Information provided by Health Train Express and Digital Health Space is informational only. We do not endorse specific solutions. Inclusions are provided as reference only. Readers should consult with their own consultants for further details.

Wednesday, June 29, 2011

ePatient Dave is In The Room


Some of us talk about the “elephant in the room’ which everyone knows about but ignores. We also may make the same mistake about the person across from you in the examination room.

Watch this video….Dave deBronkart is not only articulate and entertaining at this TED talk, he has some original ideas about communicating ideas to patients.

Let’s see if Google or some other software can develop this one. If Facebook and twitter are worth so much money, how much would these advances make for our patients.

follow  ideas on twitter  glevin1   facebook/gmlevin 

Tuesday, June 28, 2011

Darwinian Social Media Engagement

My Photo

The Health Train Express enjoyed an enormous response to our series on social media for medicine.

Many asked questions, so I am including some more advanced feature sets from which to obtain material, organize your SM entries, to analyze your network as well as to organize it.

Forrester has released a new report, Accelerating Your Social Maturity: How To Move From Social Experimentation To Business Transformation, which you can also find as a new chapter in the newly updated paperback version of the Groundswell book.

While this  report is written with the larger enterprise in mind, much of it applies to your neophyte media presence. It serves as a framework for your social media programs.

Five Stages of Social Media Maturity offers new as well as  mature social media users of all  sizes new ideas.

Social media is a dynamic environment, and that is one of the reasons for engagement. It seems to always announce new ideas, and trends.

Thursday, June 23, 2011

How would you like it?


Imagine if you will, a transformation of computer power and interfaces that would allow real virtualization in space transmitted by your hands, and body movements, similar to what the Wii or Kinect do with gaming.

Here is a technology looking for an application, perhaps in neurosurgery or operating in a closed body space, virtualized and harmonized with MRI and/or PET scans.

Oblong’s radically condensed G spatial operating environment. Yes Doctor, you too can be like Tom Cruise in the “Minority Report”. Try this on full  screen with HD

Hollywood imitates life. And sometimes life imitates Hollywood.

John Underkoffler, who led the team that came up with the interface that Tom Cruise’s character used in the 2002 movie “Minority Report,” co-founded a company, Oblong Industries, to make the gesture-activated interface a reality.

Using special gloves, Mr. Underkoffler demonstrated the interface — called the g-speak Spatial Operating Environment at the annual TED conference in Long Beach, Calif., a series of lectures by experts across a variety of technologies.

He pushed, pulled and twisted vast troves of photos and forms that were on a screen in front of him, . He zoomed in, zoomed out and rotated the images using six degrees of control. In one part of the demonstration, he reached into a series of movies, plucked out a single character from each and placed them onto a “table” together where they continued to move.

In this conception of computing, the input and the output occupy the same space — unlike a conventional computer, in which the mouse and computer keyboard are separate from the screen, where the changes appear.

Gesture-based interfaces are among the most significant advances in computer interface design since the mid-1980s, and they are part of a trend of accelerating advances in how humans interact with computers.

Oblong, arriving here will see consumer oriented applications in some new gaming consoles by Microsoft.  It has been an evolving process since 1994 at the MIT Media Labs.

Gosh, I wish I was just entering medical school.

Tuesday, June 21, 2011

The Individual Mandate & AMA

The American Medical Association announced yesterday that it was supporting the ‘Individual Mandate” in Obamacare.

This is puzzling, because the AMA has always defended personal liberty, freedom and the sanctity of the physician-patient relationship.

If one thing offends most healthcare providers it is this mandate, since it smacks of being unconstitutional and loss of a significant freedom. It surpasses even the internal revenue service’s income tax and the manner in which it is collected.

While the mandate is being strongly opposed by at least 30 states and awaits judicial reckoning it is even more puzzling why the AMA would come out prior to any judicial decision.  Perhaps the AMA announcement is meant to sway public opinion and judicial outcomes. Perhaps this is the means for the AMA to become a public policy force. However IMHO this is misguided and will surely alienate more physicians.

This author is not against expanding healthcare to those who cannot obtain it for whatever reasons, however this mandate surpasses what government is supposed to do.  It is also a financial irresponsibility to enact this part of Obamacare at a time when we are in a severe prolonged recession, and will paradoxically increase health costs and utilization at a time when the number of primary care providers is inadequate.

A novice project manager can tell you that prior to ramping up production a system has to have adequate workforce, supplies, and capital..  Our elected officials have little knowledge of micro-economics, repeatedly displayed in stimulus funding and healthcare.

Obamacare is constructed in a world of fantasy,  wishful thinking, altruism, and thoughtless construct. The reality is millions of uninsured patients. A quick solution is going to disrupt things even further.

Well meaning change should be gradual, and without sweeping authority given to the head of HHS.

Part II tomorrow on Health Train Express.

Friday, June 17, 2011

21st Century Medicine, Part II


“The Revolution will Not be Televised” (Gill Scott Heron).

The Black Panther video from the late 1960s is just the opposite of what is taking place in America in the 21st Century. Although much of the proposed changes appear to be transparent, all of medicine wonders what is really happening in committees in congress, behind closed doors of insurance company lobbyists and our representative as well as hospital negotiations for CMS reimbursements.  What is the AMA doing? Is what happening, The revolution will not be televised?

Over the past 20 years there have been many recommendations to alleviate the shortage of primary care physicians.  The term itself is worrisome and casts a shadow which belies the nature of family practice in the present setting of medicine beginning in the last quarter of the 20th century.

The advent of managed care, HMOs has also deepened the divide on the landscape of family practice and general medicine.

There are internal factors within the educational system, and also extrinsic factors involving reimbursements, referral patterns, authorization for services,

Central to the issue is a relative shortage of “Frontline Medicine” to Consultative medicineFrontline medicine indicates the first stop on the Health Train.  This point is where the patient enters the non-system. The provider may or may not be a ‘pcp’. It may even be a specialist a pediatrician, an Ob/Gyn, a cardiologist, an ophthalmologist, a chiropractor or a nurse practitioner. 

Some say that primary care is what takes place as an outpatient, or not in the hospitals. Or that only specialists should admit to hospitals. This  is what is practiced in the U.K.  In fact, the general practitioners are called ‘Mister’ rather than Doctor which is reserved for specialists. The GPs do not admit to hospitals.

As a matter of fact there are many hospitals that now employ “Hospitalists” who care only for inpatients, whose care is transferred to them upon admission by a GP and then returned to the GP on discharge. The practical result is that it is easier for the GP to remain in his office and work efficiently, not  losing time travelling to and from hospital, and also not requiring a disruption on the office schedule. Yet there is a disruption in continuity of care, and it takes special measures to ensure communications for the transfers.  Patients often feel abandoned.

Numerous plans have evolved to attempt to correct the shortage of PCP.

Preferential acceptance of students from poorer communities, and incentives for returning to those communities to practice by forgiving medical student loans. At times this is enabled by the use of the  USPHS or Federal grant block funds to community clinics and Indian Affairs.

Medical schools were mandated to increase their class size, increase diversity of the incoming classes,  and adding residency programs for family medicine specifically, tied to continuing federal funding, with the threat of losing federal grants if they did not do so.

Some medical colleges, such as the new University of Central Florida, have enrolled a charter class with a four year scholarship free tuition for students with limited assets.  The emphasis is on multi-culturalism. Their stated goal is, “The UCF College of Medicine was established in 2006 by the Florida Legislature and the Florida Board of Governors to address the growing physician shortage nationwide and provide economic benefits to Central Florida and the state”

This in a state with a relative abundance of physicians.

The Revolution Will Not be Televised.

Wednesday, June 15, 2011

Medical Schools for the 21st Century

This is the first in a series of articles on changes in education, the physician workforce, and what is driving changes.

Many studies have been done to analyze the physician/population ratios in different areas of the United States. In addition to their being an overall shortage of physicians, there is a disparate imbalance of primary care physicians (formerly called family doctors and/or general practitioner) and specialty physicians.   This general statistic does not delve into specific oversupply of specific specialties.  In some cases there is a severe shortage of psychiatrists, and mental health professionals.  The statistics also do not account for physicians who function in a primary care role, but are not statistically accounted for, as such. For instance, Ob/Gyn, Moonligthing resident physicians who staff ED and Urgent care centers, Pediatricians, some general internal medicine physicians who function in a dual role as a PCP and specialist.  Many women use their Ob/Gyn specialist as a PCP.

In the last several decades the number of female physicians accepted into medical school has increased. Women are faced with a difficult choice, biological imperatives and the very real responsibility of medical practice. For that reason many select a specialty with controlled hours, or a hospital specialty such as radiology or anesthesiology, dermatology, not primary care. For those who do select primary care their careers are punctuated by pregnancy, family needs, and often premature retirement, or finding a non-clinical career.

Karen Sibert,M.D. (who is an anesthesiologist) writes in the New York times,

“I’m a doctor and a mother of four, and I’ve always practiced medicine full time. When I took my board exams in 1987, female doctors were still uncommon, and we were determined to work as hard as any of the men.


Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time. .

About 30 percent of doctors in the United States are female, and women received 48 percent of the medical degrees awarded in 2010. But their productivity doesn’t match that of men. In a 2006 survey by the American Medical Association and the Association of American Medical Colleges, even full-time female doctors reported working on average 4.5 fewer hours each week and seeing fewer patients than their male colleagues. The American Academy of Pediatrics estimates that 71 percent of female pediatricians take extended leave at some point — five times higher than the percentage for male pediatricians.

Today 53 percent of family practice residents, 63 percent of pediatric residents and nearly 80 percent of obstetrics and gynecology residents are female.

The uniformed medical services have PCPs that are not available to the general public unless they moonlight in an outside practice, hospital, or urgent care center.  The statistics do not account for these PCPs.

Other PCPs who are not counted are optometrists, chiropractors, or nurse practitioners working in retail clinics.

Many other specialists will function as a PCP on many occasions to serve their patients for minor illnesses, such as prescription refills, outside of their specialty certification.

A contributing cause to the relative deficiency in PCP accessibility is the increasing rigidity and bureaucracy of the medical system in the United States. Certain medico-legal issues also preclude and diminish the ability to practice general medicine by a threat of litigation when practicing outside the bounds of specialty certification.

The Association of American Medical Colleges estimates that, 15 years from now, with the ranks of insured patients expanding, we will face a shortage of up to 150,000 doctors. As many doctors near retirement and aging baby boomers need more and more medical care, the shortage gets worse each year.

The short answer is yes there is a relative shortage of PCPs, however there is no shortage of specialty physicians. Perhaps there is an imbalance and availability of specialists.  Many of the factors are aggravated by what happens between a medical student’s enrollment in medical school, and their graduation from school, or during the training years.

This gap is especially problematic because women are more likely to go into primary care fields — where the doctor shortage is most pronounced — than men are. Today 53 percent of family practice residents, 63 percent of pediatric residents and nearly 80 percent of obstetrics and gynecology residents are female.


Medical licensure by states offers a license to practice general medicine, and in fact does not restrict in most cases what type of medicine a physician practices.  Specialty care is regulated mostly by hospital credentialing authority for procedures, and departmental classification by medical staff regulations and bylaws overseen by the hospital administration.

Recently the public’s attention has been brought to the expenses of a medical education, and the economics of 150,000 to 200,000 dollars borrowed to pay for it by a student.  Some would say this is an investment in the student’s future, however there are burdens also on society. While it is an economic boon and cash cow for banks regarding interest, it produces another parasitic industry, and more bureaucracy.

Dr Sibert goes on to say,

“Medical training is not available in infinite supply, if it were there would be graduates to replace or supplement those who work part-time, however, can only afford to accept a fraction of students who apply.

An even tighter bottleneck exists at the level of residency training. Residents don’t pay tuition; they are paid to work at teaching hospitals. Their salaries are supported by Medicare, which pays teaching hospitals about $9 billion a year for resident salaries and teaching costs as well as patient care.

In 1997, Congress imposed a cap on how many medical residencies the government could subsidize as part of the Balanced Budget Act. Last year, the Senate failed to pass an amendment to the health care bill that would have created thousands of new residency positions. Even if American medical schools could double their graduating classes, there wouldn’t be additional residency positions for the new doctors. Federal and state financing to expand medical education will be hard to find in today’s economic and political climate.”

Policy makers could encourage more doctors to stay in the profession by reforming the malpractice system to protect them from frivolous lawsuits, safeguarding their pay from further Medicare cuts and lightening the burden of bureaucratic regulations and paperwork.

PCPs carry a disproportionate share of paper-work and also acting as the gatekeeper for specialty referrals, insurance company authorizations, telephone work (none of which is reimbursable, yet takes up at least 10-25% of the daily workload).

Physicians defer saving money during their early years meeting this financial obligation, at the same time deferring home ownership.  Many are in their late 20s and early 30s before they have disposable income to meet loan payments. In some cases interest accrues until payments are begun. All physicians are aware of the conundrum, increasing tuition, living expenses, deferred adulthood and dependency upon parents and relatives. Few would make it through the system without family assistance in some form.

The emotional toll of these circumstances cannot be overestimated for medical students and their families. Unlike PhD candidates who receive fellowship grants medical students have far fewer institutional or federal grants, unlike NIH grants, or federal NSF grants.

The deferment of savings also has a severe effect on eventual retirement for the early years the lack of the most powerful investment tool (the compound interest curve of savings, or even other investments is negated).

Compound Interest Curve is exponential

Lack of any saving during the first ten years of adult life, between age 30 and 40 years of age will later effect a physicians life,  and statistics reveal there are many physicians who cannot retire or do so in poverty, totally dependent on social security benefits.  

The problems are serious, and not isolated from the many challenges of medical practice. Physicians have been left out of the planning process, most practitioners are now isolated from academic medicine and no longer are directly involved in training new physicians. Most of us receive requests from alumni organizations asking for donations, bequeaths and scholarship funding for individual medical students.

Monday, June 13, 2011

What does Bon Jovi or U2 have to do with The Health Train Express?

These images came to mind while I was reading what Brandon Betancourt (a pediatric practice administrator had to say about  your staff (and you) putting on a consistent show for your patients. KevinMD in his blog shared Brandon’s take on enabling consistency in the practice on a daily basis and at moments of fatigue and near burnout periods of the day.

I can only add a small addition to Brandon’s excellent allegory about performers, stage hands, physicians and their staffs.  I remember as a medical student and training asking myself how I could build my stamina and reliability for my patients. I used the same methodology of pretending I was an actor, performing for each patient encounter.  I pictured myself as a third person in the room rather than myself (not unlike an out of body experience).

Unlike actors however physicians are presented with a unique situation for each patient, requiring a different role, and most of the time requiring a different act to suit the clinical objective of the day’s visit.

I always wondered how actors and performers such a  Celine Dion,  and some very experienced performers accomplished this necessary . 

The best actors very rarely miss a beat, the process when repeated often enough becomes automatic.  Surgeons have their automatic movements in the operating room, a ritual performance, like a maestro, part of, but also the leader of the team. The supporting actors (actresses) take their cue from the main character.  Asking an actor,performer, dancer, musician or artist  to do less is anathema.  The same for a surgeon or physician.  .

Medical clinicians should do the same, and act as leaders for their staff by example.  I think Mr. Betancourt’s lesson by allegory is an outstanding way to teach all office and hospital allied health providers their roles in the play of medicine.

The method served me well for over 35 years, and hopefully my last ‘act; was as good or better than my first act in 1969.

Sunday, June 12, 2011

More Meaningless Bureaucracy


Here is the latest from the Obama Whitehouse.

Obama Creates Rural Council To Advise on Health IT, Other Issues


On Thursday, President Obama signed an executive order establishing the White House Rural Council, which will advise the president on various issues affecting rural communities, AHA News reports (AHA News, 6/9).

The executive order includes just about every Department (25 to be exact) of the Executive Branch of the Office of The President. I am sure there are many rooms at the WH that have conference tables big enough to have all at the same table. 

As an oxymoron, it even  included the Department of Housing and Urban Affairs.  Trust me, “We’re from the government and we are hear to help you.”

Friday, June 10, 2011

Health & Communications

Gary M. Levin M.D.

Many of the barriers to teaching our patients, care-givers and health professionals have dissolved thanks to the digital age, the internet, mobile applications, and an open door between information technology and medicine at all levels, from practitioners to personal health records, to hospitals, government, data integrators, analytics, biomedical applications, and basic research.  New applications developed to bridge the void between previously unintelligible scientific information (scientists, clinicians) and user friendly software for patients and professionals alike.

Much like the Ronald Reagan era our health system  is tearing  down the walls between ‘east and west’. (providers/caregivers—patients)

Health 2.0 Innovators have developed applications that mine data previously buried in huge data files at HHS, Medicare, CDC, and converted them into legible interactive graphic presentations sorted by regions, diseases, public health statistics, and more.

For Instance: These are some apps which extract data from tables of information into a legible user friendly interface. (click on the link)

In 2010, The National Conference on Health Communication, Marketing, and Media presented multiple video sessions addressing Health Communications

This year on August 9-11, 2011 the conference will again be held in Atlanta Georgia

Wednesday, June 8, 2011

Physicians Take Back Your Hospital !


Physicians, Take back your Hospitals !

I was listening to Piers Morgan interviewing Jack Welch, former head of General Electric. Jack Welch led General Electric from a $30 billion dollar company to one worth over $130 billion dollars. Watching the interview one thinks, how could he not succeed ?

“An organization's ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage.”

“Change before you have to. Control your own destiny or someone else will. Face reality as it is, not as it was or as you wish it to be.”
“The Internet is the Viagra of big business”
(Jack Welch’s quotes)

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In listening to Jack Welch speak one realized he has the remnants of a slight stutter, a challenge he overcame in due time. One thing for sure, he never stuttered in his vision for General Electric.

Jack’s enthusiasm overflows onto his audience. I was moved by it and wondered how this enthusiasm could be transferred to you and me as physicians.

Jack talks about integrity, something which has eroded in our medical ethics and perhaps the foundation of what our patients admire most in physicians. Patients still trust physicians to accomplish what is most important for them when they come to us in hospitals, clinics and the operating rooms of our hospitals…

What has happened is that too many of us, not out of greed, but necessity have allowed bureaucrats, government and foolish regulations to control our patient’s destinies, and thereby us as doctors. Most physicians are now bogged down with financial survival, having business that must be sustainable. This is true whether we are in private solo practice or a large multi specialty practice. Some think that a large practice insulates them from financial ruin or disaster. This is just not true, although it appears this way in the present phase of growth of overwhelming regulation and intrusion of government bureaucrats and insurance companies..

Creativity is maximized by ‘protected time’ a commodity rare in clinical practice.

Bureaucrats are convinced they know more about outcomes, evidence based medicine, cost containment, telling physicians to practice medicine and let them run the business. During my career I have seen this lead to many disasters.

Today many of our brightest innovators and bright minds are choosing technology industries to make a living. I write a column on technology, and it is apparent the energy is there. Young and old entrepreneurs are dynamic, innovative, daring and have a goal in mind. Our young physicians are turned out, and quickly become burned out, too busy and overwhelmed to energize their own creativity.

Some of our brightest minds go into medicine, only to become disillusioned at the prospect of preferred practice patterns, regimented paradigms to ‘improve outcomes’ when there is little scientific evidence that it works. The results thus far are disappointing, and not tested by time.

I agree that systems are critical to hospital efficiency and safety. Within reason some hospital activities would benefit from business techniques such as sigma six.

How many physician executives demonstrate the enthusiasm exhibited by a Jack Welch or a Donald Trump? Most clinicians are senior when they become executives or management leaders. True creativity for most occurs in late teenage years, and early adulthood. There are some rare older leaders in medicine, however they usually demonstrate this skill at a younger age and are promoted to leadership by staff members as a result of their demonstrated exceptional clinical skills. It is a rare physician that excels in clinical acumen and leadership qualities making for a competent departmental leader. Academic medicine has the distinct advantage of structure and close peer review leading to the correct selection of physician leadership. This is not true in private practice where individualism outweighs collaboration and team spirit.

The paradoxical thing is that most physicians are highly social, and must relate to people of all walks of life, financial means, social setting, and have a better understanding of human nature. It is just not applied other than in a one on one setting, physician to patient and vice-versa.

Jack says, “ Act Quickly”. We must, its almost too late. !

It’s Not Easy Being Right

Justice, and the American Way

The Title of the Post today is a take off from Kermit the Frog, “It’s not easy being Green” (unless you are Al Gore)

There is some good news in the fight for ‘freedom” and opposing laws that are counter to the U.S. Constitution.

ATLANTA (AP) - Judges on a federal appeals court panel on Wednesday repeatedly raised questions about President Barack Obama's health care overhaul, expressing unease with the requirement that virtually all Americans carry health insurance or face penalties.

All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates. The panel is made up of two Democratic appointees and one Republican appointee.

During almost three hours of oral arguments, the judges asked pointed questions about the so-called individual mandate, which the federal government says is needed to expand coverage to tens of millions of uninsured Americans. With other challenges to the law before other federal appeals courts, lawyers expect that its fate will ultimately be decided by the U.S. Supreme Court.

Hope ?

Monday, June 6, 2011

Prezi A novel way to present

I decided to use a  new presentation application for variety.

Where to Go Not to Die (Hospitals)

Thomson Reuters today announced the top 10 Health Care Systems. And there are surprises in the list.

  1. Advocate Health Care*  ― Oak Brook, IL

  2. Cape Cod Healthcare ― Hyannis, MA

  3. Care Group Healthcare System ― Boston, MA

  4. Kettering Health Network* ― Dayton, OH
  5. Maury Regional Healthcare System ― Columbia, TN

  6. Mayo Foundation**  ― Rochester, MN

  7. North Shore University Health System ― Evanston, IL

  8. OhioHealth* ― Columbus, OH

  9. Partners Healthcare ― Boston, MA

  10. Spectrum Health** ― Grand Rapids, MI

Health Train’s first observation is that there were three systems in the Boston, MA market, one of which is in a relatively small town on Cape Cod.

Secondly many are in what I consider, smaller markets and finally there were only two systems that has been on the list more than once, and three that have been on it twice. This may be an indication of the effects of outcome studies and penalties for ‘never events’.  Hospitals seem to be paying attention to updated guidelines to ensure patient safety.

Overall Jean Chenoweth, senior VP for Performance Improvement at Thomson Reuters said, 

"To produce consistent, strong performance across multiple hospitals, health system leaders must be providing crystal clear goals and communication as well as the means for staff to execute effectively,"  Chenoweth went on to say, “These systems are positioned well  as we move into the era of health reform”.   The Train is on the move !

The performance of 258 health systems were judged on these metrics:


  • In-hospital mortality
  • Medical complications
Patient safety
  • Average length of stay
30-day mortality rate (post-discharge)
  • 30-day readmission rate (post discharge)
  • Adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services
Hospital Consumer Assessment of Healthcare Providers and Systems patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals). 

  • More details can be found here

    Sunday, June 5, 2011

    Graduation Season in Medicine


    Here’s a great graduation speech by Zdogg MD who also blogs.

    Zdogg raps at  ZDoggMD

    I cannot add much to this soliloquy except to say  “Right On”  Remember those days when we were fresh as picked carrots or celery. Ready to overcome all obstacles, then chewed up by life, medicine, and finally our wonderful government.

    Mature Physicians May Quit

    Mature Physicians May Quit Rather than Recertify

    Although many statistics elaborate on how much money physicians earn, these figures, and averages are very distorted.. Averages are very misleading. A few extremely high earners will distort the average. Real statistics including medians, standard deviations, probability factors would reveal the truth about physician earnings.  As overhead continues to rise and reimbursements decline, as well as patient volume being forced to expand Health Train   predicts a rapid decline in physician-surgeon numbers.

    Many have already abandoned their private practices and have joined group practices, not only to relieve stress, but also as a transition to a non clinical or even non medical career, using their relatively free time to become educated in business or begin a career in technology, sales, or related biomedical career, consulting for pharma or other medically related business.

    Orthopedic surgeon Lee Hieb, M.D., current president of the Association of American Physicians and Surgeons (AAPS), writes that she had to spend time studying theory of joint replacements, which she never does, instead of focusing on spine surgery, her specialty. Then she needed to hire a lawyer because bureaucrats were refusing to allow her to sit for the examination—for lack of a signature sheet on her application.


    Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” she writes, in the summer 2011 issue of the Journal of American Physicians and Surgeons.

    Many physicians are choosing not to recertify. According to the American Board of Internal Medicine, 23 percent of general internists and 40 percent of subspecialists are not renewing their internal medicine certification.

    The added requirement of re-certification, while well intentioned, is expensive in it’s own right, and creates loss of income while preparing for the exam and absence from the practice. It is unnecessary and redundant. The addition of unsubstantiated ‘evidence based medicine’ is also ridiculous given the intense study and scientific method of peer reviewed journals in the training process.  Obviously whoever writes these ‘protocols’ is far out of the training loop, and exists in the past by at least a decade.   It should not be in the domain of insurance companies, nor Medicare to set standards when hospital credentialing and medical boards set a standard for medical licensure in each state by requiring documented CME every two years to be eligible for re-licensure. The American Boards were duped into providing these examination without taking these factors into account, rolling over fearing another government agency would take it over. Once again our ‘leaders’ who are mostly academics compromise to appear compliant and cooperative as agents of a government that is out of control.

    If these entities want assurance that doctors are up to date let them query state medical licensing agencies, or hospitals. They now  represent consumers, rather than doctors. In California the power and authority have now been given to political figures on our licensing board, in the name of ‘enforcement’, alluding to physician inability to police themselves

    In the airline industry who pays for pilot testing and recertification? The airlines. So perhaps hospitals and insurers should do the same for physicians.

    Okay I am on the far left (or is it right?)  It really does not matter because I am way out on a limb bringing this up, but I  also know that in the elevator or in the doctor’s lounge, these major annoyance are always discussed by colleagues.

    Okay so it may be worthwhile to certify or recertify in skills and newer procedures, but this is in the domain of hospital specialty departments, and is actually served better with peer pressure and education.

    I am also getting  suspicious that doctor lounges and elevators are monitored. I know elevators have cameras…why not microphones. I am almost fearful my laptop is monitored with my camera, microphone, and maybe even a key logger….laugh if you will at my pseudo-paranoia, but think about the things that have happened in our dis-belief already.

    Physicians & Surgeons alike are retiring early, frustrated, overwhelmed and discouraged, in an environment where physicians are in short supply. While there is an imbalance between numbers of PCPs and Specialists there is no over abundance of specialists. Take a look at wait times to see a specialist….there is your true indicator….not a meaningless misleading ratio.

    Common sense must prevail, yet I see no indication that our representatives use common sense (or is it ‘evidence based medicine?) or fathom this simple measure.