Monday, February 29, 2016

Direct Primary Care for Geezers: Smile and Keep Practicing

OK, so you're a Family Physician near the end of your practicing career.  A little tired, a little fed up, but still seeing a Family Physician when you look in the mirror every day.  How do you crawl out from under the piles of administrivia each day and still look ahead to the next day of patient care?

If it's harder each day and you are looking at your retirement plans more often, but torn because you love being a Family Physician, what can you do?

Direct Primary Care (DPC)is one option.  I spoke about "DPC for Geezers" at the recent DPC Ohio UnSummit IV.  As an independent Family Physician near the end of my practice years, I love what I do, but qualify as someone who's fed up with the "piles" and other issues mentioned above.  I'm a "Geezer".  I have a Medicare card.  I own and play records (before CD's).  My hair is beyond gray.
I look at my practice as an asset, but realize that only a hospital would buy it.

How do I find a younger physician to join in the practice?  None are seriously looking for a traditional independent practice.  DPC to the rescue.

As a hybrid DPC physician (Traditional plus DPC) who needs to transition to what I call Mixed DPC (DPC plus some self pay visits) by January 1st 2017, I see hope in the resident physicians who want a job in DPC- yes, a JOB - not a small business ownership right out of residency.  I can offer them a job, if they want to evolve into potential ownership later.

The combination of end of career independent FP's in DPC with residents who want to do DPC could be a game changer for lots of people.  The Geezer gets to extend their career, slow down and mentor the resident in the ways of private practice while the resident gets freedom to do DPC and connect with their new patients better than the hospital employed physician.

Geezers and DPC and New Physicians are a great combination.

What do you think?

Thursday, February 25, 2016

Summary of DPC Ohio UnSummit IV: The Culture Grows and Glows

The DPC Ohio culture moved ahead on February 20th as 24 fans of DPC gathered at the Dublin Integrated Education Center.  Medical students, residents, a FNP student, Family Physicians, General Internists, a Rheumatologist, a practice manager and six faculty shared information and ideas in a stimulating one day UnSummit.
From Cincinnati to Columbus to Cleveland to Beavercreek, Bellfontaine, and Waverly, OH to Uniontown, PA and SouthBend, IN, Physicians in Direct Primary Care disclosed their strategies for success and the challenges behind and ahead.   Dr Jonas, your host for the Dr. Synonymous Show, was one of the presenters  (DPC for Geezers: Hybrids and Pitfalls, DPC National Tour Online, and Networking and Teaching DPC).  He reviews some of the highlights of the meeting and ponders what may lie ahead.  At least two future interviews for the Dr S Show were assured from the people and ideas at this enthusiastic session in an incredible facility: The Dublin Integrated Education Center on the OU Dublin, Ohio Campus.
The Center for Innovation in Family and Community Health thanks the FMEC for their help planning and announcing the meeting and to LibertyDirect for help with sponsorship.  Special thanks to onsite and ongoing CIFCH member, Patrick Jonas (my oldest son), for his efforts and to FMEC staffer Shayla Rammel for her help with the preparatory work online and through social media.

Thursday, February 18, 2016

Last Call for Direct Primary Care Ohio UnSummit IV February 20

The snow is melting and we're warming up for the DPC Ohio Unsummit in Dublin, OH February 20th from 8:30 until 4:30 PM.  Agenda, Location and Registration- double click:   DPC Ohio UnSummit IV 

Among our registrants, we have medical students from OSU and OU, resident physicians from Indiana and Ohio, and a nurse practitioner student from Ohio.  There is a practice manager from Virginia and a physician/ practice manager couple from Pennsylvania, a new DPC practice internist from Ohio and a renowned Family Medicine Researcher who is editor of the Annals of Family Medicine.

Good News for persons interested in DPC:  You can still sign up online and bring your check with you to the meeting.

Good News for people coming to the UnSummit:  Free Lunch!

Liberty Direct is one of our sponsors who came through with support for the meeting which enables us to send out for a luncheon such as salads and pizzas, etc. to be determined by those present.

We'll see you Saturday!

Saturday, February 13, 2016

DPC Ohio UnSummit IV February 20: Celebrating the Ohio DPC Culture

OK, Folks, we're in the homestretch for the next Ohio DPC education opportunity in Dublin, OH on February 20 from 8:30 AM- 4:30 PM.  Click on the link at the bottom for the Agenda, Faculty list and Registration Form.

Our first speaker, Brian Sammon, DO is a resident leader with experience in the Atlas MD practice in Kansas who will speak of "DPC 101".  Next is the President-Elect of the Ohio Academy of Family Physicians, Ryan Kauffman, MD explaining how he left his traditional practice in 2015 and started a new DPC practice in a neighboring town in January- "Why DPC?  Why Now? Why I Started Hickory".  He received training at the DPC National Summit III and with Access Healthcare Direct.

Larry Bauer, MSW, MEd (Family Medicine Educator and leader since 1978) will help put DPC in a broader context, especially for the medical students and residents and even more experienced physicians with "Career implications of DPC".

With consideration for physicians later in their careers, even near the end of their practice years, Will Sawyer, MD (of Henry The Hand fame) and Pat Jonas, MD (a Past President of the OAFP in 1995) present "DPC for Geezers:  Hybrid Models and Pitfalls".  Yes, we'll even look at some dangers in DPC, just like we do daily with our patients when reviewing potential benefits and harms of interventions and therapies.

Plenty of Question and Answer time is in the schedule and faculty will spread out for lunchtime conversations.  We'll have water, coffee and snacks for two breaks.  Lunch is on your own and there is a warming and refrigeration kitchen for storing your lunches, etc.  Many sent out for salads or pizzas at previous UnSummits.

After lunch we get into a newer area of DPC with a fascinating presentation by Jed Constantz, "DPC and Hospitals: New Options"  informing us about a project in Ohio with a hospital and DPC. Hospitals are encouraged to send someone to the meeting to hear about how DPC can save them money on employee health and other areas.

A National Tour of DPC practices online is a feature of each UnSummit.  Bring your laptops, tablets, superphones, etc. to follow along and save sites for future reference.  A look at state and national legislative issues about DPC will help participants to hear about some friendships and hurdles that impact DPC.  Ohio has no specific laws about DPC which may make us vulnerable or fortunate. We'll discuss both.

What's different in daily practice with DPC?  Pat and Ryan, the Past and Future Presidents of OAFP, will reveal how it is in their practice.  Time, Time, Time and Time may be mentioned.  Relationships are always a big part of Family Medicine and other primary care specialties.  Are they different in DPC?

Sharing plans are a unique aspect of many DPC and non-DPC practices.  Liberty Healthshare with their Liberty Direct opportunity for DPC patients and physicians is headquartered in Canton.  Dr. Kauffman has some Liberty patients and uses their plan for his personal health plan.

After an important discussion about how we can network in Ohio and nationally, we'll review some ways that DPC might be taught.  Just as the practicing physicians had to teach Family Medicine to get the specialty started, DPC should be taught by DPC physicians primarily.

The Town Hall open session wraps up our UnSummit.  These are always interesting as they are guided by the questions of the participants.

WARNING:  Specific DPC Prices, fees, etc. can't be discussed due to federal restraint of trade guidelines as interpreted for AAFP and OAFP policies.  Dr Kauffman will help us not to mention the unmentionable. He will explain this at the start of the meeting and in the afternoon.  Please respect this limitation.  It is slightly stifling, but the internet isn't.  We'll explain.  Twice.

Thanks to the Family Medicine Education Consortium, Inc. (FMEC) for support in planning and communication.

There's still time to sign up and come to Dublin, Ohio on Saturday February 20th.

A nice follow-up could be the DPC National Summit in Kansas City July 8-10,2016.

DPC Ohio UnSummit IV

Patient or Doctor Passes Wind in the Exam Room

I heard a distinct sound when the elderly patient got up from the chair, the sound of "wind" passing.

I examined the infant's abdomen and it "passed wind".

The nine year old jumped onto the exam table and "passed wind".

So what should a Family Physician say or do at times like these?

On the patient side, many could note how their doctor "passed wind".

What should patients say or do, if anything?

What is the proper "Wind Passing" etiquette?

Wednesday, February 10, 2016

Cultural Development of DPC: Pure, Mixed and Hybrid

Here's the overview of my BTR Show from Tuesday February 9, 2016. I review several definitions of culture and several models about cultural structures and functions from an interesting outline from Texas A & M University.  Here's the link to the DPC Ohio UnSummit Agenda and registration forms --to be held on February 20th: DPC Ohio UnSummit
Direct Primary Care is growing and groaning.  What drives it?  What goes into the development of the DPC culture? Is there a culture of DPC?  "A culture is a way of life of a group of people--the behaviors, beliefs, values, and symbols that they accept, generally without thinking about them, and that are passed along by communication and imitation from one generation to the next." one Internet definition.
Models of DPC include "Pure", Mixed and Hybrid.  I'll define Mixed during the show.  
Who is doing it and how does it come together?
The DPC Summits help to anchor the movement.  July 8-10 in Kansas City is the next national one.
Our Ohio UnSummit seeks to help with the development of the Ohio DPC culture.  I'll discuss the UnSummit (Feb 20th in Dublin, OH) and shamelessly promote it during the show.

Click Here to listen: Cultural Development of DPC: Pure, Mixed and Hybrid

Sunday, February 7, 2016

Payment Reform is Costly and Misguided: Except for Direct Primary Care

Some of my thoughts after reading the Health Affairs Blog about the Conundrum explained in the link below.  We're headed toward a government only health system. Now doctors get incentives to be employed, penalized to remain in a Fee for Service model (which has been twisted to maximize profits for employers of physicians, which only took 9% of GDP with mostly independent physicians while now,  with mostly employed physicians, it's 18% of GDP- read the comments with the article, too, they're very thought provoking and no one starts name calling- they politely give their opinions).   The mandated models aren't proven, cost more in reality, are only successful where prices had been extremely high, drive physicians into becoming shills for industry and are ignoring Patient Autonomy- one of the principles of medical ethics, other than that they feel good to many non-physicians.

This will probably be my last year in any insurance plans.  I have a Direct Primary Care Track (called Direct Family Medicine the way I do it).  That new part of the practice is called Neighborly Family Medicine.  We're open for uninsured families in our Beavercreek office.  Those who can act should act in the next couple years.  None of this is fast, but it's deadly.

Over-testing is almost mandatory as is over-prescribing for so-called quality bonuses.  Physicians of 90 year olds are starting them on statins in spite of no scientific support to do so and knowing that cognitive dysfunction is one of the side effects of statins that every Family Physician has seen.  We're (The Medical- Industrial Complex) in a steady decline for medical quality and shamelessly bankrupting America in the name of "Quality".  I see evidence of this daily.  Daily. Not in a philosophy column by a health planner or government official or a political rant, but in person in my medical office daily.

Health Policy and Payment Reform Conundrum