While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider ...

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I share this post here to point out the discrepancy in physicians' average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine. This post is not written to argue that physicians must be paid more. I would submit that if ...

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Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches. Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the ...

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A guest column by the American College of Physicians, exclusive to KevinMD.com. I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many of us about health care in the U.S., there is often an answer that points quickly to a particular villain ...

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I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that ...

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FACT: Four determinants of health account for 40% of all deaths in the U.S. – smoking, unhealthy diet, physical inactivity, and alcohol use. FACT: A mere 3% of Americans do all of the relatively "simple" things they should to stay healthy – i.e., exercise for 20 minutes 3 times a week, don't smoke, eat fruits and vegetables regularly, wear seat belts regularly, and remain at their appropriate BMI. FACT: According to the ...

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Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources.  A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients. Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients ...

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Recently I was sent this commentary on the issue of health care costs.  It seemed like a pretty good summary of the problem to me, though it didn't delve into solutions or the current controversy about the Affordable Health Care Act.  In our country, we've built up a huge medical-industrial system that can do lots of good but at a huge cost.  It seems that we are on the brink of a ...

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Recently, I had a wonderful opportunity to cruise the Mediterranean and visit some fascinating cities.  The land excursions were mind-expanding but quite physical. The rugged terrain and steep hills were not difficult to walk upon because I was in good shape and healthy. But, what if I wasn’t?  Questions raced through my mind such as: What if I got sick onboard the ship? What if I got injured? What type of doctor signs on ...

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Malpractice lawsuits are a necessary evil in our society.  At times, they are frivolous, often resulting from a patient’s or family’s anger at a result that was not what they had hoped.  Some are actually designed just to try to get a financial settlement.  When doctors are sued for malpractice, it is a searing process, isolating and painful.  I have known several excellent doctors who have given up established practices ...

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