Era 3, Overload, Stewardship in Healthcare, Nix Med MJ Now

Click here for Overload my show this week

Dr Jonas, your host for the Dr Synonymous Show, does a quick show tonite just because.  Lots is happening.

Much could be said-- or not.  Non- Directive Imagery could be a helpful shortcut out of overload. 

JAMA era 3 article by Don Berwick, MD reviewed, generating comments about G Gayle Stephens, MD a Founder of FM.  Dr. Stephens had a great talk about the covenant and the calling of physicians versus the contract and the job of modern era.  I added the community and the citizen becoming a steward of scarce valuable resources with the patient.  Both stewards, both human create the next era in health care.

Medical Marijuana are mutually exclusive words.  I expand on the idea.  Below is the definition of Marijuana from the Ohio Revised Code.

Non-Directive Imagery was my modality this week to get clarity from overload.  I reflect on the Holistic Consultation clinics we just added at our Free clinic (Open Arms Health Clinic) in Bellbrook, thanks to the Institute of Holistic Leadership with Patti McCormick, RN, PhD at the helm.

Tune in for a blip on the Dr Synonymous radar.

 "Marihuana" means all parts of a plant of the genus cannabis, whether growing or not; the seeds of a plant of that type; the resin extracted from a part of a plant of that type; and every compound, manufacture, salt, derivative, mixture, or preparation of a plant of that type or of its seeds or resin. "Marihuana" does not include the mature stalks of the plant, fiber produced from the stalks, oils or cake made from the seeds of the plant, or any other compound, manufacture, salt, derivative, mixture, or preparation of the mature stalks, except the resin extracted from the mature stalks, fiber, oil or cake, or the sterilized seed of the plant that is incapable of germination.  Ohio Revised Code

Family Medicine: Quality Suppressed by Insurance Companies- Costs of Care Driven Up

I got another threatening letter from an insurance company.  I have thirty percent more long visits than my peers.  Since I didn't align with what my peers do, they are threatening to audit me.  How do you insured folks feel about your insurance company pressuring your Family Physician to do less (or at least to code at a lower cost to them)?  With all the guidelines and other quality initiatives inflicted on Family Physicians in recent years, one should only expect that the level of service would go up and the charges would go up.  But no, they want them to remain the same.  Unfortunately, the majority of FP's undercode their visits for a wide variety of reasons.  Self esteem is a big one.  Training is another one.  Afraid of the insurance companies is another one.

I used to think that pressuring a whole group to do the same financial thing with their business was price fixing and would be outlawed by the Federal Trade Commission.  I guess that's not true.

Employers have no idea that the physicians caring for their employees are being pressured by the insurance company to do less, allowing their employees to be referred to more subspecialists because the physician held down the level of service at the primary care level and sent it up to the more expensive level.  The insurance company is forcing the costs up and driving the premiums up.

SURPRISE.

What do you think?

Eat Bacteria, Bacteria Food and Fats to Stay Healthy, Medical Geezer Reflections on Internet Radio

Click Here for the Dr Synonymous Show

Your host, Dr Jonas, will reflect on a fermentation session he attended today.  Kefir, kombucha, scoby and scoby hotel were some of the interesting subjects.  The food world is changing and physicians need to keep up.  

Physician burnout is a growing factor in workforce development for healthcare.  The "Match" for med students adds little hope for an adequate primary care workforce for America.  Dr. Jonas reflects on the role that Direct Primary Care may play in shifting med student specialty preferences.

What is Liberty Health Share and Liberty Direct?  Dr. J explains his practice transformation into Neighborly Family Medicine and Family Health Connections, Inc.

Pain management, pressures on physicians to not (ever) prescribe opiates and the role of the state medical board come up in the discussion (OK, monolog).

Dr J reviews TdaP immunization in pregnancy study in JAMA and a letter to the editor. 

Tweet review is brief. 

The blog post of Medical Mojave is reviewed (welcome back MM).

Blog, Tweet and literature review is always a part of the show.  The OSMA Annual Meeting is coming up.  What's big?

Dr. Jonas manifests his Medical Geezer status to pontificate a bit, too.  (No surprise)

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?

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

Clink here to hear -- The Dr Synonymous Show about the DPC OH UnSummit IV

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.