The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland. In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private ...

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The setting: an inpatient unit in the Bronx, circa 2005. I was a resident (and hence was likely disheveled, groggy or exhibiting some other outward display of exhaustion) of the internal medicine program at Albert Einstein University Medical Center/Moses Division, aka Montefiore. The fact that the program was considered "malignant" by those in my industry — mainly due to the strict nature of the training program — likely strengthens the possibility ...

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It’s no secret that health care is an unbelievably complex subject. One of the most complex issues facing the health care system is that of surprise medical bills. Surprise medical bills happen when:

  • Patients receive emergency care by an out-of-network provider (one not included in their insurance plan);
  • Patients are unaware that one or more of the providers of their non-emergent care were out-of-network; and
  • Patients choose out-of-network care without ...

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In the market for a locum tenens position? If you search online "How to book a locum assignment?" you'll likely find vague advice such as "Develop a relationship with a recruiter." Or "Do your homework when choosing an agency." Thanks, Internet ... Having worked as a locum tenens recruiter for over 15 years, I have seen consistent trends in how the best clinicians are able to stand out and book jobs. ...

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One stunning afternoon I walked into a patient’s room to discuss our plan, informing her that the nurse would come to draw blood. “You can draw my blood, Miss,” said the male family member sitting in a corner of the room, as far from the patient as possible, his legs crossed, smirking, “We can go into the next room and lock the door.” His smug grin brought back memories of older men ...

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There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance and the government. It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs and, ultimately, reduce care quality as a result. Lawmakers should focus on this “first pillar” of cost control as they go back ...

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Thanks to internist Steven Mussey for translating the language of hospital administrators.

Rehabilitation medicine is one of the best-kept secrets in health care. Although the specialty is as old as America’s Civil War, few people are familiar with its history and purpose. Born out of compassion for wounded soldiers in desperate need of societal re-entry and meaningful employment, “physical reconstruction” programs were developed to provide everything from adaptive equipment to family training, labor alternatives and psychological support for veterans. Physical medicine and rehabilitation ...

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“I was surprised when the emergency doctor at Cityside Hospital said he was going to call you to discuss my case," Farmer Carr said when I saw him today. “I figured you’d be asleep at that hour.” I smiled as I recalled the cell phone call that had come in at 9:30 the night I had sent him back to the hospital for a reassessment. “No, I was sitting in my camping ...

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The moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the wrong move or give a wrong answer, have them see rust on a ceiling sprinkler, ...

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