where the inherent financial risks are to organizations. With the help of analyst Elizabeth Tremblay, they have analyzed the financial data from the National Board of Medical Examiners (NBME) - which conducts the testing for medical students - and have found troubling signs. Foremost is that the NBME has a retirement fund that is worth almost $300 million which is twice the value of the organization. On top of this, the retirement fund is still underfunded which means it is at some risk for default with an organization that clearly could not meet those extra payments since it is dwarfed by the size of the retirement fund. Of course, the great risk is to medical students which would probably be on the hook to make up for the financial offset if the retirement fund becomes grossly underfunded. The only real source of revenue for the NBME is its examination fees. And for medical students, they are forced to pay whatever fee the NBME comes up with since there is no competition and alternative testing organization in the United States. The financial mismanagement of this and other organizations will fall hardest on those with no choice and the least ability to pay. Defined Benefits are the ProblemRetirement benefits are usually of two main types, defined benefits and define contributions. It effectively shifts the risk either on the employer or the employee. In the private sector, defined benefits (guaranteed payouts over the length of your retirement) haven't really existed for 35 to 40 years. Nowadays, private companies and most non-profit organizations offer 401Ks which are specified contributions but do not guarantee your future payouts - they are whatever they returns are. What is so unusual is that all of these medical education boards use defined benefits as their retirement structure which puts their organizations and, by definition, their clients at risk for covering the gap of underfunding their benefits. According to Kroll, unless the organizations kill their defined benefits plans they will be at increasing risk for insolvency or at a minimum, jacking up fees to students. Learn more about your ad choices. Visit megaphone.fm/adchoices
It's easy to become despondent about controlling spending or eliminating waste through reform on government expenditures. We've all seen the headlines about the $1 million hammer or toilet seat and governments losing track of money. Also, with all the people who have been elected on the platform of 'transforming' government or making it efficient, there has been almost nothing but the exact opposite happen. It's why the joke about death and taxes not only funny but very true. To make matters worse, imagine government getting involved in the purchase of a product that is incredibly expensive and wasteful - US health care. This is a recipe for budget overruns, poor health outcomes, and a bottomless pit of spending. The opportunities for wasteful spending is so great and the lobbyists to keep the gravy train of spending so powerful that tackling it at the state level seems hopeless. Yet that is exactly what Christin Deacon did. Reforming New Jersey's Health and Benefits Plan Maybe it's because Christin Deacon didn't know any better but she looked at the amount of money being spent on New Jersey's health and benefits and actually thought she could find some meaningful savings for taxpayers. To her credit, she asked the questions that no one had asked and pursued solutions that no one had seriously tried before. Through her persistence, Deacon helped save New Jersey citizens over $500 million per year for years. Those billions of dollars have been used to fill other gaps in the state budget and most importantly, haven't been thrown away on poor contracts or inflated pricing. Learn more about your ad choices. Visit megaphone.fm/adchoices
Expanding Choice for Physician Board Certification (NBPAS) with Dr. Paul Mathew A rite of passage for doctors is completing a residency in a specialty. Sometimes, they complete multiple specialty trainings but ultimately sit at the end of their years of training for board certification. At one time, once a physician got board certified, they were considered a specialist for life and no further testing or training was necessary. That all changed in the 1990s as the governing board for all the specialties, the American Board of Medical Specialties (ABMS) began to require that new trainees only receive time limited certification. This meant they would have to undergo new testing or requirements in order to maintain their board certification. Initially, this expiration was every ten years and usually just involved an exam. Physicians grumbled about retesting within their discipline which required time, money, and travel usually. Eventually, over the years, the testing and continuing education modules grew and expanded requiring more and more time and expense. Now, a physician who is triple board certified, like a hematologist-oncologist, would have to do testing every 2-3 years with almost continuous rounds of studying parts of medicine that he/she no longer practices. This can cost the doctor upwards of $40,000 every ten years! Why NBPAS is NeededAs the onerous and expensive requirements for ABMS recertification continued to pile up, doctors from prestigious medical institutions from around the country decided that it was time for another choice for board recertification. The concern was not in the initial training and certification process but simply in the verification of continued mastery in the doctor's field of practice. Therefore, they set out to create a board certification that recognized prior training but focused continued medical education that the physician felt best helped them in their day to day practice. This allowed the new all volunteer board to decrease the annual certification price to only 30% of the ABMS price while also drastically eliminating all of the mind-numbing busywork that doctors say contributes nothing to their practice but grows their burnout. Doctors were upset over the perceived exploitation and lack of response to their concerns over the recertification process so another choice through the NBPAS is a welcome addition. NBPAS is Now Accepted by URAC and NCQAOne of the main limitations in the acceptance of NBPAS by hospital credentialing committees is the fact that private insurance carriers couldn't get credentialed by their credentialing bodies if they didn't use ABMS credentialed physicians only. Hospitals were very hesitant to allow medical staff who were not qualified to get paid by insurance carriers as they feel that this puts their patients at risk for surprise bills. Fortunately, NBPAS has now obtained acceptance by NCQA and URAC which are the main credentialing services for insurance carriers. This paves the way for physicians to have a choice between the ABMS certification or NBPAS and still get paid. Learn more about your ad choices. Visit megaphone.fm/adchoices
The COVID pandemic has created a lot of interesting surprising and challenging political dynamics in countries all over the world. In the United States, we have a clear divide between those who declare themselves Democrats and Republicans in whether they support mandates and vaccine passports. The treatment of children remains a subject of a tremendous amount of strife. However, our neighbors to the North in Canada are having the same political tension growing as exhibited by the Freedom Convoy. What is the Fredom Convoy?The Freedom Convoy began January 22nd as a decentralized protest movement in Canada led by truck drivers entering the nation's capitol, Ottawa. According to my guest today, Warren Speyers, the convoy is seeking to end the vaccine mandates for traveling and generally moving into businesses. Speyers says the truckers are not looking to fight vaccination, rather, just the mandates and edicts which they feel are restricting their freedoms and businesses. The convoy consists of not just truckers but also many other Canadians who share those same goals and values. Speyers says that there are all sorts of trucks, tractors, and even personal vehicles which line the streets around Canada's Parliament. From Speyers' description, the convoy has been met with lots of support from citizens in Ottawa. The protests have been largely festive celebrations with people packing saunas, hot tubs, and even their hockey skates along with their families. The truckers have been showered with food, meals, valentines, money, hot showers, and offers of diesel gas from well wishers. The Canadian Government's ResponseAlthough the protests have been peaceful, the Canadian government has sought to end the movement without pulling its restrictions and mandates. On the day we recorded, February 14th, Prime Minister Trudeau and the federal government invoked the Emergencies Act which is essentially grants the federal government extraordinary powers to prevent massive violence, threats to Canadian sovereignty or a threat to public safety and health. In practice, the government has threatened to freeze and seize the financial accounts of anyone who financially supports or participates in the protest since most of those involved are owner-operators and not actually parts of large corporations. Learn more about your ad choices. Visit megaphone.fm/adchoices
If there is one thing that seems obvious throughout the pandemic, public discourse on just about everything seems to have broken our brains. We are incapable of having discussions without vitriol and there appears to be a real desire to not simply win arguments but destroy our ideological enemies. This leads to all sorts of strange behavior like fracturing previously solid personal relationships between family members, friends, colleagues, and, in today's example, patients and their doctors. Going After Her Medical LicenseIt began with a surprising email in her gmail account in the fall of 2021 for Dr. Meg Edison. A man identified himself as an investigator for the Michigan State Medical Board and was following up on a patient complaint for 'misinformation.' After a google search to feel comfortable that the individual was an actual state employee investigator, Dr. Edison gave him a call to find out what the nature of the complaint was against her. It turns out that one of her long standing patients had lodged a complaint with the state board of medicine claiming that she was pushing misinformation at their child's last visit. The claim consisted of the 3 allegations:
That cloth masks were not a very effective barrier for protection from infection by COVID and they would do better to wear a higher quality mask,
That it was unlikely that the FDA would approve a pediatric vaccine, and
That even 70% of the deer in Michigan have been infected with COVID as shown by serology testing.
As one can see, all those statements are correct and were true by government authorities even back in the fall of 2021. Fortunately, the story has a happy ending and the Board of Medicine found the complaint to lack merit and was summarily dismissed without any action taken against Dr. Edison. How Organized Medicine Can Protect DoctorsOrganized medicine can be an extremely challenging and aggravating landscape for physicians to navigate sometimes. However, when it comes to standing up for doctors, there aren't many organizations that will do it. And when it comes to taking on the licensing boards, state regulatory bodies, or hospitals the only groups that have doctors' backs are the professional groups. Dr. Edison made the point that it is important to find your niche in organized medicine and run with it to help foster relationships with other physicians and learn more about the state of medicine and different ways to practice. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Graham is the most frequent guest on the Paradocs Podcast and has appeared 5 previous times to discuss COVID (they can be found here, here, here, here, and here). Today, we talk a lot of COVID but also what it takes to retire amidst a pandemic. Do you need extra financial security during these times? What strategies work best? But mostly, we discuss Graham's optimistic feeling on where we are with the pandemic. The Pandemic is EndingDr. Graham's very optimistic that we are in the final stages of the pandemic. Both from a scientific, social, and political aspect. Scientifically, we are closely approaching the point where nearly everyone in America has been infected or acquired immunity to COVID from vaccination., This will significantly reduce the chances of mortality and move future infections to less severe. Socially and politically we are definitely seeing a shift away from shaming and hysterical calls for zero-COVID towards a more rational approach of accepting the virus' endemicity and learning to live with its presence without extreme mitigation measures. There also seems to be a real reckoning that most of what we did to prevent transmission was largely ineffective even within the ruling class. This is an important point that makes it less likely that these measures will be broadly pushed in the future. Of course, there are still further calls to now push vaccine passports and mandates but the utility of them is crumbling as we see that vaccination is hardly effective at preventing the spread of the virus. Pushes to continue mask mandates except to N95s are present in some communities (especially schools) has occurred but are being met with even more hostility from the lay public. One Way Masking is Now PossibleAs for N95s, it is clear that they are fairly protective for individuals and all other masks have limited utility. This means that if you are an individual who wants extra protection from others, you can simply don the N95 yourself. This also means, that others can operate in their lives in a pretty normal capacity without worrying about others. Since vaccinations and boosters are widely available, anyone can get the protection they want without having to worry about others and what their 'status' is. This is a huge leap forward and Graham argues is the way forward with schools and businesses as it allows those who want extra protection to protect themselves and those who choose not to to live a fairly normal life. It is probably the only politically feasible path forward for our schools and everyday life. Paxlovid is a Game ChangerFinally, Dr. Graham spoke a little in that he is more optimistic because Paxlovid, the novel protease inhibitor, is now approved and has had amazing therapeutic results for those at risk of serious complications with COVID. It also may serve as a platform or basis for future therapeutics in other respiratory viruses. Yet another reason to be optimistic on the future of the pandemic. You can listen to my latest discussion with Dr. Monica Gandhi to get her explanation of Paxlovid in episode 154. Learn more about your ad choices. Visit megaphone.fm/adchoices
(The following is a speech I would give if I were allowed to replace the current head of the Presidential task force on COVID-19, Dr. Anthony Fauci. We have had a huge loss of trust in our public health institutions and a change must be made. This is the speech someone needs to make as they replace the current regime which has had a run through two presidential administrations.) My fellow Americans, it is a great honor to receive this appointment to head the US task force on COVID-19. I want you to realize that I approach this position with great humility recognizing that I can never have enough knowledge and must rely on others to gather the most complete picture on this virus. The fact that this is a new pathogen means that our knowledge is ever-evolving and we must be nimble in our course of action. It has been a long and dark 22 months that we have been dealing with this pandemic. SARS-CoV-2, the virus that causes COVID-19, has killed hundreds of thousands of Americans and millions world wide. Make no mistake, this virus can be deadly. Unfortunately, throughout the pandemic’s response, the American people’s trust in public health, modern medicine, and government authorities has eroded significantly. Large swaths of our population no longer trust voices whom they deemed trustworthy just two years ago. This is mostly the fault of those in charge of public health and I seek to reestablish that trust. Of course, regaining lost trust is not easy. It requires those who were in authority to accept their missteps. It requires a whole profession to admit it was wrong..... Learn more about your ad choices. Visit megaphone.fm/adchoices
Whether you are in medicine or not, you are affected by the board certification and board recertification process. The certification and recertification process is not only expensive but also stressful contributing to burnout with physicians. After completing a specialty residency training, candidates for board certification have to jump through a number of tests to become board certified. These include a written exam and then possibly other components like oral exam, case review or something else. That something else is the subject for today's show - the Objective Structural Clinical Examination (OSCE). What is the OSCE? The OSCE is a new addition to the board certification process by the American Board of Anesthesiology whereby the trainees are subjected to various tests with 'standardized actors' to see how they can perform various personal skills like informed consent, canceling cases with surgeons, etc. This type of extremely subjective exam (despite the title) is ripe for interpretation that puts residents at the whim of cultural, personal, and acting disadvantages. The further question would be does this actually add anything to the skills of the physician? What do Residents (And Program Directors) Think of OSCE? The study conducted by Dr. Goudra looked at what residents thought of the value of OSCE was not good. In fact, 90% felt that it was a useless component that provided no benefit to determining whether someone was a good physician or better clinician. A previous study conducted by the ABA actually found that a majority of program directors also thought the exam was not worthwhile - yet it was implemented and still exists. This is about as good an example of the specialty boards' complete lack of accountability and focus on revenue. We've talked about all their problems with recertification here, here, and here. Learn more about your ad choices. Visit megaphone.fm/adchoices
Throughout the pandemic that has raged over the past two years, the press and public have leaned heavily on experts on navigating our way through uncertainty. The most prominent member of this class of public health experts is Dr. Anthony Fauci who is essentially the face of the pandemic response and sets policy used by most state, county, and local public health officials. Unfortunately, through a number of missteps and poor communication techniques, the trust in Dr. Fauci and public health in general have suffered tremendously this year. How Mistrust Develops Dr. Pomerantz points out that the loss of trust in public authorities is multifactorial and influenced by things like over reassuring the public, panicking and overreacting, flubbing the rationale for lockdowns, abandoning the flatten the curve plan, and insisting that public health be in charge of many aspects of the pandemic response. All of these points were areas where the public health authorities made mistakes leading to a continued erosion of trust in their abilities, motivations, and perception of expertise. Can We Rebuild Lost Trust in Public Institutions? Losing trust in public health, or the health system in general, is not one that should be viewed lightly. It can have profound long lasting effects. This is exhibited by the research from Dr. Sara Lowes (from episode 120) where she found distrust towards modern medicine generations after unconsented medical experimentation in parts of previous colonial France (Congo). What is amazing is the passing down of distrust towards medical authorities for years despite obvious advances in medicine and ethics. Unfortunately, for trust to be rebuilt there must be a tremendous effort put in by public health authorities. This begins with a big mea culpa for all their mistakes in messaging and getting things wrong (like mask flip flops, vaccines stopping transmission, etc.) and also the endless shaming and 'othering' of those who run contrary to their edicts. The most critical aspect of all of this is to bring back the part of the public that has been pushed out of the group by showing empathy. Unless that is done - and soon - we risk delegitimizing public health for generations. Learn more about your ad choices. Visit megaphone.fm/adchoices
DonorSee is a New Innovative Way to Run a Charity with Gret Glyer When Gret Glyer decided to search for meaning in his life after a short stint in corporate America by flying on a whim to Malawi, he never expected that in less than ten years he would create and run a multi-million dollar global charity. In his search for a fulfilling life, Gret found much more - an innovative way to raise money for those in need. Using Video to Fundraise Soon after arriving in Malawi - one of the poorest countries on Earth - Gret recognized the tremendous material needs for so many and he sought to find ways to help. He began by blogging and asking for help but found that it didn't resonate the way he had hoped. So on a whim, he figured he would harness the power of video and document those in need and then follow up after people had provided the financial support. He was struck by how capturing the need and success in video brought people the personal connection they rarely got with traditional charitable organizations was so powerful. Later, he harnessed the powerful draw of video to launch an incredibly ambitious project to build a self-sustaining all girls high school - in 12 weeks. Building a School Prior to crowdfunding for the school, all of the projects Gret had done were small in their scope. He had never embarked upon a project this ambitious He would need to raise a little over $100,000 in just twelve weeks in order for the school to open in time for school that year. Perhaps the most critical steps of this project were that there was overwhelming support for the creation of the school within the village and he had a local partner who had a plan. Her plan was not just to build a school but how to fund it, staff it, and educate girls in a self-sustaining manner throughout the years. So he then embarked on a fund raising plan to document by video weekly laying out the vision and then the construction of the school as they raised the money. Through this concept Gret pulled all the donors along the way to show exactly where their money went and the progress it made. Amazingly, his efforts raised the necessary capital to complete the school and it opened that fall in 2016. To this day, the Sunshine Academy is doing great graduating girls in a country where girls almost never receive secondary education. DonorSee is Born With this proof of concept, Gret launched DonorSee a few weeks later where people anywhere in the world can donate directly to a project and then receive a video update afterwards where they are usually personally thanked by the receiver of the funds. Projects range from buying a goat, paying for simple medical expenses, building homes, and paying for education. You can either pick out individual projects or donate monthly to random projects. No matter how you choose to contribute, you receive video feedback of the impact of your donations. Relief Vs. Development An important aspect to charity is being mindful of the impact that the donations have. We must be careful to separate relief from development. Sometimes, an individual just needs relief like after a natural disaster or medical emergency. But we must be careful to not provide services and goods that result in preventing the local economy from developing properly. That is why it is so important to have people on the ground with local knowledge to vet projects and makes sure the relief allows for human flourishing and not dependence. To that end, Gret and his partners in Malawi started a very ambitious project to build a self sustaining STEM school to train the next generation of scientists, doctors, and technicians to help move Malawi into the 21st century and serve as a bright example for other African countries. Learn more about your ad choices. Visit megaphone.fm/adchoices
Vaccine mandates, mask mandates, boosters, and variants have been a constant source of debate and controversy with the pandemic. My guest today is Dr. Monica Gandhi, an expert in immunology and infectious disease who runs the HIV clinic at UCSF. She has been a fairly prominent voice in support of the mask and vaccine mandates in her home state of California and city of San Francisco. She returns from her visit in June where we discussed the delta variant for SARS-CoV-2 in which she guessed that it wouldn't evade the vaccine or prior infection (spoiler alert: she was right). Do Vaccine Mandates Make Sense? Dr. Gandhi is the first to point out how she has been very supportive of mandating vaccines in the general population and specifically for health care workers. She has written extensively in many local and national outlets about the case for vaccines to reduce transmission of SARS-CoV-2 and hospitalizations. However, she has begun to rethink her support for these draconian measures because of a number of reasons:
It can cause a problem with mental health in those who are restricted from interacting normally with society.
It erodes the public trust in public health officials and well established measures.
Even when vaccinated and boosted, those individuals can still become infected and infect others limiting its value as a way to stop transmission in its tracks.
The political payback for politicians who support these measures may be significant at the ballot box.
Are there Good Therapeutics Coming Out? One of the more exciting developments out of the pandemic is the emergence of designer drugs for this coronavirus. The newest therapeutic drugs are protease inhibitors which can be developed with a specific virus in mind. These drugs work by blocking the ability of the virus to successfully hijack your cell's ribosomes to create more viruses. Molnupiravir has been approved by the FDA but hasn't been shown to be all that effective because it was not designed with this specific virus. However, the new drug Paxlovid has show extremely high efficacy approaching levels seen with the vaccine around 90%. The advantage of these drugs is obviously that as soon as you show signs of symptoms it can arrest the extent of the infection and prevent hospitalizations and worse outcomes. Is Omicron Worth Worrying About? Finally, the question of whether the new SARS-CoV-2 variant, Omicron, is one that should concern us was posed to Dr. Gandhi. Much like the Delta variant, she is very confident that those who have gotten an adequate immune response from vaccination or prior native infection should be well protected from serious harm. Additionally, reports out of South Africa and elsewhere have seemed to show that this variant causes a much more benign infection. She believes it is possible that this variant - if it is truly more infectious but benign - might be the world's ticket out of this awful pandemic. Learn more about your ad choices. Visit megaphone.fm/adchoices
What happens when you take Go Fund Me and put it into an ecosystem of likeminded folks who want to build a community to care for each other's health care expenses? You get Crowd Health which draws upon some of the concepts of crowd funding for one time health care expenses within its community. By taking people from all over the country and putting them into a community where there are expectations of caring for others, Crowd Health offers a solution to paying for health care expenses without breaking the bank. Is Crowd Health Insurance? If you've been paying attention to the US health care space for the last, well, forever, then you know that it is expensive and keeps getting more so. People stay at jobs they don't like just to keep their health care coverage which is often not very good anyway. However, for those who are self employed or with a very small business, it seems their only option is to go out onto the open ACA exchange and grab a lousy and expensive plan that hardly covers anything. Crowd Health offers an alternative to paying for health insurance. Although it definitely isn't insurance since you are asked to pay into your own bank account each month to be prepared to pay others' health expenses. There is also no guarantee that your expenses will be paid as you often have with a traditional insurance policy. However, oftentimes even with traditional insurance you don't get everything covered and have to cover up to the deductible and everything over until you hit your out of pocket maximum. And that's before considering the inflated prices paid by insurance companies. Is Crowd Health a Health Sharing Ministry? The answer to this question is more complicated. In short, yes and no. We discussed sharing ministries in my previous ventures with Samaritans and an episode with Liberty Health Share. Basically, in a sharing ministry you send your monthly 'premium' to someone in the community. If you have a health expense, you submit a claim after you pay the bill and people will then mail you checks to cover the expense. The down side of this process is that the delay to getting paid can be fairly long (months) meaning you will have to have the funds to cover the bill that might be fairly large. And people don't often have that much money sitting around in the bank. How Does Crowd Health Work? CEO Andy Schoonover describes the fairly simple mechanics of Crowd Health. You take a group of like minded people who want an alternative to the traditional way of paying for health care. Then you have them commit to contribute a small amount to run the overhead of the community which helps pay for the technology and people tasked with negotiating with local hospitals, etc. and assisting patients with their navigation through the health care space. Community members pay the first $500 of a health care event and then request the community fund the remaining amount. Each community member then has the option of helping out or not. Each member carries a social credit score determined by how often they 'help', ask for help, or shop around for less expensive health care options. Learn more about your ad choices. Visit megaphone.fm/adchoices
The COVID Drawdown Today we are going to discuss the COVID drawdown. Essentially, this is what must inevitably happen for us to return to lives of normalcy where we have typical interactions with others at family gatherings, sporting events, concerts, and business meetings. Unless we are prepared to radically change the way we live our lives and choose isolation (which probably has far greater physical and mental health detriments) then we have to consider how the drawdown occurs and what conditions ned to be present for it to happen. What HaS TO HAPPEN FOR THE DRAWDOWN TO OCCUR? We've talked to numerous experts who all have various opinions on how the pandemic will play out and what strategies will be needed to get to the 'other side' of the pandemic. You can find the initial conversation with Dr. Graham, immunology with Dr. Gandhi, and science ethics with Dr. Bhattacharya on the episode list at the end of this writeup. The following is a short list of what conditions need to be present to return to normal:
Broad acceptance of the fact that the virus, SARS-CoV-2 which causes COVID-19, will become endemic.
Recognition that the endemic virus cannot become eradicated and will absolutely infect everyone - probably multiple times.
Understand that vaccination including booster shots will not significantly stop transmission of the virus but only provide protection from serious illness.
Sterilizing immunity (protection from infection) for SARS-CoV-2 will be temporary whether one has had vaccination or prior natural infection.
Accept that no measures to stop transmission outside of severely draconian restrictions on movement and social interaction have middling effects on the spread of the virus.
We will have to be comfortable with no longer 'looking' for the virus with every respiratory illness and only test those whom we feel are at high risk or can use novel therapeutics.
Public health officials, politicians, and policy makers have to accept that there is very little that can be done to 'contain' the virus.
What the Drawdown Will Look Like The drawdown will look different depending on what part of life you are looking.
Schools: Most schools will continue their current policies through the end of this school year. Next year, most school systems will have returned to pre-pandemic policies of no temperature checks, mask wearing, etc. Only the most heavily unionized schools or urban will mandate extreme measures like vaccinations. This will become even harder to enforce as the majority of the country has returned to normal and we see a striking similarity of outcomes between the two ways of schooling.
Universities: Already there are differing policies in place between schools and the lack of differences with outcomes will move nearly all universities to eliminate all restrictions next school year.
Mask Mandates: These will disappear completely by next year in almost the entire country. The political cost for maintaining these measures will be increasingly steep and politicians will declare victory over the virus and insist that their earlier measures did their job to save lives but are no longer needed.
Vaccine Mandates: Despite attempting to impose these mandates through federal fiat on transportation and for air travel - these will disappear as more and more states reject their use.
Hospitals: Health care facilities will still likely be burdened with extraordinary personal protection measures like masking at all times throughout all of next year. The federal government controls this regulation and unless there is extraordinary political pressure these will continue. Perhaps the loss of workers in health care will encourage the removal of this rule but that will take longer than this year.
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When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with the employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Who do the brokers work for? You or the Carriers? I spoke to Katy Talento in episode 111 who runs a business where she unbundles health insurance for employers and helps them run an efficient and less expensive health care plan. One of the problems she saw is that insurance carriers bundle all these services and then charge a very large administrative fee to run the plan. Also, their plans rarely save you money as they build in enough profit to cover the agents who sell those plans - the brokers. That's the world that David Contorno is trying to combat with his company at ePowered Benefits. The business was founded with the intent of looking at real ways of not just unbundling but finding high quality and inexpensive ways to receive care. As Contorno said, "The only way to pay less for health care is to pay less for health care." Health Plans Are Gimmicks Through his 18 years of experience in the health insurance broker field, David points out that most of the various plans sold by insurance carriers are really just gimmicks that don't really change the cost of care. Whether it is an HMO, PPO, of some hybrid FFS plan - it ultimately just ends up being the same in failing to control costs. The reason is that the care comes from the same hospitals and with the same contracts no matter how they make the employers and employees pay with copays, deductibles, and coinsurance. Even HSAs (health savings accounts) which are held up as a way to control costs by putting the patient in charge, rarely bring about the cost control as advertised. This is primarily because even using an HSA and picking where you get your care still is within the framework of hospitals, insurance contracts, and provider networks which all have massively marked up prices. Only by leaving the insurance network entirely can one see real savings. Why Don't the Brokers Work for You? Simply put, the work that health insurance brokers do is to carry water for the insurance carriers. The carriers are the ones who pay their bonuses, provide them with expensive trips to Tahiti, and give them sales targets for selling their plans. The checks aren't written by employers but by the insurance carriers. So naturally, the brokers respond first and foremost to what the carriers want. This doesn't make them bad people but understandably their incentives are not aligned with those you'd hope. The reason most brokers don't even know they're working for the wrong people is best summarized by the quote from Upton Sinclair, "It is difficult to get a man to understand something when his salary depends on him not understanding it." David Contorno is the CEO and founder of ePowered Benefits. David spent 18 years as a traditional broker in health insurance but felt that it could be done in a better way. Learn more about your ad choices. Visit megaphone.fm/adchoices
Not only has the COVID pandemic politicized our country - it has led to a lot of misinformation and a shutdown of communication. For instance, is there really asymptomatic spread of COVID? Or just pre-symptomatic and symptomatic spread? That might seem like splitting hairs but it can have a profound effect on policy for quarantining and testing. We've talked about this before on the show as well as general discussions on COVID policy which can be found here, here, and here. 12 Myths and 12 Facts About COVID-19 If there is one certainty during this confusing pandemic it is that there are plenty of myths circulating in the media and popular culture about COVID. In fact, many of the things we think we know are wrong. Public officials get them wrong. Doctors and nurses get them wrong. The CDC and FDA get them wrong. Unfortunately, once we discover the truth, often the word doesn't get out there widely enough to change behavior, regulations, or rituals. Dan Halperin points these out in his book on 12 common myths and 12 uncommon facts about COVID-19. One great example of this is the transmission of SARS-CoV-2 on surfaces. We have almost no instances of the virus transmitting in this manner and it travels almost exclusively through aerosol means. However, despite this, businesses, individuals, and regulatory agencies still act as if 'deep cleaning' and intense adherence to eliminating surface contamination will help prevent viral transmission. This is patently false but it's been over a year since we have known this and yet we are still wasting our time practicing this type of hygiene. Another example of a myth believed by many is the transfer of viral particles from asymptomatic individuals to uninfected people. There are almost no documented cases of this type of infection yet we treat asymptomatic infection almost as a common vector. It is important to note that there is pre-symptomatic spread but people who never develop any symptoms just aren't infectious. It is also true that you never know if you're about to become symptomatic but we could certainly change the way we approach close contacts if the infected person never develops any symptoms. Is the Current Environment of Scientific Debate Akin to McCarthyism? Not only has Dan Halperin written on the epidemiology of COVID but he has also weighed in on his concerns with the academic and public nature of scientific debate. He notes how one of the creators of the mRNA technology expressed some "strange views" which many did not agree with. But instead of rebutting the researcher's concerns, he was virtually eliminated from history. His contribution to the development of mRNA technology was removed from Wikipedia and he has been eliminated from all common public forums. Dr. Halperin says it feels a little like McCarthyism which happened in the 1950's over concern that the Soviet Union and communists were infiltrating American government and society. At the time, most Americans were in favor of the practice of 'blackballing' people because of the perceived threat of nuclear annihilation from our Cold War adversary. Only through the lens of time can we now look back and find the practice objectionable and he suspects the same will be the case with our current lack of public acceptance of differing opinions on COVID. Daniel Halperin is an epidemiologist and full professor at the University of North Carolina School of Public Health and the author of the book: Facing COVID without Panic: 12 common myths and 12 lesser known facts about the pandemic. Learn more about your ad choices. Visit megaphone.fm/adchoices
There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed free standing ERs before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We have also discussed pediatric urgent care clinics but those never had the component of doubling as primary care. What is Urgent Care? Probably the most puzzling questions you can ask even someone who works in health care is: What is the difference between urgent care and emergency care? The answer is that it depends which is why you really need a better triage system that people (patients) can access before then head across town to either the ER or UC clinic. It's this triage that is probably the most important way to keep ER visit costs low and less frequent. This is one of the services offered by Next Level Medical to their members. Why Urgent Care Membership? At first, it seems strange that one would establish any sort of membership status with an urgent care clinic. But Next Level has made it work by basically selling it as a one stop primary care clinic. Or a primary care clinic on steroids that comes equipped with supplies for taking care of fractures, lacerations, laboratory studies, and imaging. And if you have the same staff working a regular schedule you can get physician continuity for patients making well care a very achievable goal. Employers like the flexibility as it provides the primary care for their employees with convenience since there are clinics all over town. Additionally, the clinics can care for their employees who might get injured either at home or work. This added benefit means a whole lot less in expensive ER care and probably healthier employees since their primary care is taken care of without all the copays and hidden costs that keep lots of hourly employees from staying on top of their chronic conditions. Doctors Like the Schedule Doctors looking to become employed usually have to make a lot of concessions. First in their autonomy and second in the lack of control over their schedule. The amount of work they take home or 'unpaid' time can be large at times making a forty hour a week job quickly turn into 50 or 60. This is where Next Level can offer doctors the opportunity to truly do shift work, have a regular patient panel, but not take home their work and let the sophisticated call center triage their patients overnight. Dr. Juliet Breeze is the founder and CEO of Next Level Medical which offers membership based urgent care services in the Houston, TX area. show notes Episode 146: Today's show Next Level Medical: Dr. Breeze's urgent care clinic company. jbreeze@nlucc.com - Dr. Breeze's email if you want to contact her. LinkedIn: Dr. Breeze's profile Episode 035: Free standing and fully transparent ERs is Oklahoma Episode 069: Pediatric urgent care clinics to eliminate a lot of the burden from the ERs. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
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A lot has happened since we last met with Dr. Keith Smith from the Surgery Center of Oklahoma back in 2018. Back then, we talked about how he brought the radical notion of full price transparency to the surgery space in 2009 all without taking any government payers. We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their surgeries which are more backed up than ever. His surgery center is a great alternative for an increasingly backlogged health system that is strained under the COVID crush of patients. Can Other Surgery Centers Dabble in Direct Contracting? One interesting aspect to Dr. Smith and his crusade for more transparency and market forces within medicine is the development of using clearinghouses for arranging surgery. The clearinghouse is used as a quick means for posting prices anonymously and then linking the agreeable surgery center and potential payers who are either patients or employers.. This is a great way to ease into direct contracting for a lot of surgery centers that are still dealing with commercial and government contracts. What is the Future for the Free Market Medical Association? Dr. Smith says the FMMA has grown significantly over the past few years as more and more facilitators, physicians, surgical centers, and administrators gather to learn how to harness the market to increase their book of business. Now that the pandemic has caused a lot of disruption in the market people are really starting to look for fresh solutions to survive and the FMMA feels like it has just what they need. Anyone can sign up and their next conference in in April 2022. Dr. Keith Smith is the co-founder of the Surgery Center of Oklahoma which has 100% price transparency which opened its doors in 1997. He also founded the Free Market Medical Association which works to promote the free market in all health care transactions. show notes Episode 145: Today's show Surgery Center of Oklahoma: Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. Free Market Medical Alliance: The organization that Dr. Smith helped co-found to encourage using the free market in more US health care transactions. @SurgeryCenterOK: Twitter for the Surgery Center of Oklahoma LinkedIn for Keith Smith, MD Atlas Billing Company: The company that helps link employers with surgery centers without posting all their prices openly to allow some direct contracting. Episode 012: Dr. Keith Smith on a fully transparent pricing system for surgery. Deputy: Today's sponsor who helps you with your employee scheduling and so much more. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
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A big struggle for doctors is when they watch what goes on in the state and national legislatures and realize that there is very little knowledge of what they do, how they practice, and what they did to get where they are. There are no better examples of this failure to understand the nature of what physicians do than the debate over the Affordable Care Act (Obamacare) in 2013.That episode was what put the fire in the belly of today's author, Dr. Matt Moeller, to write his article that went viral and later led to a book. Professional Stresses There are quite a few stresses that cause lots of problems for practicing doctors Inconsistent schedules making a home life difficult to plan Multitasking by expecting doctors to do multiple things at once No downtime to get away from work where patient concerns (following up lab results, etc.) never stop even on vacation or after hours Rules and regulations The Difference Between Income and Wealth Doctors usually command a big income but don't accumulate wealth until much later in life. This puts them at a disadvantage as income is taxed much more heavily than wealth. It also makes it much harder for doctors to catch up financially to others who began working in their 20s and compounded their wealth and were not as saddled with student debt. How Do You Discourage Doctors? Keep technology complicated and makes doing their job harder. Insecurity among medical staff with their pay and jobs in perpetual jeopardy Turning them from decision makers into decision implementers (algorithm medicine) Escalating productivity expectations Increased responsibilities with decreased autonomy leading to learned helplessness Placing more barriers between physicians and their patients Solutions to What Ails Health Care Simplify costs and reimbursement and increase transparency Reform tort laws Increase the role patients have in their own health through expanding HSAs Prevent chronic illnesses Reign in the numbers and salary of administrators Dr. Matthew Moeller is a gastroenterologist in Grand Rapids, MI and the author of What It's Like to Become a Doctor that addresses the journey through medicine training. The second half of the book spends time addressing the problems in medicine and some potential solutions. show notes Episode 142: Today's show Dear Lawmakers: This is what it's like to be a doctor today: Dr. Moeller's seminal piece that become viral and was reposted in mainstream media in 2013. Dr. Moeller's KevinMD Page Live Free Now Podcast: Hosted by John Bush Dr. Moeller on LinkedIn: LinkedIn link for Dr. Moeller. Locum Story: Today's sponsor who will help you find locum tenens opportunities. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
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Ask any primary care physician and they will tell you the toughest thing about helping their patients change lifestyle is that they don't have enough time or contact with the patient. Especially when it comes to weight loss control, primary care docs are stretched so thin on time that they struggle to have the impact they'd like on their patient's healthy habits or lack thereof. Weight Loss Begins with Awareness It's no surprise that a successful weight loss program begins with awareness that you have a problem with weight and your lifestyle. Dr. Egan, says that to be successful one must stay focused on a number of things. All of these are a priority with her management style at her new practice: Relationship with food. One must pay attention to why they are eating and to recognize healthy and unhealthy options. This is all with an awareness of how we are often left with no perfect options because we don't have the right ingredients, time, or abilities. Movement. This goes beyond just saying someone needs to exercise. The movement program must be created with the specific patient in mind and their input. Medications. Sometimes once the other parts are optimized, it is best to look at medications to supplement the rest of the weight loss program. A well designed drug regimen including hormonal treatments can be the difference between success and failure. How to Pull Off Weight in Primary Care Dr. Egan is teaming with Dr. Bitner (from episode 115) and using an entirely new model of care to help women lose weight. Instead of trying to develop a multidisciplinary clinic through an insurance based model, they have decided to go with a membership model where they limit the number patients to allow for more time and contact with the physicians. It's similar to direct primary care but probably more accurately described as direct contracting. I suspect it will be a much more successful model for getting patients the results they want than through the traditional insurance model. Dr. Egan is an internist who is board certified in weight management and will be starting at True Women's Health in August, 2021. show notes Episode 138: Today's show True Women's Health: Dr. Egan's new practice where she will work with Dr. Bitner. True Women's Health on LinkedIn Dr. Celia Egan on LinkedIn True Women's Health on Facebook @truewomenhealth on Twitter Physician Advocacy Institute: This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. @PhysAdvocacy: Twitter for the Physicians Advocacy Institute. Episode 115: Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. Episode 102: Dr. Fung on the advantages of intermittent fasting. Episode 107: Dr. Fung on cancer and how excessive weight puts you at increased risk for cancer. Care Cloud: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
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Being an expert has a lot to do with muffins. Or rather, when I was eating a fresh muffin the other day for breakfast it certainly got me thinking about experts. You see, I eat my muffins differently than the rest of my family. They break off the top of the muffin and butter the top and then the bottom. I felt like it would be better to cut my muffin down the middle so I could eat a muffin top with every bite (since the tops are the best). Well, this brought teasing from my kids and wife. The other day, my daughter got a broken muffin so she had to eat it 'my way' by buttering it down the middle. She admitted after eating it that I was right and my way was better. We both considered ourselves experts in what we liked to eat. Who Is an Expert? The definition of what an expert is is fairly well defined but the exact qualifications is not. Being an expert is probably more a matter of degrees of knowledge and mastery than any absolute number. I am certainly more an expert in all things medical than most people, but when compared to other physicians that would sometimes not be the case. Is the Expert Really an Expert in What We Are Discussing? The biggest problem with the use of the term expert over the last year and a half of the pandemic is that we proclaim people experts when they can't possibly be experts. No one has lived through a unique respiratory viral coronavirus pandemic such as we are having. Yet, many proclaim that they know the best treatments, mitigation measures, and modeling predictions. Certainly, some have a better foundational knowledge than others but since this is brand new there is no way anyone can be an expert in this particular disease/phenomenon. Stay Humble Ultimately, if you are in this space where you might not really be an exact expert in what is being discussed, you need to acknowledge it and accept some humility that you can't know. Also, you have to be open the possibility that you may, in fact, be completely wrong. Even experts in their own specialized field are occasionally wrong and must recognize that and be even more cautious when giving 'expert opinion' on topics in which they can't know as much. Self reflection on who an expert is and whether they might be wrong is critical. show notes Episode 137: Today's show Doctorpodcastnetwork.com/advicemedia: Advice media helps you fix your online social media engagement issues. Click now to get a free $60 amazon gift card just with a complimentary consultation. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
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There has been no shortage of casualties in the last year and half with the COVID pandemic. Schools have been closed, businesses shuttered, and families torn apart with different levels of concern for the virus. But one surprising victim has been science itself. The practice of scientific inquiry, discussion, and debate disappeared. Instead of science - which we can loosely define hypotheses that are then tested and either proven or disproven - is longer present when it comes to COVID. Learn more about your ad choices. Visit megaphone.fm/adchoices
If you want to get a doctor's blood pressure up or make her sweat, just tell her that you have a great electronic health record (EHR) to use. EHRs are the bane of a physician's life because they don't work well with your work flow, create extra work and inefficiencies, and cost a ton of money. That's why I spoke to Dr. Richard Sztramko of Hamilton, ON who is co-founder of Arya health technology company that has designed a new EHR. Learn more about your ad choices. Visit megaphone.fm/adchoices
"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals and funeral homes. Are the variants that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi, the answer is a simple no. Learn more about your ad choices. Visit megaphone.fm/adchoices
This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. Of course, their expectation is that they will lower health care expenses by over 10% with this plan. If this doesn't happen, the hammer comes down on everyone providing care and they lose their license to practice. Learn more about your ad choices. Visit megaphone.fm/adchoices
In many ways, Dr. Fauci's failure to properly handle the pandemic response with COVID was inevitable. Men like him - according to my guest Peter Suderman of Reason.com - believe in the general infallibility of the bureaucratic process. They think that by following a mechanical paperwork process that they will come to the best, safest, and correct conclusions. These public health bureaucrats also hold a paternalistic view of the average citizen and that those citizens need their protection. Learn more about your ad choices. Visit megaphone.fm/adchoices
Perfection. We all strive for it. Some more than others, but we all look to be better versions of who we are. In medicine, we tend to be high achievers so we want to 'conquer' parenthood. Being perfect isn't any more possible in parenting than it is in medicine. Human relationships are messy and raising children up to be the best versions of themselves has no handbook. The push and pull of you trying to get your kids to be who you think they should be is often at odds with who they think they should be. Learn more about your ad choices. Visit megaphone.fm/adchoices
The most important question we have to ask ourselves is who should get the vaccine? The question comes down to who should get the vaccine, or rather, who shouldn't get vaccinated?
This is where Dr. Noorchashm argues that anyone who has had COVID-19 and cleared the disease should not get vaccinated. A near immunological certainty is that once you have cleared a viral infection, you have immunity that is at least if not more robust than immunity you can acquire from a vaccine. Learn more about your ad choices. Visit megaphone.fm/adchoices
We're talking about COVID and our American Independence Day from SARS-CoV-2 on June 1, 2021.
The first thing I need you to do is look down and if you're wearing a red shirt, take it off. Not just one sleeve, take it all the way off. Likewise, if you're wearing a blue shirt, I need you to do the same thing. There are no red teams or blue teams here. We're just Americans.
It's time to open up. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. If you're a doctor, you know all about the unfairness of this system which requires more money, paperwork, money, testing, money, time away from patients and families, and money. It contributes to physician burnout. For patients, it is why your doctor might retire early, look stressed out, or be unavailable when you need him or her most. Learn more about your ad choices. Visit megaphone.fm/adchoices
Health care, according to today's guest Dr. Eric Bricker, is filled with euphemisms. One you hear a lot is value based care. The claim is that we need to restructure insurance plans to reward health systems that provide care focused on outcomes instead of activity. Conceptually, it makes a lot of sense that you would reward the people providing superior outcomes with better pay. Unfortunately, this scheme has been tried before and failed. It's unlikely the outcome will be any different this time around. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today, we depart from our pandemic of SARS-CoV-2 to discuss what was easily the number one killer of colonial Americans in the Revolutionary War - infectious disease. It is estimated that battle casualties totaled 5-6,000 while disease (infections like small pox and the like) killed between 40-50,000. The toll paid by the civilian population was even worse as loose estimates put the death toll at 100,000 from infection. Learn more about your ad choices. Visit megaphone.fm/adchoices
Advocates for vaccine passports are multiplying by the day. But rest assured, this a bad idea. Not only will they be impractical, they will be useless in a few short months before the passports could really be developed and adopted. In the show, I will lay out the case for passports and then explain why they are bad idea from a practical and civil liberty perspective. Learn more about your ad choices. Visit megaphone.fm/adchoices
My guest today is Dr. Vatsal Thakkar who developed an app to take away the pain for patients and health care professionals trying to file out of network insurance claims. Lots of care is provided outside of insurance contracts which requires people unfamiliar filling out insurance paperwork to do so. Thakkar created Reimbursify which does all the filing automatically and eliminating a huge pain point for these practices and their patients. Learn more about your ad choices. Visit megaphone.fm/adchoices
There is so much evidence right now that shows that the virus spreads and bursts into regional epidemics independent of local measures to contain it. This doesn't mean that masks do not work for individuals to prevent infection or protect others. However, it is pretty clear that laws don't affect much in the spread of the virus. Comparing states to one another shows that there is little difference in the extent of outbreaks based on their policies - but more dependent on where the state is located. Learn more about your ad choices. Visit megaphone.fm/adchoices
Trust is essential in medicine. Not only between a doctor and patient but between a community and the health care system. A unique difference between the United States and Africa is the relative recency of colonial powers controlling the country. Our colonial past is distant dating back to the 1700s. For Africa, it's as recent as the late 20th century. But how does history of recent colonialism affect current attitudes towards medicine? Learn more about your ad choices. Visit megaphone.fm/adchoices
Today is a departure from a direct discussion of the medicine or the US medical system. We delve into food. Food, is medicine in a way since it has physiological effects on how our bodies function. Finally, what's the deal with eggplants?
If the food is locally sourced it has many inherent advantages like improved 'ripeness' at harvesting, decreased transit time and chance to spoil, and it supports a local food network. Learn more about your ad choices. Visit megaphone.fm/adchoices
One thing few outside of medicine realize are the unique challenges doctors face in their personal relationships. Marriage can especially difficult due to the unique responsibilities and expectations placed on doctors with work. Unusual hours, call, and administrative work that can find its way into the home is stress that can strain any relationship if the couple isn't careful. Learn more about your ad choices. Visit megaphone.fm/adchoices
Entrepreneurs are funny creatures. Some seem to be born to innovate and create businesses. Others, like today's guest, create new businesses out of necessity because they can't find a system that works for them. Dr. Rick Rosenfield is an OB/GYN who enjoys gynecological surgery. He didn't feel that he could do that in his first job with a large health system so he struck out on his own and started doing something no one else had thought to do - outpatient laparoscopic hysterectomies. Learn more about your ad choices. Visit megaphone.fm/adchoices
One thing you can be certain of with COVID-19 is that there is no shortage of controversy. Whether it is lockdowns, treatment, vaccines, or testing there have been volumes written about what should or should not happen. So today, we're going to learn about the most common test in the middle of the controversy - the PCR.
That's why I reached out to expert, Kevin McKernan of Medicinal Genomics to understand the test, its advantages, and limitations. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Diana Bitner describes herself as a survivor. As an OB/GYN, she had what one would describe as a typical practice. She was employed in a large multi-specialty physician group that later got acquired by a large health system. But within this traditional insurance based practice, Dr. Bitner looked to deliver care to her OB/GYN patients in a different way. She thought of herself as an 'intropreneur' where she was continuously trying to innovate processes within the large health system. Learn more about your ad choices. Visit megaphone.fm/adchoices
In his excellent book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19, Dr. David Graham lays out the upcoming evolution from pandemic to endemic for SARS-CoV-2 virus. Although published months ago, the book has proven to be right on with how the virus is progressing and we now find ourselves in the transitional phase of the pandemic. The virus is transitioning from a global pandemic to one where it will live forever in the worldwide human population. Learn more about your ad choices. Visit megaphone.fm/adchoices
Pain. We all experience it. It is as much a part of life as breathing itself. But what is pain? Is it physical? Is it mental? Is it emotional? Is it mechanical? Also, how does pain become chronic? One of the few things experts on pain can agree on is that our ability to treat pain - especially chronic - is not very good.
My guest, Dr. Melissa Cady did a pain fellowship and realized that it wasn't working. So she wrote a book, Paindemic, where she describes the system and how it can be better. Learn more about your ad choices. Visit megaphone.fm/adchoices
As COVID-19 continues to rage across the globe, everyone has been trying to figure out how to protect themselves from getting infected. Although we know a lot about what puts people at risk (age, diabetes, heart disease), not much is talked about as far as preventative care goes. That might be where we should begin our discussion about vitamin D. Perhaps this common vitamin is a linchpin to preventing severe disease and maintaining immunological health. Learn more about your ad choices. Visit megaphone.fm/adchoices
The most obvious statement we can make about the US health care system is that it's a mess. It's complicated, expensive, and rarely delivers what patients expect.
The unserious answer to how you fix the health care system is to blow it up and start over. As the largest sector of the economy that hires the most people, there are far too many interests in keeping the system just as it is. The solution will have to come from entrepreneurs, employers, and patients. Learn more about your ad choices. Visit megaphone.fm/adchoices
Direct primary care (DPC) is a style of practicing medicine we have discussed many times. The way DPC works is that instead of using insurance to cover the cost of doctor visits with copays, patients contract directly with the doctor – usually on a monthly basis. What happens when care has to be episodic like with a pregnancy? And if you're that doctor covering all the patients in your panel for 24/7/365 how do you ever take time off if one becomes pregnant and needs to be delivered? Learn more about your ad choices. Visit megaphone.fm/adchoices
Well, it finally happened, the COVID-19 vaccines have started to arrive and get administered to health care workers in the United States. Both vaccines use a revolutionary new technology for inducing an immune response, messenger RNA (mRNA).
As millions of doses start rolling out throughout our hospitals and nursing home care workers we need to reflect on whether the vaccine is effective, safe, and how it should be distributed. Learn more about your ad choices. Visit megaphone.fm/adchoices
What does it mean to feel grief? Is it sadness? Anger? Resignation? Unfortunately, life will almost certainly present you with grief at some point. Where there is love there will also be grief when the love is lost. But always, grief is a human emotional state that we will all have to struggle with before our life is over.
As a physician, one treats not only physical illness but also mental anguish. We see people at their worst and lowest points when they are scared, angry, and anxious about the future. Learn more about your ad choices. Visit megaphone.fm/adchoices
Cancer. It is a word that evokes feelings of fear, pain, hopelessness, and loss. It also brings to mind images of chemotherapy, nausea, weight loss, hair loss, and loved ones suffering in pain. Cancer is all of these things and so much more. What is more interesting is why do people get cancer? Why do all cancers end up looking the same despite originating from different parts of the body? And why is something so common that it is a leading cause of death in the United States still so difficult to treat? Learn more about your ad choices. Visit megaphone.fm/adchoices
It's been a while since we have discussed medical liability on the show but malpractice is a large and expensive part of what doctors have to face in today's medical landscape. Physicians are often under attack not just from frivolous lawsuits but also attacks from disgruntled patients online or office disputes. It is important for doctors to understand the risks they face both to their careers and personal reputation and to their practice and business. Learn more about your ad choices. Visit megaphone.fm/adchoices
Direct primary care (DPC) is a movement that is growing quickly in the United States. Patients and physicians are looking to bypass the traditional box store medical practice and deal directly with one another.
The shift to this sort of practice can be scary for a doctor. In order to answer some of these questions I asked nine DPC practices from around the country what is the one question you wish you knew before you started a DPC practice? Learn more about your ad choices. Visit megaphone.fm/adchoices
What's it like living a year without health insurance if you are a family with two doctors? Well, we found out sort of by choice and sort of by chance.
It was one where we learned a lot about expenses, prices, and the utter insanity of medical system pricing. We become better shoppers of medical services. We hired a doctor to help navigate buying drugs, getting labs, and imaging tests.
Best of all, we saved over $3000 by using a sharing ministry and direct primary care doctor. Anyone can do it. Learn more about your ad choices. Visit megaphone.fm/adchoices
Since 2010, the number of NPs in the United States has grown from 109,000 to 290,000. It is transforming the health care landscape in the United States. But is it improving overall health? Is it providing more care for patients? Is it allowing for improved access? Is the quality improved or at least the same with physician-led care? Does that solve the problem of rural care?
These questions are the ones Drs. Rebekah Bernard and Niran Al-Agba attempt to answer in their book, Patients at Risk. Learn more about your ad choices. Visit megaphone.fm/adchoices
The last few years have seen a resurgence in the use of fasting. Fasting is an ancient practice tied to religions and culture. In many ways, how and when we eat developed based on the availability of food.
My guest is Dr. Jason Fung, a nephrologist and expert in intermittent fasting for the treatment of diabetes and weight control. His first argument, however, is a simple one - fasting is old, safe, and simple. One doesn't need to do extensive planning, dietary food restrictions, or break the bank. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. David Graham returns again this week to discuss his newly published book, From Killer to Common Cold. The book touches upon the topics we have discussed on this show for a few months now. The central theme of the book is how SARS-CoV-2 will transition from the pandemic killer COVID-19 to a common cold coronavirus.
Dr. Graham expertly lays out his case in a short book that is easy to digest. He sets a background of what viruses are, basic physiology and epidemiology, and history. Learn more about your ad choices. Visit megaphone.fm/adchoices
Episode 100 is a momentous achievement for a podcast about medicine where I had only about 3 show ideas in mind when I launched.
My guest host today is my wife, Marcy, who has been by my side throughout the show and obviously, the loss of our son Andy in a car accident. His death has served as a dedication to the show, a way to honor him with his audio track closing every show, and a reminder to me of the importance to treat every day and person as special. Learn more about your ad choices. Visit megaphone.fm/adchoices
Okay, so today's title to the show is a little provocative. But it's meant to convey the most important takeaway from the discussion. Our problem is the recent news that asymptomatic people and athletes showed signs of myocarditis (heart inflammation) on cardiac MRI and there was concern that this put them at immediate risk of heart diease.
To explain the controversy, I brought Dr. Rohin Francis onto the show. He is an interventional cardiologist from London who is getting his PhD in cardiac MRI. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's discussion begins way back in the early 1990s when Congress was trying to figure out a way to reduce its health care expenses. Sound familiar? Some things never change. And this story is as old as Congress itself as legislators try to solve one problem and end up creating a bigger mess that actually ends up creating far more harm than was occurring with the original. It goes by the rather harmless name of the 340B program. Learn more about your ad choices. Visit megaphone.fm/adchoices
We're breaking from our discussion of COVID-19 and discussing life after pandemic with finding means of passive income. Specifically, how one can earn passive income through real estate.
My guest is Dr. Jeff Anzalone, a periodontist in Monroe, LA who has created a website to help other high income earners find ways to earn passive income through real estate. He is an advocate for investing in real estate syndications. Learn more about your ad choices. Visit megaphone.fm/adchoices
Following our discussion last week where we discussed the probable lower herd immunity rate threshold for COVID-19, today we are going to discuss the transition from a global pandemic to endemic state for the virus. This makes one fundamental assumption - that COVID-19 isn't going to go away, ie, it won't get eradicated. The reasons to suspect this are all around us in that almost no viruses have been eradicated. Learn more about your ad choices. Visit megaphone.fm/adchoices
One commonly used expression regarding the current COVID pandemic is herd immunity. People are obsessed with reaching herd immunity as soon as possible so that we can put this pandemic to bed. It is hoped that the development of a vaccine will get us the herd immunity of 60-80% far quicker than waiting to reach it through natural infections. But my guest today is convinced her modeling puts the actual immunity threshold at only 10-20% meaning we may already be there in some cities and countries. Learn more about your ad choices. Visit megaphone.fm/adchoices
Pharmacy benefit managers (PBMs) are one of the 'middle men' in health care that have recently come under fire for the added expense they bring in the prescription drug market. What was once a relatively unknown player in the health care delivery process, PBMs are now finding themselves with a target on their back for the first time. Learn more about your ad choices. Visit megaphone.fm/adchoices
One driver of health care inflation in the United States are pharmaceuticals. Although we usually associate rising drug prices with prescription medicines, that is not always the case. In fact, the purchase of generics through insurance plans can be surprisingly expensive. This is because the 'discount' provided by your insurance carrier may not really be much of a discount and your copay could be many times more expensive than the wholesale price of the drug. Learn more about your ad choices. Visit megaphone.fm/adchoices
Maintenance of Certification (or MOC) is a requirement by all the specialty boards in the United States that is above and beyond what the original certification is to become board certified. In the 90's specialty boards put time limits on the original certification and began to require MOC and its outrageous fees and busywork.
Dr. Torie Sepah is a board certified psychiatrist in Pasadena, CA and feels that the MOC process has become nothing more than a new shakedown. Learn more about your ad choices. Visit megaphone.fm/adchoices
Now that we're approaching the half way point of summer it's time to start thinking about what we're going to do with school for K-12 (and college) kids. States and communities are starting to finalize their plans with how they expect to conduct elementary and secondary education in the face of the COVID pandemic. The only certainty is that there is a lot of uncertainty in what will happen. Learn more about your ad choices. Visit megaphone.fm/adchoices
Hydroxychloroquine is an old medicine and treatment for conditions causing cyclical fevers like malaria. But hydroxychloroquine has been used in the treatment of infections like SARS, influenza and others. Why did this happen? Where did it start? And what is its place today in the treatment regimen for COVID-19?
My guest today is Dr. Adam Rodman of Bedside Rounds Podcast. He is an internist and amateur medical historian who has studied in depth on the origins of hydroxychloroquine. Learn more about your ad choices. Visit megaphone.fm/adchoices
What does it mean to have a virtual telehealth doctor's visit? Can artificial intelligence (AI) and telehealth actually work in a medical setting in a way that doesn't frustrate doctors or patients? Well, my guest today is the chief medical officer of 98Point6 which is a text based primary care service for patients. That's right, patients use their phone or tablet with texts to receive their primary care. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today I'm joined by my friend and colleague Dr. Randy Lovell who has opened his own innovative practice in Grand Rapids where he looks to become fully transparent.
Dr. Lovell has implemented and perfected the technique of WALANT or Wide Awake Local Anesthesia No Tourniquet. He describes in great detail the advantages of this practice technique not just for the patient and physician experience - but also for the way it allows him to build a private practice that simplifies the billing too. Learn more about your ad choices. Visit megaphone.fm/adchoices
We're back at it again discussing the Coronavirus pandemic. The shutdowns/lockdowns continue in the United States and the tenor of the debate or discussion had changed within the media and culture. At the beginning of the pandemic the focus was on flattening the curve. Today, it is about stopping people from 'catching' the coronavirus. This is a mistake. Learn more about your ad choices. Visit megaphone.fm/adchoices
Now that we are over a month into the variable stay at home orders in the United States for the coronavirus it is probably a good time to reflect and guess as to how this all unfolds. Today I interviewed infectious disease specialist Dr. David Graham. Dr.Graham lives in Billings, Montana and provides a perspective on the pandemic that I had not yet heard. He suggests that at the forefront of this nationwide panic is that our media and government are not being honest with us. Learn more about your ad choices. Visit megaphone.fm/adchoices
The response from state governments in the United States have varied in how they are responding to the Coronavirus pandemic (COVID-19). Michigan has been in a state of emergency for weeks with it now extending through the end of the month. Our government deems "allowed" instituted more draconian rules in the face of no evidence of benefit. This is not to say that there is no risk to resources or people from the virus - simply that we need to consider the differences within the state and the real tradeoffs. Learn more about your ad choices. Visit megaphone.fm/adchoices
Once again I discuss the coronavirus outbreak in the US. Today, I speak with Dr. Michel Accad about the ways the US has bungled the response. We specifically look at how the mistakes from ossified bureaucracies have prevented decision makers from having necessary data and the ability to make informed decisions.
Also, what is the financial impact to doctors and their practices and what about the loosening of scope of practice restrictions within the states? Learn more about your ad choices. Visit megaphone.fm/adchoices
Five months ago, my family dropped our health insurance and switched to a health sharing ministry (Samaritans). So far, so good. We've gotten better medical care by hiring a DPC doctor and have saved over $2000 in five months.
What will it be like dealing with coronavirus without insurance? I'm pretty sure fine. However, the second half of the show I talk about the reasons the US response has been so poor to coronavirus. Tariffs, certificate of need laws, the FDA, and more. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dominating the news today is the pandemic coronavirus or COVID 19. It is unique in that its hosts are often asymptomatic but infectious for days making its spread so effective.
There is some reason for concern that the response in the US may have been too swift. Perhaps we should have waited another week or so to allow some more community infections to improve herd immunity since there is no vaccine on the near horizon. Learn more about your ad choices. Visit megaphone.fm/adchoices
Child abuse is a something we can all agree is a terrible crime. It is something that we must work to stop. But what is the best way? And how can we be sure that those accused of abuse actually did?
Because we can agree that child abuse is bad - so it removing children from their family if people are wrongly accused. My guest is Dr. Niran Al-Agba who details the story of her patient who was taken from his family after sustaining innocent injuries. The story is how they got him back and how it happened. Learn more about your ad choices. Visit megaphone.fm/adchoices
A discussion on where the lines are on making vaccinations mandatory. Are you compelled to get vaccinated to help the overall population's herd immunity? Or do you have a right to control what is injected into your body no matter the consequences to others.
We tackle those questions and try to get to the bottom of the question of where your rights end and mine begin. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today I discuss how Dr. Bill Hennessey of Pratter, Inc. is already forcing price transparency in the market for health care products. He helps self insured businesses and unions save money by showing them lower cost alternatives for their members.
By showing the price for every imaging exam, lab, etc. in town it is then easy for people to decide where to go to get the best price. Without any laws this is the sort of market disruption that will revolutionize health care as we know it. Learn more about your ad choices. Visit megaphone.fm/adchoices
A new phenomenon of the 21st century is the online attack. This is where people launch a coordinated attack on a business with the intent on destroying its reputation. The attackers hit you on Facebook, Yelp, Google Reviews and aren't interested in a discussion - just destruction. This can be very damaging to a business but also it causes many doctors and professionals to withdraw from the public square.j
Dr. Todd Wolynn gives his personal story on the attack and how they won. And how you can win too. Learn more about your ad choices. Visit megaphone.fm/adchoices
In today's special Patreon release we enter the world of politics and discuss independent Rep. Justin Amash from Michigan. I speak with Nathan Leamer, a former state house and federal staffer in Amash's office. This unique exposure to who Amash is as a person and boss leads to a better understanding of what his goals are in politics.
We discuss Amash's run for Congress as an independent and whether if he instead chooses to run for president as a Libertarian - can he actually win? Learn more about your ad choices. Visit megaphone.fm/adchoices
Pharmacy Benefit Managers (PBM) have been villains in earlier episodes. Basically, PBM are the largest health care corporations in the US and exert tremendous lobbying pressure. Although their role in health care is to settle claims they make their billions through a complicated series of kickbacks and rebates from drug companies.
My guest today is Vinay Patel, a pharmacist who was frustrated by the actions of the PBM and decided to do something about it. Learn more about your ad choices. Visit megaphone.fm/adchoices
It isn't often that people walk into hospitals and ask themselves how does this thing work? In fact, the same can be said for those who work in hospitals too. Whether you're a doctor, nurse, phlebotomist, orderly, or patient - how the whole enterprise works is usually a mystery. Also, what protections are there for patients so that they don't have people who are grossly negligent or dangerous caring for them like what happened with the famous case of Dr. Death - Dr. Christopher Muntsch of Texas. Learn more about your ad choices. Visit megaphone.fm/adchoices
The beginning of a new year is always a good time to reflect on the medical trends on where we've been and where we are going. What are the positive and negative medical trends we're seeing right now. Despite all the negativism about health care I believe that there is much to be hopeful about whether you are a patient or physician. Of course, there is no shortage of potential policy misadventures that could make things much worse too. I discuss both the good and bad medical trends in this episode. Learn more about your ad choices. Visit megaphone.fm/adchoices
As sure as life exists, death will follow. As such, people will continue to try to control not only their life but the circumstances of their death. Life is also full of instances of suffering, pain, and despair. Those who are in significant pain, the throes of depression or despair may not see any solution to suffering except taking their own life. The questions then come down to whether we need to have doctors involved and whether we should encourage those looking to end their life. Learn more about your ad choices. Visit megaphone.fm/adchoices
Many physicians and those supportive of markets in medicine are making a big deal on Trump's proposed executive order to increase price transparency in hospitals. The thinking is that by exposing how much each hospital charges for their services, hospitals will begin to compete on price and the cost of care will go down. Although I believe this to be an admirable goal, I think it is very shortsighted to think that a law or order without a significant market demand will change the behavior of hospitals. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the most common questions I get asked about the health care system is why are medical bills so enormous? It seems strange that the explanation of benefits you receive after getting care or services are so obviously inflated. Yet those charges which the hospitals, health care professionals, and pharmacies post are there to see which they clearly have no expectation of getting paid. Why does this happen? Learn more about your ad choices. Visit megaphone.fm/adchoices
If you own your own business, which physicians who are independent or run concierge or DPC practices do - you need to focus part of your time on branding and marketing. What words you use to describe yourself is critical to success and an important part of marketing and branding. I speak with Dr. Nitin Gupta about what he did with marketing to turn things around at his clinic. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the most expensive ways to receive care in the US health care system is thru an emergency room. The use of urgent care centers is a less expensive alternative. Unfortunately, one of the problems with urgent care centers is that the care is often not very good. It is especially poor when it comes to treating children where the average urgent care refers 40% of its patients to the ER even though about half receive no special treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices
Moving from academic medicine to private practice is a scary thing to do for any doctor. But what is it like for a specialist is the city with the highest concentration of her specialty to find patients? My guest today is Dr.Rudrani Banik, who treats patients with vision disturbances, headaches, and other neurological conditions related to the eye. By leaving academics (partly since she still does research) and striking out on her own, she recognized the need to do more than just practice medicine. Learn more about your ad choices. Visit megaphone.fm/adchoices
Surprise billing is a nationwide problem and Michigan is not immune. Surprise billing refers to the instance where patients are expecting their insurance company to pick up the entire tab of a medical bill but they instead find a huge bill for the amount 'left over.' The worst instances of this occurring is when the patient unknowingly encounters someone who is 'out of network' with their insurance company. Learn more about your ad choices. Visit megaphone.fm/adchoices
Direct primary care is just starting to really accelerate within the primary care world. And Josh Umbehr, MD has been at the forefront with his practice and line of products to service DPC doctors at Atlas MD.
In this episode, we discuss the state of DPC, how commercially there are more people looking to get involved in selling ancillary services, and the battle he and other DPC docs are having with their own professional society, the American Academy of Family Physicians. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Kris Held is the president of the AAPS and is an ophthalmologist in private practice in San Antonio, TX. She is suing the state of Texas to have the right to dispense drugs to her patients in her office. This would improve patient safety, reduce costs by over 50%, and is already being done in 44 states and the District of Columbia. We discuss her lawsuit, how she practices as a surgical specialist without insurance, and more. Learn more about your ad choices. Visit megaphone.fm/adchoices
My discussion with Jennifer Zeng, a Chinese woman who was persecuted by the communist government for her beliefs. She is an author and activist working to bring to light the actions of China on its own people and those in Hong Kong. We discuss growing up in China, who China tortures, their process of murdering political prisoners to sell organs for transplant, and what the struggle in Hong Kong is all about. Learn more about your ad choices. Visit megaphone.fm/adchoices
What's the deal with nurse practitioners (NPs)? Why is there so much anger from physicians and NPs when it comes to how patients are treated? Every day on my twitter feed I hear about how nurse practitioners are "acting like doctors without the necessary training" and are "dangerous because they know nothing." Meanwhile my friends who are NPs and PAs cite studies that claim they provide better care than physicians. Both camps' arguments are hogwash. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today's discussion is about hospitals. Namely, what does it mean to be nonprofit? Over half of all hospitals in the United States are not for profit entities - but do they really look differently than for profit institutions? That is the question that few politicians or those debating health care speak about. In many instances, one would be hard pressed to know whether hospitals are for profit by how they run. Learn more about your ad choices. Visit megaphone.fm/adchoices
I haven't spoken to a lot of ancillary medical professionals in the show and explored ways that they are changing the way we deliver medical care. Today I spoke to a physical therapist who chose to run his practice unlike traditional practices. He doesn't structure therapy based on what maximizes revenue from insurers but instead on treating the patient and their injury. Learn more about your ad choices. Visit megaphone.fm/adchoices
Serving the poor in health care is a mission that many enter medicine to do. Whether that is through medical missions, working free clinics, or in some other way - doctors are doing what they can to help the poor receive care. Some choose to work in underserved regions of the country both urban and rural that are paid in part by the federal government. These clinics are called federally qualified health centers. The question we must ask is if these clinics are the best way to serve the poor. Learn more about your ad choices. Visit megaphone.fm/adchoices
Irish doctor Clodagh Ryan worked in the UK's NHS and US as a family doctor. She says the NHS has some advantages but they come at a cost to patient care. Among those are excessive wait times, reduced innovation, and poorer outcomes in certain treatments. Learn more about your ad choices. Visit megaphone.fm/adchoices
Direct care is a newer way of providing care to patients. It is a cash system without insurance. Direct care is now becoming more common for specialists. My guest is an allergist who has adopted this model and practices medicine the way she wants that isn't rushed or filled with bureaucratic paperwork. Learn more about your ad choices. Visit megaphone.fm/adchoices
Self Care is the term used to describe how patients can take care of themselves and use techniques to improve their health and healing. Utilizing self care is a component of integrative health where traditional medical services are combined with other strategies to help patients recover from illness or deal with chronic conditions. Learn more about your ad choices. Visit megaphone.fm/adchoices
February marks the month designated by the American Heart Association as its "Go Red for Women" campaign to raise awareness of the real risk of heart disease in women. Too often, men are seen as the victims of heart attacks and people forget that women can suffer from heart disease as well. In fact, women die more from heart disease than men, right?
Well, not exactly. And that's what we discuss in the show. Learn more about your ad choices. Visit megaphone.fm/adchoices
Everyone needs health insurance, right? Health insurance keeps you from going bankrupt, right? But what if it ends up costing you more for basic expenses?
In this episode, I recount my experience getting a 2000% markup on a laboratory test. I explain how this is a perfect example of so much that is wrong with our health care market. Learn more about your ad choices. Visit megaphone.fm/adchoices
Zombies aren't real, but sometimes they sure seem like it. Especially when it involves medicine and the law. Health Diagnostics Laboratories (HDL) went into bankruptcy after being discovered it was ripping off patients by overcharging them and providing kickbacks to doctors and health organizations for using their services. Learn more about your ad choices. Visit megaphone.fm/adchoices
The topic of abortion seems to have gained more momentum in the news cycle of late with states passing laws relaxing or loosening restrictions on the practice. It feels like the 1973 ruling of Roe v. Wade might actually come before the US Supreme Court. As a physician and hospital, the social and ethical questions that surround abortion are both personal and professional. What is the obligation of institutions to perform abortions? How about the physicians or nursing staff? Learn more about your ad choices. Visit megaphone.fm/adchoices
National health care policy is always at the forefront of the political discussion in the US. Democratic candidates are offering their visions of what the US system should look like and point to other countries in the world. One held up is the United Kingdom and its National Health Service (NHS). But is it better than what we have here? My guest today is Philip Booth. He has written on the health care policy in the UK and is able to describe the UK system and how it differs from the US and Europe. Learn more about your ad choices. Visit megaphone.fm/adchoices
Physician wellness has come to the forefront today as health systems deal with ever increasing numbers of physicians dealing with mental illness and even suicide. There is no shortage of explanations nor ways the health systems are trying to fix these docs. Dr. Sanchez Wohlever has personally dealt with burnout and offers her own prescription for solving the problem. Its systematic approach is both simple and personal. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the most important things a young student can do to help their future is to pay attention to finances when he or she is young. This means to focus on minimizing debt, living lean after you get a paying job, and investing a sizable amount of your take home pay to achieve financial independence. Dr. James Turner, aka the Physician Philosopher, is an anesthesiologist and hosts a very popular financial website to help those in medicine to navigate the treacherous waters of finance. Learn more about your ad choices. Visit megaphone.fm/adchoices
Physician burnout and mental health problems have been well documented as has the physician suicide epidemic. Health systems implement wellness programs and have mental health awareness initiatives. However, the wellness programs do a poor job addressing the root causes of burnout and physicians have a hard time getting mental health help because of the professional stigma and inability to be sure that their treatment is truly confidential. Learn more about your ad choices. Visit megaphone.fm/adchoices
There has been no shortage of ink spilled arguing how we fix our broken US health care system so today I will use the spoken word instead. Fundamentally, we all want the same things from the system: Quality care, Affordable care, and Access to care. The real question is how do we move from here to there? Are there people who have fixed these problems even on a small scale that we can use as guides to work things out? Finally, should we look off shores for solutions to our woes? Learn more about your ad choices. Visit megaphone.fm/adchoices
This podcast has been dedicated to bringing you disruptors to the health care market and today's show features a discussion about health sharing ministries. The ministries work as a substitute to carrying health insurance allowing for people to use the service to pay their medical bills. Individuals pay a "sharing amount" each month which is then aggregated by the ministry amongst its members and sent to those with medical bills. Learn more about your ad choices. Visit megaphone.fm/adchoices
Today, we continue our journey discussing physicians who are using direct patient care through a membership model as disruptors in the health care field. Direct primary care is one of the most disruptive and innovative models to emerge in recent years and more and more specialties are looking for ways to adopt the insurance-free notion of providing care to patients. Now we can add an OB/GYN to the ever growing lists of physician specialties as I discover the practice of Deborah Herchelroath, DO. Learn more about your ad choices. Visit megaphone.fm/adchoices
For women, a very scary and anxious time of their life is pregnancy. C/sections are a very common procedure in the US for women constituting 33% of all live births.
However, my guest Dr. John LaGrand's practice, in which he works collaboratively with four certified nurse midwives (CNMs), he believes is a different way to practice obstetrics and has led to a c/section rate of only 5%. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the great challenges to those paying for our health care today is determining who is high quality, who is truly expensive , and who is doing the right thing. Unfortunately, the payers in medicine are not the patients but third parties like Medicare. Since the person receiving the care is not directly paying for the service, administrators in an office have to make the determination of how to pay without experiencing the care and knowing whether the physician was providing the right care. Learn more about your ad choices. Visit megaphone.fm/adchoices
Physicians today need to be more than healers. They need to also be leaders for their patients and partner with the patients throughout all aspects of care. Until we as physicians take an active role in finding solutions to every problem encountered by our patients, we aren't doing our job. This includes being mindful of the cost of tests, procedures, and pharmaceuticals and doing something to lower those costs to make getting the necessary care affordable. Learn more about your ad choices. Visit megaphone.fm/adchoices
How do PBMs (pharmacy benefit managers) pass on savings to themselves and leave patients and insurance companies holding the bill? It's hard to answer that question without first understanding what a PBM is, how they work, and what their role is in the pharmaceutical market. Unfortunately, the PBMs intentionally cloud what they really do in order to continue ripping off patients and insurance companies with unnecessarily high drug prices. Learn more about your ad choices. Visit megaphone.fm/adchoices
This week's episode is a longer interview I did as a guest on the Gray Matters Radio Podcast with Mike DeVine. He had me appear in February as part of his series exploring the US health care system and its many dysfunctions. In this episode we explored the problems with the pricing system, group purchasing, economic scarcity, and why things are just so darn expensive. Of course they all get answered and wrapped into a nice little bow at the end of the interview. Learn more about your ad choices. Visit megaphone.fm/adchoices
Only in medicine is discussing prices before providing care a revolutionary concept. Prices serve as an important signal to both providers and patients as to the relative scarcity of care. Whether that is time with a physician, time in the operating room, the cost of equipment necessary for procedures, or medications the price signal is important for both sides to understand the real cost of using resources. Learn more about your ad choices. Visit megaphone.fm/adchoices
How would you feel if someone who didn't know, was unfamiliar with your symptoms and story, and had never examined you dictated the way you were treated? Would you be upset if the people making those decisions were not specialists or maybe even had the same training as a physician? Unfortunately, this practice is very common today in every doctor's office in America and it is called prior authorization. Learn more about your ad choices. Visit megaphone.fm/adchoices
If there were a conventional treatment for a disease in a traditional medical practice that worked only 10% of the time or less - would anyone feel comfortable claiming it was a fantastic cure? I suspect not, yet those abysmal successful treatment numbers are present in some areas of the mental health arena when it comes to addiction treatment. However, you almost never hear about the failure of the 12 step programs or outpatient treatment plans and their high failure rate. Why is that? Learn more about your ad choices. Visit megaphone.fm/adchoices
Today, the topic physician burnout and looking at the numbers at who is suffering and what the causes are. Medscape published its 2019 Survey of Physician Burnout, Depression, & Suicide that dives deep into the demographics and causes of the phenomena. However, what was notably absent from the possible causes for burnout was financial matters. What effect does a high personal debt have on physician well being? And if it is a problem, how can you find your out of debt to improve your psyche as a physician? Learn more about your ad choices. Visit megaphone.fm/adchoices
I have spent a lot of time discussing innovative ways of delivering medical care on this show and it has primarily been based around primary care. However, those who are specialists who traditionally practiced using third party payors (Medicare, Medicaid, commercial) are also beginning to strike out on their own and switch to cash pay. The reason for this is that the cost of using insurance and the lack of access allows these specialists to find a market for the type of medicine they want to practice. Learn more about your ad choices. Visit megaphone.fm/adchoices
What is the difference between a first year medical student and a senior in college? A lot of debt and neither knows anything about medicine. Contrary to popular belief, medical students don't know the first thing about the health care system, how it is delivered in the United States, or what challenges face physicians in caring for their patients. So all of the popular opinions floating around in the general undergraduate student population are present upon their training. Learn more about your ad choices. Visit megaphone.fm/adchoices
For those who have encountered the health care system - the emergency room is the greatest mystery for charges. Although little of emergency care is truly emergency life threatening care (est. ~3%) the care is some of the most expensive in the hospital. Whether that it is imaging, laboratory, or professional services - patients and insurers are expected to pay the inflated costs. So how do we control costs and not break the bank for all of our patients when they are possibly at their most vulnerable? Learn more about your ad choices. Visit megaphone.fm/adchoices
If there is one thing patients and doctors agree about when it comes to primary care it's that it isn't properly working for either one. Doctors have too little time to spend with patients, can only address one or two problems at a time, and spend most of the little face time they get staring at a computer screen than at their patient. Learn more about your ad choices. Visit megaphone.fm/adchoices
When it comes to working, we all have different goals on what to accomplish during our careers. However, almost everyone anticipates on retirement as the way they end their professional life. The FIRE movement is one which emphasizes achieving your financial independence and retirement at a younger than traditional age. With careful planning and goals in place at a young age, you can achieve the goal of financial independence with more time to control your life without worrying about financing living. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the tasks assigned to physicians, and certainly not a task one thinks of when entering medical school, is to verify death. The first time you declare someone dead - for me, it was as a first year resident in the ICU - is a weird feeling because of the finality of it. As with anything you do as a physician for the first time there is some uncertainty that you aren't "messing up." But you don't need to be a doctor to declare someone dead because anyone can tell when someone or something is dead, right? Learn more about your ad choices. Visit megaphone.fm/adchoices
Direct Primary Care (DPC) is starting to gain some steam and popularity with established physicians, residents, and medical students. Patients are also beginning to learn about this alternative to traditional insurance based care. Instead of copays, deductibles, and limited visits and times with the physicians - DPC works as a monthly fee with unlimited access to the physician. Learn more about your ad choices. Visit megaphone.fm/adchoices
Physician suicide is an epidemic. How else do you describe 400 physicians per year ending their own lives which is over twice the national average? Why do so many doctors feel that the only escape from their pain is suicide? How do we end this epidemic and begin to heal the healers? Learn more about your ad choices. Visit megaphone.fm/adchoices
We can all agree - outside of a few overpaid pharma CEOs - that the American Health Care system is too expensive. In fact, one could argue that the system of delivering health care in America is designed to cost the most possible without any parts that can check its growth. If you were to try and design a more costly and inefficient system I dare say you would be unsuccessful. Learn more about your ad choices. Visit megaphone.fm/adchoices
Who is that man or woman in the white coat? What is he/she thinking as you are being examined or operated on? Is that physician burned out? Suicidal? Feeling optimistic about his/her profession? The future? There is a lot going on between the ears of that physician that isn't devoted to healing people. Today, I take a deep dive solo-style into the results of the comprehensive 2018 Survey of American Physicians by the Physician's Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices
The opioid crisis has been in the news for a few years now and those to blame for it are many. Is it pharmaceutical companies who made easy to prescribe formulations of powerful pain killers? Is it physicians for over prescribing pain medicine for simple aches and pains? How about federal guidelines that encouraged the over treatment of pain? Or the creation of the fifth vital sign in the late 90's that treated pain as important as heart rate. Learn more about your ad choices. Visit megaphone.fm/adchoices
Social media is ubiquitous in our lives and doctors have a less than average presence within that sphere. The reasons are many but probably partly related to concerns about medical liability, their employers, and reputations as physicians. Dr. Dana Corriel set out to change that. She created the #SoMeDocs which encourages physicians to engage the world more and bring their unique perspectives to patients and the public through the use of social media.
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Our discussion hopefully offers some insight into grief while being sincere with brief moments of humor. What to expect, what is comforting, what is not helpful, and how it has changed our lives. Specifically, we discuss the process of forgiveness, grace, and practical things you can do to help your family members or friends in dealing with the grief. My hope is that this episode will be a comfort or helpful for those in the grieving process or those helping a loved one go through the process. Learn more about your ad choices. Visit megaphone.fm/adchoices
Sometimes, the best way to understand your present is to view it through the lens of the past. HMOs (Health Maintenance Organizations) were a product of the 70's and exploded onto the scene in the early 80s. Specifically, he recounts the 'industrialization' of health care delivery where a cottage business of caring for the sick transformed into the business it is today run by large corporations. Learn more about your ad choices. Visit megaphone.fm/adchoices
HIPAA (or the Health Information Portability and Accountability Act) passed in 1996 and has been touted by legislators, physicians, patients, and health industry leaders as a law that protects patient medical data privacy. It turns out, as with the names of many laws that pass in Congress, the act does the exact opposite as what you might guess. The act allows for over 2.2 million entities in the US to trade, disperse, and sell your personal medical data without your consent. Learn more about your ad choices. Visit megaphone.fm/adchoices
Did you know that most hospitals (or hospital systems) enjoy a non-profit tax status? Despite revenues in the billions of dollars these entities operate within your city or community with a tax exempt status including all the medical offices, laboratories, imaging centers, and billing offices that they build and purchase. Does this give them an unfair competitive advantage over for profit imaging centers, laboratories, or physician private practices? Learn more about your ad choices. Visit megaphone.fm/adchoices
Few are aware of the practice of public reporting for health care and on its face, it seems to be an obvious goal for policymakers. However, comparing health care systems, hospitals, or individual physicians is incredibly complex and probably impossible to do in any sort of meaningful way. Traditionally, patients relied upon local knowledge with their primary care physician to refer to the best few specialists. Learn more about your ad choices. Visit megaphone.fm/adchoices
Maintenance of Certification (MOC) continues to weigh down physicians encouraging early retirement, burnout, and financial strains leading to all sorts of other personal and professional problems. The private specialty boards (ABIM, ABA, ABP, etc) are under the auspices of the ABMS which sets many of the rules that are ruining physicians' lives. Learn more about your ad choices. Visit megaphone.fm/adchoices
Certificate of Need (CON) laws are commonplace in the United States and affect every patient and physician who lives in one of the 36 states which have them in place. The laws stipulate that you need permission from one a government regulatory board proving a need in your community to open a competitive health care service like ORs, laboratories, imaging centers, or hospitals. Learn more about your ad choices. Visit megaphone.fm/adchoices
Everyone knows that one of your most important assets is your identity. Without that you will have difficulty getting anything accomplished. Most importantly, whoever holds the key to your identity will wield the ultimate power. Thankfully, today's digitized world and the emergence of block chains for public accounting and private security is bringing us to a place where you can store this information in a decentralized space allowing the individual to have the power. Learn more about your ad choices. Visit megaphone.fm/adchoices
If you knew that millions of people were being murdered by government in the world what would you do? If you found out these people were being murdered for 'spare parts' to be sold to the highest bidder - what would you do? These are the questions we have to ask ourselves as we look at the practice of involuntary organ harvesting occurring in China to this day. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the most overlooked aspects of medical training is what to do after you finish your training. Especially any guidance for how you introduce new products to market as a physician. Doctors are coming up with products all the time that keep us healthier, make our life easier, or doctor's lives easier but there is usually not a lot known by those launching new products about how to do it. And what the pitfalls are. Today, I will discuss just those things with two physician entrepreneurs. Learn more about your ad choices. Visit megaphone.fm/adchoices
It's easy to forget that physicians are people. Certainly when we discuss doctors in our national political debates we forget that there is a critical relationship ignored - the patient-physician relationship. As that relationship is strained with the introduction of electronic medical records, production pressures, administrator rules changes, and malpractice physician burnout is almost inevitable. Learn more about your ad choices. Visit megaphone.fm/adchoices
One of the biggest obstacles faced by patients and doctors in health care is the exchange of payment for services as this is now accomplished through intermediaries like insurance companies, Medicare, etc. What would happen if we used a cryptocurrency with verifiable records on a blockchain with miniscule transaction fees? Or if you could earn credits as a patient by performing healthy acts? Learn more about your ad choices. Visit megaphone.fm/adchoices
Would residents (doctors in training) forget to rest and nap if there was no bureaucrat making rules regulating it? Would people leave rotten food in refrigerators without ACGME accrediting body recommendations? Who exactly is in charge in the hospital teaching centers? Do the hospitals function to get people better and who new doctors how to do it or do they exist to enforce rules from far off bureaucracies at the expense of educating new doctors and treating their patients? Learn more about your ad choices. Visit megaphone.fm/adchoices
Why is health insurance so expensive? Why have premiums accelerated under the Affordable Care Act (a.k.a. Obamacare) even more than they were before? Even with the increased guaranteed coverage requirements, the price increases on premiums has outstripped those variables even more than you would expect. Learn more about your ad choices. Visit megaphone.fm/adchoices
What does it mean to treat a patient? Is it knowing your patient and making an educated decisions about how best to treat them or is it viewing people in the aggregate and working towards making the best medical choices for your community or health system? This is the crux of the question that Dr. Michel Accad poses when deciding how you want to practice medicine (or be cared for by physicians.)
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What impact do FDA (Food & Drug Administration) regulations have on Americans? Are they truly benign or could they be costing us not only extra money at the pharmacy but our lives? Today, Dr. Mary Ruwart and I discuss the true impact of FDA regulations and how they do in fact shave years off of our lives. Learn more about your ad choices. Visit megaphone.fm/adchoices
Episode 009: Doctors Getting Worked Over By the ABIM with Dr. Wes Fisher Once again we revisit the issue of maintenance of certification (MOC) only this time with a lurid tale of conniving, cronyism, and dishonesty. Today's tale is of the American Board of Internal Medicine (ABIM) which is charged with setting the standards for board certification for about one quarter of America's physicians. Their exploits have made the rounds even in the lay press and many physicians have called for the torches and pitchforks to take on this seemingly corrupt board. Dr. Wes Fisher stumbled upon the story with the extra time he was afforded while recovering from surgery. The questions he posed publicly was noticed by a forensic accountant, Charles Kroll, who also had time on his hands. Together they have uncovered an almost unbelievable tale of corruption, million dollar offshore accounts, downtown real estate purchases, and missing tax filings all on the backs of the physicians they claim to support. Join Eric and Wes as they tell the tale of the ABIM and how they abuse their own physicians with little respect for their time, talents, or money. Whether you are a physician or not, you will want to get involved and visit the GoFundMe page to begin a class action lawsuit against the ABIM and its parent organization, the American Board of Medical Specialties (ABMS). I donated after the show and urge you to do the same - even $5. [caption id="attachment_1743" align="aligncenter" width="108"] Dr. Wes Fisher, an electrophysiologist from Chicago, uncovered this tale of corruption and retells it in this episode.[/caption] show notes Dr. Wes's Home Page: The place to follow Dr. Fisher and his continued reporting on the shenanigans at the ABIM. GoFundMe class action lawsuit against the ABMS/ABIM: Click here to donate to end MOC with a class action lawsuit. Practicing Physicians of America: The organization leading the charge in the lawsuit. Join today whether you are a physician or not you can remain updated by signing up. Why You Should Care About Maintenance of Certification with Dr. Meg Edison A primer on the maintenance of certification issue and why physicians are so upset and leaving the practice of medicine early. What Happened to All the Medicine: The interview with Dr. Mass discussing the role GPOs and PBMs have in creating meciation shortages referred to in the show. Patreon - Become a show supporter today and visit my Patreon page for extra bonuses. Every dollar raised goes towards the production and promotion of the show.
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One unique stressor facing physicians is malpractice litigation. Its occurrence is so common that 10% of physicians are in the litigation process at any one time. The incidence of physicians admitting to suicidal ideation in a year is 7% - twice the rate of the general population! Learn more about your ad choices. Visit megaphone.fm/adchoices
Join me as Dr. Wacasey's folksy humor, vignettes, and aphorisms take you on a humorous journey to leave you better informed the next time you head into the health insurance market. Learn more about your ad choices. Visit megaphone.fm/adchoices
Episode 006: "Doc, I'm Over Here, That's Just a Computer Screen." Why Don't Electronic Health Records Help with Dr. Ken Fisher Electronic health records (EHRs) were supposed to revolutionize the way we practice medicine. They were going to improve efficiency, reduce errors, and radically change we take care of patients. EHRs have managed just one of those goals - radically change the way we take care of patients - but not in a good way. As people taking care of patients we spend more time clicking, typing, and searching for critical information than we do in laying on of hands and talking to those who are ill. How did this happen? Computers and electronic record systems have made many aspects of our economy so much better. We can order food online, carry maps in our pockets to never get lost (unless you're a new teenage driver), and efficiently order products to minimize waste. But few of these benefits present themselves in hospitals despite billion dollar efforts to computerize everything. Dr. Ken Fisher joins me as we try to get to the bottom of why we have these clunky EHR systems and why they don't work as advertised. How did they come to pass and why is the market for EHRs dominated by so few products. As the author of a popular book titled Understanding Health Care: A Historical Perspective, we also get sidetracked to discuss ways to improve upon the delivery of health care in general. Specifically, we discuss HSAs and Medicaid spending. Dr. Fisher is a nephrologist in Kalamazoo, MI who has run multiple residency and fellowship programs and has been published both in scientific journals and the lay press. [caption id="attachment_1706" align="aligncenter" width="200"] Dr. Ken Fisher, Author of Understanding Health Care: A Historical Perspective[/caption] show notes Understanding Healthcare: a historical perspective Freedom in Healthcare: A website with links to alternative places (other than Amazon) for finding his book. EHR: An Ill Conceived Idea: Article from Medical Economics about EHRs. Why Your Doctor's Computer is so Clunky: Wall Street Journal article referred to in the episode. Episode 002: How Direct Primary Care Direct Primary Care Made Me Love Medicine Again with Dr. Belen Amat Episode 004: A Step-by-Step Guide to Starting a Direct Primary Care Practice with Dr. Chad Savage Patreon - Become a show supporter today and visit my Patreon page for extra bonuses Learn more about your ad choices. Visit megaphone.fm/adchoices
Are you aware that we face critical shortages of basic medication and medical supplies on a daily basis in the United States? Currently, over 100 generic medications are at various levels of critical supplies. Spinal anesthetic kits are undersupplied as are a large number of chemotherapeutic medicines.
If we have a country where you never have to go a day without kale in the supermarket, why should we not have basic pain medications for months? Learn more about your ad choices. Visit megaphone.fm/adchoices
Have you wondered what the steps are to open your own direct primary care practice? Whether you are a resident physician or established physician this episode will offer a guide to starting your own practice to begin practicing medicine the way you want on your own terms.
In this episode, Eric and Chad walk through the advantages of opening a direct primary care practice and each step you need to complete to make the plunge. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, Eric and Congressman Justin Amash (R-MI3) discuss the state of health care in the United States and what changes are likely to transpire at the federal level. Is Congress hopeless (spoiler alert: yep)? What would he do if he were in charge of transforming the US Health Care Industry? Which is better, Star Trek or Star Wars? Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, Eric speaks with Dr. Belen Amat, a med/peds physician who switched from a traditional medical practice of using insurance to one of direct primary care in Grand Rapids, MI. Eric & Belen discuss the direct primary care model for delivering health care in America. Dr. Amat describes how the switch to a new model changed her whole attitude about primary care and has made her happier, empathetic, and a better doctor. Learn more about your ad choices. Visit megaphone.fm/adchoices
Eric & Meg discuss what maintenance of certification (MOC) is and why it is a problem for physicians and their patients. Meg describes why the MOC process is so destructive to the practice of medicine and why non-physicians should care. Learn more about your ad choices. Visit megaphone.fm/adchoices