The 3rd Paradigm Shift In Medicine

By Robert Keller MD

We are in the 3rd paradigm shift in medicine.

The first evolution occurred during the American Civil War when medicine developed standards for surgical procedures. The second shift occured during the early 1900 with the introduction of pharmaceauticals and the start of internal medicine. Both of these practices were reactive based medicine; in other words, after the fact medicine. The United States became the center of reactive medicine by developing empirically based evidence to support the treatments. Still, the model was reactive. Thus, we became adroit at treating disease after it had declared itself with symptomatology. The twenty First century now enters the 3 medical revolution: proactive medicine. We now have the ability to develop protocols that predict disease very early in the disase state or more excitingly before the disease expresses itself. Treatments such as stem cells, DNA and protienomonics, advanced labs such as telomer testing, virtual angiograghy are just a few of the prospective ways to prevent disease.

Yet, a challenge remains. How do we as physicians shift to the proactive revolution when the third party carriers reimburse for reactive treatments? Therein lies the rub. It is my contention that a cash based model for paying physicians for proactive services will evolve until the insurance data tables reflex proactive medicine is less expensive that reactive treatments. As we all know, this will take years. So, my advice: begin to incorporate a cash based element into your daily practice. It's good "insurance".

About: Robert Keller, MD is a world renown physician who specializes in cash based proactive medicine.

Submit a guest post and be heard.

The Top 10 Reasons You Should Go To Medical School... And The Single Best Reason Not To

By Jeremy Weaver, Medical Student and Editor of Uncommon Student MD

Whether you're a first year medical student or a practicing physican, there's a good chance you've asked yourself the quesion, "WHY the @#$% DID I GO TO MEDICAL SCHOOL?" Here are a few EXCELLENT reasons... and one bad one.

Just as the blisses of Christmas break was ending for most of us tortured souls who fly the banner of "medical student," and sail these uncertain scholarly seas, Uncommon Student MD got some serious traction with medical students around the world. I believe timing had a large part to do with the explosion in its popularity. Simply put, after christmas break a lot of medical people were thinking, “what am I doing here?!” - A case of mass buyers remorse.

It is an understandable and laudable question to be sure. If we spent half the time wrestling with the question of what to do with our lives that we spend OMGing and LOLing on Facebook, we would probably all be Nobel laureates (at the very least we wouldn’t use retarded abbreviations as much). There are a lot of bad reasons to go into medicine and there are a lot of good reasons not too… Conversely there are also many great reasons TO pursue medicine as well as a lot of bad reasons not too. Confused? Me too, but I do know that there are two sides to every pancake (perhaps three if you screwed the recipe up).

F. Scott Fitzgerald once said that, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.” So, even though I happened to agree with a few salient points made in the aforementioned article, I am trying to follow the advice of good old F. Scott and entertain the flip side of the coin. Maybe incite some wrath while I’m at it… one can only hope.

I am not sure, but I am of the opinion that there are as many good reasons TO go to med school as there are NOT to go (we should do a prospective cohort study to find out). At the very least I know there ARE more reasons than the sole example our friend Dr. Ali Binazir espoused. And so without further hemming and hawing… The top 10 reasons you SHOULD go to medical and 1 reason you should RUN WHILE YOU STILL CAN… in no particular order.

1. You will have a HUGE range of options at the end of your medical education.

To me flexibility and possibility in a career are of FAR greater importance than money, girls, fame, cars, illicit drugs, horses, blue suede shoes, kittens, my high score on angry birds, tickle-me-Elmos, or just any other temptation under the sun. Medicine opens up a WORLD of...

Click to read more ...

Confessions of a Surgeon

By Paul Ruggieri MD, FACS

Confessions of a Surgeon

It has been a little over a month since my book, "Confessions of a Surgeon:  The Good, the Bad, and the Complicated...Life Behind the OR Doors" was published and I have finally had time to think about the unique places it has taken me.   I cannot describe to you what it feels like to be at the end of a very long journey.  I started writing in my head ten years ago and knew someday the words would make it to paper.

I wanted to let the public into my operating room world with a very honest depiction of what I do and how I feel about what I do.  The book is a very blunt depiction of life, death, imperfection, emotional stresses, legal pressures, and human frailties.

I believe , because of our unique day (and night) jobs, everyone one of us physicians has an extraordinary story to tell, a story the public has a right to hear.  Everyone of us has a book buried deep inside our gut (being the general surgeon that I am) that just may need a little coaxing to bring out.

I was not a seasoned writer and had no understanding what it involved to write,publish, or promote a book.  All I knew was I had a story to tell and Julie Silver's Harvard Writing course was something I had to experience.  I had to experience it so much that I attended her course twice before writing my book, once in 2005 and again in 2010.  The first time got me warmed up to write (the timing was just not right).  However, the second time I attended the course, the stars were aligned and it ignited the fire in me.  Her course taught me very usable lessons on how to organize my story, discipline my writing, and instill confidence in my ability to complete what I had set out to accomplish.   Dr. Silver's course was also instrumental in giving me access to top New York City agents and professional writers.  The funny thing was I almost did not attend her course in 2010.  It was a last minute decision and probably the best one (outside of asking my wife to marry me) I have made in a very long time.

Writing my book was not easy and there were many a time when I just stared at my labtop, hoping the keyboards would just move by themselves.  To me, writing anything never came easy.  Remember, I am a general surgeon and if I cannot drain it, remove it, or rearrange it within a few hours I move on to the next one.  Most of us do not have the patience to write almost every night and weekends, one page at a time.  So, when I received my first galley copy in the mail from Penguin Publishing, I got drunk.  No, I am only kidding.  However, I did open up a bottle of single malt I had been saving and toasted everything in sight.  When I finally received my free 50 copies of the finished product,  then I finished the bottle off and got drunk.

The best advice I can give anyone who has a dream is to just go do it.  Do it with honesty and sincerity.  Do it because people need to know what unique lives we lead.  People will never know what is in our heart unless we show, not tell them.

About: Paul Ruggieri MD,FACS is a general surgeon in private practice, writer, stepfather, and a lover of single malt scotch. He writes at http://paulruggieri.com

Submit a guest post and be heard

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.

Break Your Ideas In Half

This video is right on target with it's message about cutting all of your ideas in half and structuring your business to excel at the basics.

Click to read more ...

Keep Your Goals To Yourself