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Primary Care Doctors: How Valued Are They?

Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.

I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores.

Here’s what they found:

… the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians.

In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the researchers report in the Archives of Internal Medicine.

Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.

Of course, regular readers of [this] blog know that healthcare reform will do little to decrease the disparity. The pay raises that will be coming to primary care will be far too little to change the perception that, in the United States, specialists are more valued by far. Read more »

*This blog post was originally published at*

Dr. Abraham Verghese: The “Top Gun” Of American Medicine

The first-year medical students I precept were too young to see Tom Cruise’s alter ego Lieutenant Pete “Maverick” Mitchell grace the big screen in the 1986 blockbuster film “Top Gun.” Yet, the story has a relevant analogy to medicine. 

According to the film, during the Vietnam war American pilots were relying too much on technology to bring enemy fighters down. They weren’t as skilled in taking out the opposition. They fired their technologically advanced missiles to try and get the job done. They didn’t think. It didn’t work. They forgot the art of dogfighting.

The military discovered that technology alone wasn’t going to get the job done. The best fighter pilots needed the skills, insight, and wisdom on when to use technology and when not to. As a result, the Navy Fighter Weapons School, known simply as Top Gun, was created to retrain the military pilots on this vital lost skill. The goal of the program was specifically to make the best of the best even better.

Like the military, the country is discovering that the healthcare system enabled with dazzling technology isn’t getting the job done either. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Primary Care: Has It Been “Oversold?”

Citing a new study by the Dartmouth Atlas, the Wall Street Journal’s health blog provocatively asks: “Has the notion of ‘access’ to primary care been oversold?”

The Dartmouth researchers found “that there is no simple relationship between the supply of physicians and access to primary care.” That is, they found that having a greater supply of primary care physicians in a community doesn’t mean that the community necessarily has better access to primary care. Some areas of the country with fewer primary care physicians per population do better on access than other areas with more primary care physicians.

The researchers also report that the numbers of family physicians is more positively associated with better access than the numbers of internists, although they call the association “not strong.” Although both general internists and family physicians are counted as primary care clinicians, “in [regions] with a higher supply of family physicians, beneficiaries were more likely to have at least one annual primary care visit. In [regions] with a higher supply of general internists, fewer beneficiaries had a primary care visit on average.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Emergency Rooms Overused For Routine Care

The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients.

A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departments in the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care? Read more »

*This blog post was originally published at EverythingHealth*

Doctors Wanted For Hazardous Journey


With this want ad, circa 1914, Sir Ernest Shackleton recruited 28 souls with an unimaginable challenge: To cross the unexplored Antarctica on dogsled. The polar explorer knew exactly what human characteristics he needed to pull off such a feat and understood that straight talk would resonate with a few select men.

Shakleton and his crew boarded their ship, the “Endurance,” and sailed the world’s most dangerous oceans straight into harms way — still considered one of the world’s greatest survival stories. Amazingly, all men survived against unimaginable odds. Their story reminds us that we all stand on the waves and wakes of dreamers, doers, slaves, and fools, all who say, “We did it, took our chances, immigrated to the U.S., headed West, built a new business, risked it all.”

And, if you listen closely, you will hear their stories as an invitation that has been repeated throughout history: “What will you do? Whether your turn or your calling, what will you do?”

Today, I’m posting a similar want ad to medical colleagues. The journey may be far less physically dangerous, but considering prevailing attitudes, perhaps it’s as daring in imagination. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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