Enjoy our most current issue of the most popular medical e-newsletter on the internet.
Blogs and Thoughts for May 18th to May 24th:
Here is what we had this past week
- How Times Have Changed by Steven Mussey MD
- The Derm Response
- UnitedHealth Outdoctors The Government
- That’s More Like It by Pat Conrad MD
- Rookie Move by Pat Conrad MD
- The One Minute Doctor
- Quote of the Week: Earl Nightingale
1. How Times Have Changed by Steven Mussey MD
2. The Derm Response
May 23rd, 2017
I recently did a review of a ridiculous study and you can see it here. After mocking it I said this:
I guess when you make so much money you have to find a way to distract people from being too critical? How? First up, throw the evil sun at them. If that fails then you create a new prejudice. All we need now is a law to stop any movie from depicting someone who is “integumentary challenged”. (I made that term up. Do you like it?)
Before anyone thinks I am too insensitive let me summarize my thoughts on this:
Humans are not perfect and we all have our blemishes.
We all don’t need a personal dermatologist to see us to fix every blemish.
ALL sun is not evil.
This study is ridiculous.
Dermatologists make too much money.
Was I too harsh? Maybe. Is it true? You decide. (You will notice that I never mentioned their value, their intelligence, or their work ethic).
Well, the dermatologists struck back and treated me as if I committed a hate crime. Please read the above again and then see if the following comments were warranted. All are real and from dermatologists who felt they needed to say this:
- “Don’t be bitter because of your poor performance in medical school. Had you worked harder you could have been a happy dermatologist, not a miserably envious PCP.”
- “Trial lawyers get paid over 1.5 million on average too…And your field makes 300-350,000 with a full time schedule of 14 days a month so what’s your point you guys get way more time off than anyone and are grossly over paid for running a bunch of test in the ER that insurance companies have to dish out lots more money for driving everyone else’s health care cost to the moon. All my primary doctors call me up and I get their patients in the day of we make room for our schedule in my office for emergencies. The reason why you can’t get your patients in is bc of you, you sound like the biggest jerk who blames everyone else for their unhappiness while looking at other specialty journals you wish you got into but didn’t have the grades or the good standing in medical school.”
- “Doug your full of shit, punch biopsies free etc. yea they are free because your charging patients a monthly recurring fee regardless of if they need your services that month. You are charging each patient 900 a year. When they see a dermatologist they get charged for appropriate care. I bet you don’t even know what to do with your biopsy results and then you send to Derm. Hahah next time around get a better step 1 score and do what you really wanted to do in life and stop hating! Your ego really shows AKA “the king of medicine” And stop doing biopsies when you don’t even know what your looking for!”
- “Wow. Who are you? An offensive ass. I am a dermatologist and dermatopathologist in private practice. I do not practice cosmetology- that is a joke. Do you say the same of plastic surgeons who choose to practice cosmetic surgery only? I doubt it. Yes, I help patients with treating their disfiguring acne scars and birthmarks. Primarily though, I see complex medical dermatology patients, manage autoimmune blistering skin conditions and other severe dermatoses and prescribe many immunosuppressants. I diagnose and treat skin cancers much earlier than any other specialty. Last year, I diagnosed a systemic aggressive lymphoma in a pregnant woman that everyone else missed for six months and she nearly died. Two weeks ago I saw a patient with unrecognized gangene of the penis due to warfarin-induced necrosis that had been treated for 2 months by his PMD for an “infection” and had to undergo penectomy. These are just many examples of what I and many dermatologists do each day. Many of my referring MDs have my cell phone and I will work in patients for them. I am so sick and tired of dermatologists getting no respect from other specialties. Wait until you or a family member gets a crazy skin condition, develops melanoma or another skin cancer and needs our help to get them better. I am damn good at what I do. I see a lot of patients in day due to demand and that is why I might make more money than some, but not all, primary care docs. Demonizing another specialty is pathetic. You’re just a troll. If I was a patient looking for a PMD I would stay far away from you. There’s something called karma- watch out, Doug.”
- “Wow Doug you sound really super bitter. That first line, “who cares what you resent?” just reeks of resentment. Also, you’re kind of an ass. Maybe not kind of, really an ass. You took the time to write this piece and mock one of the most competitive specialties in medicine. More importantly, you’re quite out of touch with reality. I can’t tell if you’ve just had interactions with bad physicians or if you’re delusional, but something’s off. If you’d like your patients to have sub-par care then great, get rid of dermatologists altogether. Take care of all their skin problems yourself. See how happy your patients are when you can’t figure out their rashes, can’t clear their acne (yes, acne is important, anyone who’s ever been a teenager will tell you), can’t stop them from losing their hair, can’t catch their skin cancer at an early stage so they can live, can’t put together a complicated pathology report with an unusual rash to come up with a life changing diagnosis, can’t tell the difference between neonatal lupus and seborrheic dermatitis (yes, that happened), can’t tell the difference between a wart on the foot and fungating melanoma (yes, that happened), etc etc. You’ve clearly never seen a dermatology textbook (try opening one! I recommend you start with Bolognia) and since you clearly have no idea what the majority of dermatologists do all day, you have no space to talk, let alone insult and ridicule. Do we also freeze warts and inject pimples and Botox and yada yada? Yeah, we do, that’s our job, comes with the territory. We are all physicians and we all have our corner of medicine. You couldn’t do my job. Quit complaining about it, because you sound pathetic.”
- “Oh Doug! You are such a saint! If only the rest of the world were so righteous and selfless the world would be perfect. You have masterfully proven the point that you are superior to other doctors because you do things for free. Capitalism is so bad!! Gosh golly. If everyone would just do stuff for free then they too would be justified in whining about how everyone else makes too much money. Then everything would be as peachy as it is Venezuela.(To the rest of the primary care guys reading this, I think you should get paid more than you do. I respect your work and I think it goes under compensated. Farrago though, I think he should make less so he can be more justified in his complaining here. His sense of moral superiority…. THAT is what he gets to have instead of payment)”
- “Many of us don’t do cosmetology that’s an aesthetician. I personally practice general dermatology taking melanomas out, putting my psoriasis patients on biological and Mohs surgery on skin cancer patient most of which are VA patients that have served our country. If you guys feel we are useless and don’t see “real cases” than why don’t you guys start seeing dermatology patients instead of texting us pictures and calling us since most doctors have never had even one month of dermatology since it’s not required. Or better yet let Dr Google be your new dermatologist. I resent this physician shaming that is in this article. This should never be done to another physician or a speciality group in public or on paper. We already have enough people against us physician trying to pay off our loans, trying to get insurances to cooperate so patients can get the medications they need, people stealing from our offices and frustrated patients. This energy should be better spent on tackling getting better care to our patients.”
- “He’s an idiot masquerading as an writer. Can’t believe I wasted my time reading his envious, uneducated post.”
I am not going to even reply to these comments and sent them right to the trash section. After a few days I changed my mind and felt they need to be seen. I welcome your response to this. But before you do please take a look at this article entitled “Elephant in the room of dermatology” by Dr. Brett Coldiron where he states the following:
“The honest ones in private practice, however, say, “Man, I make $200,000 a year off my PA while I am off.” The honest academics say, “Listen, I work in a gulag, and I would never be able to travel if my nurses didn’t see my patients.” Time is money, and the academic who gets an extra 10 hours a week out of clinic is benefiting as much as the guy who makes $200,000 a year.”
Dr. Coldiron, by the way, was past-president of the American Academy of Dermatology.
Making $200K off your PA while you’re off? Family docs don’t make this themselves in a year. Does anyone else see something wrong with this? I understand that not all derms do this but the fact remains that the average dermatologist makes double what a primary care doctor makes.
I think it is fair game to question a procedure based payment system that results in a disparity between dermatology and family medicine by a ratio of 2 to 1. If that makes me bitter, offensive, self-righteous or an idiot then so be it.
3. UnitedHealth Outdoctors The Government
May 22nd, 2017
The Justice Department on Tuesday has accused UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. They are alleging “that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved.” How does this happen? Well, Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. It seems UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated.
The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.
It never ceases to amaze me how greedy these insurers are. They do NOT lose money. Sure they got a little squeezed by the ACA but they had exit guarantees that made the move less risky. Add to this that they raised ALL the rates outside of the exchange and they won big. You can see their profits and their stock prices if you don’t believe me. But that wasn’t enough. They had to cheat even more by making patients “sicker” then they are or by making up diagnoses when they needed to.
I guarantee they pay a minimal fine for this when it is all said and done. And the taxpayers will lose again.
4. That’s More Like It by Pat Conrad MD
May 21st, 2017
Miss USA is getting her mind right, courtesy of the mob. After saying during her title-winning pageant answer that health care is a “privilege,” she was scorched for such a horrible slight to humankind. She has since clarified: “I am privileged to have health care and I do believe that it should be a right,” McCullough said on “Good Morning America,” adding, “I hope and pray moving forward that health care is a right for all worldwide.”
Now your talking girlfriend! That’s what Whoopi and Joy and the studio full of intellectuals at “The View” want to hear. Honestly, it wouldn’t hurt if you could go on “Live with Kelly and Ryan” and mention that you know, doctors do make an awful lot of money, and maybe they should…well, that comes with practice.
We’ll know you have total commitment when Congress asks you to testify about the worsening health care crisis on which you will by then have been deemed an expert on the basis of your acceptably compassionate views.
The important thing is to never stop feeling, and never allow that rational nuclear chemistry-trained intellect of yours to interfere with giving the people, the important, beautiful people, what they need to hear. Don’t worry about Aetna bailing on ObamaCare, or the millions of families pushed to the margins because they voted for health care to be more of a right, or the 20 trillion debt and what a real economic collapse will look like when the hospitals can’t even get normal saline. Because if you do, that nasty little bug that Kahn put in your ear via Twitter will start chewing on your brain, and the screaming will return.
5. Rookie Move by Pat Conrad MD
May 20th, 2017
Ooooh, she didn’t read the script! Everybody knows there are acceptable opinions, and there are rude, nasty, ugly points of view that will get you blasted from fashionable circles quicker than you can say “personal responsibility.”
Kara McCullough is a 26 year-old daughter of a U.S. Marine, a graduate of South Carolina State University with a B.S. in Chemistry and radiochemistry, member of multiple honorary societies, and a scientist working for the Nuclear Regulatory Commission’s Office of Nuclear Security and Incident Response. And not to be sexist, but she is a total bombshell and as Miss D.C. just took the crown for Miss USA. She is also an idiot.
“Miss DC was my fav but … not after that answer,” wrote one Twitter user, and justifiably so. Poor dimwitted Miss McCullough, when asked during the pageant whether she thinks that affordable health care for all U.S. citizens is a right or a privilege, said, …sigh… “I’m definitely going to say it’s a privilege.”
“As a government employee, I’m granted health care and I see firsthand that for one to have health care, you need to have jobs, so therefore we need to continue to cultivate this environment so that we’re given the opportunities to have health care as well as jobs for all Americans worldwide,” said the silly girl. Kara that is no way to get invited on “Ellen!” You know good and well that your dad’s service, your parents’ efforts in raising you, and all of your hard work have nothing to do with the good health you apparently enjoy at the expense of others. And don’t think being black is any excuse, noooo ma’am! You should know your place as assigned by the popular media and deep Twitter thinkers like the one who said, ” “Well I guess poor people don’t deserve health care because the new Miss USA said it was a privilege.” Okay, so you didn’t actually SAY poor people don’t deserve health care, but we can all read between the lines, can’t we? How can you hold your head up and look the cast of “The Today Show” in the eye if you can’t demonstrate more obvious compassion, even if it means a little less reason?
Kara, you might be an accomplished scientist, but you weren’t there with us in the auditorium that first week in medical school, when we started getting the script on acceptable opinions. Most of the academics that first week told us that everyone deserved the same level of care no matter what, and they had left the slapdash economics of the private clinic for the sureties of academic medicine, sovereign immunity, and tenure to prove it. We were told further on rounds during third year that the crack mother delivering lucky baby #7, and the 350 lb. smoker on food stamps going blind from diabetes all deserved the very best care the taxpayer could render, and got more of the same during the interminable days of residency. If you had sweated out those board exams and med school loans, you might know that the actual privilege is to dole out free care to those who think they somehow earned it without actually doing the work or paying any of the freight. Health care a privilege?? How will you ever get any audience applause on The Late Show with an attitude like that?
6. The One Minute Doctor
May 19th, 2017
From the late, great Placebo Journal
7. Quote of the Week: Earl Nightingale
May 18th, 2017
“We become what we think about most of the time, and that’s the strangest secret.”
UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF THE SAMPLE CLOSET!
Douglas Farrago MDTweet