As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime.  From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable.  Bionics and the repair of human tissues was captivating and the Six Million Dollar Man became a hit series. Now, much of what was thought to be ...

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I’m not sure if you’ve heard the parable of the tall man and the cat. Maybe not, since I had to make it up in light of health care’s unending cost increase. In this allegorical village, there was a group of citizens who were very upset with a man who lived there. This man was very, very tall, and he made all the villagers feel uneasy (they were insecure about the crowns of their heads, ...

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We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid. The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or ...

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“So like a concierge doctor?” That was the most common response upon explaining my future direct primary care practice while in residency. That perception and label really perturbed me. My vision was to care for a diverse group of people. I spent the majority of my residency clinic hours in an urban safety net clinic, but certainly didn’t want to swing the pendulum to the opposite 1%. To avoid that stigma, I ...

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Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies.  The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease.  As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give ...

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As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures. While I am no means an expert of health policy nor medical business and financing, I think it's important for medical trainees and enthusiasts alike to understand the very general basics of ...

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I chose to leave clinical medicine in 1996 after just three years as a general internist. At the time, I was certain that it was the right decision and necessary for my overall health, but could not have articulated all the reasons why I needed to leave. I loved both the intellectual challenge and the art of medicine. I thoroughly enjoyed my connections with patients. I regarded my professional life ...

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We’re living in a world or ratings. Books get rated on Amazon, dry cleaners get rated on Yelp. Doctors are getting rated, too -- not only on web sites, but also in ways that end up dictating how much money we can make, or whether we can keep our ability to work in a hospital. Is this a good way to improve medical care or medical outcomes? Is it ...

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Prestige in medicine often follows research. Physician-scientists who do basic science research have often been considered among the giants of medicine. As the field of medicine advanced, the gap between what we knew from basic science and how we practiced grew. This created a need for more translational researchers: physicians who could bring what they knew from the laboratory bench to the bedside through large clinical trials. Now, the next great gap ...

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Are insurance companies making more decisions about the health care you receive? While a decade or two ago utilization nurses working for insurance companies had some power to approve or reject certain treatments, the reach of insurers into the patient-physician relationship is lengthening. In March, I reported that insurers were sending questionnaires to policyholders newly insured under Obamacare asking about their health conditions and medical needs. And some people were filling them ...

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