Dr. Emily's Blog

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Let's Ban Surveys

Why are post marketing surveys so popular now? It seems as though every interaction we have generates a survey request. You purchase an appliance--a survey arrives. You use a video chat application--another survey. You listen to an audiobook--you are asked to write a review. Speak on the phone with a customer representative and invariably you’ll be asked to complete a survey about your experience. You hire a repair person--another survey. It’s overwhelming. You could spend all your time doing nothing but surveys. I remember having my car serviced at a San Francisco dealership and the poor representative followed me out to my vehicle as I was leaving to plead privately for ratings of “excellent on all items”, explaining that a “good” was considered as terrible as a “poor” rating for them. Interactions like that give the impression that surveys are being used to pressure and control customer service workers instead of being used as a tool to help managers implement better ser

Don't Bully Your Doctors

By the time you are reading this the election will have been completed. We may not have a final result, but the voting will be over. Our country is extremely politically divided right now and tensions are at an all-time high, but when discord slips into threats towards physician leaders and bullying of medical organizations, things have gone too far. I come from a family whose members have a variety of political opinions, as I imagine many of you do. Some are democrats, but others are republican, libertarian, green or something else altogether. If we only ever loved those who have identical ideologies a lonely world ours would be. Our differences make us interesting, and diversity lends balance to society. As a county, we must remain civil and respectfully strive to reach sensible compromises. If families can disagree, but come together in ways that only families can, our country can do this as well. However, right now, in the midst of a pandemic, things are happening that have

Parable of the Pizza Shop

One day a man decided to open a pizza shop. The first week he sold pizzas, collected money from his customers; the happy customers ate hot pizza and business was good. The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas. Since so many of his customers had purchased pizza insurance, the man signed a contract with Blue Wall agreeing to discount his pizzas in return for a larger volume of customers. And so it went with United Pizza Insurance, PizzaNet and Pizzaetna. Pretty soon the man started having trouble getting the pizza insurance companies to pay for the pizzas he sold, and he had to wait a few months for his payment. They also started meddling with his cooking and trying to dictate what toppings he could use. They even restricted the use of some of the more expensive ingredients. He had to hire extra employees to fill out forms and paperwork they required before they would reimburse him. Th

California's Managed Care Medi-Cal I thought if I wrote about “Medi-Cal Managed Care” that my readership may run screaming in the opposite direction. But hey, what is life without risk? Anyway, look at this--you’re still here. Kudos to you for your determination and tenacity. Here we go: CAPITATION In 2013 California decided to change the way Medi-Cal reimburses primary care providers from fee for service to capitation 1,2 . Lots of private insurance Health Maintenance Organizations (HMO’s) also reimburse under this model. For those of you lucky enough not to understand capitation, here’s the quick and dirty: Traditionally physicians have been paid a set amount for each service rendered: aptly named fee-for service. Under capitation, a physician is assigned a number of patients and gets paid a monthly fee, generally a few dollars per patient per month (PPPM), regardless of whether the patient receives services or not. In theory, this is supposed to motivate ph

The Slow Demise of the Private Office

Doctors have been bemoaning changes in the practice of medicine for years, and with good reason. It’s harder and harder to make a go of it in private practice. In recent years our area has lost several small practices -- Hal Grotke’s Redwood Family Practice closed*, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital Medical Group), and Beverly Copeland relocated to Ashland. As I was writing this, Dr. Windham announced that he is ceasing the provision of primary care at his small office. Unfortunately, young, freshly trained physicians are not arriving here to take their places. Most recent graduates take positions with large organizations that can offer loan repayment funds, regular hours and steady salary. It’s no wonder new physicians want to be employees with reasonable pay and limited hours. If you are not working for yourself, there is no reason to b

Quality Improvement--or is it?

QUALITY IMPROVEMENT (QI): or Is It?* Who says the quality of medicine needs improvement? According to some, we have the best health care in the world. What could we possibly do better? Do you suppose that during the 11 years of medical training I received, the focus was on giving substandard care? And besides, how do the health care wonks know that what they suggest will improve upon what we are already doing? Did anyone think to ask those of us providing primary care if we want to do this, or have time to participate in these protracted projects? No! However, let’s give the policy makers the benefit of the doubt, and suppose that primary care does need quality improvement. Common sense would dictate that no one does anything perfectly and that we all can find ways to improve. The world of QI is not a pretty picture. First off, it seems as though everyone and their grandmother has some QI program that physicians are expected to implement. These programs are all