The Ant and The Grasshopper (Aesop)

The Grasshopper And The Ants (1934)

"The Ant and The Grasshopper"

In a field one summer’s day a Grasshopper was hopping about, chirping and singing to its heart’s content. An Ant passed by, bearing along with great toil an ear of corn he was taking to the nest.
“Why not come and chat with me,” said the Grasshopper, “instead of toiling and moiling in that way?”
“I am helping to lay up food for the winter,” said the Ant, “and recommend you to do the same.”
“Why bother about winter?” said the Grasshopper; “we have got plenty of food at present.” But the Ant went on its way and continued its toil. When the winter came the Grasshopper had no food, and found itself dying of hunger, while it saw the ants distributing every day corn and grain from the stores they had collected in the summer. Then the Grasshopper knew:
“IT IS BEST TO PREPARE FOR THE DAYS OF NECESSITY.”

Arrogant Pompous Doctors

http://www.nytimes.com/2008/12/02/health/02rage.html

Interested in going into medicine?  Meet your future colleagues!

How Starbucks Saved My Life

In the spirit of Thanksgiving, I thought this would be a most opportune time to post the following story.  Michael Gates Gill talks about his journey from great wealth to having little on the Sunday Morning Show (excuse the crappy quality of the video but it really is worth watching). Going in the opposite direction most of us strive for, see how Mr. Gill ironically finds a sense of contentment and well being that we all yearn for yet eludes so many of us. What struck me most in this clip is when he talks about how he is so much happier living in his one room apt versus his 20 room mansion in his former life. No longer burdened with the all the stresses to maintain such a home, Mr. Gill is able to live a more peaceful state of being. On another program, he compares this feeling to that of being in the airport and being weighed down by lots of luggage vs having a light backpack with all that you would ever need. If you want to learn more about Mr. Gill's story, you can pick up a copy of his book, "How Starbucks Saved My Life" or you can watch his life story on film in an upcoming movie where Tom Hanks plays his character.

Peter Schiff Was Right 2006-2007

Wow...Is this guy dead on or what? And is it no wonder why our American credit driven society is currently in the beginning stages of an economic meltdown? The day of reckoning has finally come for Starbucks loving SUV driving McMansion squatters and the greedy Wall Street leeches who took advantage. Get ready to cringe as you watch Ben Stein proclaim banks a screaming buy and other financial "pundits" predict DOW 15K and the never ending increasing housing prices. I guess Peter Schiff is having the last laugh now. Can you say total pawnage?!

The Grass was greener on the other side

THE FARMHOUSE. KILKENNY, IRELAND.

Originally uploaded by EDWARD DULLARD

 

 

From time to time over in SDN land, the Student Doctor Network, I get questioned and even accused of being a depressed person and that the problem was with me and not with our current flawless healthcare system which the rest of the world should strive to emulate.  Here was my response that I posted in an attempt to address these misconceptions.

"I wouldn't say I am a depressed person, far from it. In fact, I believe we live in an amazing world with so many incredible opportunities and it depresses me to think I am missing out on so much being married to healthcare. A marriage gone terribly bad and I want a divorce. In fact, I believe this "funk" I am in is entirely environmentally induced.

How do I know this? In between switching specialties, I had a year off where I had taken a job in a very different career- one in which I always yearned to try. I didn't do "research" nor did I do a prelim year so I wouldn't lose my skills as some recommended. What the **** is that anyway???? I had this time away and I was going to make the most of it. Let's just say I felt like a caged bird released into the wild. A year out of medicine reminded me how good life could be when you had time to embrace it. I had an incredible year- more than I would've ever expected. I LOVED waking up every morning and going to work- imagine that? In fact, it didn't even feel like work at all. I felt respected, appreciated, and actually felt like I was making a difference in the lives of others. My stress level went from like an 11 down to a 1. The hours were to die for- 35-40 hr weeks, no weekends ever, no call (huh? what is that?), no pager going off in the middle of the night, no getting stuck to god knows when each and every day, no dreading monday mornings anymore, no fear of getting sued, no "I am mightier than God" attitudes or malignant personalities to contend with, oh and i could call in sick without feeling like I committed murder. I could go and on. My very best day as a resident didn't even come close to my very worst day that whole year. And that is the God honest truth.

Maybe that is why I am having such a hard time. There are others who want out of medicine but don't have the courage to do it or simply don't know what else they would want to do so they just stick it out and go through the motions. But I know exactly what I would do. I find myself constantly comparing my life now to what it was like then. We have all heard of the saying that the "grass isn't always greener on the other side". I sometimes think people say that just to make themselves feel better over their current dire situation. But let me tell you, the grass WAS truly greener on the other side- as green as the greenest grass in all of Ireland. I hope to return one day."

Lawyer Burns Harvard Law Diploma

"If success is not on your own terms, if it looks good to the world but does not live in your heart, it is not success at all."                                                      -Anna Quindlan

Do you find yourself questioning your current path while at the same time to others on the outside everything appears to be in perfect order?  Are you truly living the life of your choosing or are you rather living a life to live up to society’s expectations?  Do you sometimes wish you could just trade in your current treadmill running frenetic harried pace of life for one of a more simpler and peaceful existence?

        In Adventures of Voluntary Simplicity, Jack, a thirty something Washington D.C lawyer, blogs about these very issues.  In June, Jack announced he was planning on leaving his $300,000 dollar a year job as a lawyer for a more simpler way of living.  Furthermore, on October 27, Jack symbolically burned his Harvard Law School Diploma on youtube for all the world to see:

 

From Jacks intro to the video:

"Ive been thinking about doing this, in one way or another, for a while now. But I was never really sure if I would be doing it for the right reasons. Not to mention how silly it sounded whenever I brought it up to people. But this weekend it all came together: the weather was beautiful, the trails were inviting and freedom seemed just around the corner. So I went for it.

This is NOT a knock against Harvard. Or a calculated criticism of legal education. Or even a rejection of elitism, per se.

Sometimes you just need to say goodbye to your past in order to move forward.

In the end, it was just a piece of paper. Nothing more. I would rather live my life on my own terms than be a person that needs a piece of paper to justify their own worth."

Care to open your mind to another way of living?  Check out Jack's blog below:

http://adventuresinvoluntarysimplicity.blogspot.com/

 

 

 

Escaping the American Rat Race

 

Here is the story of Hans Keeling, a Stanford grad, who quit his corporate law job at Sullivan and Cromwell and traded it in for the beaches of Brazil. An inspiring story that definitely makes you stop and think. Are you truly living the life you want or are outside forces laying out a life for you as if you were some merciless leaf in some raging river?

 

http://www.bankersball.com/2007/07/02/interview-leaving-biglaw/

 

"And while the money was good (for my age group in particular), it quickly became clear to me that it wasn’t worth the tradeoff."

"I think that was a big enlightenment point – realizing that even if all went perfectly and I worked my butt off, the “prize” at the end of the rainbow was one I didn’t want. That’s when you really know it’s time to make a change."

"But once I got out of school I had the brutal wake up call that this job was going to be a very harsh reality for a very long time"

"SAVE YOUR MONEY. It’s easy to get sucked into the “gold handcuffs” of the corporate world – fancy dinners, designer suites, convertibles, 5 star hotels and debt on your credit cards. But if and when you’re ready to make the jump to your own gig, trust me you’ll be glad to have the extra start-up capital and financial cushion to get you off the ground"

"You have to have the confidence that your intellect and work ethic got you this far in a very competitive field, and there’s no good reason it won’t continue to take you above and beyond in a career or business that you choose for yourself. Again, hopefully you’ll choose something you enjoy doing, then the work doesn’t feel like “work”, even if you spend lots of time doing it."

Duck Tales Inflation Lesson

With each passing day, the economic crisis in America appears to be only getting worse. First it was individual banks failing, then it spread to states like California and Massachusetts, and now just this week whole countries like Iceland. (geesh are we next???) So what got us in this situation anyway? Simply put- GREED. The perfect storm was created when you have Americans living well beyond their means whose actions were validated by unscrupulous mortgage lenders. Watch this Duck Tales Video which shows how there really is no easy way to get money. As one commentator on the video pointed out, hopefully "idiot americans will get this now that it is presented on their level of thinking". Who would've thought- money does not come easy- it comes out of HARD LABOR AND YOUR PRECIOUS TIME. This should serve as a reminder also how important it is to live frugally and be in a line of work you enjoy so you don't find yourself being a slave to some miserable job.....like a medical one (couldn't help myself for the tie in).

How to Pay Off Your Student Loans Super Fast!

 

So, I was diligently researching the internet tonight trying to find someway, somehow, to escape this medical hell I am in and came across the following possibility.  Check out what this Stanford Law Student did to wipe out her six figure student loan debt:

  http://www.mercurynews.com/ci_10600922?IADID=Search-www.mercurynews.com-www.mercurynews.com

So I figure, since I am already whoring away my dignity and time, I must as well get paid like an Elliot Spitzer high class 5 diamond call girl.  Instead, I am being paid as if I am some fat meth addicted edentulous washed up 50 year old back alley Atlantic City hoe who should feel grateful for getting ten dollars an hour after providing some yum yum.  Smart chick- except for the tax evasion part.

Doctor/Lawyer Couple in $532,000 Debt!

I saw this clip this morning on the Today Show about a doctor/lawyer couple in $532,000 debt!    I can't help but think how overly screwed they are.  This poor couple needs more than a money makeover, they need a money "do over".   Just to pay the interest on that monster will take 50K a year in gross income (30K after tax assuming average interest rate of 5-6%).  That is more than a medical resident's salary-  is slaving away 80 hours a week for a whole year under incredibly stressful conditions working with malignant personalities in a skanky smelling cesspool hospital worth it TO JUST PAY THE INTEREST.  Can you say OUCH!!!  And don't even get me started on how this prominent doctor/lawyer couple is being shipped off to the Siberia of America- Buffalo. 

Watch and see for yourselves modern day slavery in action.  Let's think about this for a moment.  Sacrifice away your twenties in school with mushrooming debt followed by your thirties paying it down to just break even.  Now you get to toil away like a work horse in your forties playing catch up to everyone else who started earning and putting away money very early on.  Again, is it really worth it- go all through that to wind up a Siberian slave?

http://www.msnbc.msn.com/id/22425001/vp/26494902#26494902

25 Years to be a Physician?

Does it really take that long?   Well let's do the math:

Kindergarten-  1 Year

Elementary School - 6 Years

Middle School- 2 years

High School- 4 years

College- 4 years

Medical School- 4 years

Residency- 4 years

1+ 6 + 2 + 4 + 4 + 4 + 4= 25!

Is the privilege of being called "doctor" worth trading in 25 years of one's life?  Still not sure... but what about when you consider the three ring circus like environment healthcare has become in this country?  In a thought provoking manner, the following article attempts to enlighten us on such a question.

http://www.theonion.com/content/news/6_year_old_stares_down_bottomless

"It's difficult to know the effect on his psychological well-being when he grasps the full truth: that his education will be followed by approximately four decades of work, bills, and taxes, during which he will also rear his own children to face the same fate, all of which will, of course, be followed by a brief, almost inconsequential retirement, and his inevitable death."

What advice would you give that poor little 6 year old inside of you if you could go back in time?

The Bible and frugality

One man pretends to be rich, yet has nothing; another pretends to be poor, yet has great wealth.

- Proverbs 13:7

Diminishing Job Satisfaction

An article put out by the NY times earlier this week gives an inside glimpse on what is leading to the escalating dissatisfaction seen in the doctor's profession: 

“Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ” Recently, he confessed, he has been thinking about quitting.

"In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession."

"Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue."

"increasing liability premiums that have forced many into early retirement."

"A 10.6 percent cut in Medicare payments to physicians is scheduled to take effect on July 1. Further cuts are planned in coming years."

http://www.nytimes.com/2008/06/17/health/views/17essa.html?ex=1371528000&en=68fc7d81aa444219&ei=5124&partner=permalink&exprod=permalink

Hump that pillow!

Hump that pillow!

Originally uploaded by Edica-sensei



A premed asks over on the Student Doctor Network (SDN) how he can prepare for residency through the process of sleep deprivation. "Sacrament" replied as follows:

"Trying to simulate residency by limiting your sleep is like trying to simulate sex by dry-humping a pillow"

I found this comment so hilarious yet so right on.  My nomination for quote of the year over on SDN.

Introducing the WalMart Clinic

http://blogs.wsj.com/health/2008/02/...cs-still-cool/

"The clinics are typically staffed by nurse practitioners or physicians assistants"

"Wal-Mart said it would be opening its own brand of retail clinics — and that they’d be affiliated with local hospitals and health systems."

"Wal-Mart says it plans to open 400 clinics by 2010 under the truth-in-advertising brand name “The Clinic at Wal-Mart.”

Who is going to take responsibility when a patient complains of abdominal pain and is sent home being told it is a stomach virus when later that night their appendix ruptures leading to massive sepsis and death?  Who is going to take responsibility when a 16 year old presents with testicular pain and is prescribed an antibiotic for an infection when in fact he is having a torsion and loses a nut?  I can go on and on.  There is a reason a person is not allowed to practice medicine without going through four years of medical school and three years of residency.  Since WalMart has deep pockets it will be interesting to see how long these clinics last until they are bankrupted with lawsuits in our highly litiginous medical environment.

More is Better

http://video.yahoo.com/watch/2046923/6462881

        The above clip is from a segment of 60 minutes which aired over the weekend delving into the topic of what constitutes happiness. Living in a highly commercialized crap buying society, Americans are taught from a very young age that "More is Better". Through the purchase of more "things" we can temporarily quell our unhappiness. However, just like a junkie shooting himself up with heroin, it feels really good only for a brief moment until we start craving the next hit. We are never satisfied and always want more, more, more! And since "More is Better" how do we get more? You have to work more!
        Is it no wonder why Americans work among the most hours on this planet? So in order to get more you have to work more or go into more debt. With physicians in this country working an average of 55 hours and up a week amidst declining compensation in the face of inflation, are those extra things really worth what one is putting in? As for myself, I am really start to think that I have a better chance of finding "happiness" by downshifting my life than continuing to run on this never ending medical hamster wheel.

Suze Orman speaks to Culinary School grad about student loans

This is a pretty scary clip from a recent episode of the Suze Orman Show where a culinary grad speaks about being saddled with six figure debt with little hope of ever getting out. Could med school grads in the foreseeable future see themselves in a similar predicament? With sky rocketing tuition costs and stagnant/declining salaries it does not take a genius to envision what could lie ahead.

Breaking News: Psychologist Killed with Meat Cleaver In Upper East Side

http://wcbstv.com/local/stabbing.upper.east.2.652693.html

Scammie Mae CEO Albert Lord drops the "F Bomb"

Turn the volume up and listen to CEO Albert Lord drop the "f bomb" (0:22) during Scammie Mae's most recent conference call this past December 2007.   With all the probing questions regarding Sallie Mae's operations during this event, the kitchen was apparently getting a little too hot for Mr. Lord to handle.  This is the dirtbag who gets a cut of your check every month and is largely responsible for the rise of indentured servitude among today's younger generation.

I Love Lucy and the American Healthcare System

Ever wonder what it's like to work as a resident in today's American healthcare system?  Here's a small glimpse.

Harvard Undergrads Defect from Sciences and The Berlin Wall

http://www.theharvardcrimson.com/article.aspx?ref=521740

"In addition to the impersonal nature of many science courses, students also report that being a science concentrator is difficult because of the rigorous work required for the discipline and the competitive nature of other students."

“I felt like no one really cared about actually learning—they were just focused on beating everyone else and were worried about what the curve was going to be,” Younger says of her experience in Life Sciences 1b last spring. “I was really turned off by the whole environment.”

"Younger, a sophomore who chose English over molecular and cellular biology, cites the difficulty of scheduling “huge chunks of lab time” while “trying to have a life” outside academics."

        This article tells us nothing new but I actually like the author's choice of the word "defect" to use in the title of this article.   Just as East Berliners risked their lives to "defect" to the west via the Berlin Wall, these Harvard students are escaping the harrows of the long pathway to entering the "highly esteemed" medical professions.  We all are aware of the competitive cut throats that populate these science classes.  If you confine yourselves to this warped circle of future physicians, you will hear the word "weeded out" used instead.  Supposedly, those who can't hack it are "weeded out".  But are they really?  Perhaps these drop out weeds are in fact the smartest of all...wise enough to foresee the dismal future that lies ahead.   So those of you having doubts out there (which are 100% warranted), don't see yourself as being "weeded out" but rather as a "defector".   Why live in some horribly oppressive regime, when you can live a way better life elsewhere?

 

        There is no Berlin Wall with guards posted on top of towers to shoot you if you choose to make an escape at this early stage.  There is a wide open green field that lies right before you and all you have to do is walk across it.

 

        However, choose to wait and the walls will start to build around you and the German guards( aka attendings, evil nurses, Sallie Mae, HMO's, malpractice lawyer leeches) will be lurking making an exit most definitely difficult.  Run away while your balls are still free (if your a guy that is.....girls just run!).

John Ritter's family goes on sueing spree

http://ap.google.com/article/ALeqM5gmv6HnJJPBee2gWgEYResT5m6YkAD8UJTVT00

"Ritter's second wife, Amy Yasbeck, and his four children have already received a reported $14 million in settlements with nine other medical entities, including the hospital where he was treated."

Geez lady, 14 million is still not enough???  Sucks for the ER doc and cardiologist getting sued....I'm sure they wished they just would've called in sick that day.  Just goes to show you how every patient that rolls through the door is a possible ticking time bomb that can blow at any moment unleashing fury on those within standing distance.

This story reminds me of Sweetie, the cute Cocker Spaniel that my family had when I was a young and gullible kid.  One morning before going off to school....I think I was like in the fifth grade....I was rolling around the kichen room floor playing joyfully (and intentionally delaying myself from going to the bus stop) with Sweetie when she was a little puppy.  All of a sudden I felt a sharp stabbing pain on the side of my head.   When I reached up I felt blood trickling from my ear and onto my hand.   When I wasn't looking, my dear Sweetie lunged at my ear and bit it!!!  Though I still have my right ear, I have the scar to this day to prove it.  So why do I mention this story?  Because in today's medical zoo like environment where the jackpot lotto abounds, the cutest grandma or the most cheerful teenie bopper can cut you down when you least expect it.  Though they say having good rapport reduces lawsuits, you can sure bet that when millions are on the table any sort of "great relationship" you had with your patient will quickly take second seat.  Motto of the story?  Beware of Sweetie!!!   She can hurt! 

23 more years!!!

Sesame Street: Bert's Physical


The best part of this 3 minute clip is the last 30 seconds when Ernie explains to Bert how it will take him 23 years to officially call himself a doctor.   Watching Bert pass out at the very end is classic.   My advice to Ernie....don't do it!!!!!!!

Don't Cha?

This was a question posed by someone over on SDN tonight-

"What do you like about being a MD?"

Here is my response:

Top ten things I love about being a MD:

1. I exude prestige...it seeps out of every pore of my very being...all those around me can sense it and bow down in my presence

2. I am a total chick magnet....So many girls crawl all over me I literally have to push them away and pluck them off me one by one

3. I rake in the dough...with one small withdrawal my bank will literally go into default

4. I am so smart...smarter than lawyers, bankers, ceos and computers

5. I am stylish...I get to wear clothes of only the very best quality...my suits are all imported from Italy and I am to die for in my pearly white coat

6. I am powerful...my power rivals that of the czars of Russia and the emperors of empires long past....those under me tremble in fear and piss in their pants

7. I am important...if i call in sick the hospital I work at will come to a screaching halt and all my patients will die a gruesome death

8. I am respectworthy...no other job out there comes close to that of being a physician. The public is so appreciative of my efforts and will never spite me.

9. I am happy...my life is so great (because of all the above) that I beam ecstasy; my smile is infectious and instills joy into all the wonderful nurses and dedicated residents I get to work with each and every day

10. I am amazing....simply amazing! Don't cha you wish you could be like me?

The Pussycat Dolls - Don't Cha (Uncensored)

Dentist Sketch

"Hilarious sketch from "The Carol Burnett Show", with Harvey Korman and Tim Conway"

If I were 25 again...

 

just some interesting quote I stumbled upon while surfing around the internet this evening and thought I would share:

"If I were 25 again, I think I could more easily work until 65 or 70 doing something I loved part-time than working until 50 doing something that stressed me out and made me dread Monday mornings. The more I start hating my job sometimes, the more I envy people who love their work, even if they only made 1/3 the salary."

                                                                                                   -ziggy29

In my case, in addition to dreading Monday mornings i would also have to throw in Saturdays & Sundays, 1 AM & 5 AMs, Christmas and New Years, endless calls & home back up calls.   But damn, what an earth shattering, ground breaking, epiphany of a quote this is to me!  Oh ziggy29 where were you 10 years ago when I could've used your words of wisdom!!!  Do I trudge on till I am 50 sacrificing another LONG 2 decades of my life (no way I can last a day past fifty on the path I am currently on!)?  Or go to 70 doing something I love (heck make that 80 God willing!) ?  I know one reason some people feel "stuck" is because they have no clue what they would do instead, so they plod onwards.  As for myself, I know exactly what I would do.  The answer seems so obvious yet why can't I cut myself free and embrace happiness?

Asking myself why?

 

I came across the following story while surfing through one of the forums I often frequent.  I absolutely love this story because it wonderfully forces oneself to STOP and THINK.   Why do we needlessly complicate our lives?  Why do we push ourselves to the brink, yet we can't pull away?  Why, why, why???  Oh how I wish I could stay and hear the fisherman play the bouzouki while relishing some Greek wine!  But I can't.......not yet at least:)

  A boat docked in a tiny Greek village. An American
> tourist complimented the Greek fisherman on the quality of his fish
> and asked how long it took him to catch them.
>
> "Not very long," answered the Greek.
>
> "But then, why didn't you stay out longer and catch more?" asked the
> American.
>
> The Greek explained that his small catch was sufficient to meet his
> needs and those of his family.
>
> The American asked, "But what do you do with the rest of your time?"
>
> "I sleep late, fish a little, play with my children, and take a siesta
> with my wife. In the evenings I go into the village to see my friends,
> dance a little, play the bouzouki, and sing a few songs. I have a full
> life".
>
> The American interrupted, "I have a MBA from Harvard and I can help
> you. You should start by fishing longer every day. You can then sell the
> extra fish you catch. With the revenue, you can buy a bigger boat. With
> the extra money the larger boat will bring, you can buy a second one
> and a third one and so on until you have an entire fleet of trawlers.
> Instead of selling your fish to a middleman, you can negotiate directly
> with the processing plants and maybe even open your own plant. You can
> then leave this little village and move to Athens, Los Angeles or even
> New York City! >From there you can direct your huge enterprise."
>
> "How long would that take?" asked the Greek.
>
> "Twenty, perhaps twenty-five years," replied the American.
>
> "And after that?"
>
> "Afterwards? That's when it gets really interesting," answered the
> American, laughing. "When your business gets really big, you can start
> selling stocks and make millions!"
>
> "Millions? Really? And after that?"
>
> "After that you'll be able to retire, live in a tiny village near the
> coast, sleep late, play with your grandchildren, catch a few fish, take
> a siesta with your wife, and spend your evenings singing, dancing and
> playing the bouzouki with your friends".
>
> There ends this lesson in philosophy.

Man says he was sodomized in NYC ER

Wednesday, January 16, 2008

NEW YORK —   A construction worker claimed in a lawsuit that when he went to a hospital after being hit on the forehead by a falling wooden beam, emergency room staffers forcibly gave him a rectal examination.

Brian Persaud, 38, says in court papers that after he denied a request by NewYork-Presbyterian Hospital emergency room employees to examine his rectum, he was "assaulted, battered and falsely imprisoned."

His lawyer, Gerrard M. Marrone, said he and Persaud later learned the exam was one way of determining whether he had suffered spinal damage in the accident.

Marrone said his client got eight stitches for a cut over his eyebrow.

Then, Marrone said, emergency room staffers insisted on examining his rectum and held him down while he begged, "Please don't do that." He said Persaud hit a doctor while flailing around and staffers gave him an injection, which knocked him out, and performed the rectal exam.

Persaud woke up handcuffed to a bed and with an oxygen tube down his throat, the lawyer said, and spent three days in a detention center.

A request by the hospital to dismiss Persaud's lawsuit was denied by Justice Alice Schlesinger, who ordered a trial to start March 31.

Hospital spokesman Bryan Dotson said, "While it would be inappropriate for us to comment on specifics of the case, we believe it is completely without merit and intend to contest it vigorously."

Persaud's lawsuit, filed in Manhattan's state Supreme Court, seeks unspecified damages. A judge dismissed a misdemeanor assault charge against him.

Source:  Associated Press

"Beck from the dead"

Beck From the Dead

Glenn talks about his "very dark experience" in the hospital after being admitted for complications after hemorrhoid surgery.

Boutique Medicine- A new trend of the future?

Article published Jan 6, 2008

STAFF PHOTO / ROB MATTSON

Drs. Brad Lerner, left, and Louis Cohen traded their own private practices for LernerCohen Healthcare, their shared concierge service. Cohen says he now cares for 300 patients instead of 4,200 and has more time for each.

The doctor will see you, anytime

By DAVID GULLIVER
david.gulliver@heraldtribune.com
 

At his former medical practice, Dr. Carlos Caballero was working 14 hours a day, five days a week, and the occasional weekend.He had about 4,000 patients and saw 25 to 30 of them a day, with his two physician assistants seeing the same number."I was working harder then, and I was terrified," he said. "Your drive home is sitting there thinking, 'Did I do everything I was supposed to do?'"He is hardly slacking now. He works seven days a week, including 12-hour weekdays and two to four hours on weekends.

But he seems considerably more relaxed, sitting on a sofa in an elegant side room at his medical offices during a midday break from seeing patients.

Today he will see a half-dozen patients, spending an hour to 90 minutes with each, and take phone calls from several others.

"It allows me to work better," Caballero said. "I think they're getting better attention."

Welcome to the world commonly called concierge medicine, boutique medicine or, as its practitioners now prefer, "direct practice."

In it, doctors essentially swap a high-volume, low-margin world for just the opposite.

A study by the Government Accountability Office in 2005 is still the definitive look at the style of practice.

The agency found concierge physicians take on far fewer patients, typically less than 400, and each patient pays an annual fee, usually $1,500 but as much as $15,000, in return for unlimited access to the doctor.

The result is guaranteed revenues of at least a half-million dollars a year, and far more in wealthier areas where residents can afford higher prices.

The combination of less stress and more stable income proves alluring. While only a handful of the country's doctors have gone to direct practice, their numbers have grown rapidly.

There are about 500 such doctors across the country, reports the Society for Innovative Medical Practice Design, which began as the American Society of Concierge Physicians.

That represents a tripling from 2004, when the GAO found only 146 in its study.

The agency traced the trend's origin to MD2, a Seattle medical practice that opened in 1996, founded by the former team doctor of the city's Supersonics basketball team.

Most of the practices are clustered around affluent areas: GAO found the biggest clusters in Seattle, Boston and West Palm Beach.

Caballero was Sarasota's first direct practice. He opened Private Physician Services in October 2001. He has since added a partner.

Two years ago, two of Sarasota's most respected doctors -- and members of two of its dominant practices -- opened their own boutique practice.

"We jumped at the opportunity, and haven't looked back since," said Dr. Louis Cohen, partner with Dr. Brad Lerner in LernerCohen Healthcare.

Others probably will follow. Doctors of at least two Sarasota practices have told patients or colleagues that they are considering charging patients an annual retainer. Both said that they have not made a final decision.

But there are powerful draws for the direct-practice approach: Fewer hassles, lower overhead, and certainly more money.

A doctor's view

At his old practice, Cohen would start his day at 6:30 a.m. with hospital rounds, see patients in his office from 9 a.m. to 5:30 p.m., and at night sometimes be the lone doctor on call for his group's 50,000 patients.

"Controlled bedlam," he said. "Was it the best way to deliver medicine? No, I think absolutely not. Was it a necessity of the way medicine is practiced nowadays? Yes."

Now he cares for 300 patients instead of 4,200. That day he had five scheduled appointments, which allowed him to spend more time with each. The smaller patient load also gives doctors more access to each person.

"We feel that allows us the ability to be there anytime the patients need us, whether it be for a house call, for a nursing home visit, an office visit, to give them the level of service that they want," Lerner said.

With the added attention comes special services. Caballero's Private Physicians Services and LernerCohen both have dietitians on staff and draw blood in their offices, services often handled at labs or hospitals.

The style benefits the doctors, too, in more ways than just reduced stress.

By having patients pay up front, they are essentially a cash business. They do not have to haggle with insurance companies or government programs like Medicare or Medicaid. That means they can save money -- at least $100,000 per year -- on bookkeeping-type expenses.

They also likely make more money, by setting their own rates instead of accepting declining reimbursements from Medicare and private insurers.

LernerCohen's prices range from $2,800 a year to $5,800 a year. Patients over 80, who they found required much more time, pay the highest rates. Caballero's existing patients pay $2,500 to $4,000 per year, with those 65 and over paying the higher rate.

Both practices have held prices constant for existing patients, in part by charging a higher rate for newcomers; Caballero's is $7,500.

Doctors know the financial structure is both advantage and drawback.

"The only thing negative I can see about what we're doing is that everybody doesn't have the opportunity to participate," Lerner said.

"This is a luxury item and it costs money like a luxury item. Not everybody can afford the cost of this kind of service, and insurance companies won't pay for this type of service."

LernerCohen and other concierge practices urge patients to maintain their insurance or Medicare coverage. Medicare does not pay for concierge physicians' fees, and by law the doctors cannot "double-dip" by billing Medicare. Concierge physicians' fees cover only the primary doctor's services and pay neither for specialists nor for hospitalization.

But multiply fees by patients, and a concierge practice can easily generate $1 million or more in revenue a year.

That has drawn scrutiny from the American Medical Association and the ire of some doctors.

Another doctor's view

Dr. Randy J. Silverstine has worked 60- to 80-hour weeks in Sarasota since 1982, earning incomes in the low six-figure range, he said.

His patients have included cabdrivers, professors, retired doctors -- and, lately, many people who could no longer afford their doctors, he said.

So he views concierge medicine and its potential million-dollar revenues as "unprofessional, unethical and a spectacular show of greed," he said.

"It's wanting to work less and make a phenomenal amount of money," he said. "It's not a solution for health care in this country. It's health care for the rich and famous."

Those questions have swirled around concierge medicine almost since its outset, and practitioners are well aware.

In 2001, the American Medical Association voted to study the issue, and its Council on Medical Service returned with the same answer: "A multitiered system of care already exists in the United States."

The council saw no ethical problems with the concierge approach, pointing to established AMA policies that say doctors have the right to set up their practices as they want, and charge a fair fee established in a patient contract.

It also said there was "no evidence that special physician-patient contracts, such as retainer agreements, adversely impact the quality of patients' care or the access of any group of patients to care."

In fact, the council said the issue was overblown. "It would appear that the amount of media coverage devoted to the subject has been disproportionate," the report said.

But it did cite what it termed "risks" associated with concierge medicine: that smaller patient loads might dull a doctor's skills, and that doctors switching to a high-fee practice might leave some patients without care.

That was at the heart of Silverstine's lament.

"After developing real, meaningful, beautiful, caring relationships with many patients and their families, how do you turn around and demand they now begin paying 5 to 10 thousand dollars per head?" he asked.

"Just because something has a price doesn't mean it's right, doesn't mean that it works or it's good for the profession or for the patients."

Some pay nothing

Concierge physicians are trying to counter that perception.

At Caballero's practice, 20 percent of the patients pay nothing for care, he said.

Before a reporter's visit, he had given one such "scholarship" patient a 90-minute annual physical.

"We do it because it makes sense, but we also feel a need to work with the community," he said.

As a medical student, people invested in him -- for example, letting a novice draw blood and practice procedures.

"The community invested in me; I owe something back," he said.

LernerCohen does much the same. "A significant percentage of our practice are completely scholarship, or at a reduced cost, because we felt an obligation," Lerner said. "We anticipated that would be a knock, and this was our way to respond to it before it became an issue."

They also contend that concierge practices can produce better results because they have more time to learn about their patients.

"The level of involvement and the level of care and the level of knowledge that goes between patient and physician is infinitely higher," Cohen said.

Doctors with smaller patient loads can practice more preventive medicine, catching small problems before they become expensive ones, Lerner said.

Not necessarily less work

But fewer patients does not mean less work, they contend.

"This is not an easy job," Lerner said. "We are each taking our own phone calls 24 hours a day, seven days a week. Every patient has access to" each doctor "literally around the clock."

Not every doctor wants to be in that position, he said.

Nor can every physician attract hundreds of patients willing to pay thousands of dollars a year that they did not have to pay before.

"You can't just hang up a shingle as an unknown quantity in a town like this and expect to succeed in this type of practice," Lerner said.

He and Cohen have practiced medicine in Sarasota for more than two decades, both of them founded prominent practices and both have been chief of medicine at Sarasota Memorial Hospital.

Caballero practiced in Sarasota for only six years before starting his concierge practice but carries an impressive resume, including Stanford Medical School and residency at Harvard-affiliated Brigham and Women's Hospital.

About 100 of his 4,000 patients followed him to his concierge practice. Lerner and Cohen started with about 300 patients, a similar percentage of their original practices.

But patients who make the switch appear to be pleased. Caballero claimed 99 percent retention and a long waiting list. Lerner and Cohen declined to comment on their retention but said they balance any attrition with new patients.

Not all such practices last. In 2003, Dr. Tony Trpkovski started a concierge practice in Venice, reportedly spending $300,000 to outfit the offices. He later closed it, worked for a time at a Venice-area clinic and is now practicing at the Kauai Medical Clinic in Hawaii. He did not return calls seeking comment.

Still, the transition is becoming easier, in part because of a fast-growing Florida company that claims concierge medicine produces better results.

The concierge playbook

Boca Raton-based MDVIP has essentially franchised concierge medicine for seven years, making it easier for physicians to transition to the concept.

The privately held company now bills itself as the national leader in "personalized and preventive health care."

"It is not enough to just put a toll booth at the practice's door," said Dr. Edward Goldman, MDVIP's chief executive.

Now the company stresses its resources for disease prevention, such as its affiliations with the Mayo Clinic, Cleveland Clinic, Memorial Sloan-Kettering and other name institutions.

It also promotes its comprehensive "MDVIP physical," which concentrates on a risk factor assessment as well as a battery of tests. The idea is to head off illnesses before they start, as opposed to spotting them via tests like mammograms and prostate-specific antigen checks.

"That is not prevention; that is early detection of disease," Goldman said. "Let's look at your potential for illness. We don't want the pilot to get to 30,000 feet and find there's an engine knocking. Let's check it on the ground."

The prevention emphasis pays off, he said. MDVIP claims that its doctors' patients were hospitalized 65 percent less frequently than Medicare beneficiaries in 2005, and 85 percent less than commercial insurers' patients. The statistics could not be independently confirmed.

MDVIP has grown to a network of 190 physicians and 65,000 patients, up from 154 physicians a year earlier -- not bad, considering the company rejects 80 percent of doctors who apply, Goldman said.

The company's president, along with about 100 direct-practice physicians, turned out recently for the Society of Innovative Medical Practice Design's annual conference, outside of Washington, D.C.

Speakers including Newt Gingrich, former speaker of the House of Representatives, led a roster of experts in preventive medicine, information technology and health care finance.

Society President Chris Ewin said a more widespread acceptance of direct practice medicine could break physicians' dependence on Medicare and private insurance -- something he and his colleagues already enjoy.

"Some of us will never work for the government or the insurance industry again," he said.

heraldtribune.com

I am all about introducing fresh ideas and throwing out alternatives to those who are suffering within  the burning hell of the current American medical system.  Particularly, for those in primary care (God bless their souls), imagine seeing less patients and spending more time with each?  Not only that, but just think of the decreased amount of paperwork, the freeing of oneself from HMO's, and all the while preserving your income!  Sounds like medical nirvana doesn't it?