Public Policy Contributor Brad Flansbaum writes….

After discussing the budgetary unease of our country in my last post, I wish to pick up with a brief overview concerning physician salary and workforce issues.  Because U.S. doctors train in an environment favoring subspecialty over primary care, along with the asymmetric pay coupled with that association, it is a simple to assume specialists make more because their work is more complex, they do more “stuff,” and, well, that is the way a higher power wants it.

If you spend time reading about how our remuneration system and workforce ratios evolved and why they interact like they do (beyond the RUC), you will learn Read the rest of this entry »

John Nelson writes…

Notice anything similar about these two articles?

Where have all the General Internists Gone?

and

The Impending Disappearance of the General Surgeon

Generalists, it seems, could be on the way out Read the rest of this entry »

Public Policy Contributor Brad Flansbaum writes…

If there is one issue that unites physicians of virtually every stripe, it is the ongoing difficulties in resolving the SGR pay fix.  While not to appear too disingenuous, as I like my salary as much as the next physician, there is a disconnect in our midst that also speaks to the unrest on display nationwide, beyond the healthcare sphere.  As we demand our $250B, the cost of the shortfall, it is instructive to see how precarious the finances of our country are now and where that money will come from.   Below is Read the rest of this entry »

Mike Radzienda writes…

A man presented with urinary retention and a UTI. He also complained  of mid -thoracic spine pain that was sub-acute. His PMD treated him with antibiotics but his symptoms persisted. He had worsening urinary symptoms and developed lower extremity weakness. On presentation to the hospital, he was admitted to the neurology service and was found to have spastic paralysis of his lower extremities. Exam at that time showed marked upper motor neuron sign in his legs. A brain MRI was read as normal. An MRI of the spine revealed no evidence of spinal cord disease but the thoracic images were not interpretable due to motion artifact. The neurologist commented in his note that the MRI of the spine was normal. The following day the MRI was redone and reported out as, “a retro-pulsed disc is compressing the spinal cord at T-8 and there is enhancement in the anterior portion of the cord adjacent to the area of cord flattening.”

Subsequently, the team never Read the rest of this entry »

Jack Percelay writes…

“I need to up my Press-Ganey Blog scores, so please, if there’s any reason you can’t rate me 5 out of 5 after reading this blog, please let me know before submitting your score so that I can make it right.”  I don’t know about you, but I’m fed up with the intrusion of  marketing techniques into healthcare.

Don’t get me wrong, I am a ferocious advocate of  patient and family-centered care and incorporating patient preferences into medical decision-making.  But all too often it seems to me that some marketing techniques are less about shared decision-making and more about “lies, damned lies, and statistics”,  “putting lipstick on a pig,” or a Goldman Sachs like inability to recognize one’s  professional and fiduciary responsibilities.  (Don’t get me going there.  That topic merits a stand alone column.)

What stirred my dander is my 17 yo daughter’s Read the rest of this entry »

Troy Ahlstrom writes…

My wife and I managed to get away for a weekend this spring.  It’s something we hadn’t done for years with everything else going on, and we were both looking forward to it.

I made reservations at a nice resort about an hour away from home.  They had a romantic getaway package with a nice room, champagne, and chocolate covered strawberries.  I reserved the package and off we went.  We had a great time, but there was a small glitch.  Read the rest of this entry »

Public Policy Contributor Brad Flansbaum writes…

The health bill is now law.  What next for hospitalists?

Most of the chatter these days concerns access, and to a lesser extent, system reform and cost control.  In HM circles however, bundling and episode-based payments have been de rigor for 2-3 years.  Conceptually, it is rather simple to grasp what this form of payment and practice involves.  For that reason, individuals on the financial front lines have invoked these models as the next saving graces of healthcare.  I must admit, from the perspective of the overhaul stakeholders (government, employers, and insurers), I can’t blame them.  Additionally, policy wonks have Read the rest of this entry »

Jack Percelay writes….

No, I haven’t been in a coma unaware of what is probably the most significant change for hospitalists for the decade, it’s just that I’m Read the rest of this entry »

Mike Radzienda writes…

Last month I read The Commonwealth Fund Report on Global Payment Potential. If you have not read it, you should.  With unwavering certitude, the sixteen current and former healthcare system and health insurance executives interviewed for this report agreed that the global payment model for healthcare services will manifest this decade. In other words, capitation will be back and better than ever.

Regardless of what happens on the Hill this week, the real meat and potatoes of healthcare reform will come down to Read the rest of this entry »

Troy Ahlstrom writes…

The Society will host its annual conference, Hospital Medicine 2010, from April 8-11, 2010 at the Gaylord National Resort and Convention Center in Washington, D.C.  This will be the best attended SHM event in history.  Little wonder, given the rapid pace of change that hospitals and Hospitalists face as well as the uncertainties existent in our national healthcare delivery framework.

The annual conference is an event well worth your time.  Our hospitalist group’s attendance last year impacted nearly every aspect of our program for the coming year.  We saw seven members attend the meeting with three of them inducted Read the rest of this entry »