The healthcare reform debate, not to mention the rising costs and increasing demands, has forced many physicians to consider the future of their profession.
So for the April issue, we considered what the job of the private practice physician would look like in 10 or 20 years. I spoke with a host of innovative thinkers and practitioners who shared their views on how the profession would transform.
From virtual visits to more midlevels to a new reimbursement model, I heard many compelling predictions about the future of healthcare.
I invite you to check out the article and share your own notions of how the landscape will evolve.
Friday, April 2, 2010
Thursday, April 1, 2010
Randall Wong, MD: Content is king
The success of any Web site is the content of that site. No matter what the nature of the content (i.e. health information, practice information, etc.), good content will increase the popularity of the site. Here are a few tips about writing good content to keep your readers happy and to maximize your SEO (search engine optimization).
Remember, Google and your patients like relevant and fresh content. There is nothing worse than going to a Web site that is old and stale (no new information) or to a Web site where portions are still "under construction."
People are eager for information. They want answers — now! Irrelevant information or stale Web sites are a huge turnoff.
If you want to add content to your Web site, I suggest starting with two or three topics. This is a small enough number of projects that you can complete in a reasonable amount of time. And remember that Google ranks Web pages, not Web sites. You want to have two or three "cornerstone" topics of your Web site. The more complete they are, the better they will rank.
Read more
For instance, while I am a retina specialist, I only have three cornerstone areas: diabetic retinopathy, macular degeneration, and retinal detachment.
Once you have created a sound foundation, then branch out. Watch out, don't be surprised if this takes weeks!
Write in a style that is comfortable for you, but relates to the patient. My own bias is that too many docs speak in a so-called business phase. I am comfortable writing in the same style that I use when seeing patients in the office. This works for me.
By speaking and writing at the same level, you stand a better chance of engaging your readers, and thus lending more credibility to yourself. Writing above your readers’ level and using too much techno-mumbo-jumbo are two great ways to bore your readers. They'll never come back.
Write regularly and often. I try and write on my own blog at least four times a week Monday through Friday. Next month, I will be approaching my 200th post. I am not saying you have to write this much. I used myself as an example. I have now reduced my writing frequency to about three times a week after establishing a pretty comprehensive archive.
Sticking to a regime is the hardest part, but there are several ways to avoid self-exploitation:
Ghost writers - there is a huge market for this and I'll share more with you in the future, but there are a ton of good writers looking for work.
Guest bloggers - this may be hard to achieve in the beginning, but there are many bloggers looking for links back to their own blogs who might write an article or two for you. I do this myself.
Your colleagues could also chip in and create content articles for you.
Be thorough, but not too thorough. This is tough for us. We tend to be know-it-alls. Keep the length of your article similar to what you read here. I'd recommend no more than 500 words and I'd shoot for a good 350 each time you start. The cornerstone articles should be a bit longer, think of them as reviews. Perhaps choose a length of 500-1000 words for the main bits.
Too lengthy gets boring. Too wordy is dull. You don't have to include every detail that you know. Just share a part of what you know. The goal is to show off your knowledge (i.e. authority) without being cocky or boring. Break it up into parts if you have that much to write about.
Remember, Google and your patients like relevant and fresh content. There is nothing worse than going to a Web site that is old and stale (no new information) or to a Web site where portions are still "under construction."
People are eager for information. They want answers — now! Irrelevant information or stale Web sites are a huge turnoff.
If you want to add content to your Web site, I suggest starting with two or three topics. This is a small enough number of projects that you can complete in a reasonable amount of time. And remember that Google ranks Web pages, not Web sites. You want to have two or three "cornerstone" topics of your Web site. The more complete they are, the better they will rank.
Read more
For instance, while I am a retina specialist, I only have three cornerstone areas: diabetic retinopathy, macular degeneration, and retinal detachment.
Once you have created a sound foundation, then branch out. Watch out, don't be surprised if this takes weeks!
Write in a style that is comfortable for you, but relates to the patient. My own bias is that too many docs speak in a so-called business phase. I am comfortable writing in the same style that I use when seeing patients in the office. This works for me.
By speaking and writing at the same level, you stand a better chance of engaging your readers, and thus lending more credibility to yourself. Writing above your readers’ level and using too much techno-mumbo-jumbo are two great ways to bore your readers. They'll never come back.
Write regularly and often. I try and write on my own blog at least four times a week Monday through Friday. Next month, I will be approaching my 200th post. I am not saying you have to write this much. I used myself as an example. I have now reduced my writing frequency to about three times a week after establishing a pretty comprehensive archive.
Sticking to a regime is the hardest part, but there are several ways to avoid self-exploitation:
Ghost writers - there is a huge market for this and I'll share more with you in the future, but there are a ton of good writers looking for work.
Guest bloggers - this may be hard to achieve in the beginning, but there are many bloggers looking for links back to their own blogs who might write an article or two for you. I do this myself.
Your colleagues could also chip in and create content articles for you.
Be thorough, but not too thorough. This is tough for us. We tend to be know-it-alls. Keep the length of your article similar to what you read here. I'd recommend no more than 500 words and I'd shoot for a good 350 each time you start. The cornerstone articles should be a bit longer, think of them as reviews. Perhaps choose a length of 500-1000 words for the main bits.
Too lengthy gets boring. Too wordy is dull. You don't have to include every detail that you know. Just share a part of what you know. The goal is to show off your knowledge (i.e. authority) without being cocky or boring. Break it up into parts if you have that much to write about.
Gerald O'Malley, DO: Secret myths and quiet truths of the ER
I was in the grocery store the other day and something caught my eye as I pushed the bananas and Ho-Hos through the price-check scanner. Reader’s Digest had an article about my childhood hero, Willie Mays (I know he was a Met, but even Yankee fans recognize greatness), but that wasn’t what made me buy the magazine.
It was the picture of the young woman dressed in scrubs accompanied by a headline like: “50 Secrets ER Doctors Won’t Tell You (Read This Before You Call 911).” I couldn’t resist.
The American ER (and the people that work in ERs) has always been fertile ground for urban myths and legends. I’ve heard the same outrageous stories told in ERs from Virginian Beach to Los Angeles: The violent PCP patient tossing around security guards after being tazed, the guy with the vibrator in his rectum, the “dead” patient that sits up and moans…
ERs all have similar stories and sometimes it gets hard to separate truth from fiction. Reader’s Digest actually picked some uncomfortable but undeniable truths to reveal as “secrets.”
Some of my favorites from the March issue of Reader’s Digest include:
Read more
• Never, ever lie to your ER nurse. Their BS detectors are excellent and you lose all credibility when you lie.
• Standing in the doorway and staring at us while we work won’t help your loved one get treated more quickly. We’re pretty used to people trying to intimidate us.
• The busiest time starts around 6 p.m.; Mondays are the worst. We’re slowest from 3 a.m. to 9 a.m. If you have a choice, come in the early morning.
• If you come in with a bizarre or disgusting symptom, we’re going to talk about you. We won’t talk about you to people outside the ER, but doctors and nurses need to vent, just like everyone else.
Harsh to read, but I had to grudgingly admit that there was some truth to the “secrets.” The reality is that this can be a really crappy job a lot of the time. For every good, happy, positive outcome, there are a dozen that are heartbreaking and terrifying.
The first of the 50 secrets in the article seemed a little obnoxious and condescending. It read: “Denial kills people. Yes, you could be having a heart attack or a stroke, even if you’re only 39 or in good shape or a vegetarian.” Seemed a little self-evident to me.
Tonight I tried everything in my power to resuscitate a 43-year-old woman that I pulled out of the front seat of her boyfriend’s car. I remember smelling and seeing the burning cigarette in the car ashtray as I wrenched my back trying to untangle her feet from under the dash, lift her out of the car and drag her out onto the ER gurney. The boyfriend took the time to light and smoke a cigarette while he drove this dying woman to the ER.
I thought of the first secret as I sat to explain to her 13-year-old son why I couldn’t save his mother.
It was the picture of the young woman dressed in scrubs accompanied by a headline like: “50 Secrets ER Doctors Won’t Tell You (Read This Before You Call 911).” I couldn’t resist.
The American ER (and the people that work in ERs) has always been fertile ground for urban myths and legends. I’ve heard the same outrageous stories told in ERs from Virginian Beach to Los Angeles: The violent PCP patient tossing around security guards after being tazed, the guy with the vibrator in his rectum, the “dead” patient that sits up and moans…
ERs all have similar stories and sometimes it gets hard to separate truth from fiction. Reader’s Digest actually picked some uncomfortable but undeniable truths to reveal as “secrets.”
Some of my favorites from the March issue of Reader’s Digest include:
Read more
• Never, ever lie to your ER nurse. Their BS detectors are excellent and you lose all credibility when you lie.
• Standing in the doorway and staring at us while we work won’t help your loved one get treated more quickly. We’re pretty used to people trying to intimidate us.
• The busiest time starts around 6 p.m.; Mondays are the worst. We’re slowest from 3 a.m. to 9 a.m. If you have a choice, come in the early morning.
• If you come in with a bizarre or disgusting symptom, we’re going to talk about you. We won’t talk about you to people outside the ER, but doctors and nurses need to vent, just like everyone else.
Harsh to read, but I had to grudgingly admit that there was some truth to the “secrets.” The reality is that this can be a really crappy job a lot of the time. For every good, happy, positive outcome, there are a dozen that are heartbreaking and terrifying.
The first of the 50 secrets in the article seemed a little obnoxious and condescending. It read: “Denial kills people. Yes, you could be having a heart attack or a stroke, even if you’re only 39 or in good shape or a vegetarian.” Seemed a little self-evident to me.
Tonight I tried everything in my power to resuscitate a 43-year-old woman that I pulled out of the front seat of her boyfriend’s car. I remember smelling and seeing the burning cigarette in the car ashtray as I wrenched my back trying to untangle her feet from under the dash, lift her out of the car and drag her out onto the ER gurney. The boyfriend took the time to light and smoke a cigarette while he drove this dying woman to the ER.
I thought of the first secret as I sat to explain to her 13-year-old son why I couldn’t save his mother.
Wednesday, March 31, 2010
Trendspotter: Do We Want Hospitals to Run Health Care?
By Ken Terry
Major changes in the healthcare delivery system are coming, and they will affect every physician. The question is whether those changes will have the effect we all want or whether they will lead to unintended consequences that we don’t want.
Back in the 1990s, during the debate over the Clinton plan and in the period following its rejection, hospitals and physicians began preparing for what they assumed was going to be a massive shift to prepaid managed care. While that never happened, many physicians joined larger single-specialty and multispecialty groups, and hospitals purchased many practices, some of which they later returned to their owners. Something similar is happening now as hospitals snap up practices right and left in anticipation of a reform-driven shift to various types of financial risk. According to one estimate, around half of the doctors in the country are already working for hospitals, and there are some markets where hardly any private practices still exist.
Some experts believe that the fragmentation of our delivery system is responsible for much of our out-of-control spending and the poor quality of care, especially at the primary level. In that view, the disorganization of American medicine, coupled with fee for service and overspecialization, encourages redundant, wasteful, and even harmful care. But I question whether hospitals and healthcare systems are the right agents to reduce this fragmentation by employing more and more physicians.
The problem with the hospital-centric view of the world is that it’s all about hospitals. Whether for-profit or not-for-profit, hospitals seek to maximize their revenues, their market share, and their competitive advantage. In that sense, they’re very much like corporations in any other field. When they employ physicians, they’re thinking about the value of each doctor’s admissions – about $1.5 million per year, on average – and whether they want their competitors to get those referrals. They may also be considering how a particular physician or group can help sustain or grow existing or new service lines and feed new imaging equipment.
Having hospitals run a revamped, better-organized system creates other issues as well. One is related to the mal-distribution of specialists, which is endemic across the country. Some communities are saturated with specialists, while other communities have very few or no specialists in certain key fields. As hospitals control an increasing percentage of physicians, some facilities will not be able to provide certain kinds of care, because the competing hospital in town has locked up all of the specialists who are capable of providing those services.
There is much validity in the concept of “accountable care organizations”--combinations of hospitals and doctors that can provide particular services or types of services for a budgeted payment, with the ability to share in cost savings. ACO supporters say that these organizations might be “virtual” organizations that tie together independent practices and hospitals through information technology. Unfortunately, however, one outcome of the move toward ACOs and payment bundling—both goals of the reform legislation—might be the growth of hospital power in many communities. And I don’t think we should place responsibility for the future of healthcare in the self-interested hands of hospitals.
I’m not predicting that this is the only possible result of current trends. We’re also facing the influx of millions of newly insured patients in 2014, and it’s clear that there won’t be enough primary-care physicians to care for them. That will be true even if every primary-care doctor in the country is working for a hospital by then. So we’re going to see an increasing emphasis on community health centers, which have received a steep increase in funding from the Obama Administration. Those clinics, which now care mostly for poor patients who have little money, will soon be seeing more middle-class patients—just as retail clinics do. So they will be competing with hospitals, but I don’t see them ever having the same power and influence that the healthcare systems do.
What we need now is for policymakers to give some serious thought to the long-term implications of the trends that are now being set in motion. It’s always easier to make course corrections along the way than to deal with unintended consequences later on.
Tuesday, March 30, 2010
Jennifer Frank, MD: An "oops" of epic proportions
An acquaintance recently reminded me of a painful episode in my parenting history. “I was telling someone about you yesterday,” she started. “My friend was giving me grief for not bringing our daughter to the doctor right away when she had a wrist fracture. I told them that you missed your son’s clavicular fracture and you’re a doctor.” Ouch.
Two summers ago, our oldest son was playing with a friend while we were attending a minor league baseball game. His friend swung him around and let go. Our son landed on his outstretched arm and started crying.
My husband brought him back to where I was sitting with our daughters. He seemed like he was in a lot of pain, but it was hard to tell if he had fractured something. I palpated along his humerus, rotated his hand back and forth, looked for swelling. He could move his arm but said his shoulder hurt. It wasn’t dislocated and I couldn’t find anything specifically wrong. So, we comforted him with cotton candy, stayed for another 30 minutes to watch the end-of-game fireworks and headed home.
Read more
Our son alternately appeared totally fine and then would start crying and complaining about his arm hurting. On the drive home, my husband and I debated the necessity of a trip to the ER. I did a more careful exam in our kitchen once we arrived home. He was guarding his arm a bit but told us that it felt better. It was late and we were all tired. I imagined how we would be triaged on a busy Saturday night in the ER and pictured waiting with a sleepy, cranky kid for hours. We gave him some ibuprofen and put him to bed, planning to take him in the next morning if it was still hurting him.
By the next morning, he seemed better. He was playing happily in his room. Every once in awhile he would complain of his arm hurting, but as he tends to be overly dramatic at times, we weren’t sure how much he was actually bothered by his arm. I would spy on him as he played Legos to see if he was using that arm or not. He seemed to hold it close to his side but would use it if needed. I still wasn’t sure. We decided to keep observing him.
By Tuesday morning when he was still complaining of arm pain, we took him to his family doctor. Unfortunately, he had suffered a clavicular fracture. Fortunately, he had self treated it by holding it flexed and close to his body. He was fitted with a cool-looking arm sling that offered a little bit more protection until the bone healed itself.
Of course, my husband and I both felt terrible, and still do, that we – two physicians – missed this in our own child. However, it helps me to comfort my patients’ parents when they too miss something and serves as a good reminder why I don’t doctor my own kids.
Two summers ago, our oldest son was playing with a friend while we were attending a minor league baseball game. His friend swung him around and let go. Our son landed on his outstretched arm and started crying.
My husband brought him back to where I was sitting with our daughters. He seemed like he was in a lot of pain, but it was hard to tell if he had fractured something. I palpated along his humerus, rotated his hand back and forth, looked for swelling. He could move his arm but said his shoulder hurt. It wasn’t dislocated and I couldn’t find anything specifically wrong. So, we comforted him with cotton candy, stayed for another 30 minutes to watch the end-of-game fireworks and headed home.
Read more
Our son alternately appeared totally fine and then would start crying and complaining about his arm hurting. On the drive home, my husband and I debated the necessity of a trip to the ER. I did a more careful exam in our kitchen once we arrived home. He was guarding his arm a bit but told us that it felt better. It was late and we were all tired. I imagined how we would be triaged on a busy Saturday night in the ER and pictured waiting with a sleepy, cranky kid for hours. We gave him some ibuprofen and put him to bed, planning to take him in the next morning if it was still hurting him.
By the next morning, he seemed better. He was playing happily in his room. Every once in awhile he would complain of his arm hurting, but as he tends to be overly dramatic at times, we weren’t sure how much he was actually bothered by his arm. I would spy on him as he played Legos to see if he was using that arm or not. He seemed to hold it close to his side but would use it if needed. I still wasn’t sure. We decided to keep observing him.
By Tuesday morning when he was still complaining of arm pain, we took him to his family doctor. Unfortunately, he had suffered a clavicular fracture. Fortunately, he had self treated it by holding it flexed and close to his body. He was fitted with a cool-looking arm sling that offered a little bit more protection until the bone healed itself.
Of course, my husband and I both felt terrible, and still do, that we – two physicians – missed this in our own child. However, it helps me to comfort my patients’ parents when they too miss something and serves as a good reminder why I don’t doctor my own kids.
Monday, March 29, 2010
CMS could get new director
After more than three years without a permanent leader, CMS might have a new administrator. Obama plans to nominate to the post Donald Berwick, MD, a pediatrician, health policy scholar, and CEO of the Institute for Healthcare Improvement.
Read more
Berwick, who would need to be confirmed by the Senate, has challenged doctors and hospitals to provide better care at lower cost, and that payments should be based on the value of services, not the volume, according to the NY Times.
As the head of CMS, Berwick would certainly have his work cut out for him in the wake of the healthcare reform legislation.
MGMA applauded the news in a statement: “As healthcare organizations and professionals shape a reformed healthcare delivery system, his knowledge and proven leadership will be critical to success.”
Read more
Berwick, who would need to be confirmed by the Senate, has challenged doctors and hospitals to provide better care at lower cost, and that payments should be based on the value of services, not the volume, according to the NY Times.
As the head of CMS, Berwick would certainly have his work cut out for him in the wake of the healthcare reform legislation.
MGMA applauded the news in a statement: “As healthcare organizations and professionals shape a reformed healthcare delivery system, his knowledge and proven leadership will be critical to success.”
Melissa Young, MD: Selection bias on physician rating sites
A couple of weeks ago, a patient from my prior practice said that she Googled me to find my new location. She said that in addition to finding my new address, she also found my practice address, and an article about me that had been written while I was at my old office.
Out of curiosity, I decided to Google myself. I found the above links, but I also found links to physician rating sites. I clicked on them to see how patients were rating me. I found that almost without exception, I had either no ratings or very poor ratings.
At first glance, my one-star ratings in nearly every category make me look like a horrible physician with no bedside manner, whom no one would recommend to family or friends. I also apparently had incompetent, discourteous staff. But a closer reveals that there is only one rating. One rating by a very angry patient. One who thinks I need “to learn to be a human.”
Read more
These ratings were all dated (where available) in the spring of last year. I can only assume that they were made by the same person. One Web site had two ratings. One with single stars across the board, dated in the spring of last year, and one with four to five stars, dated within the last three to four months.
Now, personally I don’t care if one or two disgruntled patients rate me poorly. I suspect they are noncompliant and possibly were dismissed from my practice. But other patients might care, patients who may assume that these ratings represent how most of my patients feel about me. And what happens if the payers start caring?
Who is going to take the time to go to theses sites to rate a physician? Most satisfied patients don’t feel the need to rate their physicians. Even at the best restaurants, I’m sure the kitchen hears more complaints then praise. How many store managers have customers call about an employee’s good job? And how many get calls about a bad job?
Oh sure, there are customers who will let an employer know when someone goes above and beyond, but for the most part, satisfied people don’t feel it necessary.
And the same goes for physician rating sites. I have patients I have treated for years. Some who moved out of state who still come to see me. I have new patients who used to see other docs but have chosen to see me because I have seen their neighbor, coworker, friend, or relative, and have been told that they will like me and my practice better.
Would they do that if I needed “to learn to be a human”? Referrals like that beat online ratings any day.
Out of curiosity, I decided to Google myself. I found the above links, but I also found links to physician rating sites. I clicked on them to see how patients were rating me. I found that almost without exception, I had either no ratings or very poor ratings.
At first glance, my one-star ratings in nearly every category make me look like a horrible physician with no bedside manner, whom no one would recommend to family or friends. I also apparently had incompetent, discourteous staff. But a closer reveals that there is only one rating. One rating by a very angry patient. One who thinks I need “to learn to be a human.”
Read more
These ratings were all dated (where available) in the spring of last year. I can only assume that they were made by the same person. One Web site had two ratings. One with single stars across the board, dated in the spring of last year, and one with four to five stars, dated within the last three to four months.
Now, personally I don’t care if one or two disgruntled patients rate me poorly. I suspect they are noncompliant and possibly were dismissed from my practice. But other patients might care, patients who may assume that these ratings represent how most of my patients feel about me. And what happens if the payers start caring?
Who is going to take the time to go to theses sites to rate a physician? Most satisfied patients don’t feel the need to rate their physicians. Even at the best restaurants, I’m sure the kitchen hears more complaints then praise. How many store managers have customers call about an employee’s good job? And how many get calls about a bad job?
Oh sure, there are customers who will let an employer know when someone goes above and beyond, but for the most part, satisfied people don’t feel it necessary.
And the same goes for physician rating sites. I have patients I have treated for years. Some who moved out of state who still come to see me. I have new patients who used to see other docs but have chosen to see me because I have seen their neighbor, coworker, friend, or relative, and have been told that they will like me and my practice better.
Would they do that if I needed “to learn to be a human”? Referrals like that beat online ratings any day.
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