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Navigating fair market value as an independent or locum tenens physician [PODCAST]
Health care attorney Dennis Hursh discusses his article, "What independent and locum tenens doctors need to know about fair market value." Dennis explains why understanding fair market value (FMV) is crucial for independent and locum tenens physicians, not only for securing appropriate payment but also for ensuring compliance with federal laws like the Stark Law. He breaks down the Stark Law's definition of FMV as compensation arising from bona fide bargaining between well-informed parties not in a position to generate business for each other, and introduces the vital concept of "commercial reasonableness"—meaning an arrangement should make sense for the parties' goals, even if not directly profitable for the hospital regarding that specific physician's services. Dennis provides a practical method for locum physicians to estimate their minimum acceptable rate by calculating the total hourly cost of an equivalent employed physician, factoring in salary, benefits (typically 20 to 30 percent of compensation), paid time off, and amortized bonuses, offering a family medicine physician example where this cost exceeds $216 per hour. He advises locums to consider situational factors like a hospital's urgent need or difficulty in recruitment as leverage, and to proactively research and ask insightful questions to ensure their contributions are properly valued.
Why fixing health care's data quality is crucial for AI success [PODCAST]
Physician executive Jay Anders discusses his article, "Health care's data problem: the real obstacle to AI success." Jay asserts that the transformative potential of artificial intelligence in health care is fundamentally dependent on the quality of the underlying clinical data. He explains that while tools like large language models and conversational AI show promise in synthesizing information and easing documentation, their reliability is compromised when fed with data from repositories often filled with inconsistencies, errors, and gaps. This can lead to an "increased workload paradox," where clinicians spend more time verifying and correcting AI-generated outputs, and a failure to produce the structured data vital for regulatory compliance, quality metrics, and analytics. Jay emphasizes that the "garbage in, garbage out" principle severely hampers interoperability and contributes to significant financial and clinical risks, including medical errors and inefficient workflows. To counter this, he advocates for robust data validation and normalization, enhancement of clinical terminologies, and the use of AI paired with evidence-based algorithms to rectify historical data issues, stressing that establishing trusted data sources is paramount before AI can truly revolutionize health care delivery.
How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]
Patient advocate Tami Burdick discusses her article, "How collaboration saved my life from a rare disease doctors couldn't diagnose." Tami shares her personal and arduous journey with granulomatous mastitis (GM), a rare and poorly understood condition, and how embracing collaborative health care in three key ways led to her successful remission. She details the crucial partnership between her conventional Western medicine doctor, surgical breast oncologist Dr. Kelly McLean, and her functional medicine practitioner, Jared Seigler, which allowed for innovative testing and a broader perspective on her illness. Tami also highlights the power of patient-to-doctor collaboration, emphasizing how her own relentless research and self-advocacy were instrumental in uncovering answers that the traditional system initially missed, largely due to time constraints on physicians. Furthermore, she underscores the profound impact of patient-to-patient collaboration through her support group, where shared experiences and knowledge provided critical guidance and helped others navigate the complexities of GM. Tami's story is a testament to the potential of integrating different medical approaches, the necessity of patient empowerment, and a call for systemic changes in health care to foster more such collaborations, including better insurance coverage for alternative practices and more dedicated time for doctor-patient interactions.
Reimagining Type 2 diabetes care with nutrition for remission [PODCAST]
Endocrinologist William Hsu discusses his article, "Reimagining diabetes care with nutrition, not prescriptions." William argues for a paradigm shift in treating Type 2 diabetes, moving away from a primary reliance on medications for symptom management towards a focus on achieving disease remission and regression through comprehensive, nutrition-based lifestyle interventions. He critiques the traditional model that often consigns patients to a lifelong battle with chronic illness and a heavy medication burden, emphasizing the need to address the root causes of the disease, such as insulin resistance and impaired pancreatic beta-cell function, while aiming for optimal body composition and tackling premature aging. William highlights programmatic approaches like the Fasting Mimicking Diet (FMD), used under medical and dietetic supervision, as a promising strategy that not only improves glucose levels and promotes fat-focused weight loss while preserving muscle mass but also fosters deeper cellular renewal and offers a sustainable, long-term plan. He advocates for a "triple bottom line" in diabetes care: achieving remission or regression, addressing underlying mechanisms, and enhancing longevity and quality of life, positioning nutrition-led programs as the new gold standard.
Avarie's story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]
Patient advocate Lianne Mandelbaum discusses her article, "What Avarie's death in Rome teaches us about the gaps in food allergy education." Lianne reflects on the tragic death of Avarie, a young American student with a known tree nut allergy who died in Rome due to anaphylaxis, contrasting this loss with the promising advancements in food allergy research and treatment. She meticulously outlines the systemic failures in Avarie's case: despite informing the restaurant of her allergy, she was served pesto containing cashew; her first epinephrine auto-injector reportedly failed; and the responding ambulance lacked the appropriate medication. Lianne underscores how lived experience with anaphylaxis shapes risk perception and highlights the urgent need for comprehensive, lifelong food allergy education starting from a young age. This education must cover crucial skills such as safe food ordering, self-advocacy in various settings including when studying abroad, and clear emergency response protocols. She points to a pervasive societal underestimation of food allergies and calls for widespread education at all levels—for patients, families, schools, universities, the hospitality industry, physicians across specialties to ensure timely allergist referrals, and particularly for first responders to be properly equipped and trained. Lianne advocates for making the knowledge and use of epinephrine as normalized and accessible as CPR, urging the community to translate knowledge into action to prevent further avoidable deaths.
How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]
Health reporter Martha Rosenberg discusses her article, "Conflicts of interest are eroding trust in U.S. health agencies." Martha outlines how faith in government health bodies like the FDA and CDC has plummeted due to escalating conflicts of interest, tracing some concerns back to the 1992 Prescription Drug User Fee Act (PDUFA), which allowed drugmakers to fund aspects of the drug approval process. She points to a pattern of FDA commissioners, such as Dr. Scott Gottlieb, Dr. Robert Califf, and Dr. Margaret Hamburg, having significant financial ties to the pharmaceutical industry, and notes the concerning practice of drug trials being funded by the manufacturers of the drugs under investigation. Martha also examines the CDC Foundation, which accepts private donations, and cites several CDC directors, including Dr. Brenda Fitzgerald, Dr. Tom Frieden, Dr. Julie Gerberding, and Dr. Robert Redfield, who faced scrutiny over alleged conflicts or ethical issues. The conversation delves into the pervasive influence of pharmaceutical lobbying on Congress and the increasing tendency of medical journals to publish industry-funded research, highlighting the danger these interwoven interests pose to public trust and patient well-being.
Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]
Shane Tenny discusses his article, "Navigating your 457 plan: key steps for physicians changing jobs." He provides crucial advice for physicians, particularly those with non-governmental 457(b) plans, on how to manage these retirement savings vehicles during a career transition. Shane clarifies that a 457(b) is a type of deferred compensation plan offered by state and local governments and certain tax-exempt organizations, differing in key ways from 401(k)s. For physicians leaving employers with non-governmental 457(b)s, he highlights critical considerations such as the likelihood of mandatory distribution upon separation, the general inability to roll these funds into an IRA or another qualified plan (a common option for 401(k)s and governmental 457(b)s), and the potential for the entire plan balance to become taxable income in the year of distribution. Shane outlines actionable steps for physicians, including thoroughly reviewing their specific plan documents, engaging in strategic tax planning, exploring possibilities for scheduled distributions to spread out tax impacts if the plan allows, and assessing the retirement benefits offered by their new employer. He also notes unique features of 457(b) plans, such as the absence of a 10 percent penalty for withdrawals before age 59 ½ and a special catch-up contribution provision for employees in the three years preceding their normal retirement age.