American College of Physicians: Internal Medicine — Doctors for Adults ®

Friday, January 22, 2010

Facing the Future

This post by Rob Lamberts, ACP Member, originally appeared at Musings of a Distractible Mind.

The following is an actual fictional conversation that took place in the doctor's lounge at a local hospital.

Internist: Dang, these Medicare cuts are coming and I doubt that Congress has the wits to avoid them. I am not sure I can go on practicing if they cut them anymore.

Family Physician: Yeah, we already get paid so little by Medicaid and the private insurers, we have had to start to look for other sources of revenue.

Internist: Really? We have been looking into that as well. What are you thinking about doing?

Family Physician: We thought about doing cosmetic procedures, but we have an especially good-looking population, so we really can't make it work.

Internist: Bummer.

krispy kreme by House of Sims via FlickrFamily Physician: Yep. Instead, we have decided to open a kiosk for Krispy Kreme donuts. We figure we can make money off of the donuts, plus we can get more of our patients obese. Then we can treat worse diseases and code a higher level for each visit.

Internist: Genius. Plus, you can get all of the kids hyperactive on the sugar and treat their ADHD.

Family Physician: And the "Hot Donuts Now" sign along with the scent of fresh-baked donuts will really draw in new customers ... I mean patients.

[Click on the More link below to read the full post.)

Internist: One of the GI doctors in town is doing the same sort of thing, opening a Starbucks in his office. He figures he gets walk-ins, gets people with worse dyspepsia, and gets free WiFi to boot.

Family Physician: Brilliant. What have you been thinking of?

Internist: We have noticed the interest our patients have in holistic medicine, and thought we should capitalize on that.

Family Physician: So you are hiring a homeopath?

Internist: No, they wouldn't set foot in our office because of the "evil" immunizations we use. We tried to get all sorts of alternative providers, but they would always sneer at our practices. And so we finally opted for two things: First, we are doing aromatherapy, which has our staff so relaxed that they don't seem to have noticed that we cut their pay by 50%.

Family Physician: Great.

palm reader by markresch via FlickrInternist: Second, we have a psychic who goes around in our lobby doing palm reading and tea leaves on our patients as they wait. There are two positive outcomes from this: the patients who get bad fortunes told are so anxious that their blood pressure is up and they are ripe for anxiety treatment; the ones with good fortunes are happy enough that we can order all sorts of tests on them and they don't seem to care. There is a downside, however.

Family Physician: What's that?

Internist: My partner now thinks that we should take our entire budget for next month and invest it in Power Ball lottery tickets. He says it is a "sure thing."

Hospitalist: Hey guys, what's up?

Family Physician: We're just discussing what we are going to do to offset the impending Medicare cuts. Do you have plans?

Hospitalist: Oh yes. I don't like the idea of increasing the load to 70 admissions per day. Fifty is plenty. Instead, we are capitalizing on the fact that our patients are a "captive audience."

Internist: This I've gotta hear.

Hospitalist: We figured that we have enough turnover that some sort of direct marketing scheme to our patients could be quite lucrative. We are now certified Amway sales representatives.

Family Physician: I love it!

Hospitalist: Yep. We have these patients in a position where they can't move, and we sell them cleaning solvents, vitamins, and skin care products. Instead of taking cash, we just add it on to their hospital bill, so they usually buy a bunch.

Internist: As an added bonus, the families of your patients will be so scared that you will try to sell them Amway products, that they steer completely clear of the hospital.

Hospitalist: Bingo! It works like a charm. We got this idea from the intensivists who were holding Tupperware parties in the ICU. The patients were sedated "just enough" so that they left the hospital with all sorts of cups, jugs, and bowls.

Family Physician: Any complaints?

Hospitalist: Not yet. You figure, what we charge for the solvents is 1/4 of what the hospital charges for an aspirin. The patients really don't notice a little more charge. We have even had some insurances mistakenly pay for some of our Amway products!

Internist: You know, maybe this Medicare cut may just be a good thing. Look at how it has pushed us to open new frontiers in medicine. Our children will look back on this time as being one of the real turning-points in American healthcare.

Family Physician: Yeah, today Amway ... tomorrow ...

Hospitalist: Healthcare reform? Higher reimbursement? A fair payment model?

Family Physician: Used cars.

Internist: I am so glad I went into medicine.

Rob Lamberts, ACP Member, writes the blog Musings of a Distractible Mind and is on Twitter. His podcast, House Call Doctor, is available online and on iTunes). He is board certified in Internal Medicine and Pediatrics and was an early adopter of electronic medical records.

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Blogger Michael Kirsch, M.D. said...

Perhaps, you could sell cigarettes also, as a doughnut chaser. The pharmacies all stock them behind the counter as the customer is paying for cardiac medications.

January 23, 2010 at 8:48 AM  

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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