Contract Supply Clients
  8/17/2008 - Intellectual Integrity 
This a call for intellectual integrity from our leaders.  Some  might even use an old fashioned word... honesty.

Recently headlined in the AAFP News.... "Match Results Show Resurgence in Family Medicine Interest".  The News reported there was a record high match rate of 90% and thus concluded there was a resurgence in family medicine.

Talk about "spin"... this may be a new low.

Facts (also known as the truth):
1. There are around 1000 less residency positions in family medicine than there were about 10 years ago.
2. 90% of a lower number is not an all time high (just threw that in to help with the math).
3. Approximately 60% of matched family medicine residents are NOT graduates of US medical schools (by definition, that means they ARE foreign medical graduates).

Intellectual integrity would therefore admit that primary care, especially family medicine, is something less than rewarding on many levels these days.  "Less than rewarding"..... what am I saying?!?  We're going backwards, lossing the war, being marginalized!  The spinners don't seem to get it or don't care!  Oops, came off the tracks there for a moment.

Intellectual integrity would ask why and then begin to honestly address the issues.  I volunteer to explain the "why" part... that will take a good 2 minutes.  I'll make the sacrifice.

Gee Whiz... can we at least agree not to lie about the reality of our situation?  At least not to each other.


  8/12/2008 - P4P 
Hey readers.  After a brief hiatus for the board exam, I'm back.  I am of course having less time to blog because of my anger management counseling over having to take the boards again.  Did I mention it was the FOURTH time!!!

But, more on that later.

Big news flash..."P4P found to have little impact on care quality".  So says the review on a study published in the July/August Health Affairs.  The study compared similar groups of physians with one group given incentives (read... we'll give you a little bit of money if you do what we want) vs. the second group of physicians with no incentives to perform quality care (the poor saps just took care of their patients because it was the right thing to do... imagine that). 

Guess what?  No difference.  None.  The two groups performed the same.  The "quality" measures improved equally over the 3 year study in both groups.  The performance was "statistically indistinguishable".  The review said "there is a fundamental problem with the P4P programs: They have little to no impact on quality".  Really.  The nerve of these guys screwing up such a great idea like that.  They took good care of their patients because... get this... they're doctors, and it's what they signed up for in the first place.  Whoda believed.

Not to be daunted by a little thing like data, one reviewer commented that this had little impact on his view of P4P because it was just one component of the overall strategy to improve patient care... presumably the same care provided by the saps without incentives (other than that whole doctor thing).

So P4P marches on... going somewhere, for some reason.

the Big Kahuna who believes (just not in P4P)

  7/6/2008 - Doctor of Nursing 
Well the time has come.  The first DRE must be awarded.

Many of you read in the AMA News that the National Board of Medical Examiners has decided to create a certification for "Doctors of Nursing".  Those who complete the training may join the rest of us in paying the Board a hefty fee to take a certification exam.  Then they get the priviledge of being primary care providers (translation... work really really hard for the least pay in medicine).

It's hard to know which is worse... the Board's unashamed reach to find more groups to pay them fees to certify (and later recertify) OR the poorly disguised search to find someone (anyone) willing to do primary care.

There are plenty of avenues for real doctors to train for primary care currently in existence... they're called medical schools and residency programs.  Problem is fewer and fewer of us are willing to work so hard for so little.

So, why create a lower level practioner to do the job?  Why not deal with the issues that keep real doctors from going into primary care?  Your guess is as good as mine.

But... for their effort... the Board certainly is a deserving recipient of the first drs4drs DRE award!!!

the Big Kahuna... who believes.

  6/30/2008 - Medicare Bill 
As usual, congress is trying to  hoo-doo doctors and consequently, the elderly in our country.
The Senate failed to pass the bill to elimate Medicare cuts for doctors.
We have to keep the pressure on.  Contact your senators and let them know this is NOT acceptable and it WILL effect our ability to see Medicare patients.


  6/24/2008 - Medicare cuts 
We all need to respond to the passage of the House's bill to stop Medicare payment cuts.

Today the House of Representatives passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331). The bill received 355 "yes" votes and 59 "no" votes. Because it was brought to the floor under suspension of the rules, it requires a two-thirds majority (290 "yes" votes) to pass.

H.R. 6331:

Halts the 10.6 percent cut to Medicare physician payments scheduled for July 1;
Maintains the current 0.5 percent payment increase through 2008; and
Eliminates the additional 5 percent cut scheduled for Jan. 1, 2009, replacing it with a 1.1 percent increase for 2009.

Take the initiative to contact your Senators and urge them to support this Bill.


  6/16/2008 - Mondays 
It's Monday.
Seeing patients.  Studying for Boards (again).  Running an office.
Too tired to blog today.
Too tired to award a DRE... even though there are many so deserving.

the Big Kahuna... who believes.

  6/13/2008 - special awards 
I'm already hearing from you about my first A&O award.  I expect these to be going out less often than my DRE ('s just what your thinking...the Digital Rectal Exam award).  It's for those who annoy us and just generally don't have a clue about the real world of medicine.  I believe there will be many deserving recipients.

If you have some nominees, feel free to post them in "Rant & Rave"

the Big Kahuna... who believes.

  6/13/2008 - Survey results 
I've been looking at the results of our survey.  So far 31% of you have listed help with overhead costs as one of, if not the #1 priority.  It's ridiculous that so many doctors have no buying power and consequently, our overhead is so high.

Hang on.  Remember...Power in Numbers.
We have an awesome Group Purchasing tool launching soon.  I can hardly wait to share the details...but any doctor anywhere will be able to buy supplies on-line.  The more of us that participate, the more negotiating clout we'll have.  It's going to be incredible!

the Big Kahuna... who believes.

  6/11/2008 - Take back medicine 
Today I am giving out my first  A&O award.
The honor goes to Dr. Keith Leap for his article in May 2nd Medical Economics, "Take back medicine".
Dr Leap is one of few to speak out honestly and clearly about the realities of being a doctor in day-to-day practice.
A few of his great points:  Medicine is hard, Medical care isn't free, Insurance destroyed medicine, and my personal favorite... Policymakers see too few patients.

Check out the whole article.  It may brighten your day.

For his efforts I award Dr. Leap the A&O (alert & oriented) award.  This will be the envy of you all I know.  Keep trying... you too could one day get an A&O.


  6/7/2008 - Calling all Kahunas…drs4drs to the rescue! 

Now ALL doctors EVERYWHERE can unite using incredible technology and the world wide web.  We are now able to come together in a virtual community to achieve common goals for the good of all doctors


Why do we find ourselves in such a predicament?  Simple answer…we are fragmented!  There is no such thing as “organized medicine”.  The very term is an oxymoron…until now.


drs4drs is a doctor advocate organization.  Think “AARP” for doctors.  The AARP has proven that it’s possible to harness the power of large numbers of diverse individuals all over the United States for a common purpose with incredible results.



Now it’s do-able.

Now there’s hope.


Power in numbers…independent but together…on the web.


We CAN do this!


I can hardly wait to hear your responses & ideas,


The BIG KAHUNA……who believes.



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