Primary care physicians in the U.S. have been relegated to the back room. As a result, people are dying younger than before. One year ago, I asked whether declining life expectancy was just the tip of the iceberg, suggesting we should turn our attention to the dwindling supply of primary care physicians. What will it take for those in charge sit up and pay attention? How low will life expectancy have to go? Stay tuned…
Reaching down to pick up her dance bag off the ground, I began to close the van door, knowing the child safety feature would not allow complete closure. This really got her attention. She grabbed the bag, used her body to block the door, and hopped back into the van. “Wait! I want you as my mother.” She even wanted to go home with me. Skeptical, I clarified, “Are you sure? It means you must commit to being my daughter from now on?” She nodded.
Micro-hospitals are best suited to handle short-stay admissions anticipated to be less than 48 hours. Costs are slightly higher than for an urgent care center, yet lower when compared to traditional hospital settings. Micro-hospitals can meet 90 percent of patients’ basic healthcare needs and tend to flourish most in markets with critical service gaps by preventing at-risk populations from falling through the cracks. Ideally, micro-hospitals should be located within 20 miles of a full-service hospital, to facilitate transfer of patients to larger institutions should higher acuity healthcare needs arise.
When asked about this, the Public Affairs Manager, Cassandra Hockenson, at the Medical Board of California responded“there is not a huge difference between plastic surgery and dermatology.” She suggested contacting the Physicians’ Assistant Board for the State of California instead. She kept repeating that the supervising plastic surgeon had no complaints against him. I learned two important lessons from contacting the Medical Board of California: 1) Without complaints, a physician can supervise midlevel providers in any specialty they choose, and 2) while required by law to supervise mid-level providers, the safety of patients is not a high priority for the Medical Board of California.
Confucius said, “the man who moves a mountain begins by carrying away small stones.” It is time to lay the groundwork for Kitsap residents to formally engage in meaningful dialogue with leaders of our local hospital corporation, whether operated by CHI Franciscan, Dignity Health, or a still-to-be-named corporate entity.
While there have been no more 9-1-1 calls and unexpected visits from police officers, this experience is another one of those parenting life lessons. Most of all, I am thankful the deputies “dropped by” when the scene was calm. If they were on my doorstep on any other regular evening, things might have turned out differently. I wish all of you a Happy Thanksgiving, and may you enjoy a day free of a surprise visit from your local Sheriffs’ deputies.
“I am so sorry,” I said. I was sorry for many more things than I could say. This is one moment I wish could be erased from my memory and done again, though differently. Ideally, I would greet the mother and child with a warm smile, take an extensive history, perform a thorough physical exam, discuss a list of possible diagnoses with mom, and send blood tests accordingly. I would reassure this mother we would properly evaluate her concerns.
While childhood injuries will continue to be a rite of passage, pediatricians have the opportunity to reduce those with long-term consequences, such as skull fractures and intracranial bleeds. Educating parents will go a long way toward ensuring the next generation grows up to make their own mark on the world in the future.
The American Board of Medical Specialties (ABMS) eliminated “lifetime” certification to shore up their financial outlook; a modification having little to do with quality and much to do with rate of return. Between 2003 and 2013, the ABMS member boards’ assets ballooned from $237 million to a staggering $635 million, an annual growth rate of 10.4%. MOC is outrageously lucrative. Almost 88% of their revenue came from certification fees.
The idea of micro-hospitals is gaining traction because costs of construction are far lower than that of more traditional hospital facilities –costing anywhere between $7-$30 million, depending on the range of services available, according to Advisory Board statistics. Micro-hospitals can meet 90% of the community healthcare needs. They seem to flourish best in markets with critical service gaps. Ideally, micro-hospitals are located within 20 miles of a full-service hospital, facilitating the transfer of patients to larger facilities if higher-acuity needs arise. Hospital stays anticipated to be longer than 48 hours are sent to higher-acuity facilities.
