What's Up Doc?

"Oh, you dubbuh-cwossing wabbit! As many of you know, the first "true" appearance of Bugs Bunny and Elmer Fudd occurred in 1940. Elmer is a dimwitted hunter, "wooking for wabbits." Bugs is clever, smooth-talking character, who confuses Elmer with double-talk and misdirection. Elmer is no match for the wascally wabbit.

This morning we rose a carrott in honor of Bugs Bunny. Not only did Bugs outsmart Elmer, but Bugs seems to outsmart my Tucker nearly every morning. I can't help but to wonder if Tucker knows those wascally wabbits cannot be caught.

I heard Tucker squeeling a couple blocks away. Say, have you seen a wabbit wun by here? asked my little Tucker...as if he is going to get an answer from the doves. Finally, my little guy comes running up the sidewalk at full speed ahead. He bites his sister in the butt, and keeps on moving.

The wabbits have been in my yard as well. Sometimes they seem to appear out of nowhere. What's Up Doc? Oh, you wascally wabbit, I have seen you in my landscape...eating in my all-you-can-eat-buffet. They have devoured my spring flowers including some of my summer blooms. My consolation is that they are eating everyone's garden.

One day, Mr. Wabbit, Tucker and I will get you...Be vewy vewy qwiet. I'm hunting wabbits!

Insurance Is About Protecting Against Risk

Rather than using insurance to subsidize the consumption of all medical care, Americans should use it only for catastrophic expenses.


By George P. Shultz, Scott W. Atlas and John F. Cogan
January 5, 2014

As the acute problems of the Affordable Care Act become increasingly apparent, it also has become clear that we need new ways of ensuring access to healthcare for all Americans. We should begin with an examination of health insurance.
Insurance is about protecting against risk. In the health arena, the risk at issue is of large and unexpected medical expenses. The proper role of health insurance should be to finance necessary and expensive medical services without the patient incurring devastating financial consequences.
Over the last decade, however, Americans have come to expect their health insurance to subsidize the consumption of all medical care. Rather than simply protecting against financial catastrophe, insurance has become a pass-through mechanism to pay for every type of medical service, including routine ones.
This shift in expectation has meant that health insurance stands out as entirely different from all other types of insurance. Ask yourself: Would you use automobile insurance to buy gasoline? Would you use homeowner insurance to finance painting your house?
This wrongheaded view has played an important role in contributing to rapidly rising healthcare costs. Patients with insurance do not perceive themselves as paying for the cost of routine services, nor do their physicians and other healthcare providers. The natural result has been a more-is-better approach, with patients and doctors embracing costly healthcare services that are often of little value to the patient. Given healthcare's crucial role in well-being, it is important to assist individuals who can't afford even routine medical expenses, but it shouldn't be done through hidden insurance subsidies.
The entire concept of health insurance must be reconsidered. One attractive option for insuring those in need would be to expand the use of high-deductible health plans in combination with health savings accounts. This approach provides a cost-effective vehicle for insuring against catastrophic medical expenses while simultaneously helping individuals defray the costs of routine medical care.
Such coverage protects individuals from losing a lifetime of assets and from the devastating consequence of financial bankruptcy due to unpaid hospital and associated medical bills, a contributor to financial stress for millions of Americans every year. Such coverage means less-costly insurance policies, since they cover only major expenses and thereby reduce the bureaucracy and expense of smaller claims. And, with high deductibles, the hidden prices of medical care become far more visible, a necessity for containing costs. Price transparency coupled with greater availability of accurate information on health outcomes and provider quality are essential if patients are to choose healthcare services based on value.
Combining high-deductible insurance with health savings accounts provides a way to help individuals defray the costs of necessary, but routine, medical expenses. Such savings accounts allow individuals to set aside money tax-free to purchase immediate or future medical care.

Ask Dr. J—Coffee and LDL

Ask Dr. J—Coffee

Question: Can drinking too much coffee raise LDL (bad) cholesterol?

Answer: This is a good question, especially since I am a coffee lover! Actually, this raise in LDL cholesterol only applies to boiled or unfiltered coffee. A raise in LDL is not the result of caffeine, but rather, by the ingredients in the coffee. In fact, the LDL is only raised when the coffee grounds have been brewed for a long period of time, or when brewed coffee has been left to sit at high temperatures for long periods of time.

Diabetes REVIEW

If you have diabetes and peripheral neuropathy, it's critical that you carefully control your blood sugar levels. High blood sugar over time damages the blood vessels and nerves in your legs and feet. Fortunately, a good diet and regular, moderate intensity exercise can help improve your body's use of insulin, get your weight under control, and improve blood sugar.

Adopting healthy eating and exercise habits is "tremendously important" because it keeps blood glucose (blood sugar) levels under control. Lifestyle changes can prevent the development and slow the progression of microvascular complications. In addition, exercise like walking can relieve the pain, probably because it improves circulation.

To change your lifestyle:

• Get regular physical activity. Aside from helping you reach and maintain a healthy weight, exercise also improves the body's use of insulin and improves circulation. It also strengthens muscles, which improves coordination and balance in muscles that may have been weakened due to decreased nerve activity. Get started on an exercise program that won't be hard on your feet -- like walking, swimming, biking, or yoga. You may need to limit exercises that do stress your feet, such as running or aerobics. People with neuropathy -- especially those with bone deformities -- should always wear well-fitted shoes to avoid pressure sores and ulcers on the feet.
• If you smoke, stop. Smoking makes circulatory problems worse, which is thought to be one cause of neuropathy, and worsen the symptoms of peripheral neuropathy. Smoking also greatly increases the risk of heart disease in people with diabetes.
• Carefully limit alcohol. Excess alcohol intake can worsen neuropathy and make it hard to control your blood sugar levels.

Eat a Balanced Diet:

To keep blood sugar as close to normal as possible, it's important to follow the right meal plan. A well-balanced diet can make a big difference. You might want to consult with your doctor or a dietitian to learn what foods are best, when to eat, how much to have of each food, and what to avoid.

You will need to keep close track of the carbohydrates you eat since they have the most immediate effect on your blood sugar. Carbohydrates are in these food groups:

• Fruit
• Milk and yogurt
• Bread, cereal, rice, pasta
• Starchy vegetables

You should eat plenty of fiber since it plays a role in the digestive process, reduces heart disease risk, and can improve blood sugars. Choose from:

• Fresh fruits and vegetables
• Cooked dried beans and peas
• Whole grain breads, cereals, and crackers
• Brown rice
• Bran products

It's important to eat foods that are low in fat. Good choices are:

• Lean meats. Bake, broil, grill, roast, or boil - never fry
• Low-fat dairy. That includes cheese milk, yogurt
• Low-fat vegetable cooking spray
• Low-fat margarines and salad dressings

Avoid high-sodium foods, which can cause high blood pressure:

• Salt
• Boxed mixes of potatoes, rice, pasta
• Canned meats
• Canned soups and vegetables
• Processed and packaged foods (lunch meat, sausage, bacon ham)
• Salty snack foods

Are YOU a Champion? 

The dictionary definition of a champion is a person who has defeated or surpassed all rivals in a competition. My personal favorite definition, is to "live your life in your own way, to reach for the goals you have set for yourself, and to be the YOU that you want to be."

What makes a champion? I bet you know a champion. Are they your neighbor, your co-worker, your family member? Is it Mary Lou Retton, Kelly Clarkson, a pastor, a doctor, a nurse?

I want you to imagine yourself right now as a champion...go ahead, close your eyes, and imagine what it would look like to be a champion. No, I do not want to hear you say, "I am not good at anything. " Now go ahead, close your eyes. I want you to imagine what it looks like to be a champion.  This may take a little time. I want you to find a quiet place. There must be no distractions. Make a list in your head of all your talents.

I can see that it is not hard for you to list the talents if you are a top speed skater, a pro basketball player, a famous artist. Are you the fastest runner on your team?  Have you won All-conference honors on your basketball team? Did you qualify for the National Golf team? Are you an award-winning novelist? Do people naturally gravitate toward you because you are a natural leader?

Ok, that is a great start. Next, I want you to list those talents you have that are a little deeper inside. You know they exist! These are the talents that you have kept hiding and are not being fully utilized. Keep this list because we will refer back to it.

Now, picture you are looking for someone to join your team. You are looking for a champion. It can be your softball team, your rowing team, your debate team, etc. When you pick your teammate, are you looking at their "gifts" that are obvious? For example, are you looking at the person's gifts and projecting those into the future? They have talent now so they will be my champion in the future. Or are you thinking that person has a lot of potential and with hard work, passion, discipline, commitment and good instruction, that person can be an amazing teammate?

Its okay, there is not a right answer. I just want you to be aware that many people who have amazing talents, never reach their full potential, so you may have passed up the true champion who was ready, willing, and able to be your student. It might have been you...with all your "hidden" talents that were not being utilized.

I ask you again, "Are you a Champion?" More importantly, "Can you pick the champion?" I will tell you this one thing to be more true now then ever before...the kind of feedback students get from the people who evaluate them (their parents, their teachers, their coaches) makes the difference between finding a champion or finding someone who is not. Specifically, champions are found when evaluating the process (e.g., effort, learning) as opposed to a focus on the person (e.g., talent or ability).

Dreaming Really, Really, BIG!

"The greatest discovery of the 19th century was not in the realm of the physical sciences, but the power of the subconscious mind touched by faith. Any individual can tap into an eternal reservoir of power that will enable them to overcome any problem that may arise. All weaknesses can be overcome, bodily healing, financial independence, spiritual awakening, and prosperity beyond your wildest dreams. This is the superstructure of happiness." – William James, Harvard Psychologist, the Father of American Psychology.

William James (1842-1910) stated that if you form a picture in your mind of what you would like to be, and you keep that picture there long enough, you will soon become exactly as you have been thinking. This process of forming a picture in our minds is often referred to as visualization and is based on the biblical idea, "As you think, so shall ye be."

And so, this 1800's idea is a driving force today when discussing the pursuit of excellence. To achieve your potential, somewhere deep in your core you have to create the belief that you can do it. By dreaming about your BIG dream, and focusing on your daily goals (the little steps), you nourish your commitment, your confidence, and your belief in your ability to achieve.

Even if you never make it to your ultimate goal, your dream of getting there inspires you to be better than you otherwise would be.

The IronLady

From one "Iron Lady" referring to THE "Iron Lady" it is hard not to feel sadness. Margaret Thatcher passed away today. Her character, philosophy and achievements made her one of Britain’s greatest prime ministers. The world has lost a true champion of freedom and democracy.

Margaret Thatcher fought socialism in England and unyieldingly promoted free-market views. She put a stop to the British labor unions and strongly believed in a limited government by lowering spending and taxation.

Ronald Regean and Margaret Thatcher were political soul mates, committed to freedom and resolved to end Communism. As Prime Minister, Thatcher had the clear vision and strong determination to stand up for her beliefs at a time when so many were afraid to “rock the boat.” As a result, she helped to bring about the collapse of the Soviet Union and the liberation of millions of people.

Mrs. Thatcher famously said, “The trouble with socialists is that they always run out of other people’s money.” Margaret Thatcher once said that her competition would rather the poor were poorer provided the rich were less rich. That way you will never create the wealth for better social statuses. In a system of free trade and free markets poor countries – and poor people – are not poor because others are rich. Indeed, if others became less rich the poor would in all probability become still poorer."

I have listened to many speeches by Margaret Thather and one which hits home with me is this: “I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it. ‘I have a problem, I’ll get a grant.’ ‘I’m homeless, the government must house me.’ They’re casting their problem on society. And you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also, to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There’s no such thing as entitlement, unless someone has first met an obligation.”

The magnificence of Thatcher was her refusal to accept the conventional wisdom of her age...her refusal to conform. History will enshrine Margaret Thatcher as a transformational leader who helped defeat communism, promote freedom, and bring hope to the oppressed. Her penetrating words and compelling vision will last for generations.

 

DreamBIG

When God created you, He deposited in you everything that you need in order to fulfill your calling. He gave you the desire and the ability. He equipped you with gifts and talents. No dream is too big. No challenge is too great.

Ask Dr. J

 

Question: I am a 35 year old, 165 pound male, wanting to put on the most muscle mass possible. What are the best exercises for each bodypart to accomplish my goal?

Answer: This is a real good question and one that bears a lot of controversy. For example, it was once thought that the leg extension, an isolation exercise, involved the most fibers. The problem with this theory is that it is based on measurement of heat production and oxygen deprivation. It has nothing to do with the number of fibers activated.  Have you ever noticed male models that have small, detailed quads? This is undoubtedly from doing lots of leg extensions with no time spent in the squat rack.

The moral of this story is, if you want to hit the most muscle fibers with one movement, make the big, compound exercise the core of your routine. This is no revelation to bodybuilders, but let me explain the reason why, for instance, the squat builds more mass than the leg extension. The answer is Synergy. When there is synergy, or teamwork, from surrounding muscle groups, you can place considerably more weight on the fibers in the target muscle. Now we grow big!

Here is a list of some of the best mass building exercises for each bodypart:

Quads:                               Squats

Hamstrings:                      Stiff-legged deadlifts

Calves:                              Toes-pointed leg curls

Lats:                                  Pull-downs or chins to the front

Midback:                           Behind-the-neck pull-downs

Chest:                                Bench press

Delts:                                Overhead presses

Biceps:                              Barbell curls

Triceps:                             Lying extensions or close-grip bench presses

 

Abdominals:                     Incline or hanging knee-ups

Center Stage Physique by DR. J

It might be said that bodybuilding is losing its luster, that female bodybuilding has crashed and burned, and that top pro shows such as The Arnold Classic and the Olympia are all washed up.

I hate to break it to you, but you are wrong...competing in these events is growing stronger. Take for example, The Arnold Classic: The Arnold Classic celebrated its 25th Anniversary during the March 2013 Arnold Sports Festival. The Arnold Classic has grown over the years into one of our sport’s most prestigious events, and was the catalyst for the Arnold Sports Festival – the nation’s largest multi-sport festival. The Arnold Classic includes five IFBB Professional League Divisions including Arnold Classic (professional men’s bodybuilding) and the Ms. International (women’s professional bodybuilding), which also debuted in 1989. The Arnold Classic Weekend also features the Fitness International (founded in 1994), Figure International (2003) and the Bikini International (2011).

With this kind of history, how could you doubt the fan base and the competetive profiles that are alive and well?

I once had a dream that I would be up on one of those two stages. That dream ended on the Team Universe stage in 2007. I am now coaching young athletes to perform in these events. It has been a dream come true so to speak, as I am able to coach athletes in bodybuilding, figure, physique, and bikini.

Check out www.facebook.com/CenterStagePhysique. Like my page and check out my athletes who are competing in June 2013.

Weight Management Programs

What Defines an Effective Weight Management Program?

It is easy to get overwhelmed with the abundance of weight loss programs and supplements available today. For this reason, you may want to keep the following guidelines in mind as you search for a healthy weight loss program.

1)    There is no magic pill for weight loss. Please beware, a commercial or advertisement promising weight loss with pills or supplements may only want your money.

 

2)    A program needs to fit your body. Some programs may not be suited for your lifestyle or current fitness level, and may cause burnout or even injury.

 

3)    Make sure your physician has approved your physical activity program. It is important for you to be well-informed and cleared medically before starting anything new.

 

4)    Select a program that will provide you with the healthy lifestyle education that you can use for the rest of your life.

 

You can find out more information about Dr. Malea Jensen by going to and clicking the "Like" button on: www.facebook.com/CenterStagePhysique

 

 

Stretching

I would guess there are a lot of you who do not stretch at all, or if you do, you stretch the muscle you’re going to work for 5 seconds at most. What you must realize is that stretching helps muscles recover, increases muscle elasticity and decreases the chance of injury.

Stretching is crucial for every sport or fitness activity, and too many people neglect this part of their workout. Stretching will not only increase your flexibility and minimize your chances of pulling or tearing muscles, but it will also improve your performance. A flexible muscle reacts and contracts faster, and with more force, than a non-flexible muscle. Flexibility also increases your agility and balance.

 

Stretching exercises should be performed after a short warm-up, between weightlifting sets, and/or during your cool-down. As an added benefit, stretching is an excellent relaxation technique. Use your stretching time to focus on your sport or workout, visualizing success. Make sure you leave plenty of time to stretch after your workout. Do a number of stretches for the body parts you just worked, and hold each stretch for about 20 to 30 seconds.

Do not neglect this important aspect of fitness. It may be the most crucial to your success!

 

 

 

 

Cash Pay Medical Practices

As many of you are well aware, medical insurance is very costly. If you or someone you know has been hesitant to see a doctor because they do not have insurance or the deductible is sky high, consider finding a low cost, cash only, doctor.

Currently, Center Stage Primary Care is offering $50 office visits. Payment is expected at the time of check-in. If labs or other tests are needed for further management, you can use your insurance. We can find alternative treatment options that are cost effective if you do not have insurance.

I do acknowledge the need for patients to have some medical insurance in case of emergencies. People should have health insurance for catastrophic illnesses or surgery. Use your best judgement and talk to your health insurance company regarding your options.

I am a big believer that the direct-pay model accomplishes what many people want out of health care reform – increased access for the uninsured, decreased costs, and price transparency.There are no surprises. You know what you're getting. You know what you're spending for it. You wouldn't buy clothes and not ask how much it costs before you go to the counter or look to see. Why should medicine be any different?

Logo is Finished!

A winner understands the importance of a positive attitude.

Happy January 1, 2013!!!

 

Today is the first day of 2013 and I am starting my marketing! Please help me share my LinkedIn and facebook links for Center Stage Primary Care.

 

Each of you can help me out by first "liking" my facebook page and then Forward my blog to friends and family who may be needing a family practice physician. The more "Likes" I get, the more traffic I will get from others outside my circle. Thanks to each of you in advance.

 

In addition, I will picking up hours starting Feb 1, 2013 at the office of Dr. Doug Hoisington. As many of you know, he is an ENT physician in West Des Moines.

 

Read:http://www.vitals.com/doctors/Dr_Douglas_Hoisington.html#ixzz2GkSMD6LC

 

Dr. Hoisington will be renting me space as I will continue to remain my own entity of Center Stage Primary Care.

 

The address and hours are as follows:

1455 29th St West Des Moines,IA 50266

 

Please continue to use my current phone number to schedule appointments:

515.226.2580

 

Hours:

Wednesday: 830-5

Thursday: 830-5

Friday: 7-330

 

It is going to be a great year!!

 

Here are the Links:

Center Stage Primary Care | Facebook

Malea Jensen, DO | LinkedIn

TWAS THE WEEK BEFORE CHRISTMAS

Twas the week before Christmas and all through my town,
People were frantic, but nowhere a frown.
Hy-Vee and Fareway were stocking with care,
In hopes that the blizzard would soon be there.

The children were excited and nestled in their beds,
While visions of steep hills danced in their heads.
And mommy in her apron, and daddy in his cap,
The DOCTOR was on call, but settled for a nap.

When out on my lawn, there arose such a clatter,
The dogs sprang from the couch to see what was the matter.
Away to the window, I walked with my phone,
I wondered if tonight, the cops would soon groan.

The moon shown its light on some new fallen snow,
The green grass was at ease for spring would soon flow.
When what to my wondering eyes should appear,
It is no suprise, it's the neighbors scraping with fear.

With the snow falling, and wind so fierce,
I knew in a moment, the sirens would soon pierce.
More rapid than rabbits, the parents would run,
They whistled and shouted, and slipped on their buns.

And then in a twinkling, I looked to the sky,
I knew from above, Jesus stood by.
For my friends and family this is the season,
I don't have to tell you, Jesus is the reason.

New Years Resolution

Losing Weight--No Simple Resolution

It is mid-November and it has been unseasonably warm. Many of you put up Christmas lights this past weekend. Perhaps you have even created your list of New Year's resolutions to include losing weight for a spring cruise. Just saying that you want to lose weight isn't going to provide the impetus to do it. Instead, approaching your fitness goals by evaluating why and how fit you want to be, is the answer to your resolution. In other words, envision what you want to achieve through fitness, write it down (i.e. I want to lose 10 pounds), and finally, make a game plan.

First off, each person needs to define what “health” means to them. For most people, they are interested in health in order to pursue other things they are passionate about in their lives. As mentioned above, some want to get in shape for that all-important spring cruise. Find out where you stand in terms of fitness.

Another important aspect is that you should “want” to be healthy. Choosing your health means comprehending what it will take to get there—usually, a lot of hard work and difficult lifestyle changes. I have found that many people, once informed of the effort needed, will realize they don't want it that badly. I would have to agree that it is better to know that now, than to fail with fitness regimens when your heart is not really in it.

Once you define what your health and fitness is to you, and you have chosen to be healthy, it is now time to create the game plan. The game plan will be unique to each person, depending on the personal vision of health. In other words, there is not a diet or exercise program that is universal. Some things may seem very unconventional to a bodybuilder like me, but totally “right” for a stay-at-home mom. I believe there are some common ground components, however. For instance, you need strength building, stretching, and aerobics, in any good exercise program.

If you are having trouble getting started or do not think you have the time, I have listed a few things that may help get you on track.

1.      Stay consistent with your workouts. Try not to skip. If you are going out of town for a few days, map out a walking or jogging program where you will be staying. Google some routine exercises that can be done in a hotel gym or your hotel room.

2.      Begin your day with your workout. The sooner you get it done, the less likely you are to have other obligations get in the way.

3.      Plan your workouts ahead of time. This will save you time and make you less apt to quit midway through when you do not know what to do next.

4.      Write a daily blog or post a daily entry on Facebook or Twitter regarding your exercise routine. When others know about your accomplishments, you will feel more accountable and motivated to stick with your routine.

5.      Multi-task during your cardio session. I like to check email on my smartphone or make lists on my memo app for things to do later. Use this time wisely so you are not getting anxious about what you need to do next.

6.      When the rush of the season is getting to you, try to allocate a section of your day for relaxation. Read a book, read a daily devotion, or simply sit quietly.

Finally, be mindful of your progress and make any necessary changes and adjustments along the way. Health and fitness is not a static process, but one that needs to be evaluated on a regular basis.

I hope this has helped set the ball in motion to a healthier lifestyle. Stick with your IronLadyDoc and see where we can go together! Take your health Center Stage!

TAKE YOUR HEALTH CENTER STAGE

Not to beat a dead horse about the lack of primary care doctors, but I want everyone to realize this FACT...there IS a lack of primary care doctors. It has been well documented that fewer and fewer medical students are choosing to enter primary care specialities, such as family medicine. The truth is, our friendly leaders in the White House have also been reviewing statistics on this same subject. So, one of the many ways Mr. White-House is trying to encourage more family practice docs, aside from giving them our tax money to go to medical school (oops, that is top secret information), is to expose more medical students to family medicine, such as by requiring them to do a clinical clerkship in a family medicine office. I guess the logic is that if they see how great and fulfilling it is to be a family doctor, then more of them will want to go into it as a career.

As well-intentioned as this may seem, there is no better way to turn off medical students from going into primary care than by having them see first-hand how frazzled, frustrated, and overworked a primary care doctor's life really is. In fact, have them rotate through our local walk-in clinics and they will see first hand how it works...check in patient, take back to room, give pill, collect money, send out the door, go to the next room and do it all over again. Never mind that their blood pressure indicates risk for stroke or heart attack, or that their weight puts them at risk for diabetes.

But, if you really want students to go into primary care, have them rotate through an office where there is enough time to talk with patients, where doctors are not overworked, and where both doctors and patients are happy.

One of the worst pieces of advice I got in medical school was to guard my ‘professionalism’ – which meant, act like a talking robot. I think he worked for Mr. White-House. Hogwash! Doctors are all unique, and the better patients get to know us, the better they’ll sort themselves into good matches with their primary physician.

Will family medicine survive? Of course it will! Society is going to get the health care it wants and deserves, and medical students are going to get the medical career they want and deserve. Make no mistake: We are not  helpless pawns in the current system. When given a choice, patients will go where they receive quality care.

One month ago, I embarked on a quest to serve my patients. The many who know me and the many who will get to know me, will find it refreshing that I am someone who is not simply on a mission to get in and out of the exam room and who prefers to address the actual problems instead of throwing pills at them.

So, in an effort to "guard my professionalism" and maintain my Hippocratic Oath (an oath historically taken by physicians swearing to practice medicine ethically and honestly) I have decided, with the help of some very special people, to create my solo medical practice.

I thought it appropriate to name my practice, "Center Stage Primary Care", because realistically, my hope is that you will allow me, to help you, take your health "center stage." Each patient no matter what age, will learn about overall health and wellness.

I will focus on diagnosing and treating conditions of all ages while emphasizing preventative medicine. I will refer patients, when appropriate, to specialists and/or to hospitals for tests, further treatment and therapy. Most importantly, I will focus on YOU, the patient!

My new address:1601 NW 114th St Suite 142, Clive, IA 50325. For now, you may call 515.222.3151 to schedule an appointment. When you hear the receptionist say, "Central Iowa Orthopeadics," don't hang up. You have the right number. Let Kerri, Jodi, Pam, or one of the other fabulous girls in the office welcome you and schedule your appointment. And, just between you and I, thank them for giving us a home so we can help each other take your health CENTER STAGE!

Official start date is October 15, 2012 provided no delays in my credentialling.

Are You Ready for a Doctor Shortage?

I believe the projected doctor shortage caused by the Affordable Care Act will drive primary care into two opposite tracks:

• The “Apex of the Pyramid” Track
• The Concierge Medicine Track

Each is a distinct and logical response to the patient overload from the doctor shortage that is rapidly approaching. Each points out gaping holes in our medical education that must be addressed. Concierge medicine has an additional powerful force acting in its favor.

 

The American Medical Colleges estimates that there will be a doctor shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake of the SCOTUS decision to let the Affordable Care Act stand. This doctor shortage is caused by a tidal wave of newly insured patients has to be served somehow and US Medical Schools and Residency Programs cannot supply anywhere near these numbers of new physicians in this short of a time frame.

 

How will healthcare markets respond to this doctor shortage – especially with regards to primary care? I see two likely options.

 

1) Volume Driven: Doctor as apex of a care pyramid

In the more traditional practice structure, the doctor shortage will force the primary care physician to become the leader of a care team supervising a number of physician extenders who provide the majority of the hands on services. The skill and experience of the physician will be saved for the more complicated and severe cases seen that day.

 

The majority of the doctor’s activity will be devoted to leading and coordinating the care provided by the pyramid of N.P’s and P.A.’s who are their direct reports.

 

The challenge to this model is the complete absence of functional leadership skills training in most medical school and residency programs. 30-50% of these physician’s time will likely be spent in leadership and management activities for which they are not prepared on graduation.

 

2) Service Driven: Concierge Medicine/direct care model

 

As the doctor shortage worsens, the typical patient will begin to notice they are only seen by a physician on rare occasion. A certain percentage will become willing to pay for that privilege. I suspect this will quickly grow to a huge new demand for concierge medicine services, where you pay a reasonable monthly fee to guarantee you are always seen by your doctor.

 

As the doctor shortage continues to worsens, I believe a larger and larger segment of our population will become willing to pay to continue to see their primary care doctor as they do today and their only alternative will be concierge medicine.

 

The huge popularity of concierge medicine will have another important driving force – the office duties of the concierge medicine physician are exactly the opposite of those in example #1 above.

 

In a concierge medicine practice, the physician is often seeing less than 15 patients a day, providing direct patient care and continuing to have meaningful personal relationships with their patients.

 

 

Let me know your thoughts. Which direction do you think medicine is going?

John Galt Speech

A John Galt Speech For Direct-Pay Physicians
“You demand to know what has happened to us, the physicians you thought you controlled. You have cried that our sins are destroying the world and you have cursed us for our unwillingness to practice the virtues you demanded. Since virtue, to you, consists of sacrifice, you have demanded more sacrifices at every turn. You have sacrificed all those evils which you held as the cause of your plight. You have sacrificed justice to mercy. You have sacrificed independence to unity. You have sacrificed wealth to need. You have sacrificed self-esteem to self-denial. You have sacrificed happiness to duty.

“While you were dragging us to your sacrificial altars, we physicians who value justice, independence, reason, and self-esteem – we finally came to see the nature of the game you were playing, which we had previously been too innocently generous to grasp. And we have chosen to play no longer.

“All the physicians who have vanished from your system, the doctors you hated, yet dreaded to lose, we are gone from you. Do not cry that it is our duty to serve you. We do not recognize such duty. Do not cry that you need us. We do not consider your need a claim. Do not cry that you own us. You don’t. Do not beg us to return. We are making our own way, apart from you.

“In your cynical attempt to control the healthcare system, you have coerced us – with your threats to our livelihood, threats of massive fines, threats of jail – to abandon our sacred obligation to our patients. Society must come first, you say. The needs of the collective are paramount, you insist. We must do what the experts tell us to do, you demand. And in the process you have destroyed the doctor-patient relationship which is the backbone of our profession. You have reduced physicians to ciphers, to puppets. And you have reduced our patients – the living, loving, hoping, striving people who come to us, who place their trust in us and their lives in our hands – to interchangeable members of a vast herd. You have demanded that we guard society’s interests, and abandon our sick to their own devices in your cruel and parsimonious healthcare system.

“Your process is now firmly established. Your methods have been legislated by Congress, embodied in volumes of rules, regulations and “guidelines” (strictly and ruthlessly enforced), upheld by the courts, and finally (and most tellingly) sanctioned as being entirely “ethical” by your allies, the leadership of our own professional organizations. You have made the healthcare system untenable for doctors who value true medical ethics.

“You have placed us into a position where we must either resign ourselves to an unethical, demeaning, health-destroying style of practice, or get out. We have gotten out.
“We have gotten out. We have left your Program. We refuse to sacrifice ourselves for you any longer. We will not sacrifice our livelihoods, our morals, our independence, our minds, or our patients for your bastardized idea of virtue.

“We will practice medicine in the only manner that still permits us to behave ethically toward our patients, in the only way that we can honor the true doctor-patient relationship, in the only way we can legitimately regain the title of professional. We have chosen to be paid directly by the people to whom we provide our services, by the people to whom we dedicate ourselves as professionals. We have chosen to cut you out.

“To argue that direct-pay practices are unethical – to argue that any innovation that would somehow restore both our professional integrity and the patient’s rightful advocate is unethical – is completely upside down. This argument only reveals your own inner corruption. We are taking the only pathway that remains to us to restore the true foundation of medical ethics, to restore our profession – to always place the patient first.

“To argue that direct-pay practices threaten the general welfare completely ignores reality. We are doing the only thing we can do to begin restoring protections that people are supposed to have when they are sick and facing a healthcare system that is utterly bent on withholding their care whenever it can be gotten away with.

“To argue that direct-pay medicine will create a two-tiered healthcare system is absurd on its face. It provides a mechanism by which at least some of your intended victims can escape the deadly obstacles you have laid before them. Saying that it amounts to a two-tiered healthcare system is as absurd as arguing that slaveholders were wrong to free their slaves before Emancipation, because doing so would create an elite subpopulation of former slaves; that until all slaves are freed, no slaves should be freed. But when a few slaves were freed and walked the earth as free men, that action was not only ethical, but it also showed others what was possible. Over time, it created a widespread expectation for freedom that eventually could no longer be ignored, and that, at huge cost, was finally fulfilled.

“You wouldn’t understand this – you who already know everything, you whose experts already have all the answers – but any innovation that can potentially spare patients from some of the harm you have in store for them will necessarily be applicable to only a few patients at first. That is how disruptive processes work. In your proposed perfect system, of course, disruptive processes are anathema – because they disrupt. But in the real world disruptive processes are creative processes, processes of growth, processes of rejuvenation, processes that create opportunity. This is why you always try to suffocate disruptive processes, with your cries of “unfair!”

“Disruptive processes always begin as niche products or services, attractive only to a few high-end users; too expensive or too marginal for the vast majority; ignored, ridiculed or castigated by current providers. But if at their core they are offering something fundamentally useful, they will slowly demonstrate their worth – and eventually all the potential users will see the light, and demand for the product will become explosive. At this stage the means are invariably found to make the new product affordable and available to meet the demand, while preserving the core benefits. And when that happens, the traditional providers (who never saw it coming) are suddenly out of business.
” We are a disruptive process, and the process we are disrupting is yours.

“We are not playing your game any longer. We will no longer be victims; we will no longer subject ourselves to your attempts to make us guilty. We will no longer walk, heads bent down, to your altar of sacrifice.

“You no longer have any hold on us. We have done our time. We are getting out. If we decided to leave medicine and open a road-side fruit stand, or become lumberjacks, or just spend our time puttering around in the basement, you would have no objection to that. So by what right do you object if we hang out our shingles, and see a few patients who voluntarily come to us, using their own resources to do so? You can have no rightful objection to such a thing. So be quiet about it, or admit to your own corruption.”