Wednesday, December 4, 2013

Review of Ten All-Time Favorite Posts Physicians Are Reading
Know what a person or persons  are reading, and you know what that person or persons  are thinking.
From time to time, I review what blog posts of mine physicians are reading. This gives me a clue to what physicians are thinking, what preoccupies them, and what direction they might be headed
Here are ten items my readers have been reading among 3000 blog posts I have written over the last five years.  
I have arranged these posts from in descending order of popularity.  I append a terse comment to tell you why I think physicians are reading this particular blog.
1.       “Physician Hospital Relationships,” January 6, 2011, 28660 page views.
This does not surprise me.  Most physicians need to belong to a hospital staff to practice.  They need the relationship to refer sick patients.  They need it to perform procedures there.  They are flocking to hospitals to avoid malpractice expenses and rules, regulations, and costs of ObamaCare
2.       “Is Practice Fusion ‘Free EHR’ for Real,” May 23, 2010, 9742 page view
 No surprise here either.   EHRs are expensive to install, cut number of patients seen by 30% or more, and government rewards you to the tune of over $43,000 if you install and meeting “meaningful use” criteria.  If you can get an EHR installed “for free,” why not?
3.      “Medicare Cuts May Alienate Senior Voters,” May 23, 2010, 6711 page views.
Over 99% of physicians receive Medicare payments.  Medicare drives health reform.   Medicare is close to bankruptcy, and to save it, ObamaCare is systematically cutting physician’s payments over the next 10 years.  These cuts get physicians’ attention, and are one cause of physician shortages
4.      Treatment for Low Testosterone Symptoms,“July 28, 2011, 5326 patient views.
This may be a response to patient demand generated by extensive media marketing.   You can scarcely turn on TV these days without hearing about male sexual potency or penile rigidity and how to resurrect both – by oral, skin pad, axillary or injection.  A man’s a man and all of that is a potent message.
5.       Texas and the Future of Health Reform, “July 1, 2012,”5151 page views.

Since it instituted tort forum,   physicians have flocked to Texas in droves.  Texas has taken a tough line with Medicaid expansion and government health reform by saying, in essence, “Don’t mess with Texas, This is the land of free enterprise, and business and physician friendly environment.”

6.      Interviews, Physician Shortage,” January 24, 2009, 4843 page views.
This was based on a series of interviews I did on why we have physician shortages. The reasons why abound – lower reimbursements,   more regulations,  more overhead, more  blame as source of high costs, more accusations of “greed, no tort reform, more ObamaCare pushes to pay on basis of “quality” and “value” without defining what each means.  It’s enough to make physicians paranoid.
7.  Americans and Their Medical Machines,” May 29, 2010, 3683 page views
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity. If the face of our machines sag, we lift its faces up. If our pipes clog, we roto rooter them out or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to remove something in the machine’s interior, we take it out through a laparoscope. If the fuel or metabolic mix is wrong, we alter the mix or correct the metabolic defect with drugs If anything else goes wrong, we diagnose it and rearrange it electronically. 

8. “The Medicare-Medicaid Triple Pickle,”  May 9, 2010, 3678 page view
The triple pickle for federal lawmakers are.

One - Can they grasp the “third rail” of American politics, entitlement programs, in this case Medicare and Medicaid which cover 100 million Americans, and which are poised to explode in growth by as much as 50 million for Medicaid in 2014 and to reach 76 million for Medicare by 2019, without being electrocuted politically? We shall see.

Two -
Can they threaten the very survival of American hospitals, which derive 55% of their revenues form Medicare and Medicaid? This is why hospitals are spending $1 million a week to defeat the proposals.

– Can they maintain access of care in the states , already cutting back on Medicaid to balance broken budgets, to the most vulnerable – children, seniors, the poor, and the disabled, while causing more doctors to drop out of Medicaid and Medicare because of lowered reimbursements. I doubt it. Doctors surveys indicate as many as 40% to 60% of doctors may opt out of Medicare and Medicaid.
9.Women Physicians and the Doctor Shortage,”  May 7, 2009, 3141 page views

Over the years I’ve written a dozen blog posts on women in medicine.   In this particular blog past, I cite these facts and trends ; Half the physicians now graduating from medical school are women;  women gravitate toward certain specialities – ob-gyn, pediatrics,  family medicine, internal medicine, pediatrics;  women work fewer hours and retire earlier than their male counterparts;   women tend to be married to male physicians; women earn less than their male counterparts; more women work part-time and require more flexible hours; women are slightly more liberal than then male physicians; and they make superb doctors.
10.Massachusetts – Doctor Wait Times, Costs, and ER Visits,” May 7, 2009.  3141 page views
Obamacare supporters frequently say the Massachusetts model is a paradigm for the federal  health law;  that its launch was slow just like ObamaCare’s launch will be; and that Massachusetts citizens like their reform plan.  On the other hand (there’s always another hand in these debates);  Massachusetts premiums are the highest in the land, waiting times are the longest in the nation despite the fact that Massachusetts had more primary care physicians per capita than any other state;   ER visits and costs are soaring far above the national average; and what works in midnight blue Massachusetts may not work in conservative America.

Tweet: Medinnovation blog readers are preoccupied with hospital relationships, EHRs, Medicare, role of women physicians, and health reform .

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