Doctors Living On Loans

CNN Money has a story about the increasing number of doctors living on SBA loans.

Read the entire story here

Dr. Bryan Glick, a family physician, took out a $198,000 SBA loan to start his own practice in Anthem, Ariz., shortly after graduating from his residency in 2009.

Doctors: Why we can't stay afloat

That loan sustained his practice for more than a year, but he still was not making money.

So he took over a concierge practice 30 miles away in Scottsdale. His concierge medical practice doesn't accept any insurance and charges an annual membership fee ranging from $3,000 to $5,000 for unlimited doctor visits and cell phone and e-mail access.

He continues to operate his traditional private practice. The concierge practice has helped Glick work off his SBA loan. He's now contemplating a second SBA loan to expand that practice.

Jasser has thought about the concierge model, too. But he acknowledged that it's not an option right now.

"Half of my patients are on Medicare," he said. "For economic and ethical reasons, I can't do it."

What's the cause? Certainly there are market forces at work, but there are also just basic business and economic changes that many physicians are having a great deal of trouble coping with; How to pay staff and make them more productive, how to structure their business, how to get paid, and how to attract the number of paients that they need.

There are titanic changes that have started and the speed with which they'll take effect will only increase. With change comes opportunity. Therer are plenty of docs who are doing just fine and makeing more money than every.

Physicians who cling to the old world will be destined to go down with the ship.

The Pharma Rep Physician Hunting Guide

Ah the famous charts and smiles crowd. Hat tip to ZDoggMD.

How Doctors Becomes Successful Writers

Suzanne Koven, MD, is an internist who came to the publishing course that I direct at Harvard Medical School (www.HarvardWriters.com) a few years ago.  At that time her goals were to hone her writing skills and to learn more about publishing opportunities. 

A year later, I invited her back to speak to the attendees--one of the few "Success Stories" we have featured at the course who has not actually published a book (though that's about to change with her first book coming out soon). 

What I remember most about Suzanne's talk was her football analogy about "moving the chain."  As I watched the New England Patriots win the AFC playoff game today I was reminded of Suzanne's comments when my daughter asked me to explain how downs work.  Getting something published--anything at all--is a lot like a first down.  Touchdowns aren't elusive, but they are harder to achieve.  Super Bowl victories are even more difficult.  But, it all starts with moving the chain and getting close to that first down and then actually achieving the first down. 

Perhaps I was thinking about Suzanne today, because she is now a professional physician-writer who regularly contributes to The Boston Globe.  Her article in today's paper--the same day that the Patriots will advance to the Super Bowl--is titled "Doctors Who Write"

Suzanne has continuously moved the chain, scored too many first downs to count, won many important games and is now on her way to the Super Bowl!  Suzanne, go for it--we'll be watching you!!

Tebowing Your Message: Applying the Principles of Tebowmania to Your Endeavors

Well, the Broncos' season is over, but not before Tim Tebowmania reached a fever pitch.  I knew it was nearing insanity when both my wife and mother-- neither of whom had ever watched an NFL game on their own before-- each independently told me they were planning on spending their Saturday night watching the game.  Needless to say, I was amazed.

It seems like everyone has an opinion on Tim Tebow.  Some people love him, others hate him.  The one thing that's agreed upon, however, is that everyone is talking about him.

What I find most remarkable is not that a young football player has taken the country by storm, but how he's done it and how clear has been his message.

Ask anyone-- and I mean anyone-- what they think about when they think of Tim Tebow and I bet you get a handful of answers, but they're all centered around Tebow's faith, his values, and his clean-cut image.

Now, you might think Tebow is an idiot, or you disagree with his message, or you think he's an overhyped player, but the key is that you're thinking about him and you know what he stands for.

Stop and think about that for a minute: When you think about Tim Tebow, you don't first think about football, you think about his message.

And I find that fascinating.

Whether you agree with Te

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Physicians + Money Management

If you've been in medicine for even a little while, you know there are a number of taboo subjects that just aren't discussed.

One of the most important discussions that medical students do not have while in training is the subject of money and overall financial management.

Last, at our most recent Medical Fusion Conference I was able to sit down with Dr. Setu Mazumdar, an Emergency Medicine physician turned financial manager.  Setu gives his perspective of "financial independence" in this interview.  Check it out...it's worth watching.  Hopefully, by learning a bit about finances while in training you'll avoid some of the common pitfalls of physicians and money.

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Emergency Medicine + Perception Problems

I was thinking this week about how Emergency Medicine physicians are perceived in busy Emergency Departments.

For those of you who aren't medical people or don't work in Emergency Medicine, a busy ER is a crazy place.  There is a constant push to make every action more efficient.  Patients are being taken to and discharged from rooms as quickly as possible so the ill in the waiting room can be evaluated.  Activities that aren't completely necessary are eliminated, simply because of the crush of needy people waiting for care.  

There is a mountain of medical literature discussing the issue of ER overcrowding, and a current focus on training physicians to eliminate any testing that isn't absolutely required.  Twenty years ago physicians working in ERs did full work ups on patients.  Today, the focus is on singling out that handful of tests that will give the physician a clear picture of the patient's pathology, so a decision can be made as soon as possible and the patient moved into the hospital or discharged home.  

Now, insert into this chaos two physicians, we'll call them Dr. Flippant and Dr. Effective (for the sake of comparing two styles and nothing more, let's make these physicians both male).

Dr. Flippant walks into a patient room having barely reviewed the chart.  He interacts with the patient in a superficial way, barely asking questions because he really isn't interested.  He does a cursory physical exam, orders no tests, and sends the patient home.  His total time in the patient's room is under three minutes, after the patient waited hours to see him. 

Now let's look at Dr. Effective.

Dr. Effective walks into a patient room having thoroughly reviewed the patient's data.  Because his ER is so busy, he begins his patient assessment the moment he enters the room, guaging the patient for unlabored breathing, ability to move in a symmetric and balanced way, and appropriate responses to questions.  He notes the color of the patient's eyes and skin, the smell of the room, and whether the patient is perspiring.  All these things are taken in within the first few moments of the physician-patient interaction.  Dr. Effective asks a few questions that are targeted, and purposely phrased to limit long responses but give maximum data for his decision making.  He does a focused physical exam, limiting the exam to the body part or parts that will quickly allow him to determine if this patient needs further testing.  Once complete, his very targeted-- yet appropriate and effective-- assessment has determined that the patient needs no further testing, and he sends the patient home.  His total time in the patient's room is under three minutes, after the patient waited hours to see him.

Now here's the problem with the perception of these two physicians...

In each case above, the time constraints limited these two physicians to less than three minutes with their patients.  However, one of these examples was a flippant, sloppy physician and the other was an effective and appropriate physician.  

The difficulty is that if you're the patient in the room, it's almost impossible to ascertain which example is treating you.  Both spent little time at your bedside.  Both asked few questions.  Both did limited exams, and neither ordered any tests.

Now, if you couple this with the confounding variable that Dr. Flippant is a charming, visually appealing person, and Dr. Effective has a more curt personality and frumpy look, the perception issue becomes even more difficult.

To the untrained eye, these physicians did the exact same thing with both their patients.  The difference between these physicians was the processing that was going on internally.

Even an excellent physician-- working efficiently and effectively taking care of a large number of patients-- in a busy ER  frequently gets feedback from patients and families that he "didn't spend time with me" or he "wasn't interested in my problem" or he "didn't even order any tests." It is difficult to explain to these idividuals that the physician was actually acting appropriately, when the patient is incensed that after their long wait time "that's all the doctor did."

What's worse, if you're the patient, you have really no way of determing which doctor took care of you.  How can you be assured that you saw Dr. Effective and not Dr. Flippant?  The unfortunate thing is that unless you have medical training or a medical family member interacting with the physician, it's almost impossible.

In my view, this is one of the most difficult issues in contemporary Emergency Medicine-- the very subjective and often skewed perception issue.  It's unfortunate, and it's a big problem for patients, and for the good physicans out there trying to take care of them.

Why Autoimmune Disease Affects Your Career

Here is a useful clinical analogy that can have great impact on your professional and personal life.

Did you know that there are more people diagnosed with an autoimmune illness than cancer and heart disease combined? That is startling given the numbers of people with each of those ailments.

Unline cancer and heart disease, though, autoimmune disease tends to cause much more daily morbidity and distress. And unfortunately for all of us, autoimmune disease is rapidly on the rise with new cases diagnosed every single year.

To refresh your memory, autoimmune disease takes the shape in many forms: MS, Hashimoto's Thyroiditis, Celiac, Type 1 Diabetes, Psoriasis, Lupus, Sjogrens, Scleroderma, Rheumatoid Arthritis, and Crohn's Disease are just a few of the top autoimmune diseases. Each of these carry their own unique challenges for patients, but each is similar in what is the root cause.

In my view, autoimmune illness represents a disordered and misbehaving immune system--an immune system that is in haywire. Under normal conditions, our immune system identifies vialbe vs. dead tissue and removes the cell turnover from our bodies so that new cell growth can occur.

When a patient has an autoimmune illness, their immune system has misfired (for reasons we do not fully understand) and now starts its assault on viable tissue. In general, this cascade of events takes place due to a "perfect storm" that arises. Here is my simplistic model:

1. Over time there is mismanagement of cortisol due to

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