acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as a team is one of the biggest reasons for my practice satisfaction increasing ...

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It is time for me to dig out from under the frustrating quagmire of paperwork imposed on me by my insurance contracts so I can reclaim my sanity and love of my work. I am terminating all of my in-network contracts, firing my billing service, and focusing my clinic time and energy entirely on patient care.  Removing my practice from the control and limitations of health care insurance companies allows ...

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A recent story in Crain’s New York Business cited the difficulty small independent medical practices face coping “with declining reimbursement rates from insurers, rising overhead costs and a torrent of new regulations that have come into play in recent years.” According to the article, only 26 percent of New York state physicians now own their own practice, compared with national rates of physician ownership of 76 percent thirty years ago. ...

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In the years since the medical community first got revved up on the idea of “value-based care” -- the conceptual antithesis of the “more is better” fee-for-service model -- a common target of criticism has been the routine physical, one of the most time-honored traditions in medicine. The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead to ...

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My new patient looked around dodging my eye contact, scanning the ceiling, the room, and me. I felt that she was hiding something. In my clinic, I often find it one of the most difficult challenges to get new patients to open up, and one of the most beautiful moments when they finally do. I stopped interviewing midsentence and took a step back. “Let’s just get to know each other. I’m ...

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Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, ...

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Beyonce wasn’t kidding when she wrote the song “Girls Run the World.”  We as women wear as many hats as some of us have shoes.  However, the cost of that can be grave if we never learn to create balance in our lives.  When I say balance I don’t mean the balancing act, I mean the act of giving back to ourselves.   Imagine that you have an energy bank account.  ...

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In the middle of a five-way thoroughfare intersection, with the early-morning sun's glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap, whose silver eye stared helplessly from among the automotive debris of previous accidents. A policeman blocked the lanes until I could pilot my car into the gas station on the other ...

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  It’s Wednesday, the day after the election. I spent the previous night clicking from one website to another, trying to find someone who was refuting what the others said was true. And when it became inevitable, I held my infant twin boys and cried. Now I’m in front of my exam room, walking in to see Mr. Bundy. I open the door to find him wearing a red hat embroidered with ...

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In my previous post, "Have physicians finally joined the working class," I discussed the changes in the health care system regarding physicians roles in these systems. In this post, I propose two strategies that could help physicians regain some influence over their work and to participate fully not just in the execution of strategy from management but also have an input in creating it. Building unions There has been a ...

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