In a previous post titled, “Is Making Primary Care More Professionally Satisfying as Simple as Lowering Panel Size” I observed that lowering panel size and implementation of an electronic medical record did not change how doctors worked. Those doctors who stayed late continued to stay late. Those who left earlier tended to continue to leave earlier. Within a health care organization often touted by many to be an example of how health care should be delivered in the country, this phenomenon existed. Why? Was making primary care more professionally satisfying and more attractive to future doctors simply more than lowering panel size? Doctors at the Permanente Medical Group, where I practice, do not have many of the frustrations of other primary care doctors. Doctors are salaried. There is no perverse incentive of doing more tests or more procedures when there is no medical benefit. Doing more is a common pressure […] Read More »
Category Archives: Other
Is Making Primary Care More Professionally Satisfying As Simple As Lowering Panel Size?
Posted on November 3, 2013
As a practicing primary care doctor, I very much enjoy my career choice. I’m fortunate enough to be in a large multispecialty practice that is collegial and forward thinking. If I was in a smaller practice like other colleagues, I would not quite feel the same. Yet concern about how to make primary care attractive for both future doctors and those currently in practice has been something I’ve been occupied with since 2010. It is simply about lowering panel size? Though that may help, the answer is more complex than that. In this post and a future post, I ask that question and propose a framework on how primary care can be better and how physician leaders might best address the problem. In 2006, my medical group transitioned to an electronic medical record (EMR). Interestingly, nothing changed on the amount of time doctors spent in the office. After becoming more […] Read More »
Why Doctors Should Read Malcolm Gladwell’s David and Goliath. Can a David Fix Health Care?
Posted on October 16, 2013
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare continued to march forward with the opening of the insurance exchanges. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath. Gladwall ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? When might a disadvantage for an underdog appear to be an advantage? As I put his observations together, I wondered are there any learnings for doctors and the health care system? Absolutely. A David typically does not have the resources or power to make a difference as viewed by conventional terms. Gladwell uses stories like the US civil rights movement, successful individuals with a dyslexia, and his excellent New […] Read More »
The problem with health insurance exchanges. The risk for patients. Pension plan to 401k analogy.
Posted on October 3, 2013
With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer based insurance coverage who may lose. They just don’t know it yet. Employers have found it difficult to absorb the rising health insurance premiums and costs, which have increased faster than inflation. They have tried many ways to slow health care spending including requiring employees to have more “financial skin in the game” to encourage them to make “smarter” choices about their health care. They’ve done this with higher deductibles and co-pays and requiring employees to pay a larger percentage […] Read More »
The Brutal Reality of Primary Care – Family Medicine
Posted on September 12, 2013
She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors”, http://www.youtube.com/watch?v=mURDwg_wilE, and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents. So this past hot Labor Day weekend in Los Angeles, I was thrilled to catch up with my former chief resident. We hadn’t seen much of each other since completing our residency many years ago. She dropped by with her 3 year old and apologized that her 8 year old daughter would be unable to attend since she was taking tennis lessons with her father. How was life treating her? Challenges in being a parent? I heard she had started […] Read More »
Get important exclusive advice and tips on how to save money while staying healthy.
Learn how to make intelligent choices in America's Healthcare System.