In 2010, I started practicing direct care in Wichita, KS. I steadily built a full roster of subscribers who pay between $10 and $100 per month to see me whenever they need to, for as long as they need to, however they want to (at their home, in my office, or via the Internet), all with zero co-pay. Recently, a patient of mine developed ongoing shoulder pain. He’s middle-aged, insured, in ...

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At a recent faculty meeting, the attendings in our practice were asked about their availability for new patient appointments. The vast majority reported that due to time constraints and patient volume, they had closed their panels to new patients. For those of my partners with open schedules, the wait for new patients to be seen was averaging 2 to 3 months, a few up to 6 months. The time to the ...

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MD-Compensation-Report Now a median of $174,000 per year is hardly chump change, so I don’t expect much in the way of sympathy on these data. On the other hand, someone has to to be last, and note that our income hasn’t increased a bit since the last time I commented on this survey three years ago. So it’s worth taking a few moments listing ...

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As physicians we are trained to assimilate data, analyze and interpret findings, and make the correct decision -- every single time.  Often these tasks must be performed very quickly and in emergency settings.  For those who perform invasive procedures, decisions are often made “on the fly” and can have significant consequences. In addition to our clinical duties, physicians are now thrust into executive roles as well.  Managing practices, budgets, government mandates ...

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A recent article in the New York Times highlighted the high costs associated with some types of subspecialty medical care, in particular dermatological procedures like Mohs surgery. Indeed, the patient profiled in the piece went for a minor procedure which, including facilities fees and questionable referrals to an anesthesiologist and plastic surgeon, generated billing that topped an unconscionable $25,000. This piece led to the predictable
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Recently, a friend posted a story on my Facebook page: “How Being a Doctor Became the Most Miserable Profession,” Oh no. “Another article on miserable doctors,” I thought. I’m an expert on miserable doctors. I used to be one. Why should I read this? What could I possibly learn? I decided to ignore it. The next day another friend posted it. Then another. Okay, now it was assigned reading. I steeled myself ...

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The other day I received my copy of the periodic newsletter of our neighboring Canadian medical society. It made me realize that both countries’ primary care doctors, in spite of our entirely different health care systems, are facing some of the same issues. The bulletin warned Canadian doctors not to enforce a one-problem-per-visit policy, but to offer more comprehensive care to their patients. The way doctors and clinics are paid in most ...

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The New York Times has a recent piece on the practice of doctors Googling their patients. The author, Dr. Warraich, intimates that essentially all doctors have done it at some time. He also writes:

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ -- and all of our -- growing dependence ...

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It seems that in the past few weeks, physicians across America have reached the breaking point. Internist Daniela Drake wrote in the Daily Beast about how miserable it is to be a physician. She talked about the lack of respect, the lack of time to see patients due to increasing paperwork and the ever-present board certification processes. Orthopedic surgeon Daniel Craviotto Jr. wrote "A Doctor’s Declaration of Independence" in the ...

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Remember personal responsibility? There actually was an era of responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes. I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault. In today’s culture, this is not scapegoating, but the pursuit of justice. Welcome to the era of big victim. In the ...

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