I like the Harvard courses in Boston called "Annual Update in ObGyn" that are held in spring and fall. I attend one of these courses every one to two years. The courses in Spring and Fall are not the same in terms of faculty and content. Check for alternatives at Yale, Duke, Cornell, UCSF, etc - these alternatives may exist, although I am not aware of them. A further advantage is that you have the chance to get in touch on a personal basis with the outstanding and very approachable faculty of Brigham and Women's. You also receive excellent print materials. You may purchase excellent Video CDs of surgical techniques for a reduced price.
Audio-Digest CDs, "the spoken medical journal" is the best CME program I have found.After you subscribe they send you a CD (or MP3) every two weeks with selected lectures of very good, renowned, expert speakers, many of them nationally known, on topics that really matter. Lectures are easy to understand. I listen to the CDs in my car on the way to work and back, over and over again - until I am bored. This is a very effortless way of learning. The material kind of diffuses in.They send you a printed summary of each CD, you can get short abstracts of their website, you can download a list of these lectures from their website. This is something I include in my recertification / relicensing papers. Of course you have the ability to collect CME points.Has proven to be incredibly effective, I would not want to miss it. The best bang for the buck in terms of CME.
The other best CME is the ABOG list of publications and the corresponding questionnaires they send out four times a year. Our hospital librarian finds the publications and copies them for all the ObGyns that participate. You can't beat this - a. you keep your board certification up to date, b. someone does the legwork of selecting interesting and relevant publications for you and c. you get CME credits
Consider a subscription to “UpToDate”, my favorite medical database and, yes, textbook. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search.Uptodate also has another very nice feature: the section on "what is new in..." and the section on ObGyn then reports about "10 important developments in the last year". Very nice, easy tool to keep up and make sure you have not missed anything during the last year!!
I also like two of the Throw-away journals:
1. "OBGmanagment" since Robert Barbieri is the editor. Barbieri, the chief of the ObGyn department at Brigham and Women's, happens to be incredibly smart, talented and also is a brilliant teacher. He and his editorial staff have an uncanny ability to find out which topics are relevant at the moment. The journal is presented very well, with hints how to read it fast, with hints as to what is important. And on top of everything he is nice if you meet him in person.
2.Contemporary ObGyn, which is Yale-powered. Similar praises as for 1.
Not so good and not recommended:
1. ObGyn Survey: somehow the selection of topics is off, I subscribed, ended up not reading it and cancelled.
2. Practical Reviews, ObGyn and Women's Health by Oakstone Publishing: they select articles, review them and comment them. The selection was just OK, the abstracts were good, the comments were just slightly changed abstracts without many new insights. Overall - not worth the time and money. Cannot hold the water to AudioDigest.
Monday, July 9, 2007
Sunday, July 8, 2007
Patient Education - Practice Tips 3
One of the basics in medical practice is to educate your patients well. It is good for them and it saves you a lot of time and phone calls. The Internet is your friend! I have had almost exclusively good effects of patients doing their own research on the net. Patients know more - good for both of us. I routinely hand out a list of websites that I recommend. I had posted this list before and I am including it again here.
Here are my tips for patient education:
Leaflets:1. ACOG leaflets – expensive, but they are “the standard”, and they look nice, fit into most purses, can be conveniently kept in wall hangers even in small examination rooms…they are just the best.
2. Significantly less expensive than the ACOG leaflets: Subscription to “MD-Consult”, which is only $220 a year over the net. This service not only gives you a large amount of textbooks, journals and pharmaceutical and pharmacological information, but, and this is the great thing that alone makes it worth the annual subscription, it gives you access to about 3000 (!) patient instructions, very well written, a good number also in Spanish. Often they have a short and long version of the same topic. I print out the instructions leaflets, copy them and keep them organized in my drawer, so that I can hand them to patients as needed - without having to log on and print them out each time. Printouts can be personalized with your name and office data. If you would purchase the “CRS Patient Advisor” on floppy disks or CD, which is what is included in MD Consult, it would cost you about $1000-1200. MD Consult includes not only the “Patient Advisor” but also info leaflets published by 2 more companies all for a lower price than you would have had to pay for the “Patient Advisor”.
3. Easiest, cheapest solution, but it feels somewhat dated: a book with CD by Miller, McEvers, Griffith: “Instructions for obstetrical and gynecological patients”, now in its third edition, at about $50-60. You are specifically allowed to copy all pages and hand them to your patients, the book comes with a CD that you can load onto your computer and that lets you easily print out all 200 plus patient instruction leaflets. The book also includes diets and illustrations. A steal. Has proven to be extremely cost effective, but may be outdated by now, since it does not contain the newest developments in e.g. HRT, contraception etc. Still good for the standard surgeries and things that have not changed such as ectopics.
4. My preferred solution - Write your own leaflets and information material! You will have tailored and customized information from you and your practice. And, your patients will first hear it from you and then read the same information on a paper at home (hopefully). This achieves maximum retention and effect. This also eliminates mixed messages or confusion when you say one thing and a website recommends another thing. I recommend not writing leaflets by a list or on demand, let's say, in response to the thought, "well, what leaflets might I need?" and then sit down and write them...NO, do not do that. I recommend a different approach: as soon as you realize that you are explaining something several times, as soon as you find yourself talking about something repetitively, let's say three times or more, you simply write down exactly what you just said. You use spoken language, simple terms. Voila, your leaflet is done. Then continue to correct and expand it with time, as the additional questions and ideas arise.
5. "The Female Patient" magazine frequently has good information leaflets in the back that you can copy and distribute to your patients.
Writing down what you think and say to your patients is also the best way to write a practice newsletter. Write down the things you explain to your patients, or the things you would love to explain, but do not have the time and mail them out or email them out every so often. Nobody says that a practice newsletter has to come out every three months. Write them and mail them as the issues arise. For example in late 2006 it was HPV, and the answers to the questions " Do I need an HPV test? Do you recommend the HPV vaccine?"
Post this information on your website. A good place to keep the original files or master files is in "Google Docs and Spreadsheets". This way you can pull them up anytime, work on them and store them.
Specifically for pregnancy:I recommend “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine to all my patients, and at one time have even given it out for free to all new prenatal patients. It is written by a mother of four, smart, witty, self-deprecating and straightforward – it really delivers what the title promises. The book is so entertaining that it reads like a novel and patients learn while laughing. Paperback, 288 pages, published by Pocket Books, ISBN 0671524313, around $12.
If you call the “special sales division” of the publisher and order about 25 books or more, you get 40% off. Many people know this book, but not all. It deserves more attention than the standard bestseller “What to expect..” which more often then not leaves patients concerned about complications and is more tedious to read. I do not recommend "What to expect..." and, by the way, one of the friends and relatives will give it to the expecting mother anyway.
I also recommend the book by Curtis and Schuler: "Your Pregnancy Week by Week", a great book that is easy to read since you only have to digest the material for one week. Has excellent drawings that help you understand how the baby looks, how large it is. Also contains useful tips for dads, such as "bring flowers without reason" or "help with housework". DaCapo Press / Lifelong Books, paperback, 15.95
My book recommendation for the time after pregnancy:"The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer", Paperback, by Harvey Karp
"Ever since I had my baby" by Roger Goldberg, a book that goes into the details of the consequences for your body of giving birth - from Roger Goldberg, MD, who is a very smart, well writing and accomplished urogynecologist from the Continence Center in Evanston, IL, and with whom I had the honor of training at BIDMC in Boston.
An excellent educational tool is to refer patients to good websites. They search on the net anyway, so tell them which sites are reliable and keep them away from the Quack and the snake oil sites. Here are the websites I refer my patients to:
http://medlineplus.gov/ MedLinePlus is the consumer health portal of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Very extensive, very good.
http://patients.uptodate.com/index.asp Uptodate patient information is an outstanding and very informative website published by doctors of Harvard Medical School.
http://www.acog.org/, the website of the American College of Obstetricians and Gynecologists. They have excellent “patient information leaflets” on all topics in Women’s Health.
http://www.4woman.gov/, the government’s website for women’s health, surprisingly good, considering that it is presented by the government.
http://www.familydoctor.org/ , the website of the Association of Family Doctors, covers all areas of medicine and explains issues very well and in plain English, in an easy to understand style
http://www.noah-health.org/. NOAH is the “New York Online Access to Health” database, which is big and bold, like so many “New York” things. Very extensive, uptodate and well done. Most important – it comes in Spanish too!
http://www.hormone.org/
http://www.menopause.org/, the website of the North American Menopause society
http://www.mayoclinic.com/, the website of the famous and excellent Mayo Clinic
http://www.fda.gov/
http://www.cdc.gov/. The website of the Center for Disease Control has great information about infections such as human papilloma virus (HPV), Herpes, HIV, travel medicine and much more
www.Managingcontraception.com. This is the website that offers the best and most accurate information on contraception. You can even download a booklet "Managing Contraception" for free. They also have a very good book on perimenopause: "The Midlife Bible" by Dr. Goodman, $17
http://nccam.nih.gov/health/ NCCAM is the National Center for Complimentary and Alternative Medicine of the National Institutes for Health, a great starting point for alternative medicine questions and information
Last, not least:www.quackwatch.org/ the site that keeps the web honest. Reports on all kinds of unscientific quackery on the Internet. Should a diagnostic method or treatment sound unfamiliar or too good to be true, look it up on this website.
Here are my tips for patient education:
Leaflets:1. ACOG leaflets – expensive, but they are “the standard”, and they look nice, fit into most purses, can be conveniently kept in wall hangers even in small examination rooms…they are just the best.
2. Significantly less expensive than the ACOG leaflets: Subscription to “MD-Consult”, which is only $220 a year over the net. This service not only gives you a large amount of textbooks, journals and pharmaceutical and pharmacological information, but, and this is the great thing that alone makes it worth the annual subscription, it gives you access to about 3000 (!) patient instructions, very well written, a good number also in Spanish. Often they have a short and long version of the same topic. I print out the instructions leaflets, copy them and keep them organized in my drawer, so that I can hand them to patients as needed - without having to log on and print them out each time. Printouts can be personalized with your name and office data. If you would purchase the “CRS Patient Advisor” on floppy disks or CD, which is what is included in MD Consult, it would cost you about $1000-1200. MD Consult includes not only the “Patient Advisor” but also info leaflets published by 2 more companies all for a lower price than you would have had to pay for the “Patient Advisor”.
3. Easiest, cheapest solution, but it feels somewhat dated: a book with CD by Miller, McEvers, Griffith: “Instructions for obstetrical and gynecological patients”, now in its third edition, at about $50-60. You are specifically allowed to copy all pages and hand them to your patients, the book comes with a CD that you can load onto your computer and that lets you easily print out all 200 plus patient instruction leaflets. The book also includes diets and illustrations. A steal. Has proven to be extremely cost effective, but may be outdated by now, since it does not contain the newest developments in e.g. HRT, contraception etc. Still good for the standard surgeries and things that have not changed such as ectopics.
4. My preferred solution - Write your own leaflets and information material! You will have tailored and customized information from you and your practice. And, your patients will first hear it from you and then read the same information on a paper at home (hopefully). This achieves maximum retention and effect. This also eliminates mixed messages or confusion when you say one thing and a website recommends another thing. I recommend not writing leaflets by a list or on demand, let's say, in response to the thought, "well, what leaflets might I need?" and then sit down and write them...NO, do not do that. I recommend a different approach: as soon as you realize that you are explaining something several times, as soon as you find yourself talking about something repetitively, let's say three times or more, you simply write down exactly what you just said. You use spoken language, simple terms. Voila, your leaflet is done. Then continue to correct and expand it with time, as the additional questions and ideas arise.
5. "The Female Patient" magazine frequently has good information leaflets in the back that you can copy and distribute to your patients.
Practice Newsletter
Writing down what you think and say to your patients is also the best way to write a practice newsletter. Write down the things you explain to your patients, or the things you would love to explain, but do not have the time and mail them out or email them out every so often. Nobody says that a practice newsletter has to come out every three months. Write them and mail them as the issues arise. For example in late 2006 it was HPV, and the answers to the questions " Do I need an HPV test? Do you recommend the HPV vaccine?"
Post this information on your website. A good place to keep the original files or master files is in "Google Docs and Spreadsheets". This way you can pull them up anytime, work on them and store them.
Book recommendations
Specifically for pregnancy:I recommend “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine to all my patients, and at one time have even given it out for free to all new prenatal patients. It is written by a mother of four, smart, witty, self-deprecating and straightforward – it really delivers what the title promises. The book is so entertaining that it reads like a novel and patients learn while laughing. Paperback, 288 pages, published by Pocket Books, ISBN 0671524313, around $12.
If you call the “special sales division” of the publisher and order about 25 books or more, you get 40% off. Many people know this book, but not all. It deserves more attention than the standard bestseller “What to expect..” which more often then not leaves patients concerned about complications and is more tedious to read. I do not recommend "What to expect..." and, by the way, one of the friends and relatives will give it to the expecting mother anyway.
I also recommend the book by Curtis and Schuler: "Your Pregnancy Week by Week", a great book that is easy to read since you only have to digest the material for one week. Has excellent drawings that help you understand how the baby looks, how large it is. Also contains useful tips for dads, such as "bring flowers without reason" or "help with housework". DaCapo Press / Lifelong Books, paperback, 15.95
My book recommendation for the time after pregnancy:"The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer", Paperback, by Harvey Karp
"Ever since I had my baby" by Roger Goldberg, a book that goes into the details of the consequences for your body of giving birth - from Roger Goldberg, MD, who is a very smart, well writing and accomplished urogynecologist from the Continence Center in Evanston, IL, and with whom I had the honor of training at BIDMC in Boston.
Websites I recommend to my patients:
An excellent educational tool is to refer patients to good websites. They search on the net anyway, so tell them which sites are reliable and keep them away from the Quack and the snake oil sites. Here are the websites I refer my patients to:
http://medlineplus.gov/ MedLinePlus is the consumer health portal of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Very extensive, very good.
http://patients.uptodate.com/index.asp Uptodate patient information is an outstanding and very informative website published by doctors of Harvard Medical School.
http://www.acog.org/, the website of the American College of Obstetricians and Gynecologists. They have excellent “patient information leaflets” on all topics in Women’s Health.
http://www.4woman.gov/, the government’s website for women’s health, surprisingly good, considering that it is presented by the government.
http://www.familydoctor.org/ , the website of the Association of Family Doctors, covers all areas of medicine and explains issues very well and in plain English, in an easy to understand style
http://www.noah-health.org/. NOAH is the “New York Online Access to Health” database, which is big and bold, like so many “New York” things. Very extensive, uptodate and well done. Most important – it comes in Spanish too!
http://www.hormone.org/
http://www.menopause.org/, the website of the North American Menopause society
http://www.mayoclinic.com/, the website of the famous and excellent Mayo Clinic
http://www.fda.gov/
http://www.cdc.gov/. The website of the Center for Disease Control has great information about infections such as human papilloma virus (HPV), Herpes, HIV, travel medicine and much more
www.Managingcontraception.com. This is the website that offers the best and most accurate information on contraception. You can even download a booklet "Managing Contraception" for free. They also have a very good book on perimenopause: "The Midlife Bible" by Dr. Goodman, $17
http://nccam.nih.gov/health/ NCCAM is the National Center for Complimentary and Alternative Medicine of the National Institutes for Health, a great starting point for alternative medicine questions and information
Last, not least:www.quackwatch.org/ the site that keeps the web honest. Reports on all kinds of unscientific quackery on the Internet. Should a diagnostic method or treatment sound unfamiliar or too good to be true, look it up on this website.
Practice Evidence Based Medicine - Practice Tips 2
PRACTICE EVIDENCE BASED MEDICINE
Use the Cochrane.org database. The Cochrane initiative was started about 20 years ago with the goal to provide Obstetricians in the UK with the best possible evidence in their field. It has developed into a global movement that fosters evidence based ObGyn by choosing a specific question, searching for available literature, eliminating insufficient studies, analyzing the remaining ones in detail, and summarizing the results. These summaries are available as “abstracts” and they are free on the Cochrane website. If you subscribe to the service you receive the complete analysis, which is not really necessary for everyday work. The Cochrane database is the best available evidence in our field - anywhere.
Use “Pubmed”, the free search engine that gives you access to 12+ million publications of the National Library of Medicine. Use the “limits” feature to customize your searches. To get the web address simply enters “Pubmed” in the Google search engine search field.
Consider a subscription to “UpToDate”, my favorite medical database. Test it with their a free 10-day trial on the net. At $500 for subscription for an individual it is more expensive than “MD Consult”, but definitely worth the money. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search, just great content!. They also have a patient information section, which I recommend to all my patients to avoid them falling prey to weird Internet rumors. Patients appreciate guidance and advice from you in that regard. It is faster to look up things on uptodate than on MD Consult, which at the moment takes quite some time to load. Check your hospital library to see if they have it and if not, ask them to get it.
Uptodate also has a very very nice feature: they have a section on "what is new in....and the section on ObGyn then reports about 10 important developments in the last year. Very nice, easy tool to keep up and make sure you have not missed anything during the last year!
Another alternative, somewhat less expensive, but it has drawbacks – not my favorite. I let my subscription expire last year. It is “MD Consult”, a database of medical information – essentially everything you need. It’s a cooperation of the 4 or 5 largest medical publishers in the country. Costs around $220 a year and is fully searchable. MD Consult gives you 40 standard textbooks including the Gabbe as well as full text articles of the “Clinics of North America” and the Mosby “Year Books” and numerous medical and scientific journals – a great steal from whichever angle you look at it. They also offer decent patient information leaflets, although they are not too well presented, do not have drawings or photos and are a little dry. If you are a customer of PIAM (Physicians Insurance Agency of Massachusetts) it’s free, if you are a member of the Canadian Medical Association it’s free, and if you have links to a major medical center it is possible that they offer it for free to their attendings – ask.
Drawbacks are: takes a looooong time to load, especially if you want to just look at or print out a patient instruction leaflet quickly. Also, their search function is a little clumsy and difficult, unforgiving in terms of spelling errors and just not as easy as we expect after using Google for a while.
Get the book “Clinical Evidence”, which was developed by the BMJ Publishing Group, publishers of the 160 year old “British Medical Journal” – it’s free if you request it from, who would have thought so, United Health. You can register to have the follow-ups sent to you for free too. It is presents pretty bare bones results evidence based medicine, and as such worth having. The book includes a CD with the complete text that you can load onto your computer and use it with full search capabilities.
To obtain book and CD, go to
http://www.clinicalevidence.org/ orWrite to the United Health FoundationWilliam W. McGuire, MDChairman, United Health FoundationMN008-T500 PO Box 1459Minneapolis, MN 55440-1459Or email him under uhfce@uhc.com
Also check out http://cebm.jr2.ox.ac.uk/ ---- the British Centre for Evidence based medicine.
Try the national guideline clearinghouse, guideline.gov.
And of course, google the term “evidence based medicine” and see what you get.
Use the Cochrane.org database. The Cochrane initiative was started about 20 years ago with the goal to provide Obstetricians in the UK with the best possible evidence in their field. It has developed into a global movement that fosters evidence based ObGyn by choosing a specific question, searching for available literature, eliminating insufficient studies, analyzing the remaining ones in detail, and summarizing the results. These summaries are available as “abstracts” and they are free on the Cochrane website. If you subscribe to the service you receive the complete analysis, which is not really necessary for everyday work. The Cochrane database is the best available evidence in our field - anywhere.
Use “Pubmed”, the free search engine that gives you access to 12+ million publications of the National Library of Medicine. Use the “limits” feature to customize your searches. To get the web address simply enters “Pubmed” in the Google search engine search field.
Consider a subscription to “UpToDate”, my favorite medical database. Test it with their a free 10-day trial on the net. At $500 for subscription for an individual it is more expensive than “MD Consult”, but definitely worth the money. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search, just great content!. They also have a patient information section, which I recommend to all my patients to avoid them falling prey to weird Internet rumors. Patients appreciate guidance and advice from you in that regard. It is faster to look up things on uptodate than on MD Consult, which at the moment takes quite some time to load. Check your hospital library to see if they have it and if not, ask them to get it.
Uptodate also has a very very nice feature: they have a section on "what is new in....and the section on ObGyn then reports about 10 important developments in the last year. Very nice, easy tool to keep up and make sure you have not missed anything during the last year!
Another alternative, somewhat less expensive, but it has drawbacks – not my favorite. I let my subscription expire last year. It is “MD Consult”, a database of medical information – essentially everything you need. It’s a cooperation of the 4 or 5 largest medical publishers in the country. Costs around $220 a year and is fully searchable. MD Consult gives you 40 standard textbooks including the Gabbe as well as full text articles of the “Clinics of North America” and the Mosby “Year Books” and numerous medical and scientific journals – a great steal from whichever angle you look at it. They also offer decent patient information leaflets, although they are not too well presented, do not have drawings or photos and are a little dry. If you are a customer of PIAM (Physicians Insurance Agency of Massachusetts) it’s free, if you are a member of the Canadian Medical Association it’s free, and if you have links to a major medical center it is possible that they offer it for free to their attendings – ask.
Drawbacks are: takes a looooong time to load, especially if you want to just look at or print out a patient instruction leaflet quickly. Also, their search function is a little clumsy and difficult, unforgiving in terms of spelling errors and just not as easy as we expect after using Google for a while.
Get the book “Clinical Evidence”, which was developed by the BMJ Publishing Group, publishers of the 160 year old “British Medical Journal” – it’s free if you request it from, who would have thought so, United Health. You can register to have the follow-ups sent to you for free too. It is presents pretty bare bones results evidence based medicine, and as such worth having. The book includes a CD with the complete text that you can load onto your computer and use it with full search capabilities.
To obtain book and CD, go to
http://www.clinicalevidence.org/ orWrite to the United Health FoundationWilliam W. McGuire, MDChairman, United Health FoundationMN008-T500 PO Box 1459Minneapolis, MN 55440-1459Or email him under uhfce@uhc.com
Also check out http://cebm.jr2.ox.ac.uk/ ---- the British Centre for Evidence based medicine.
Try the national guideline clearinghouse, guideline.gov.
And of course, google the term “evidence based medicine” and see what you get.
The Basics of a Successful Practice - Practice Tips 1
The 8 basic principles:
1. Practice evidence based medicine - it’s not just better, it is easier and cheaper
2. Develop and/or maintain good bedside manners: listen, teach, learn how to say the most important things in a short time and hand out leaflets as reinforcement and reminder
3. Educate your patients well
4. Do as much in your own office as possible, you save time and you earn the
facility fee for procedures
5. Market your practice efficiently, economically and ethically and on the Internet
6. Have a great office staff and make sure their morale is good
7. Document and bill well
8. In 2006/7 still be cautious about EMR
The basic principles for financial success in an ObGyn practice:
The big idea, the general plan, the overall strategy for a financially successful practice is:
Do as much in the office as possible, do as many diagnostic and therapeutic procedures in the office. This way you get paid for the procedure plus you receive the facility fee.
You also save yourself the wasted time that it takes to change over in the OR.
Spend as much time your office as possible, since it is YOUR office and you are in command and you can streamline all procedures to maximum efficiency. I heard it again and again from successful colleagues: if you can work most of the time in the office and avoid going to the hospital, you earn more.
Should you have to go to the OR, then try not to have block time, but try to get the first slot in the OR in the morning for one procedure. This way you avoid the loss of time involved with changing patients in the operating room.
Do your surgeries on your on-call weekends, where you can't do much else anyway or have to be at the hospital anyway. Many hospitals allow scheduled surgeries on Saturdays.
It may be worth it to combine procedures, such as hysteroscopy and saline infusion sonography.
Learn coding well to maximize your reimbursement, attend courses, listen to your colleagues, and remember - the HMOs are using sophisticated, expensive, highly specialized software to aggressively downgrade your reimbursements no matter what you do.
Visit an ACOG coding and billing course (one of those courses that are always sold out)
Market your practice.
Read the book by Neil Baum and Gretchen Henkel "Market Your Practice", $ 89. This book has all the marketing advice you will ever need, just follow his advice.
Read the books by Jay Levinson on Guerilla Marketing, and you will be inspired.
Read the book by Michael Port "Book Yourself Solid" - which inspires you to think like a marketer.
You might even consider hiring a professional marketer for developing a marketing plan and for carrying it out.
1. Practice evidence based medicine - it’s not just better, it is easier and cheaper
2. Develop and/or maintain good bedside manners: listen, teach, learn how to say the most important things in a short time and hand out leaflets as reinforcement and reminder
3. Educate your patients well
4. Do as much in your own office as possible, you save time and you earn the
facility fee for procedures
5. Market your practice efficiently, economically and ethically and on the Internet
6. Have a great office staff and make sure their morale is good
7. Document and bill well
8. In 2006/7 still be cautious about EMR
The basic principles for financial success in an ObGyn practice:
The big idea, the general plan, the overall strategy for a financially successful practice is:
Do as much in the office as possible, do as many diagnostic and therapeutic procedures in the office. This way you get paid for the procedure plus you receive the facility fee.
You also save yourself the wasted time that it takes to change over in the OR.
Spend as much time your office as possible, since it is YOUR office and you are in command and you can streamline all procedures to maximum efficiency. I heard it again and again from successful colleagues: if you can work most of the time in the office and avoid going to the hospital, you earn more.
Should you have to go to the OR, then try not to have block time, but try to get the first slot in the OR in the morning for one procedure. This way you avoid the loss of time involved with changing patients in the operating room.
Do your surgeries on your on-call weekends, where you can't do much else anyway or have to be at the hospital anyway. Many hospitals allow scheduled surgeries on Saturdays.
It may be worth it to combine procedures, such as hysteroscopy and saline infusion sonography.
Learn coding well to maximize your reimbursement, attend courses, listen to your colleagues, and remember - the HMOs are using sophisticated, expensive, highly specialized software to aggressively downgrade your reimbursements no matter what you do.
Visit an ACOG coding and billing course (one of those courses that are always sold out)
Market your practice.
Read the book by Neil Baum and Gretchen Henkel "Market Your Practice", $ 89. This book has all the marketing advice you will ever need, just follow his advice.
Read the books by Jay Levinson on Guerilla Marketing, and you will be inspired.
Read the book by Michael Port "Book Yourself Solid" - which inspires you to think like a marketer.
You might even consider hiring a professional marketer for developing a marketing plan and for carrying it out.
Tuesday, July 3, 2007
There is no physician shortage
You may have heard the rumors an "impending physician shortage". Dr. Richard Cooper from Wisconsin calculated that we will need 80-100.000 physicians more in 15 years, and is spreading alarming news about a "looming physician shortage". He recommends that we should enroll more students in medical schools, found new medical schools and expand existing residency programs and create new programs.
I disagree with the notion of physician shortage that resulted from Dr. Richard Cooper's study. I suspect the numbers and basic assumptions are wrong.
There is no shortage now. While we had 1.6 physicians per thousand Americans in 1970 (500.000 physicians total), in 2000 we had 2.4 physicians per thousand (over 800,000 physicians) and presently we have an average of 2.6 physicians per thousand Americans. Despite population growth, the ratio of physicians to patients has grown, has improved. Our present system of education is actually increasing the number of physicians per 1000 Americans.
In addition, in my opinion we have an oversupply of physicians since the 1980s. Here is why: The cost of any service is determined by supply and demand. This is so simple that most people forget it, although the sudden rise of gas prices after hurricane Katrina should have reminded everybody. Physician earning power has dropped to about 1/3 of what it was in the mid eighties.
One example from my area: 20 years ago an ObGyn in Boston earned about 400 K and a very nice home in the best area of Boston cost about 400K. Nowadays the very same house costs 1.6-2 million and the same ObGyn (working a lot harder and seeing about twice the number of patients) earns 200K. Physician income has dropped dramatically. And that means that we have an oversupply of physicians. And we have an oversupply since the 80's. No study required. You have been reading about continuous unstoppable decreases in reimbursements for physicians. Is that a sign of a balance between supply and demand? No, It is a sign of oversupply.
This means that Dr. Cooper is wrong in assuming that the present situation is "balanced" or "neutral". The present situation is not the "normal level", it is a level of oversupply.
There is no good way of planning physician supply. Who knows what will happen tomorrow and how it will impact physician supply and demand? Maybe we will find the gene for motivation to exercise or the gene for weight and obesity and the manipulation of that gene will make all the heart diseases shrink to 5% of what they are now?
When considering prediction for the future, do you remember what 60's thought the cars of the future were going to look like? There were pictures of large ship like cars with fins, rotating seats, driving fully automatically... which is just what we have now - right?
Dr. Cooper, the author of the unfortunate study, did not foresee ...
1. The "minute clinics" that are sprouting like mushrooms in CVS stores, Walmarts etc all over the country. The numbers of patients seen in these clinics are rising rapidly and the number of visits are already reaching millions. These clinics, operating under the slogan "you are sick, we are quick", are rapidly gaining in acceptance, and not only the number of visits to these clinics are growing, but also the average payment per visit. The customer satisfaction is on par with the satisfaction in physician offices. These clinics will be a tremendous competition to physicians, or, in the eyes of Dr. Cooper, a "relief" of the "shortage ". The development and growth of these clinics alone may prove Dr. Cooper wrong.
2. Dr. Cooper did not foresee or consider telemedicine. Indian physicians are already reading numerous x-rays, CTs and ultrasounds at night, due to the fact that our nighttime is daytime in India. This trend will expand, since Indian labor is cheaper, and soon we will have a decreasing need for radiologists.
3. There are large numbers of very well trained and very competent physicians in Central Europe (Germany, United Kingdom, France, Spain and Italy) that could transition to the US. These physicians would only need residency training. They would not need medical school. The cost savings for the US would be dramatic and these physicians would be available much faster than physicians newly schooled and then trained in the US.
5. If, yes, if there is really more demand for health care providers it would be much more economical to train more nurse practitioners and physician assistants, who are very well suited to take care of routine cases. Physicians would diagnose and treat the more unusual and difficult cases.
Overall, I seriously doubt we can reliably foresee the demand for physicians in 15-25 years and prefer to go with Yogi Berra's statement "predictions are very difficult, especially about the future". I do not see a shortage now and I see easy relief for any kind of "shortage" that may (or may not) present itself in the future.
Dr. Cooper's statements are extremely damaging for physicians and should be re-evaluated. This should be done before the present oversupply of physicians is worsened and perpetuated by creating more and unnecessary medical schools and residency programs.
Who benefits from this alarming rumor? Who makes money from it? Guess who - the HMOs.
HMOs make money by withholding payments, delaying payments and by lowering reimbursements. This is only possible because they can rely on a large number of physicians who have no alternatives to the current HMO contracts and payment methods (or better witholding-payment methods). The HMOs exist only because of physicians need to contract with them - because of an oversupply of physicians. It would be a disaster for HMOs if physicians could demand better payments. The future of HMOs depends on the ability to have a large supply of physicians, an oversupply of physicians, willing to work for less and less. Actually, the future of HMOs is at stake here. What do YOU want to do about it?
I disagree with the notion of physician shortage that resulted from Dr. Richard Cooper's study. I suspect the numbers and basic assumptions are wrong.
There is no shortage now. While we had 1.6 physicians per thousand Americans in 1970 (500.000 physicians total), in 2000 we had 2.4 physicians per thousand (over 800,000 physicians) and presently we have an average of 2.6 physicians per thousand Americans. Despite population growth, the ratio of physicians to patients has grown, has improved. Our present system of education is actually increasing the number of physicians per 1000 Americans.
In addition, in my opinion we have an oversupply of physicians since the 1980s. Here is why: The cost of any service is determined by supply and demand. This is so simple that most people forget it, although the sudden rise of gas prices after hurricane Katrina should have reminded everybody. Physician earning power has dropped to about 1/3 of what it was in the mid eighties.
One example from my area: 20 years ago an ObGyn in Boston earned about 400 K and a very nice home in the best area of Boston cost about 400K. Nowadays the very same house costs 1.6-2 million and the same ObGyn (working a lot harder and seeing about twice the number of patients) earns 200K. Physician income has dropped dramatically. And that means that we have an oversupply of physicians. And we have an oversupply since the 80's. No study required. You have been reading about continuous unstoppable decreases in reimbursements for physicians. Is that a sign of a balance between supply and demand? No, It is a sign of oversupply.
This means that Dr. Cooper is wrong in assuming that the present situation is "balanced" or "neutral". The present situation is not the "normal level", it is a level of oversupply.
There is no good way of planning physician supply. Who knows what will happen tomorrow and how it will impact physician supply and demand? Maybe we will find the gene for motivation to exercise or the gene for weight and obesity and the manipulation of that gene will make all the heart diseases shrink to 5% of what they are now?
When considering prediction for the future, do you remember what 60's thought the cars of the future were going to look like? There were pictures of large ship like cars with fins, rotating seats, driving fully automatically... which is just what we have now - right?
Dr. Cooper, the author of the unfortunate study, did not foresee ...
1. The "minute clinics" that are sprouting like mushrooms in CVS stores, Walmarts etc all over the country. The numbers of patients seen in these clinics are rising rapidly and the number of visits are already reaching millions. These clinics, operating under the slogan "you are sick, we are quick", are rapidly gaining in acceptance, and not only the number of visits to these clinics are growing, but also the average payment per visit. The customer satisfaction is on par with the satisfaction in physician offices. These clinics will be a tremendous competition to physicians, or, in the eyes of Dr. Cooper, a "relief" of the "shortage ". The development and growth of these clinics alone may prove Dr. Cooper wrong.
2. Dr. Cooper did not foresee or consider telemedicine. Indian physicians are already reading numerous x-rays, CTs and ultrasounds at night, due to the fact that our nighttime is daytime in India. This trend will expand, since Indian labor is cheaper, and soon we will have a decreasing need for radiologists.
3. There are large numbers of very well trained and very competent physicians in Central Europe (Germany, United Kingdom, France, Spain and Italy) that could transition to the US. These physicians would only need residency training. They would not need medical school. The cost savings for the US would be dramatic and these physicians would be available much faster than physicians newly schooled and then trained in the US.
5. If, yes, if there is really more demand for health care providers it would be much more economical to train more nurse practitioners and physician assistants, who are very well suited to take care of routine cases. Physicians would diagnose and treat the more unusual and difficult cases.
Overall, I seriously doubt we can reliably foresee the demand for physicians in 15-25 years and prefer to go with Yogi Berra's statement "predictions are very difficult, especially about the future". I do not see a shortage now and I see easy relief for any kind of "shortage" that may (or may not) present itself in the future.
Dr. Cooper's statements are extremely damaging for physicians and should be re-evaluated. This should be done before the present oversupply of physicians is worsened and perpetuated by creating more and unnecessary medical schools and residency programs.
Who benefits from this alarming rumor? Who makes money from it? Guess who - the HMOs.
HMOs make money by withholding payments, delaying payments and by lowering reimbursements. This is only possible because they can rely on a large number of physicians who have no alternatives to the current HMO contracts and payment methods (or better witholding-payment methods). The HMOs exist only because of physicians need to contract with them - because of an oversupply of physicians. It would be a disaster for HMOs if physicians could demand better payments. The future of HMOs depends on the ability to have a large supply of physicians, an oversupply of physicians, willing to work for less and less. Actually, the future of HMOs is at stake here. What do YOU want to do about it?
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