Hospitalist

Primary care, supply and demand

Economics 101 doesn’t apply to health care today:

Primary care supply is down. In a market economy, when demand outstrips supply, cost of goods goes up AND you increase supply to meet that demand. Supply ain’t goin’ up. The supply is all going into specialties which generate incomes of 2-10 times higher than primary care. It is the fault of false economies. Socialist policies. Government policies. A fixed and market …

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Quality measures . . that can kill

In the rush for quality, measures that harm patients will be inevitable:

Is Dr. Government willing to purchase malpractice insurance, to open itself up to lawsuits by the millions when one of their quality indicators show more harm than good. It will happen. Give it time. I guarantee you that. Will they shield themselves under the cloak of national interest. Of course they will. The fall out will be on …

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Time to cognate

A way to save primary care?

Universal health care: "It will kill innovation"

How more competition is needed in health care today. The Happy Hospitalist with two takes:

Price controls create artificial limits to productivity. Success is determined by somebody else, not yourself. You are the slave of someone else. There is no sky is the limit.

Competition forces innovation on the top line and bottom line. To survive, change must occur, and quickly, or you go bankrupt. That is …

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Free = more utilization

Common sense straight-talk on how to fix things:

Turn FREE into EXPENSIVE for the patient, not the sytem, and you fix the sytem. Only then will you cause a massive shift in the entitelment mentality and force upon this country the necessary evil.

Physician versus provider

Medicine is an art, and is that something any “provider” can give?

No painter, no matter who hard they try will ever be able to paint the exact same painting, ever. Anne, you are my painting, for which my artistic brush has created, what I believe, to be the best possible picture of health, based my my artistic abilities. You are different from every other person on this earth. …

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When medical errors become crimes

Exploring the case of Julie Thao.

"Money is currently being made by procedures"

Which is why medical students are staying away in droves:

Medical students, burdened with $200,000 in debt are voting with their wallets, choosing gastroenterology with it’s $200 13.5 minute colonscopies, or cardiology, with it’s unlimited access to procedures (echo, ekg, cath, stress test, pacers, ICD’s and on and on). Money is currently being made by procedures,not cognition. And there is no relief in site. In fact, Congress is proposing dropping …

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More doctor rating follies

It’s all through documentation, and can be easily manipulated:

You can see how statistics lie. Doc B may be an “inferior” doc, but knows how to play the system. Doc A maybe a doctor’s doctor but won’t play the documentation game, just practices good solid medicine. His published actual vs expected mortality data will pop up as an outlier for a doctor to avoid, when in fact, he could be …

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Money for earthquakes or health care?

Billions of dollars are being spent to make sure California’s hospitals are earthquake-proof. Is this really the best way to spend money?

So, you want to pay your doctor extra?

Well, that’s illegal for Medicare and Medicaid patients:

She was surprised that it is illegal to pay the difference between what we charge and what insurance collects. Here is a potential Medicaid patient willing to pay her fair share, and the system won’t allow it. Why? I have no idea why. Both patient and doctor win. Patient gets access, Doctor gets their fair fee.

Are hospitalists killing primary care?

No, it was pretty much dying anyways. (via Medrants)

"Witness the collapse of cognitive medicine before our eyes"

Thoughts from the Happy Hospitalist:

With my training, expertise and education, I should be able to collect at least $250/hour. I’m pretty sure medicare will pay me less than $75. After overhead I make less than a massage therapist for an hour teaching. Family’s happy but I can guarantee you that if I sent them a bill for the other $175, they would be furious. My time should be free, …

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Working as a hospitalist at Kaiser

What it’s really like.

Hospitalists

Sid Schawb on how his opinion has changed on the matter, and touches on surgical hospitalists in particular:

Taking acute consults and doing emergency operations, the surgical hospitalist makes the life of the rest of the surgeons far more pleasant, allowing them to see their patients, carry out their scheduled surgery without interruption. ORs run more efficiently because of the more ready availability of someone to fit in the …

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"It really is the very rare person who wants to do generalist practice"

Internal medicine circa 2005: 60 percent enter subspecialties. 15 percent become general internists, and more than half of those are becoming hospitalists.

Primary care is dying, may already be dead

This blog has consistently sounded the death throes of primary care – and the ivory tower academics don’t seem to get it. John Black sounds of on the many issues leading to the death of the profession:

Primary care is dying, and those in the ivory towers need to start beating the drum. One cannot tell the true vitality of internal medicine by what one saw and heard in …

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Hospitalists, officists, and recertification

Could the segregation of internal medicine be leading to lower pass rates on recertification exams?

The "officist"

With hospitalists all the rage, why bother studying critical care? retired doc explains:

If a residency trained internist becomes a “officist” you have to wonder what was the point of the ICU, CCU sick-patient training in the hospital that he endured and that in fact took up the bulk of his training. I suppose you could say he will be more able to recognize who needs to go …

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The hospital non-teaching service

The topic of whether a non-teaching service adversely affects medication education was brought up recently. Robert Centor with his thoughts on the mattter:

Dr. Wes is correct that some hospitals would rather have private hospitalists care for patients. Program directors and chairs of medicine must fight that trend . . .

. . . I know that it can be done right, because I see it being …

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