March 24th, 2009 by GruntDoc in Better Health Network
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I’ve never cooked lobsters but was reminded of the trick to the recipe today: if you try to put lobsters into boiling water you’ll have a big fight and it won’t go well, but put them in cool water and slowly turn up the heat, by the time they realize there’s a problem they’re cooked.
I thought about this while turning sideways between gurneys in the hall to get through to the next patient of many.
The temperature in my ED continues to climb, but I’ve been here so long it just seems like it’s getting a little warm.
ED’s everywhere have rising census, increasing demands, physical plants that aren’t keeping up with the crush.
Coal mines have canaries. Medicine has lobsters.
It’s getting warm, but there’s plenty of time.
Right?
December 3rd, 2008 by Dr. Val Jones in Opinion, Primary Care Wednesdays
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By Alan W. Dappen, MD; Steve Simmons, MD; Valerie Tinley, FNP of Doctokr Family Medicine
We are a family doctor, an internist and a family nurse practitioner working on the front line of the American health care system. We share a moral and ethical duty to protect the health of our patients along with all our colleagues who labor daily doing the same.We as Americans are proud of what has long been considered a first-rate health care system. Sadly, this system is broken despite our best efforts. Americans spend much more per capita for care as any other country. The World Health Organization has graded our care as 37th “best” in the world. Even worse, American citizens were the least satisfied with their medical care compared to the next five leading socialized industrialized countries, including England, Germany, Canada, Australia and New Zealand. There are many things wrong. Let’s examine a few:
Primary care medicine in America is gasping for its last breath. Internists, family doctors, pediatricians (whom health experts consider essential to a robust and cost-effective delivery system) are leaving primary care in droves. The number of newly trained generalist doctors has plummeted so fast that extinction of the generalist doctor has been forecasted within 20 years by both the American Academy of Family Practice and the American College of Physicians.
Patients are angry and exasperated with long delays, poor service and confusing and redundant paperwork. To date 17% of us are uninsured and this number will quickly grow in a deepening recession.
Employers face a huge cost burden as health insurance prices go through the roof. CEOs consistently say the runaway costs in health care benefits (which double in price every seven to ten years) threaten the viability of their companies. Since 2000, the number of small businesses offering health insurance has dropped 8%.
Health insurance companies are making so much money that several states have motioned legislation compelling insurance companies to disclose the percentage of premiums spent on actual medical care. Not surprisingly, their lobbyists are resisting. It is not uncommon for insurance companies to keep 30-40% of every dollar for “administration” and profits. Many of these companies are on record reaffirming their commitment to shareholders and short-term profits.
Doctokr (“doc-talker”) Family Medicine is a medical practice that was created to respond to the conflicts and problems listed above. We have worked to resuscitate the soul of the Marcus Welby-style patient-focused physician while adding technology to deliver fast, responsive and informed care. All fees are transparent and time-based and are the responsibility of our patients to pay. All parties that interfere with the doctor patient relationship or increase our costs have been removed from the equation. The practice delivers “concierge level” services: 24/7 access, connectivity to the doctor no matter where our patients are located, same day office visits for those that need to be seen, even house calls for those unable to get to our office. By removing the hurdles and restoring transparency and trust, 75% of our clients get their entire primary care needs met for $300.00 a year.
This post is written by three medical professionals who stopped waiting for someone else to find a solution and are actively changing primary care in ways that dramatically improve quality, convenience and access, while drastically reducing costs. The US deserves excellent health care and it must be done right. To understand why we would bother to “walk the walk,” we ask your indulgence and participation while we “talk the talk.” We hope this format will educate and inform you in ways that move you to participate in your care. Health care is about you, just as much as it about us, because we are all patients. We all have a stake in shaping the inevitable need for reform.
The next upcoming topics:
- Where did the Marcus Welby, MD-style of primary care go and how can we get it back?
- How have you as a patient lost control of your body and health?
- Turning the primary care model upside down: What does primary care need to do to reinvent itself so that it serves its patients without other conflicting interests?
- Begin the exploration of the unexamined assumptions of health care….
Until next week, we remain yours in primary care.
– Alan, Steve, and Valerie
November 7th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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There is a critical shortage of primary care providers in the United States. The public’s perception is that there is no shortage, and politicians have spent very little time talking about how to address the shortage. The American Academy of Family Physicians has been carefully studying this issue and strongly recommends incentives for physicians who would consider primary care: increased reimbursement for non-procedural work, and medical school debt-forgiveness are two of many.
The universal coverage system in Massachusetts immediately unmasked the problem of the primary care shortage. Newly insured citizens have been astonished to discover that they cannot find a primary care physician even though they want one. Wait times often exceed 6 months, and very few physicians are accepting new patients.
I have had the privilege of listening in to various healthcare reform discussions among politicians and advocacy groups here in Washington. Every time I raise the issue of “what will you do about the primary care shortage?” they offer the same tepid response: all providers will need to “work together” to provide primary care services, and innovative programs like retail clinics and nurse-driven care models will help to fill the gap in physicians.
My friend and fellow blogger, Dr. Rich Fogoros recently wrote an amusing (and cynical) post about how physicians should simply “hand over” primary care to nurses. (The same argument that many politicians seem to be making). The only problem with this reasoning is that nurses may not be willing to provide primary care services for the same reasons that physicians aren’t too keen on it: the pay is low, the workload is grueling, and there are other career options that offer better lifestyle and salary benefits.
I spoke with a group of nurses on a recent podcast about this very issue and their view was that, “we’re not suckers” – primary care is not as appealing as ICU work, for example.
Gina (Code Blog): Not every nurse wants to go back to school for additional years and shell out a lot of money to become a nurse practitioner and then not make a whole lot more than we’re making now. I’ve worked with nurse practitioners who have come back to work in the ICU because they can’t make enough money in primary care to support their families.
Strong One (MyStrongMedicine): We don’t have enough educators to teach nursing at our nursing schools. Nurse educators are paid about a quarter of what they’d make at the bedside. There are long waits to get into nursing school because we don’t have enough instructors to handle the influx. Until that problem is solved we aren’t going to see in increase in nurses entering the market.
Terri Polick (Nurse Ratched’s Place): I have a friend who’s a nurse practitioner and she had to borrow over $100,000 for her education. I’m a three-year diploma nurse so technically I don’t even have a college degree – but I’m making a lot more than nurse practitioners and I don’t have all that debt. Politicians need to know that nurse practitioners can’t just “pick up the slack” from physicians. Nursing and medicine are two different specialties and we’re trained to do different things.
So for those of you out there who may have shrugged at the primary care shortage and figured that when the docs are gone, someone else will just pick up the slack – think again. Any national universal coverage system will simply unmask what many physicians have known all along: equal access to nothing is nothing. Without making primary care a more attractive career option for providers of all stripes, don’t expect an influx of any sort into the field.
Long wait times for basic healthcare will probably become the norm in America.
