Interviews , blogging, general - Interview with Kevin Pho, MD, of KevinMD.comm fame

Prelude: Kevin Pho, MD, is a leading solo physician blogger in the United States. He has been blogging since 2004 and has a wide readership among the public, fellow physicians, and the media. Doctor Pho, a general internist, practices in a five person group in Nashua, New Hampshire.

Q: First of all, congratulations on being selected – along with Clinical Cases and Images, founded by Ves Dimov, M.D., Clinical Correlations from the NYU Medical School, The Health Care Blog, a granddaddy among blogs, and the WSJ Health Blog – as one of the five finalists for the best Medical Weblogs for 2008. You’re in august company.

A: Thank you. By the way, I read your blog often, and I appreciate this chance to explain my blog to a fellow blogger.

Q: How long have you been blogging, and what motivated you to blog in the first place?

A: I’ve been blogging since May 2004. Initially I started because I wanted to give a physician’s take on the medical news that was being reported. I sought to give a physician’s perspective. I had read other doctor blogs, and I figured I could do it too. I think the blog has evolved, and it is now regarded as the physicians’ voice, especially because of uncertainties surrounding health reform. One of the motivations of the blog was to fill the void created by lack of the physicians’ voices.

Q: You also seem to want to inform your audience what goes on behind the doors of physicians’ offices.

A: Exactly. I want to give patients insight into what they might not know.

Q: You have quite a following. You’re often quoted in the major media, including the Wall Street Journal.

A: Thank you. It’s definitely one of the more visible physician blogs, and I appreciate my readership and those who cite and follow my blog.

Q: I notice you have “subscribers,” of which I am one. How did that come about, and how many subscribers do you have?

A: I am always searching for new ways for people to engage my blog. One of the ways is delivering my contents via e-mail. Not everyone has the time to visit my site, so I deliver it to them. I currently have over 18,000 subscribers.

To help others engage my blog, I also have business arrangements with other blogs, so I can reach a wider audience. This allows me to expose my blog through their networks, and I benefit them by exposing my content to their readership.

Q: I notice you ofte solicit opinions among your readers.

A: Yes, it’s simply another way to engage my readers. It’s always interesting to have others express their opinions. I want to create a forum where others can have a relatively large readership. It’s a good way for doctors to practice writing opinion pieces. We need to get our voice out there. Otherwise those not practicing medicine are going to make our decisions for us.

Q: I notice sermo.com and the Physicians Foundation, which represents doctors in state and local medical societies, are getting the physicians’ voices out there through blogs and surveys. So you’re part of a growing movement of social networking among physicians and informing the media and policymakers that there’ something serious wrong with our system.

A: I agree. Sermo is a great site, but it’s a closed network, and the public can’t read doctors’ opinions. One reason people like my blog are its open to everyone.
Q: What is the proportion of physician versus public response?

A: I don’t have exact demographics, but I think it’s about 60/40.

Q: Perhaps it’s because I’m not a twit, but could you explain to me the “twitter” phenomenon, which has surfaced in the last year or so as a new communication tool.

A: Twitter is the so-called micro-blog. It simply asks the question, “What are you doing right now?” Users are invited to participate in 140 characters or less. It’s a way to write short concise posts. It’s called micro-blogging because of the limit on character size. I have my posts regularly posted on twitter, and people engage me that way. You have to experiment with other media to maximize the potential of your blog.

Q: How long have you been twittering, and what has been the response?

A; I’ve been twittering for 4 or 5 months now, and I have about 2300 followers. It’s been an opportunity to expose my blog to another segment of the population.

Q: What do you consider the major problems of physicians at this stage of health reform?

A: There are so many, but I would say if I had to name one - the physician payment system. We have a fee-for-service system, and doctors are encouraged to do more to generate more revenue. This has a whole host of unintended consequences. More medicine isn’t necessarily better for the patient. Fee-for-services causes doctors to rush through patients, rather than spending more time with them.

Q: Do you think the “medical home” is a potentially promising solution to the payment problem and to spending more thoughtful time guiding and understanding patients?

A: Yes, I do. The patient-centered medical home proposal reimburses for time and coordination of care. If financial incentives are re-aligned for issues that benefit the patient, it’s a good step in the right direction.

Q: What are your expectations for health reform under the new presidential administration?

A: I am cautiously optimistic. In his piece in the New England Journal of Medicine, it was clear he understands the issues facing primary care. But Obama is a politician, and politicians can’t always deliver on health reform. The devil, as always, is in the details, but with the high level of dissatisfaction with the health system, there’s a good opportunity for reform. If something is going to get done, it will get done in the next five to seven years.

Q: A final question. Do you think it’s too late to “save” primary care?

A: It can go either way. One opinion is that primary care has hit bottom, and with the tremendous shortage of these doctors, the market can only get better. According to physician recruiters, primary care is in great demand, salaries are rising, and graduating primary care doctors have their pick of jobs. It’s really a buyer’s market. So primary care may be on the upswing if Obama can follow through on his promises. Although the situation is dire, I predict a better future.