Let's talk internal medicine maintenance of certification (MOC). I recertified back in 2011, and it was an onerous process capped off with a challenging exam.  Thankfully I passed, and I'm good until 2022. Since then, the American Board of Internal Medicine has made maintenance of certification a more "continuous" process, and is sparking some outcry among physicians.  Wes Fisher has multiple posts on his site ...

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A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions. In short, patients were less likely to fill a prescription if the treatment was expensive, but certain ...

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Our privacy is eroding. Some of this erosion is our own fault -- we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication -- electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much -- if Target knows that I buy a lot of Cheerios, I’m ...

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I’m not a doctor.  And sure, you know your patients better than I do. But, I have been a patient and as a patient, I know how we think. As someone who works in health IT helping to create software to better connect patients and providers, I like to think I have a hypersensitive pulse on what’s going on. I know that as patients, sometimes we get frustrated trying to solve ...

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When they’d first entered their medical practice, some of my clients had asked an instructor or mentor to review their prospective employment agreement for them. Although these people may have been excellent physicians or teachers, they weren't acting in the best interests of their charges. When it comes to your livelihood, it's important to have an attorney, especially one who’s experienced in health law and has drafted hundreds of these ...

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My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient's health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles ...

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She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up. I sighed. "We've done the work-up and know this is not your heart. I don't think there are a lot more tests that can be run." I studied her expression, trying to discern what she wanted to hear from me. I've come ...

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Next in a series. Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the ...

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Projecting future physician workforce needs is a challenging calculation that must take multiple variables into account to avoid missing its mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large "physician surplus" and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program. Two decades later, there is a widespread consensus that the U.S. is ...

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Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing ...

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