Piper was the first and the only patient in nearly 20 years of practice for whom I have signed the birth certificate and the death certificate. 100 years ago, country doctors did that sort of thing frequently, but today, it is rare. It remains one of the hardest things I have ever done as a physician.
It seems perverse to deliver healthcare services at a place called the Minute Clinic. The kind of physician-patient relationship that can be cultivated in a minute is not one to write home about. While CVS and Walgreens see geriatric primary care as yet another untapped gold mine, for me, the relationship memorialized in Norman Rockwell’s “Physician” resonates as much today as it did 90 years ago. Seamless ecosystems are no match for a “willingness to place professional expertise at the feet of childhood magic.”
Can We Have a Reasonable Discussion on Vaccines?
The Regence auditor in charge of my case, Anke Menzer-Wallace, failed to turn up any irregularities in our documentation. But, still, Ms. Menzer-Wallace issued a stern admonition to my father and me, ordering us not to open our clinic on Saturdays to administer flu shots.
During the same period, the U.S. maternal mortality more than doubled, skyrocketing from 9.8 to 21.5 maternal deaths per 100,000 live births. That’s six times higher than most Scandinavian countries and three times higher than Canada and the United Kingdom. In the U.S., around 700-900 women die and another 65,000 experience life-threatening complications during or after childbirth. By any standard, the U.S. has the worst performance on this crucial measure of any country in the developed world.
MOC is a cash cow for the American Board of Medical Specialties (ABMS) and its 24 specialty boards, which administer the exams. According to its most recent tax filings, ABMS president Lois Margaret Nora made nearly $700,000 in compensation from the organization in 2016. Thirteen other executives made over $150,000 from the nonprofit in the same year. In total, ABMS spent over $10 million on compensation, more than half its annual revenues, which largely come from inflated testing fees.
Many families have brought their children, grandchildren, and great-grandchildren to us for more than 40 years. We have seen them through the darkest moments of their lives, at their most vulnerable, and brought them into the light. Now, our patients must guide me through unimaginable heartache and grief.
The American Board of Medical Specialties (ABMS) eliminated “lifetime” certification to shore up their financial outlook; a modification having little to do with quality and much to do with rate of return. Between 2003 and 2013, the ABMS member boards’ assets ballooned from $237 million to a staggering $635 million, an annual growth rate of 10.4%. MOC is outrageously lucrative. Almost 88% of their revenue came from certification fees.
In June 2016, Kitsap County emergency personnel participated in Cascadia Rising, a large-scale earthquake drill. At the time, three local hospitals planned to coordinate management of injured casualties: Navy Hospital, which would treat the “walking wounded” (least injured), or Harrison Silverdale and Harrison Bremerton, which would clear their emergency departments to receive the flood of injured patients. While those plans have changed, the grave risk to our community in the event of an earthquake should not be ignored.
Success is never attained by taking shortcuts. We do not need reform of health care; we need to renovate the entire system. Special interests do not belong in the picture. They are superfluous to achieving innovative solutions that place profits on the back burner. Healthcare reform is like learning to discipline a tantrum-throwing 3-year-old; it will not conform to rhyme or reason. Congress is making this too difficult. They need to roll up their sleeves, go back to the drawing board, and start again.