Volume is key

Dr. Rob nails it. He has taken the fee-for-service system given to him and makes the most of it.

We in primary care have an access issue. People wait months for an appointment. The demand is clearly there.

Doctors who don't find innovative ways of increasing their access are, i) causing patients to be further unsatisfied with their care, and ii) leaving proverbial chips on the ...

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Just like any other professional.

Richard Reece points to the dermatology, which is rapidly progressing into a two-tier field.

There are the third-party payer patients, who have long wait times and are often seen by physician extenders; and the cash-only cosmetic patients, who are seen instantly in luxurious settings.

So, if you want the medical profession to adopt electronic records, practice evidence-based medicine or raise ...

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Will this dissuade the anti-vaccine fanatics? Probably not, as their minds are made up.

But for those who are on the fence, this is more evidence that vaccines are safe.

Non-compliance

As Charlie Baker recovers from his foot injury, he talks about the difficulties of following medical orders to the letter.

Pay for performance will become widespread in the near future. How to deal with patients who are unwilling, or unable, to listen to physician orders will be a more relevant issue.

For instance, there is a subset of diabetic patients who are unwilling to take ...

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A combination of Botox and fillers would help, says a group of plastic surgeons and dermatologists.

Some speculate that he's already received cosmetic laser therapy.

Atrial Fibrillation

If I Had - Atrial Fibrillation - Dr. Zayd Eldadah, MD, PhD, Washington Hospital Center
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Information officers are paying physicians $120 per hour to participate in the implementation of electronic medical records.

That's admirable, first for including essential physician input on the planning committee, and second, for recognizing the value of a doctor's time.

(via The Medical Quack)

Sex addiction

The truth was out there recently, when David Duchovny entered rehab for sex addiction.

What exactly is that, and how is it treated?

Good doctor qualities

Rural Doctor writes about ideal traits that can apply to every physician.

I concur with "unruffleability". Performing well under pressure or unexpected circumstances is essential. This is why physicians who are booksmart do not necessarily make the best doctors.

This is especially true during training. A person's true color only comes out under the harsh circumstances that residency provides.

Nursing shortage

The bottleneck appears to be lack of faculty to teach new nurses. Predictably, the reason comes down to money:

Why would a master's-educated nurse accept a job as a professor at a local college or regional university for $60,000 yearly when (s)he can potentially earn $80,000 to $100,000+ per year as a"¦[clinical practice nurse in] a large healthcare network?

Extreme blog makeover

Many thanks to Shane Pike, who helped with the new template for my blog.

He's offering an Extreme Blog Makeover for September's top 5 contributers over at Healthcare Today, which includes blog migration, a new template, one-year of free hosting, and consultation with Shane.

For those familiar with blog tweaking, an offer like this can easily run into the thousands of dollars. It's a great opportunity for those ...

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I haven't tried it yet, but will soon. I've read that its Java and ASP processing is unsurpassed, in anticipation of Google re-inventing the operating system that will work solely through its browser.

How does this apply to electronic medical records? If Google Chrome takes off, Canadian EMR suggests that the next generation of EMRs will be ASP-based and will make Windows-based systems obsolete.

This ...

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Is strong.

Primary care

Must-read piece from Maggie Mahar, explaining the implications and causes of the primary care shortage. Many points are familiar to readers of this blog, but here are a few that I'd like to underline.

i) Some physicians (invariably naive academics) feel that the lack of medical student exposure to practicing primary care doctors discourages them from entering the field.

That is absurd.

An upcoming study suggests ...

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The medical home has been hailed as the savior for primary care. Specialists have yet to hop on board, likely because of the threat the increased payments have on their salaries.

Emergency physicians aren't that enthused either. They seem pretty bitter with EMTALA, and want primary care to take on all comers as well:

According to the ACEP, primary care sites should promise to continue to ...

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The public may have little sympathy for "overpaid" physicians and some think they deserve a pay cut.

That's fine.

But how does that really solve the reality of the situation?

Medical students graduate with a mortgage-sized school debt see specialist salaries several times more than their primary care counterparts. Predictably, this leads to a specialist boom.

Motivated undergrads read about declining physician salaries in ...

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Volunteer EMT

A man works at a law firm by day, and takes one a night a week to volunteer as an EMT. As he puts it, "At work and at home, no situation rivals the pressure of emergency care."

Nicely put. I would propose that all the policy wonks shadow a shift in the emergency room.

Perhaps some of their ideas may change after experiencing first-hand ...

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Respect

Is it really too much to ask?

Nurses and orders

Emergiblog is upset that nurses are being restricted in starting the initial workup for chest pain and obvious fractures.

I agree that this is ridiculous, especially in the emergency setting where every second counts.

Every nurse order eventually has to be signed by a physician. With overzealous regulation by JCAHO and hospital administrations, doctors are often looking over their shoulder, fearing the repercussions of any ...

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