Podcasts about paradocs

Dr. Eric Larson of the Paradocs podcast joins me to discuss what we think RFK Jr. wants to do if confirmed as head of the Health and Human Services division, what he might get done, and some priorities he ought to do to make America healthy again. q Video - https://youtube.com/live/wt69j-XebVg This episode is brought to you by Trijent's new Universal Mech-loader - https://trijent.com/spangle Trijent, a pioneering small business, proudly introduces the Universal Mech-loader. This advanced speedloader is designed for a variety of ammunition types including 9mm, .40 S&W, .45 Auto, .223/5.56mm, and 7.62mm. It significantly reduces loading time, minimizes hand fatigue, and enhances your shooting practice. With its adjustable mechanism, the Universal Mech-loader fits multiple magazine types, ensuring a universal fit for your firearms. Transform your time at the range with efficiency and ease. Do you have comments or questions about this episode? Visit it on ChrisSpangle.com and leave one! --- Join our Patreon now for commercial-free shows, bonus content, and our complete archives - https://www.patreon.com/wearelibertarians --- Join our Facebook Group to meet other listeners. - https://www.facebook.com/groups/walnutssociety --- Visit Chris-Spangle.com to see my other podcasts and projects or to add me on social. www.Chris-Spangle.com --- Looking to start a podcast? Download my podcast Podcasting and Platforms now, and check out my recommendations for buying the right equipment. Chris Spangle and Leaders and Legends, LLC edited and produced this podcast. If you want to start a podcast or take yours to the next level, please get in touch with us at LeadersAndLegends.net. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Eric Larson of the Paradocs podcast joins me to discuss what we think RFK Jr. wants to do if confirmed as head of the Health and Human Services division, what he might get done, and some priorities he ought to do to make America healthy again. q Video - https://youtube.com/live/wt69j-XebVg This episode is brought to you by Trijent's new Universal Mech-loader - https://trijent.com/spangle Trijent, a pioneering small business, proudly introduces the Universal Mech-loader. This advanced speedloader is designed for a variety of ammunition types including 9mm, .40 S&W, .45 Auto, .223/5.56mm, and 7.62mm. It significantly reduces loading time, minimizes hand fatigue, and enhances your shooting practice. With its adjustable mechanism, the Universal Mech-loader fits multiple magazine types, ensuring a universal fit for your firearms. Transform your time at the range with efficiency and ease. Do you have comments or questions about this episode? Visit it on ChrisSpangle.com and leave one! --- Join our Patreon now for commercial-free shows, bonus content, and our complete archives - https://www.patreon.com/wearelibertarians --- Join our Facebook Group to meet other listeners. - https://www.facebook.com/groups/walnutssociety --- Visit Chris-Spangle.com to see my other podcasts and projects or to add me on social. www.Chris-Spangle.com --- Looking to start a podcast? Download my podcast Podcasting and Platforms now, and check out my recommendations for buying the right equipment. Chris Spangle and Leaders and Legends, LLC edited and produced this podcast. If you want to start a podcast or take yours to the next level, please get in touch with us at LeadersAndLegends.net. Learn more about your ad choices. Visit megaphone.fm/adchoices

Accesso Technology Group PLC chief executive Steve Brown discussed the company's strong 2023 performance with Proactive's Stephen Gunnion. The year was marked by significant achievements including surpassing profitability targets and attaining nearly $150 million in revenue. Key developments included three strategic acquisitions aimed at expanding the company's global footprint. These acquisitions introduced new opportunities with companies like VGS in Milan and Paradocs in Canada, enhancing Accesso's market presence. In 2023, accesso secured 28 new venues and expanded its services to 273 additional venues through these acquisitions, which also incorporated 50 ski resorts in Canada, making it the largest provider of ski technology in North America. The company's growth drivers included increased sales penetration and transaction counts across existing venues. Looking ahead, Brown highlighted accesso's focus on improving profit margins by enhancing revenue efficiency and scrutinising low-margin revenue streams. Furthermore, the company has recently made a significant entry into the Saudi Arabian market through a partnership, building on the acquisition of VGS, which has been rebranded as Accesso Horizon. Brown also discussed the launch of 'Freedom', a new platform for restaurant and retail operations, which has already seen considerable uptake. For 2024, Brown mentioned the possibility of more acquisitions, supported by a strong balance sheet and cash position. The company forecasts revenues of around $160 million with a cash EBITDA margin of 17%, anticipating another robust year. #AccessoTechnology #SteveBrown #2023Results #ProfitGrowth #GlobalExpansion #SkiTechnology #SaudiMarketEntry #NewAcquisitions #FinancialForecasts #TechnologyInnovation #ProactiveInvestors #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

This Thursday Throwback is a previous recording of Episode 40 of The Changed Physician Podcast where the hosts interview Anesthesiologist Dr. Eric Larson about his Podcasting Journey. #anesthesiologist #paradocspodcast #podcaster #change #challenge #thechangedphysician #kevincuccaro #melissacady #physicianburnout #physicianjoy #physicianwellness #physicianhealth #beingdifferent #createyourpath #joy #fulfillment Learn More About the Community at:

With such an overwhelming number of films on offer at IDFA, we invited Wouter Jansen to help curate a watch list of films that will be on display. Wouter is the founder of Square Eyes, a sales and distribution company based in Vienna specializing in bold, author driven features and shorts. This year, he will be at IDFA with two titles, ANHEIL 69 by Theo Montoya and EUROPE by Philip Scheffner.  In this episode, we go through each section of the program at IDFA and take turns selecting titles of interest to help navigate our festival experience.  Films discussed include PARADISE by Alexander Abaturov, NON-ALIGNED: SCENES FROM THE LABUDOVIĆ REELS, HOW DARE YOU HAVE SUCH A RUBBISH WISH by Mania Akbari, and A ROBUST HEART by Martin Benchimol, among many others. For our full Docs in Orbit x Square Eyes x IDFA 2022 watch list, please visit here . EPISODE TIMECODES: 00:00 - Intro / About Square Eyes |  10:30 - Best of Fests  |  16:30 - Paradocs  |  23:25 - International Shorts Competition  |  32:10 - Competition DocLab Immersive Non-Fiction  |  35:35 - IDFA on Stage   |  40:28 - Envision Competition  |  45:35  - International Competition  |  52:30  - Laura Poitras Top 10SPECIAL GUEST BIO: Wouter Jansen is the founder of the sales and festival distribution company Square Eyes. He worked as the head of programming at the Go Short - International Film Festival during the first 10 editions. In 2013 he started Some Shorts, which changed to Square Eyes in 2019, which specializes in having outstanding non-mainstream films find the audience and recognition they deserve. With Square Eyes, Wouter represents bold, author-driven features and shorts, and collaborates closely with the filmmakers to devise bespoke festival distribution and sales strategies. This has resulted in a small catalogue of films premiering at prestigious festivals and winning multiple awards over the last few years like main prizes at Cannes, TIFF, Berlin, Locarno and Clermont-Ferrand. Wouter has been giving lectures at schools like Le Fresnoy, HEAD Geneva and Netherlands Film Academy and is an expert for Locarno Open Doors and First Cut Lab. He has moderated as well as lead workshops at festivals like IDFA, True/False, Winterthur, VIS Vienna Shorts and others. He is a Berlinale Talents alumni.For show notes visit docsinorbit.com and be sure to follow us on social media @docsinorbit for updates.

Eric Larson MD, host of the Paradocs Podcast and the Doctor Podcast Network joins Healthcare Americana this week and discusses problems and solutions from medical education and medical associations to hospitals and private practices. Follow Healthcare Americana: https://twitter.com/healthamericana (Twitter) https://www.instagram.com/healthcareamericana/?hl=en (Instagram) https://www.linkedin.com/company/healthcareamericana/ (LinkedIn) More onhttps://freedomhealthworks.com/ ( Freedom Healthworks) More on https://theparadocs.com/ (Paradocs Podcast) Subscribe at https://healthcareamericana.com/episodes/ (https://healthcareamericana.com/episodes/)

What did Americans and the government get right and wrong about the pandemic? Dr. Eric Larson joins me in person this week to talk about the past two years and what happens next for COVID-19 while discussing vaccines, how to judge information, and the future of his podcast The Paradocs.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Fast cars, machine guns, knight fights, and so much more in this episode! The Degenerate Panel describes what went down during Remso's bachelor party. Mentioned in this episode: -Follow the Paradocs on Twitter https://twitter.com/TheParadocsShow -Subscribe to the Paradocs https://theparadocs.com/ Newsletter Sign up for Remso's On The Run Newsletter https://remso.substack.com/ Hustler's University 2.0 Obtain the skills and knowledge you need to start a side hustle and new streams of active and passive income https://gumroad.com/a/539317363/qcbcb Robinhood Get your free stock just for signing up with Robinhood and start investing today https://join.robinhood.com/remsom Coinbase Get $10 of Bitcoin when you buy or sell your first $100 https://www.coinbase.com/join/martin_85hr FundRise Start investing in real estate today with FundRise and get 90-days of advisory fees waived https://www.fundrise.com/r/dzed84 Learn more about your ad choices. Visit megaphone.fm/adchoices

Has the COVID-19 pandemic damaged the relationship between the public and the professional medical community? Dr. Eric Larson, the host of "The Paradocs" joins the program to discuss this topic. Episode Sponsors -Special thanks to Privacypost.io. Mentioned in this episode: -Follow the Paradocs on Twitter https://twitter.com/TheParadocsShow -Subscribe to the Paradocs https://theparadocs.com/ Newsletter Sign up for Remso's On The Run Newsletter https://remso.substack.com/ Hustler's University 2.0 Obtain the skills and knowledge you need to start a side hustle and new streams of active and passive income https://gumroad.com/a/539317363/qcbcb Robinhood Get your free stock just for signing up with Robinhood and start investing today https://join.robinhood.com/remsom Coinbase Get $10 of Bitcoin when you buy or sell your first $100 https://www.coinbase.com/join/martin_85hr FundRise Start investing in real estate today with FundRise and get 90-days of advisory fees waived https://www.fundrise.com/r/dzed84 Learn more about your ad choices. Visit megaphone.fm/adchoices

Like most podcasters, the extent of my medical knowledge comes from Web M.D., and I need someone with an actual medical degree to explain the basics of COVID-19, how it infects humans, and how Omicron is different than past variants. Dr. Larson and I will be doing a podcast soon that answers listeners' questions about the pandemic so please send in your questions to editor@wearelibertarians.com. Download and listen to his podcast here: https://theparadocs.com/ Learn more about your ad choices. Visit megaphone.fm/adchoices

My special guest returning to the show is William Ramsey. He returns to discuss details about the concert Travis Scott held at Astroworld and if there was a sinister agenda behind it.         In Scott's previous performances, several legal issues were raised, including his incitement of incidents and praising fans for their participation. Leading a new micro-generation of trap artists in 2013, bringing punk-rock nihilism to live hip-hop, Scott was quoted in several outlets at the time as wanting to bring his childhood fantasy of becoming a professional wrestler to his concerts.[24][30][31][32] Building his reputation with an event that CNN said teetered on the brink of chaos,[33] a Complex review in 2015 entitled "I Tried Not to Die at Travi$ Scott and Young Thug's Show Last Night" called it "the most dangerous haven" and "a turn-up fight for survival."[34]  At Lollapalooza in 2015, Scott was charged with disorderly conduct after inciting concertgoers to ignore security and rush the stage.[2] 2017, he was arrested for similar conduct after performing at the Walmart Arkansas Music Pavilion in Arkansas.[35][36] He was again charged with disorderly conduct and received additional charges for inciting a riot and endangering the welfare of a minor. All charges were later dismissed, except disorderly conduct, to which Scott would plead guilty.[33] That same year, a fan sued Scott and the organizers of a concert at Terminal 5 in New York City after falling from the third-level balcony and being dragged on stage, leaving the fan paralyzed from injuries sustained in the fall, with the lawsuit blaming the fall on a crowd surge.[37] At the same concert, Scott was recorded encouraging other fans to jump off balconies, claiming that the crowd beneath them would catch them.[38] In 2019, three people were injured as a crowd rushed to enter the compound at Astroworld.[39] In late 2020, music executive Irving Azoff said that while he would remain an advisor to Live Nation for Scott's tours, he had dropped him as a client, describing Scott as unmanageable.[40]  On November 8, 2021, TMZ reported a promotional video for Astroworld, which played up the apparent danger of attending the festival, with spliced news clips hyping the prior years' chaos, had been removed from their social media accounts except for Instagram. Photos on Scott's personal Instagram with his comments glorifying and glamorizing fans who had broken their hands or passed out had still not been taken down. The outlet editorialized in both cases that Scott's "rager" persona and the Astroworld brand that supported it had caught up with them.[41][42]     Scott was scheduled to start his set at 8:45 p.m. but did not take the stage until approximately 9:02 p.m., starting at approximately 9:06 p.m. with the opening song "Escape Plan."[43][46][55][52] His appearance onstage made people push toward it, leading to a human crush.[39] According to HFD Chief Sam Peña, at about 9:00 p.m., members of the crowd pressed forward and also surged from the sides, causing a crush near the stage; he added that the crush was not caused by obstructed exits but by issues close to the stage, where the crowd was tightly packed. As people struggled to stay on their feet, several began to fall, and many were injured. Panic grew as Scott started the second song of his set, the remaining escape routes shrank, and several attempted to climb over barricades.  At 9:11 p.m., the concert's Unified Command—which consisted of Houston police, festival security, festival production staff, ParaDocs dispatchers, and Harris County Emergency Core dispatchers—reported the main stage had been compromised, instructing their helicopter to investigate, as the video showed fans unable to escape from the area closest to the stage. As the breach was limited to a single section, an official advised standing by and waiting for concert management. Follow us on Instagram Follow us on Facebook It's super easy to access our archives! Here's how: iPhone Users: Access Mysterious Radio from Apple Podcasts and become a subscriber there, or if you want access to even more exclusive content, join us on Patreon. Android Users: Enjoy over 800 exclusive member-only posts to include ad-free episodes, case files, and more when you join us on Patreon.  Please copy and Paste our link in a text message to all your family members and friends! We'll love you forever! (Check out Mysterious Radio!)

I am proud to announce a new show on the We Are Libertarians Podcast Network: The Paradocs with Dr. Eric Larson. With medical innovation and challenges leading the headlines, it is imperative to have a credible, smart voice helping us understand what's happening not only with regards to the pandemic but also with health insurance and health care. Dr. Larson approaches these subjects with a fact-based approach to help listeners make the best choices for themselves and their families and fits our mission at WAL is to inform listeners about current events from an independent point of view. Please subscribe to the show now at https://link.chtbl.com/paradocs. To learn more, visit his website: https://theparadocs.com/ When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Learn more about your ad choices. Visit megaphone.fm/adchoices

  The COVID pandemic has brought on all sorts of changes to the way we live our lives. From wearing masks, working from home, stay at home orders, and restrictions on social interactions, the virus has caused untold disruption to the way our society functions. Although the changes COVID has brought to our schools and the lives of our school age children, it is perhaps less appreciated what changes have occurred for our infants. It is a well known fact that our environment and meaningful stimulation is necessary for normal intelligence and brain development. Infants are completely dependent on their parents to put them in environments where they can maximally interact in the world. This interaction is what spurs on their brain development and social connections to others. Early Learning My guest today was Dr. Sean Deoni at Brown University described that the first 1000 days of a child's life are some of the most critical for its brain development. Babies interact with their environment and figure out how to communicate and manipulate the physical world through exploration. The less stimulation that is present, generally, the worse their neurodevelopment outcome is. One can use the Mullen Scales of Early Learning to test infants and young children on where they are developmentally on motor and language skills. Concerning Findings - A Drop in IQ Equivalents The lab at Brown University had been collecting infant and child development testing data for over ten years. Their findings generally fell in line with what would be considered 'normal' for children at that age. But suddenly, in 2020, their lab noticed a sudden change in the scoring for children. A massive loss in development scores (which are used as a proxy for IQ) were seen in infants born during the pandemic. The losses were on the order of 22 IQ points or 1.5 standard deviations from the norm.  This was an incredible finding and one that they couldn't explain. The findings were more pronounced in those with low socioeconomic status and males. Where was the drop? One would expect that the drop in scores would be related to problems with language since we are now more frequently wearing masks. However, their findings were actually a massive drop in motor skills. This might explain why male infants were more significantly affected since early motor development seems to progress a little more in them than females What's Causing the Drop? Unfortunately, it is very hard to determine what is causing this decline in scoring for infants. The research team has been able to rule out a few factors like maternal stress or actual COVID infections. It is very probable that this is due to a general lack of physical interactions and stimulation for the infants with their parents and caregivers. Perhaps it's because of increased isolation at day care or parents working remotely at home and less capable to spending valuable time with their infants. Limitations to the Findings Whenever we get concerning findings like these we have to be sure of a few facts. Are the results corroborated/reproducible: The University of Columbia did a similar study and found the same results. However, they don't have long term validation to their testing methods so perhaps this finding is an outlier. Is this a representative sample: This study (and the one from Columbia) represent a probably skewed sample of families who live in urban areas and heavily rely on day care for their child care needs. It's possible that these findings would not be found in areas with lower levels of day care usage since parents probably don't interact that differently at home with their child. COVID restrictions: PPE, limited social interactions, and masking all varied throughout the country. It's possible that one, some, or all of these significantly affected the results of child development. Perhaps masking and limited social interactions decreased infant and toddlers' physical play. Also, maybe seeing less relatives who would physically interact with the child led to lower scores. How Permanent are these Deficits? This is the million dollar question. Can the children recover from such a huge developmental deficit. It's entirely possible that they will just reach these milestones later in life and it will have no impact on their future intellect. However, oftentimes, if one does not catch up by 2 years of age or so, one never catches up  which could put these children at a huge disadvantage in academics, athletics, and the arts. The lab will continue to follow the children but only time will tell whether they are ever able to catch up. Sean Deoni, PhD, holds a doctorate in MRI Physics and is a lead researcher at Brown University studying neurodevelopment of infants and young children. show notes Episode 147: Today's show Children Born During the Pandemic Score Lower on Cognitive Tests: Dr. Deoni's Study from Brown University Birth but not Maternal SARS CoV-2 Infection Related to Lower Developmental Scores at 6 months. - University of Columbia study referenced in the show. Baby Imaging Lab: The laboratory where Dr. Deoni works at Brown University. Legaci Long COVID Study: An opportunity for children and adults with long COVID to enroll in research. Episode 143: We were so, so, so, so right about COVID Deputy: Today's sponsor who helps you with staff scheduling. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Imagine yourself in California at a clearing in a large forest. And it's on fire. There are three groups of people standing before you. A large group is screaming and running around pointing at the fire. They're yelling that we need to do something, anything we can to stop the fire. Meanwhile, there is another group (not as large) with their backs to the fire. They are mocking and ridiculing the group running around panicking. They tell them to calm down and to stop ordering people around. They insist there isn't anything wrong at all. Of course, the largest group of people are standing between these groups and looking behind those panicking at an intact forest and behind the ones who don't notice the giant flames licking at the backs of the those ridiculing the screamers. These people aren't sure what to do but in the interest of safety feel that getting away from the flames is probably the right decision. They tend to stand with the group that's worried. Obviously, this analogy describes our current situation with COVID in America. Most are not in one of the extreme camps. But we either identify with one or are left standing unsure of what to do or think. What needs to be done, and what I did with my friend Dr. David Graham in April of 2020, is to try and be reflective and better understand what it is that we are dealing with. What are the biological, historical, and medical facts or suppositions that we can make to understand this pandemic? If we return to our analogy of the forest fire, it would be best if we could somehow hop up in a hot air balloon and look down at the situation to assess what would be the best individual actions and true scope of the problem. History and biology could be used to understand the nature of fires, how they spread, what do you do to stop them, and what they are likely to do in their course. Contrary to popular opinion, we have some rough ideas about what happens in pandemics and where we will end up. And THAT is the critical fact that we have to accept - those in all camps and in between. Because if we get THAT wrong, then we get everything else wrong. The critical question we must ask is what is the endpoint for this pandemic? What is the biological consequence for SARS-CoV-2 (the virus that causes COVID-19) and its effect on humans. We have to agree on the ultimate end point in order to get our policies and strategies right for surviving the pandemic. What became obvious to us in April of last year was that this virus, despite some government efforts at the time, would become endemic. It would join the other four coronaviruses that currently cause the common cold as a virus that will circulate forever throughout the human population. It will not get eradicated. It will infect everyone probably multiple times throughout your life. This is the biological history of endemic coronaviruses. It really is the way all these common respiratory viruses operate. Rhinovirus, adenovirus, parainfluenza virus - they infect your upper respiratory tract (nose, sinus, mouth) and cause a cold because although you don't have enough antibodies to prevent infection (because they've waned over time or it's a new variant that looks different enough to evade your antibody response) you have memory T and B cells that mount a quick response after infection to prevent a systemic or lower respiratory infection (pneumonia). We know you get this immunity as a child and anyone who has kids knows small children are always sick with runny noses as they are constantly exposed to these different cold viruses which builds up their long term immunity to them when exposed later in life. The mRNA vaccines are a medical miracle and trick your body into generating an immune response. It's not magical (except the technology) and an elegant way to get your body to do the work so when it sees the real virus in the wild, it will seek it out and destroy it. But respiratory viruses often infect us before we can mount a complete immune response so you get sick and can transmit the virus. This isn't a failure - your body has done what it needs to do - and so has the virus which just wants to reproduce and move to the next host. We live in an equilibrium with these viruses, we develop immunity when we're young so if we are exposed when we're older we can prevent really bad outcomes. But we get sick and the virus continues to circulate in the world's population with different viruses coming and going. It's a sort of dance. So what does this all have to do with our wild fire? Well, we know this thing will burn until there isn't any fuel. And fuel is considered people without immunity to the virus. There are only two ways to get immunity - a vaccine or infection. Until the virus has burnt all the fuel, it will continue to burn - there is nothing we can do to stop it. We might slow it down, we might find ways of treating the fuel on fire (although most treatments for viruses are not very good), but ultimately, everyone is going to get it. What does history tell us about coronaviruses? Well, until SARS-CoV-2, we had four endemic coronaviruses that cause colds. The youngest is OC43 which researchers believe jumped from cows to humans in the late1800s. This was at the same time as the “Russian Flu” worked its way around the world so perhaps that flu was actually a coronavirus. If so, OC43 caused a lot more problems to humans back then who were older and naive to the virus according to the news reports from all over the world. But by now, we have all had multiple infections with OC43 and its variants from when we were kids to today where we usually feel terrible for a few days or maybe a week. Over time, the virus does ‘mutate' towards becoming more benign and infectious but that usually takes a long time. Anyway, it serves as a useful road map for what might happen to us in our biological dance with this new unwelcome visitor. We also know, that immunity to these respiratory viruses wanes over time. Either with natural infections or vaccines. The only way you can develop better immunity is through booster shots or infections. But what we really care about - ending up in the hospital - is focused almost entirely on the non-immune. This is a nasty bug, it affects the obese and elderly the most and it isn't going anywhere. It has definitely killed hundreds of thousands of Americans. So this gets us to the important policy considerations - if we know that it is endemic (which was obvious over a year ago) then how should we approach our public health? Obviously, the only point to slowing the spread at this time is if you could get those without any immunity (no infection and no vaccine) vaccinated to minimize the number of people clogging our hospitals. But you can't get to any vaccination rate that will stop the spread of the virus. There is no herd immunity threshold - no number of vaccinated and immune to perfectly prevent its spread. Besides the fact that our ability to slow the spread is questionable anyway, it just doesn't make a difference in the end. We are all going to get this virus. Somewhere, there's a date with you and you and you and me with this virus. Whether you've been vaccinated or not you will almost assuredly get infected. If you have some immunity through a vaccine or previous natural infection, you are much less likely to get very sick. So mandating vaccines - if we agreed that it was wise and just - wouldn't matter much to those who are vaccinated. It may slow the spread and delay the next time they're exposed but they will still get it when their immunity wanes. And again and again. If your mitigation measures worked, all you would do right now is extend the time it takes for everyone to get immunity unless you believe you can convince those who won't get immunized to get the vaccine. Even so, that only really benefits those who have chosen to not protect themselves while inconveniencing everyone else and taking away a lot of rights and simple joys of life. It's easy to see how we got here. Mission creep is not just something that happens with the military - it happens in public policy too. By believing that we could prevent people from getting infected, we have embarked on a strategy that is unwindable and with no clear end point. There is a preponderance of evidence that people can get reinfected multiple times with COVID and after vaccination. Both through research and observational data we know that infections with SARS-CoV-2 will continue to happen forever whether you are vaccinated or not, whether you have had it before and recovered, and no matter where in the world you are living. Fundamentally, we have been chasing a zero-COVID strategy in almost every aspect of our society. Obviously, vaccines are a great idea for those who are at risk. I like to point out to how getting chicken pox (Varicella) as an adult is a completely different experience for an adult than it is a child. Adults can die from chicken pox whereas kids almost never do. Also, an infection of varicella puts you at risk of getting shingles later in life which can cause pain and a host of other problems. This is one reason why we vaccinate children for chicken pox. But clearly, vaccination (since we know it won't stop transmission in its tracks no matter how high the rate is) is a strategy to keep people out of the hospital and free up hospital resources for other things like heart attacks, strokes, cancer, etc. Masks, lockdowns, testing and quarantining and any other mitigation efforts are Zero-COVID policies which are of dubious efficacy and ultimately, make no difference since we will all get infected eventually. The most sensible reason to resist vaccine mandates, masking rules, and various lockdown measures in the US at this point is because they are attempting to stop what cannot be stopped. Even 60% of the deer in Michigan have had COVID and serve as a reservoir for the virus along with mice. SARS-CoV-2 is not going anywhere so acting like you can keep it out is akin to wrapping yourself with a towel when you go swimming to stay dry. Perhaps you could argue that you are waiting until there is a childhood vaccine but that might take months or years until you get large enough numbers of kids' parents to get their kids vaccinated. What target are you looking at? It is exceedingly rare for kids to get really sick with this virus. Do these measures justify affecting their socialization and education and all the other aspects of life we take for granted? Is it worth having every child see other people as disease vectors rather than unique individuals to whom they can get to know, collaborate, play, love, and innovate? Some might argue that the infirm or immunocompromised (like those with solid organ transplants) are at risk and we should encourage vaccination to protect them. Again, the vaccinated can still spread the virus and the only thing vaccination does is frees up hospital resources (which is important). However, once people have had an infection once or maybe twice, they are much less likely to clog the hospitals. Either way, all you're doing is maybe buying some time with these extreme measures but not significantly altering the course of the pandemic in any significant way. The effect of all these mitigation measures falls hardest on our youth. They are the ones who need socialization the most. They are the ones who need interactions for learning the most. I'd argue that right now our greatest generation is our youth, (gen Z and gen alpha) as they have given up the unique experiences of high school sports, graduation, dances, gatherings, the arts - in order to protect the elderly in our society. They have given up so much and we must recognize that and always ask ourselves how much more do we need them to sacrifice to slow the spread of an inevitable disease. We have become so locked in to thinking that we need a zero-COVID strategy to slow the spread that we have forgotten that that was only supposed to last as long as it took to protect those who wanted protection. We've gotten there and now it's time to allow those who want to isolate go do it and let everyone else go about their lives. Dr. Eric Larson is the host of the Paradocs Podcast and an anesthesiologist in private practice. show notes Episode 146: Today's show Surgery Center of Oklahoma: Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. Episode 143: We were so, so, so, so right about COVID Episode 134: Dr. Jay Bhattacharya on how science is now broken Episode 132: Dr. Monica Gandhi on T cells and long term immunity Episode 128: Dr. Noorchashm on immunity from prior infections to SARS-CoV-2 Episode 127: Independence Day from COVID Locum Story: Today's sponsor who helps you find locum work as a doc. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  A lot has happened since we last met with Dr. Keith Smith from the Surgery Center of Oklahoma back in 2018. Back then, we talked about how he brought the radical notion of full price transparency to the surgery space in 2009 all without taking any government payers. We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their surgeries which are more backed up than ever. His surgery center is a great alternative for an increasingly backlogged health system that is strained under the COVID crush of patients. Can Other Surgery Centers Dabble in Direct Contracting? One interesting aspect to Dr. Smith and his crusade for more transparency and market forces within medicine is the development of using clearinghouses for arranging surgery. The clearinghouse is used as a quick means for posting prices anonymously and then linking the agreeable surgery center and potential payers who are either patients or employers.. This is a great way to ease into direct contracting for a lot of surgery centers that are still dealing with commercial and government contracts. What is the Future for the Free Market Medical Association? Dr. Smith says the FMMA has grown significantly over the past few years as more and more facilitators, physicians, surgical centers, and administrators gather to learn how to harness the market to increase their book of business. Now that the pandemic has caused a lot of disruption in the market people are really starting to look for fresh solutions to survive and the FMMA feels like it has just what they need. Anyone can sign up and their next conference in in April 2022. Dr. Keith Smith is the co-founder of the Surgery Center of Oklahoma which has 100% price transparency which opened its doors in 1997. He also founded the Free Market Medical Association which works to promote the free market in all health care transactions. show notes Episode 145: Today's show Surgery Center of Oklahoma: Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. Free Market Medical Alliance: The organization that Dr. Smith helped co-found to encourage using the free market in more US health care transactions. @SurgeryCenterOK: Twitter for the Surgery Center of Oklahoma LinkedIn for Keith Smith, MD Atlas Billing Company: The company that helps link employers with surgery centers without posting all their prices openly to allow some direct contracting. Episode 012: Dr. Keith Smith on a fully transparent pricing system for surgery. Deputy: Today's sponsor who helps you with your employee scheduling and so much more. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  When I began this podcast in the Spring of 2018, there were a lot of things I felt needed to be said about the US Health Care system. Foremost among them was the problems with the third party payment system (using both commercial and government insurance to make most of the payments for services). Also, the system was becoming more and more consolidated and the power of those extracting that wealth continued to expand. It was a pretty depressing outlook for patients and doctors. However, most things aren't so black and white. While the regulatory capture of medicine is certainly a concern and no friend for docs and patients, there is a new movement that has sprung up in response to it. As my guest Ron Barshop says, it is leaderless, decentralized, and growing exponentially despite the powers that be. he loosely calls it direct contracting which is a way of bypassing the usual middlemen and gatekeepers in health care. It includes direct primary care (which we've discussed many times on the show here, here, here, and here) but is so much more. How big is the Direct Contracting Movement? Ron Barshop, host of the Primary Care Cures podcast, describes the direct contracting movement broadly. It involves millions of patients who are employees at small, medium, and large corporations. He estimates that direct contracting for health services comprises maybe 10% of the US population or about 30 million. But it is hard to get an exact count because it depends on your definition of direct contracting. Sometimes, just negotiating with a separate pharmacy benefits manager (PBM) or laboratory is what is done by a company. Some, however, have gone all in and are putting their employees in direct primary care offices or virtual services and contracting separately for nearly every contact their employees have in the health care environment. What is Direct Contracting for Health Services? The best way to describe direct contracting for health services is by looking at the financial transaction. If it is between the employer and the facility or person providing the care then is is direct contracting. If you are using a middleman or intermediary like an insurance company to make the payment, then it is probably not direct contracting. This isn't always the cleanest definition but it is a good starting point. Right now, large employers are finding millions of dollars in savings by directly negotiating with hospitals, surgery centers, imaging centers, laboratories, pharmacies, and primary care physicians. They self fund their health care needs for employees and usually save money and provide better services because of the incredible amount of waste spent on administrators within the typical health plan. How does Direct contracting Save Health Care? Simply put, by direct contracting and eliminating a lot of the middle men who provide no value (but plenty of expense) to health care billions or maybe even trillions of dollars can be reinvested into employees pockets. Also, by pushing for an improved model of primary care and urgent care, direct contracting has the potential to keep people healthier too. It is truly a triple win of lower costs, happier providers of care (not dealing with refusals to pay by third parties), and improved health. The beauty of this movement is that it does not reside within any particular political ideology or camp and does not really require any legislation to occur. It is happening organically and is a quiet revolution that most still don't see. Ron Barshop is the host of the Primary Care Cures podcast. He has been on a personal detective hunt on how to fix the US health care system and discovered that it is fixing itself through direct contracting. show notes Episode 144: Today's show Primary Care Cures: Ron Barshop's excellent podcast where he interviews disruptors, innovators, and thought leaders in the transforming health care in America. LinkedIn for Ron Barshop Episode 002: Dr. Amat on why she chose to become a direct primary care doctor Episode 067: Dr. Josh Umbehr on DPC Episode 049: Dr. Keith Smith and fully transparent pricing for surgery centers. Episode 037: Rheumatologist, Dr. Ellen McKnight, describes her venture into direct contracting as a specialist Episode 093: Zach Zeller of Scriptco talks about his direct warehouse membership pricing for generic pharmaceuticals. @FIPhysician: Twitter for Dr. Graham Deputy: Today's sponsor who helps you with your employee scheduling and so much more. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  In April, 2020, serendipitously, my high school classmate reached out to me after one of my podcast episodes where I was talking about mask usage. I was incorrect in one of my assumptions with the use of masks and the spread of particles which he pointed out. I then read his blog post about COVID and how it pertained to his home state of Montana and recognized that the way he looked at the pandemic was completely different than most. He came on the show for episode 086 and with today's episode will have been on five times. The perspective Dr. Graham brings to COVID is one with a clear insight about where we will end up. And if you know where you are going, it is much easier to figure out the best way to get there. COVID Is Endemic The greatest insight we spoke about way back at the beginning of this pandemic was that this virus, SARS-CoV-2, would become endemic. There was no chance of eradicating it no matter what type of vaccine was developed. The virus would be ubiquitous throughout the world with individuals always having a risk of exposure and infection. There would be no place to run or hide from the virus. And now we have animal reservoirs (animals that can become infected and spread the virus to other animals or humans) which means that even if you miraculously eliminated the virus from every human on the planet, it would pop up again as soon as it found new people who don't have immunity are born or their immunity wanes. How Do We Approach Endemic Viruses Differently? Endemicity is the key point to our discussion and one which has broad reaching policy implications. Your approach for controlling the spread of the virus and expectations completely change your strategies. It is why I've personally found the strategies promoted (and currently being promoted at this writing) so frustrating. Our current strategy is pointedly directed at preventing any and all transmissions of SARS-CoV-2. Whether that is using masks, distancing, restrictions on social gatherings, vaccine mandates, travel bans, or economic lockdowns we have been attacking this viral pandemic in exactly the wrong way. For an endemic virus, we recognize that we will all get infected multiple times throughout our lifetimes. Although we develop lasting T cell immunity to coronaviruses it does not completely prevent infections. That means that people will continue to contract and spread the virus but not get terribly sick. For the vast majority of people, these reinfections will be mild not requiring hospitalization. However, just because you don't require hospitalization it still might be a miserable few days similar to when you get the flu. If You Promote Masks, Promote Ones That Work We discussed mitigation measures and the colossal failure of any country, state, or city to successfully stop the spread of COVID-19 with either masks, lockdowns, or distancing. One important point was that we ned to be honest with people and if we are going to force kids to wear masks we should at least have them use masks that have some chance of making a difference. The use of cloth masks is pointless when you have a bunch of kids in an enclosed place for long periods of time. Ultimately, even good N95s probably wouldn't work very well because the kids wouldn't have good seals on them anyway. Dr. David Graham is an infectious disease specialist and the author of the book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19. He is also the author of FIPhysician.com where he is a practitioner and advocate for early financial independence and retirement. show notes Episode 143: Today's show Episode 086: Dr. Graham's first appearance Episode 096: How we transition from pandemic to endemic Episode 101: From Killer to Common Cold - We discuss Dr. Graham's book Episode 114: We're in the transitional phase right now. Financial Independence for Physicians: Dr. Graham's blog where he writes about the FIRE movement and also occasionally COVID. Vive Funds: Today's sponsor who will help you find good real estate investment opportunities. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  A big struggle for doctors is when they watch what goes on in the state and national legislatures and realize that there is very little knowledge of what they do, how they practice, and what they did to get where they are. There are no better examples of this failure to understand the nature of what physicians do than the debate over the Affordable Care Act (Obamacare) in 2013.That episode was what put the fire in the belly of today's author, Dr. Matt Moeller, to write his article that went viral and later led to a book. Professional Stresses There are quite a few stresses that cause lots of problems for practicing doctors Inconsistent schedules making a home life difficult to plan Multitasking by expecting doctors to do multiple things at once No downtime to get away from work where patient concerns (following up lab results, etc.) never stop even on vacation or after hours Rules and regulations The Difference Between Income and Wealth Doctors usually command a big income but don't accumulate wealth until much later in life. This puts them at a disadvantage as income is taxed much more heavily than wealth. It also makes it much harder for doctors to catch up financially to others who began working in their 20s and compounded their wealth and were not as saddled with student debt. How Do You Discourage Doctors? Keep technology complicated and makes doing their job harder. Insecurity among medical staff with their pay and jobs in perpetual jeopardy Turning them from decision makers into decision implementers (algorithm medicine) Escalating productivity expectations Increased responsibilities with decreased autonomy leading to learned helplessness Placing more barriers between physicians and their patients Solutions to What Ails Health Care Simplify costs and reimbursement and increase transparency Reform tort laws Increase the role patients have in their own health through expanding HSAs Prevent chronic illnesses Reign in the numbers and salary of administrators Dr. Matthew Moeller is a gastroenterologist in Grand Rapids, MI and the author of What It's Like to Become a Doctor that addresses the journey through medicine training. The second half of the book spends time addressing the problems in medicine and some potential solutions. show notes Episode 142: Today's show   Dear Lawmakers: This is what it's like to be a doctor today: Dr. Moeller's seminal piece that become viral and was reposted in mainstream media in 2013. Dr. Moeller's KevinMD Page Live Free Now Podcast: Hosted by John Bush Dr. Moeller on LinkedIn: LinkedIn link for Dr. Moeller. Locum Story: Today's sponsor who will help you find locum tenens opportunities. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money and preserving value of our time and labor without a central bank debasing it. Bitcoin has since gone from a value of well under one penny to about $40,000 per coin in 12 years. What's Decentralized Finance? The first question to ask is what is centralized finance? Basically, this is traditional finance like using banks to acquire loans. This means that you go to a business and offer some collateral and receive your loan. Now, the advent of cryptocurrency allows for finance through a smart contract. This allows for people all over the world who has cryptocurrency access to capital no matter who they are. This is a powerful tool that can be used in areas of the world without much capital infrastructure and by businesses in the developed world too. What's a block Chain? The block chain is maybe best thought of as a sheet of paper that has every transaction of every coin on it. And with each new creation of a block, the transactions are updated, new coins are added as rewards, and all the decentralized nodes work to verify and agree with the transactions that are on the block. Then a new block is added to the previous as the process is continued forever. One can see the utility of this technology not only in verifying that the funds used to buy something were real and in someone's possession but also in other contracts or information. I spoke to Dr. Huston way back in episode 018 where she described her plan on using block chains to protect the integrity of physicians' credentials. This means they would control the information and not some health system and would keep it far more secure. You could also use the block chains for other personal information like your health which is what my guest, Brendan Hodge, in episode 014 proposed with Citizen Health. How Do You Get Started iN Cryptocurrency? As with everything, getting started is the hardest part of process. Buying, trading, and investing take a little experimentation. But if you have any technological saavy, it isn't too hard to figure out. You merely have to decide what cryptocurrency to buy (there are 8 thousand choices and counting) and then whether or not you want to be in charge of the coin itself or have someone else hold it for you. The exchanges will hold the key to the coins you purchase and allow you to take possession, hold them in their vault, or trade them with other currencies. Most of the exchanges like Coinbase, Binance, Kraken, or others allow you to convert your fiat (US Dollars) and purchase the new currencies for a fee using either your bank account or credit card. Trading and exchanging always cost some fee which varies depending on the types of coins being purchased and exchanged anywhere from a few dollars to fractions of a penny. [caption id="attachment_9951" align="alignleft" width="300"] John Bush is the lead instructor and owner of Live Free Academy where he teaches the basics of cryptocurrency. John also works with clients to help them grow their portfolios using advanced trading techniques.[/caption]       Direct Download Link show notes Episode 141d: Today's show Live Free Academy: John Bush's learning institute where you can go for classes, one on one instructions, and much more. John Bush YouTube Channel Live Free Now Podcast: Hosted by John Bush Cryptocurrency fo Beginners Seminar: This is the signup page for his upcoming seminar. Advice Media: Today's sponsor who will help your practice in its online presence. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

This is my recent guest appearance on the Paradocs podcast. Eric Larson and I discussed food and cooking, health and wellness, and what to do with an eggplant. Find the link to the Paradocs podcast on the show notes page here culinarylibertarian.com/152 --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/dannreid/message Support this podcast: https://anchor.fm/dannreid/support

  Bitcoin was invented in 2008 by a pseudonymous programmer (or group of programmers) called Satoshi Nakamoto. It is a currency issued in a decentralized fashion using a complex mathematical equation on a block chain. Bitcoin then launched in 2009 and was adopted by very few people but it held out a promise to usher in a new way we can look at money and preserving value of our time and labor without a central bank debasing it. Bitcoin has since gone from a value of well under one penny to about $40,000 per coin in 12 years. What's a Cryptocurrency? My guest today is John Bush, a cryptocurrency advocate and owner of the consulting/teaching institute Live Free Academy. He has been an advocate of bitcoin since 2013 where he gained some prominence attempting to travel around the country with his family using only bitcoins to buy what they needed. Since, he has been a podcaster and teacher for those who want to use bitcoin and other cryptocurrencies to improve their lives. He says all cryptocurrencies, like bitcoin, are basically computer programs that either require computers to solve complicated mathematical equations to verify all the transactions of the block. For their reward, these computers (or miners) are rewarded with newly minted coins. Likewise, with millions of computers attempting to solve this equation, there are a lot of computers that are verifying that all the transactions on the chain were legitimate and the integrity of the chain is preserved. What's a block Chain? The block chain is maybe best thought of as a sheet of paper that has every transaction of every coin on it. And with each new creation of a block, the transactions are updated, new coins are added as rewards, and all the decentralized nodes work to verify and agree with the transactions that are on the block. Then a new block is added to the previous as the process is continued forever. One can see the utility of this technology not only in verifying that the funds used to buy something were real and in someone's possession but also in other contracts or information. I spoke to Dr. Huston way back in episode 018 where she described her plan on using block chains to protect the integrity of physicians' credentials. This means they would control the information and not some health system and would keep it far more secure. You could also use the block chains for other personal information like your health which is what my guest, Brendan Hodge, in episode 014 proposed with Citizen Health. How Do You Get Started iN Cryptocurrency? As with everything, getting started is the hardest part of process. Buying, trading, and investing take a little experimentation. But if you have any technological saavy, it isn't too hard to figure out. You merely have to decide what cryptocurrency to buy (there are 8 thousand choices and counting) and then whether or not you want to be in charge of the coin itself or have someone else hold it for you. The exchanges will hold the key to the coins you purchase and allow you to take possession, hold them in their vault, or trade them with other currencies. Most of the exchanges like Coinbase, Binance, Kraken, or others allow you to convert your fiat (US Dollars) and purchase the new currencies for a fee using either your bank account or credit card. Trading and exchanging always cost some fee which varies depending on the types of coins being purchased and exchanged anywhere from a few dollars to fractions of a penny. Why Should You Purchase Cryptocurrency? The big question, is why buy this currency which seems to have so much volatility? John Bush thinks it is wise to be invested in crypto for a couple of reasons: Our fiat dollars/euros/yuan are being continually inflated away to lose their value. Many cryptocurrencies, like bitcoin, are very limited in their creation and can hold their value over time much better. The world is moving more and more to online and digital currencies will be more commonplace. There are a lot of other uses like decentralized finance (which we will discuss in episode 141) which are available if you have cryptocurrency to use as collateral. It is a way for the unbanked to have access to capital in many parts of the world opening paths to financial freedom. John Bush is the lead instructor and owner of Live Free Academy where he teaches the basics of cryptocurrency. John also works with clients to help them grow their portfolios using advanced trading techniques. show notes Episode 140: Today's show Live Free Academy: John Bush's learning institute where you can go for classes, one on one instructions, and much more. John Bush YouTube Channel Live Free Now Podcast: Hosted by John Bush Cryptocurrency fo Beginners Seminar: This is the signup page for his upcoming seminar. Advice Media: Today's sponsor who will help your practice in its online presence. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Today we're going to wade into the uncomfortable land of mandatory vaccinations for COVID. You're already seeing these spring up in hospital systems, federal work forces, and universities.There's a lot to understand with these and I only offer my own perspective while hopefully acknowledging accurately my own biases to help you better understand the topic. We will review some science, the underlying political tension, and my conclusions. For the foundations of knowledge that you should have I'd recommend you read/listen to the following episodes: Moving from pandemic to epidemic Is myocarditis in COVID a really big problem? Understanding PCR Vitamin D and it's role in COVID The ethics of a vaccine passport Independence Day from COVID - June 1, 2021. Why we shouldn't ignore natural immunity Don't sweat the variants and explanations of how the immune system works. COVID is Real and Vaccines Work We need to start our discussion with some facts. SARS-CoV-2 is a virus that causes COVID-19. It is a potentially deadly disease that preferentially causes mortality in the elderly and frail. Young adults are relatively spared from the worst effects although on very rare occasions they can get seriously ill from COVID. For most though, COVID is somewhere along the spectrum of asymptomatic to mild/moderate disease rarely requiring hospitalization. Fortunately, children are almost entirely spared from the worst parts of the disease and rarely get very sick. Likewise, the mRNA vaccines are extremely effective at preventing people from getting severe disease requiring hospitalizations and death. That's why you see a disconnect now in many countries where even though people may get infected, they don't get severely ill.  We've Figured out a Little with Treatment We've figured out a few treatments that work like avoiding ventilators, prone positioning, early dexamethasone for hospitalized patients. Monoclonal antibodies seem to help. Most other treatments are anecdotal or unproven at this time. We Still Don't Know a lot Just as we have learned a lot about COVID, there is still a lot we do not understand. We don't know how to limit its spread outside of massively restrictive policies like those seen in communist China and the island nations of New Zealand and Australia. Rolling house arrest lockdowns and almost total bans on travel have been the only government policies which have mitigated the spread of the virus. Mask mandates, economic lockdowns, and travel restrictions have shown zero correlation with the spread of the virus. There are also a lot of confounding factors making it almost impossible to prove any specific measure works or doesn't work as we've seen the virus indiscriminately affect every state and country on a timeline of its own. Tension Between Freedom or Bodily Autonomy and the Protection of Others The current debate with the mandatory use of vaccinations centers on the tension between our freedom to do as we wish with our bodies (refuse medical care, exercise or don't exercise, etc.) and the concern that if we carry an infectious agent we could unintentionally harm others by getting them infected. This is where the debate really stands and I believe it is necessary to look at the real risk, the locations for the risk, and the costs. We can't make decisions on our policy without taking those factors into account. As I stated before in episode 127, there is no reason why any adult in the US should be at risk for COVID because they have now had months to get a vaccine if they do not already have natural immunity from an infection (est. ~30% of Americans). Therefore, it would be unreasonable to require people to go to extreme measures in order to protect those who chose not to protect themselves. If the vaccine were not very effective, then we might have a different argument but when one is vaccinated, they are almost assuredly safe from serious illness. If someone is still concerned, they always have the option of avoiding social contact  but others should not have to bow to their risk assessments. This would be more difficult if children were highly vulnerable because they are not yet allowed to get the vaccine. But despite the higher infection rates because of the newer variants, they still show no higher signs of significant disease than April of 2020. Again, the threat to children is almost negligible so those who find that level of risk too high can certainly find alternatives to getting by in life to avoid that small risk until a vaccine is out. Where is it OK to Mandate Vaccines? I definitely believe because COVID is mostly harmless to those vaccinated or who have natural immunity there is no reason to have any sort of mandatory vaccinations for most people. This means also that 'nudging' is not ok whereby the government restricts people and their ability to travel, earn a living, or leave their home. This soft house arrest or removing a means for supporting yourself financially is repugnant and should not be tolerated. That said, I do believe it is reasonable for some places to have mandatory vaccinations (or more accurately, immunity). Although it is unreasonable for those rare people who are immunocompromised to restrict the lives or most or to inject medications in their bodies against their will, it is probably reasonable for people who are most at risk to be able to safely get care when they are sick. These are places which can't be avoided by the sick and an extra level of safety is probably a reasonable expectation. SARS-CoV-2 just won't go away and the controversy keeps us fighting each other. Now some are calling for mass mandatory vaccinations. show notes Episode 139: Today's show Advice Media: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Ask any primary care physician and they will tell you the toughest thing about helping their patients change lifestyle is that they don't have enough time or contact with the patient. Especially when it comes to weight loss control, primary care docs are stretched so thin on time that they struggle to have the impact they'd like on their patient's healthy habits or lack thereof.  Weight Loss Begins with Awareness It's no surprise that a successful weight loss program begins with awareness that you have a problem with weight and your lifestyle. Dr. Egan, says that to be successful one must stay focused on a number of things. All of these are a priority with her management style at her new practice:  Relationship with food. One must pay attention to why they are eating and to recognize healthy and unhealthy options. This is all with an awareness of how we are often left with no perfect options because we don't have the right ingredients, time, or abilities. Movement. This goes beyond just saying someone needs to exercise. The movement program must be created with the specific patient in mind and their input. Medications. Sometimes once the other parts are optimized, it is best to look at medications to supplement the rest of the weight loss program. A well designed drug regimen including hormonal treatments can be the difference between success and failure. How to Pull Off Weight in Primary Care Dr. Egan is teaming with Dr. Bitner (from episode 115)  and using an entirely new model of care to help women lose weight. Instead of trying to develop a multidisciplinary clinic through an insurance based model, they have decided to go with a membership model where they limit the number patients to allow for more time and contact with the physicians. It's similar to direct primary care but probably more accurately described as direct contracting. I suspect it will be a much more successful model for getting patients the results they want than through the traditional insurance model. Dr. Egan is an internist who is board certified in weight management and will be starting at True Women's Health in August, 2021. show notes Episode 138: Today's show True Women's Health: Dr. Egan's new practice where she will work with Dr. Bitner. True Women's Health on LinkedIn Dr. Celia Egan on LinkedIn True Women's Health on Facebook @truewomenhealth on Twitter Physician Advocacy Institute: This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. @PhysAdvocacy: Twitter for the Physicians Advocacy Institute. Episode 115: Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. Episode 102: Dr. Fung on the advantages of intermittent fasting. Episode 107: Dr. Fung on cancer and how excessive weight puts you at increased risk for cancer. Care Cloud: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Being an expert has a lot to do with muffins. Or rather, when I was eating a fresh muffin the other day for breakfast it certainly got me thinking about experts. You see, I eat my muffins differently than the rest of my family. They break off the top of the muffin and butter the top and then the bottom. I felt like it would be better to cut my muffin down the middle so I could eat a muffin top with every bite (since the tops are the best). Well, this brought teasing from my kids and wife. The other day, my daughter got a broken muffin so she had to eat it 'my way' by buttering it down the middle. She admitted after eating it that I was right and my way was better. We both considered ourselves experts in what we liked to eat. Who Is an Expert? The definition of what an expert is is fairly well defined but the exact qualifications is not. Being an expert is probably more a matter of degrees of knowledge and mastery than any absolute number. I am certainly more an expert in all things medical than most people, but when compared to other physicians that would sometimes not be the case.   Is the Expert Really an Expert in What We Are Discussing? The biggest problem with the use of the term expert over the last year and a half of the pandemic is that we proclaim people experts when they can't possibly be experts. No one has lived through a unique respiratory viral coronavirus pandemic such as we are having. Yet, many proclaim that they know the best treatments, mitigation measures, and modeling predictions. Certainly, some have a better foundational knowledge than others but since this is brand new there is no way anyone can be an expert in this particular disease/phenomenon. Stay Humble Ultimately, if you are in this space where you might not really be an exact expert in what is being discussed, you need to acknowledge it and accept some humility that you can't know. Also, you have to be open the possibility that you may, in fact, be completely wrong. Even experts in their own specialized field are occasionally wrong and must recognize that and be even more cautious when giving 'expert opinion' on topics in which they can't know as much. Self reflection on who an expert is and whether they might be wrong is critical. show notes Episode 137: Today's show Doctorpodcastnetwork.com/advicemedia: Advice media helps you fix your online social media engagement issues. Click now to get a free $60 amazon gift card just with a complimentary consultation. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Essentially, there are two main ways to classify physicians - independent or employed. Today's health care in the US is becoming increasingly consolidated as  health systems and corporate entities (venture capital groups, etc.) are purchasing physician practices. With the advent of the pandemic of COVID-19 and the partial and complete shutdowns in medicine over 2020, the trend of selling practices accelerated. More and more physicians are now employed by someone - either a hospital system or corporation - eclipsing 70% of all physicians. The era of independent physicians may be coming to a close if these trends don't turn around. The question we should be asking is why is this happening and should we care? What are the Trends? The Physician Advocacy Institute surveyed physicians over 2019-2020 and found that there was an acceleration of physicians selling their practices to hospitals and corporate entities. This was not unique to any specific region of the country. You can see their paper here and it is clear that this is a trend that is not going away any time soon. Over the last two years, 48,400 doctors left independent practice and moved to employed status. Nearly half of all physician practices are now hospital or corporate based leaving an ever smaller base of people who can be nimble and innovative in the health care space. It is important to point out that many I have spoken to over the past two years have left big systems and struck out on their own to be disruptors in the space like Dr. Randy Lovell, Dr. Richard Rosenfield, Dr. Diana Bitner, and others. Reasons Docs Become Employed Cash out for retirement Avoid overhead/business frustrations like meeting payroll, etc. Market swings Paying off student debt (usually ~$250,000 from med school and undergrad) Perceived stable/reliable income Increasing regulations and reporting for things like value based care. MediCare reporting and data mining. Electronic medical records Audit processes Why Docs Leaving Independent Practice is a Problem for Us All Increased health care costs Less competition Less innovation in how to deliver care Prescription drug plan restrictions (and increased costs) Worse autonomy Increased utilization of midlevel providers Stagnant pay because no risk taking Doctors are increasingly becoming casualties of bigness in medicine. Both through health systems and corporate entities like venture capital groups. show notes Episode 136: Today's show Survey on Physician Practice Trends in the US 2019-2020: This is the article we discussed regarding what's going on with physician practices. Physician Advocacy Institute: This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. @PhysAdvocacy: Twitter for the Physicians Advocacy Institute. Episode 088: Dr.Lovell in leaving corporate medicine to practice orthopedic hand surgery in a new way. Episode 115: Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. Episode 117: Dr. Rosenfield on leaving corporate medicine to practice surgery in a more innovative way. Doctor Me First: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Dr. Errin Weisman. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  There has been no shortage of people or schemes to fix the US health care industry. US medicine consistently fails to deliver quality care at affordable prices and manages to irritate both doctors and patients alike. Politicians and think tanks come up with grandiose plans every day to treat what plagues the system. Likewise, big tech companies like Apple are now entering the fray and bringing their technology as solutions. Unfortunately for Apple (and its tech cousins like Amazon), the health space is extremely complicated and can't be solved simply using technology. Its attempt to "make it" flopped just as other ventures by tech companies have in the past. The common thread in all of those is the belief that they could replace doctors. Doctors Make it Work, Not Expensive A common misconception found at tech companies like Apple is that people are easy to replace with algorithms and gadgets. But humans aren't machines so you can't always predict how they will behave. Even with sophisticated devices monitoring heart rate, blood pressure, etc. that information is not useful in isolation. You must have someone who can figure out if any of the data is important based on examination, intuition, and experience that can't be found in any algorithm. Also, the companies believe that by removing the physician, they will find the cost savings they need to cut costs and deliver an equivalent service. But anyone who has been paying attention (or looked at expenses in medicine) will find that doctors are one of the smallest parts of the cost equation. They are easily surpassed by imaging, laboratories, pharmaceuticals and the biggest and baddest of them all - administrative. Middle men and the third party payor system in general are what are driving the majority of price inflation in health care. How to Really Solve the Shortage on Care - Hint: It's not getting rid of doctors My guest today is Dr. Doug Farrago, founding member of the DPC Alliance, newly retired direct primary care doctor, author of books on how to start your own DPC practice, and inventor of the knee saver for catchers and the cryo helmet for sufferers of migraines and concussions. Dr. Farrago points out the most obvious flaw in the plan from these tech companies - data is only as useful as the one applying it. Just as it wouldn't be recommended to get random batteries of tests to arrive at diagnoses, accumulating massive amounts of vital signs or rhythm data  is just as useless without the context provided. A good example is familiar to any doctor who has ever ordered a chest x-ray. When you get the reading from the radiologist, their diagnosis of the problem is dependent on the history of the patient. Maybe that fluffy infiltrate is extra fluid, or pneumonia, or blood. You need to correlate what is going on to get the most out of that film. Without a correlation, it is just a random test that may or may not be significant. The Solution? Direct Primary Care So what is the solution to the cost and quality problem facing primary care in medicine? Dr. Farrago (and many others whom I've spoken with here, here, here, and here) is direct primary care. The personal membership based relationship between a doctor and patient without insurance or any of the middle men allows for the best care. It is affordable and allows the doctor to use his or her intuition and clinical judgment based on their prior relationship with that patient and their previous  health history. That's why Dr. Farrago thinks DPC is the clearest solution to what is plaguing us - not some new piece of tech. Tech are just tools that the clinician can use - they can't replace a human touch, physical exam, and experience. Dr. Doug Farrago is a recently retired DPC physician previously of Forest Direct Primary Care. He is the writer at Authentic Medicine and DPC News. He is the author of many books on DPC and the inventor of the Cryo Helmet and knee saver for baseball catchers. show notes Episode 135: Today's show Apple Can't Even Get Primary Care Right This is the article we discussed focusing on Apple's failure getting into the primary care space. DPC News: This is a great resource for those interested in what is going on in direct primary care. A news accumulator with some original content. Authentic Medicine: Dr. Farrago's blog of 20 years where he has commented on medicine. DPC Alliance: This is an organization founded by Dr. Farrago that is committed to helping DPC doctors organize and learn from each other to become successful clinicians and business men and women. LinkedIn for Doug Farrago Episode 002: Dr. Amat describes why she went into DPC. Episode 045: Dr. Neuhofel explains what it was like starting one of the first DPC practices in the country. Episode 049: Dr. Gross describes how DPC is a cornerstone for rebuilding our health care system. Episode 067: Dr. Umbehr speaks about the resources he has created to help DPC docs be successful in their new practice model. Locum Story: Today's sponsor for the show is Locum Story and how they help doctors find locum tenens positions.s Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  There has been no shortage of casualties in the last year and half with the COVID pandemic. Schools have been closed, businesses shuttered, and families torn apart with different levels of concern for the virus. But one surprising victim has been science itself. The practice of scientific inquiry, discussion, and debate disappeared. Instead of science - which we can loosely define hypotheses that are then tested and either proven or disproven - is longer present when it comes to COVID. We've talked briefly about this phenomena before on the show with Dr. David Graham and also Dr. Rohin Francis. But 2020 brought about the end of serious discussions in much of the scientific and medical communities as people who chose to take unpopular views or question the mainstream opinions were removed from the public square, harassed, and even fired from their jobs. My guest, Dr. Jay Bhattacharya, has not only been willing to risk holding opinions and theories against the mainstream consensus, but he is also looking to help science return to open, honest debate. The Great Barrington Declaration One of the most publicized controversial statements on COVID in 2020, the Great Barrington Declaration, was written by three prominent epidemiologists. They were Dr. Jay Bhattacharya of Stanford, Dr. Martin Kuldorff of Harvard, and Dr. Sunetra Gupta of the UK. All of them agreed that a more prudent approach to fighting the pandemic would be to focus the majority of our resources on protecting those most vulnerable to COVID - namely, the elderly. They emphasized that the use of broad sweeping closures or mandates with a focus on disease count was the wrong strategy. Instead of focusing on infections, it would be more important to use a laser focus on protecting residents in nursing homes. This could have bein done fairly cheaply and easily with significantly less disruption to education and business. Why the Wrong Goal Led to the Wrong Policy Dr. Bhattacharya says that the key problem with public health officials' approach to the pandemic was to focus on infections (or cases) in the population rather than on how to protect those at greatest risk. Because they had the wrong objective, it led to ineffective programs like broad lockdowns and school closures which did nothing to help slow the spread the pandemic but left many seniors at greater risk to getting SARS-CoV-2 infections and dying. Also, because the policy focused on controlling all infections, not just in those most at risk, the release of the vaccine was muddled too. Instead of deploying it quickly and efficiently into nursing homes where 40% of the COVID deaths have occurred, public officials were generally aimless in its distribution handing it out to young health care workers or non-clinical personnel within health care organizations. This further put those most at risk in peril unnecessarily. Can Science Heal? Ultimately, the greatest failure in the whole response to the pandemic has been the lack of honest scientific debate and discussion. The robust challenges to dogma have been squelched leading to big policy mistakes (not including the fracturing of society along ideological lines). Public health authorities can  only issue effective decrees and statements once science has had an opportunity to come to a real consensus in which there is honest and open debate. That never happened this time and it has set the public trust towards the abilities of science back. Dr. Bhattacharya hopes to change this situation and bring back real scientific discussions. Questioning, rigorous debate, and testing are pillars of the scientific method and he seeks a way to reactivate science's roots through his organization at Collateral Global. Hopefully, we can perform an honest assessment of what was done correctly and incorrectly throughout the pandemic. The goals would be to better prepare us to handle the next pandemic that will surely happen some time in the future. Dr. Jay Bhattacharya is a professor of medicine at Stanford University and one of the co-authors of the Great Barrington Declaration. He argues for a return to real scientific debate and inquiry. show notes Episode 134: Today's show Collateral Global: This is the organization that Dr. Bhattacharya is a part of to return science back to its roots of rigorous testing and discussion. Great Barrington Declaration: The statement issued by Dr. Bhattacharya, et al regarding a more focused protection for those most vulnerable to COVID. LinkedIn for Jay Bhattacharya Episode 099: Dr. Francis discusses how most of science around COVID is garbage. Episode 114: Dr. Graham talks about how science is not serving the public well on COVID. Locum Story: Today's sponsor for the show is Locum Story and how they help doctors find locum tenens positions.s Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  If you want to get a doctor's blood pressure up or make her sweat, just tell her that you have a great electronic health record (EHR) to use. EHRs are the bane of a physician's life because they don't work well with your work flow, create extra work and inefficiencies, and cost a ton of money. That's why I spoke to Dr. Richard Sztramko of Hamilton, ON who is co-founder of Arya health technology company that has designed a new EHR. To this American, I found it very surprising that an innovative EHR product would ever be developed in Canada with a nationalized health care system. The secret is that Canada's health care system isn't that different than ours in many ways. You can catch other episodes where we spoke about EHRs and why we hate the ones we use here, here, and here. Canadian Docs Have Private Practices Much like the United States, the Canadian health care system is made up of private practices for generalists and specialists. They bill in a manner very similar to US doctors except that their payors are just governmental. They still have to collect billing information, diagnostic coding, visit or procedure types, and time spent with the patient. It would be very similar to if every service in our country went through with Medicare and Medicaid. Not all Canadian physicians are in private practice, many work in academic settings, like Dr. Sztramko, where they are employed and have the private non-profit hospitals employ them and provide the personnel to run their clinics and practices. This leaves the country with a non-uniform, disjointed medical system with software that doesn't communicate with each other and is often expensive to operate. The computer systems are the same as in the US in that it is becoming dominated by Cerner and Epic. Ultimately, our medical systems look very similar in their dysfunction for clinicians. What Makes a Good EHR? A good electronic health record is hard to find in the marketplace. But what constitutes qualities that make an EHR good? It maximizes your revenue capture. This is important that you get paid in a timely fashion by collecting all the coding information to get prompt payments and minimizing collection work. Improves daily workflow. A good EHR will make things more efficient from a scheduling standpoint and allow you to see more patients and get to the solution faster. Decrease time charting. The EHR should be quick and make charting even faster than it is on paper. Information should be easily accessible. Most EHRs make finding simple questions complicated. They aren't intuitive or they can only be found after multiple clicks Help your bottom line. The cost of the EHR should be easily outweighed by the increased efficiency and revenue that you bring into your practice. Does Arya Pass the Test? Not surprisingly, Dr. Sztramko feels that his new EHR product does what most do not. It is relatively inexpensive (only $300/user/month), intuitive, and actually decreases the time necessary to actually do your charting. One of the biggest benefits according to Sztramko is the fact that the program is so intuitive that training is very easy. He reported that in contrast to EPIC and Cerner training which takes days or even weeks to be a super user, Arya training is so easy that doctors usually only need an hour or just to watch the short introductory training video. Dr. Richard Sztramko is internal medicine and geriatric medicine trained and is an associate professor at McMaster University. He is the co-founder of Arya Health tech company. show notes Episode 133: Today's show Arya Health: Arya Health's website where you can learn more about their EHR product. LinkedIn for Arya Health LinkedIn for Dr. Sztramko @RichSztramko: Dr. Sztramko's twitter handle. Email for AryaHealth: info@aryaehr.com IGericare is a website that helps caregivers of loved ones with dementia. Free and teeming with information. Going from medical school to medical technology: Story in the Vancouver Tech Journal Episode 067: Dr. Umbehr and his EHR for DPC docs. Episode 028: Who doctors are and what they love and hate about medicine (guess what? it's electronic health records.) Episode 023: HIPAA and electronic records. Episode 015: Physician burnout due to things like EHRs. MR Insurance: Today's sponsor for the show is Michael Relvas who helps physicians with their insurance needs. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  "Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with an almost endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals, ICUs, and funeral homes. But are the variants really that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi of UC San Francisco medical school, the answer is a simple no. How Does Immunity work? Our discussion begins not with the variants but in talking about the basic units of our immune response - T cells and B cells. In short, B cells are the ones that make antibodies and persist for life (usually) in our lymph nodes waiting to get reactivated when the virus reappears later in our life. T cells function to clear the virus from our body and also persist long after the infection has gone. They too have life long memory to help us clear infections when the same viruses try and get us sick a second time. An important point to consider is that we expect the presence of antibodies to wane over time. That is a perfectly normal process in our bodies. That's why we have B cells and T cells which are left to provide the memory or past infections and at the ready to ramp up a quick response if a virus returns. If the antibodies never left our blood would be too thick with proteins said Dr. Gandhi. Will the Variants Evade our Immune Systems? The concern a lot of doctors, public health authorities, and elected officials have expressed is that SARS-CoV-2 is mutating. They worry that its variants will not become more infectious or dangerous and they will make the immunity gained through natural infection and vaccination ineffective. This is not something we should worry about according to Dr. Gandhi. Our immune system is designed to protect against just this very occurrence in nature. Viruses may evolve and change but SARS-CoV-2 is still the same virus. When we develop antibody defenses it is against around 100 sites on the spike protein so if a few of those change we will still have dozens of antibodies still that will work against the virus. This is why despite newer variants showing up they are turning out to be just as susceptible to our immune systems. Did the Lockdowns Work? How About the Mask Mandates? Dr. Gandhi also has an MPH in epidemiology and biostatistics and we briefly discussed the effectiveness of the various non-pharmacological interventions like the economic lockdowns and mask mandates. She takes a fairly sanguine view of these measures and feels that there isn't very good date showing that any of them were all that effective. Certainly, more research has to be done but it was clear that strict lockdowns or no lockdowns did not have a clear benefit when comparing various state policies. It that were the case, then California which has had the most stringent rules would have fared significantly better than other states instead of being right in the middle for cases, hospitalizations, and deaths. Should Children get Vaccinated? Dr. Gandhi is not sure what the best policy is for kids and getting vaccinated, however, she thinks we should all be glad that COVID rarely causes severe disease in children. What is more pressing, in her opinion, is moving the vaccines we are giving to our kids and distributing them throughout the world where the potential to prevent a lot more serious illnesses in the elderly is far greater. Equity in treatments should be near the top of our considerations right now since the benefit to children and the population at large is so small. Especially when there is an opportunity to do so much good elsewhere in the world. Transparency is Key. Finally, we spoke about the controversy with gain of function testing that has been occurring in laboratories around the world and whether that was a wise decision. The key for all these issues including public health is to be up front, honest, and transparent with the public. Every white lie or justification further erodes the public's trust with doctors and the government. One good example is that the push to get children vaccinated really has more to do with protecting adults that kids unlike a lot of childhood vaccines for viruses that affect children (whooping cough, mumps, measles, rubella, etc.). Dr. Monica Gandhi is a professor of medicine at UC San Francisco medical school and an infectious disease specializing in HIV. show notes Episode 132: Today's show @MonicaGandhi9: Dr.Gandhi's prolific twitter feed where she actively promotes T cells and provides a refreshing alternative voice to the echo chamber on COVID. No, You Probably Won't Need a Booster Shot for COVID-19: An opinion piece by Dr. Gandhi in the SF Chronicle. American Kids Can Wait: Dr. Gandhi and two other colleagues make the case for sending the vaccines we're using for our kids who are at low risk to other parts of the world where the elderly and vulnerable would have the most to gain. Episode 128: If You've Had COVID-19, Don't Get Vaccinated Episode 114: We're in the Transitional Phase of COVID-19 Now. Episode 127: COVID Independence Day Advice Media: Today's sponsor for the show on getting a better handle on your online presence for your practice. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. In essence, the insurance product created by the state would set minimum standards for coverage and be available to anyone. Of course, their expectation is that they will lower health care expenses by over 10% with this plan. If this doesn't happen, the hammer comes down on everyone providing care. What Happens if it Doesn't Save Money? Not surprisingly, the legislators recognized that health care systems and people who provide care might not actually provide the care needed at the reduced rates the new insurance was offering. If that happened, then medical care wouldn't be cheaper and the plan would fail. But how would the lawmakers get doctors and physical therapists, pharmacists, chiropractors, etc to accept the low reimbursements to make the plan work? Well, not surprisingly they decided to force all the people who provide care to accept those reduced rates or lose their ability to work. They accomplish this by taking away professionals' license to practice medicine, PT, OT, etc. by claiming that it is unprofessional behavior to not accept their fee schedule. And that is where the real opposition to the bill began. What Happened to Phase 2? The threat of losing your ability to practice for anyone who accepts medical payments generated a huge amount of resistance within the state. And not just from doctors but large health care organizations, massage therapists, chiropractors, physical therapists, chiropractors, podiatrists, or basically anyone who provides any sort of medical service. Everyone was at risk of losing their ability to practice if they failed to accept the insurance or perhaps go bankrupt if they did accept the payments and they didn't cover their costs. Naturally, when insurance companies, hospitals, and medical organizations are all lobbying against the bill you have just too much money to fight as a legislator. It is easier and safer to acquiesce and amend the bill to remove all of the punitive provisions. In a moment of honesty the lawmakers have to know the plan will then fail without and provisions to force cost savings but it is easier to just pass a symbolic bill and maybe hope you get what you want later when it fails in practice. What was the Risk to Direct Primary Care Doctors? Obivously, the great risk to DPC doctors was that they already work outside the insurance system by directly contracting with their patients. So any plan that forces them to take insurance immediately removes a lot of the efficiencies they gain by running a lean office and not using billing services. Also, they operate outside the insurance system which jacks up the prices as we've discussed on numerous occasions here, here, here, and here, among others. So suddenly DPC doctors, who operate entirely outside of the system, were going to be required to jump into the third party payment system or risk losing their medical license. It was total madness and fortunately the bill was amended before some doctors had to look for work somewhere outside the state. So What's the Takeaway from this Near Miss? It's simply this, you have to pay attention to what is going on at your statehouse or have someone close to you who is paying attention to warn you when bad legislation rears its ugly head. It's probably also important to meet with your state senators and representatives to talk to them about what you do and how you practice. Maybe show them your office or explain how you care for people who are too rich to get medicaid but too poor to be able to afford their own insurance. It's always best to do this when there isn't legislation pending so they know that you exist, how you operate, and the vital service you provide for so many patients. You never know when they will need a phone call to discuss amending a bill to let you practice the way you want. Dr. Belen Amat is a direct primary care physician serving the greater Grand Rapids, MI area. She also serves as a board member on the Michigan State Medical Society.       Direct Download Link show notes Episode 131: Today's show DPC West Michigan: Dr. Amat's DPC Practice Colorado HB 21-2132: The legislation in question that seeks to create a public option for residents in Colorado. Since amended to remove the more onerous portion that stripped medical practitioners of their licenses and ability to practice. How did HB 21-2132 Change?: This is a good accounting of how the legislative process unfolded and the various political players involved. Episode 002: Dr. Amat talks about her journey away from third party payment medicine to direct primary care. Episode 105: What is the One Question You Wish You Knew Before Starting a DPC Practice? Panacea Financial: Today's sponsor for the show on banking for physicians. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Dr. Anthony Fauci has been the head of the United States National Institute of Allergy and Infectious Disease since 1984 and the presidential chief medical advisor for two presidents. His rise to prominence began in February and March of 2020 and continues to this day as he was thrust forward as the main spokesman for the US federal government in its response to the COVID-19 pandemic. Dr. Fauci served as the lead for establishing policies and recommendations at the CDC and FDA to combat the virus. What's Wrong with How Fauci Led the Response? In many ways, Dr. Fauci's failure to properly handle the pandemic response with COVID was inevitable. Men like him - according to my guest Peter Suderman of Reason.com - believe in the general infallibility of the bureaucratic process. They think that by following a mechanical paperwork process that they will come to the best, safest, and correct conclusions. These public health bureaucrats also hold a paternalistic view of the average citizen and that those citizens need their protection.  As it turns out, Dr. Fauci's hubris and mistrust of the public led him to make a lot of errors in his communications and recommendations. He outright lied at least a few times including initially saying masks didn't help in order to prevent a run on masks by the public. He later admitted that they knew all along that masks were basically useless outdoors despite insisting earlier that they were effective. He also admitted to lying about the necessary level of vaccination necessary to reach herd immunity because he didn't think people would think it was possible to achieve. He very consistently eroded the already weak trust of the public in public health authorities through those deceptions. What Errors Did the CDC Have in Its Response? The CDC had been an absolute disaster in its response to the pandemic - ostensibly the sole reason for having a CDC. Initially, the CDC blocked the use of tests for COVID that were being used elsewhere in the world. Instead, the insisted on using only their own tests which turned out to be defective and delayed any meaningful testing in the US for weeks leaving our understanding of the extent of the virus in the dark. It has also decreed many contradictory statements on the use of masks, lock downs, projections of surges, and real risks to the public. Was the FDA any Better in its Response? Sadly, the FDA has probably done even worse in its reaction to the virus. It prevented the creation of rapid home tests, commercial tests for COVID from university and private labs, mask manufacturers from converting their masks for hospital use, and the production of antiseptic by various companies like distillers. These actions undoubtedly led the failure to detect or protect millions of Americans as well as the probable death of many by preventing us from having adequate and plentiful ways to assess the virus in our communities. But worst of all is the FDA handling the vaccine rollout. Even though the vaccine got into bodies in a record time, Suderman said they didn't do it nearly as quickly as they could have. Partly by delaying the approval process by weeks or even by allowing the deployment of the virus into public before gaining full approval. They also blocked the use of challenge trials which would have probably shortened the time for vaccine rollout by two months. Imagine how many thousands of lives could have been saved had they had access to the vaccine months earlier. Why Do They Mess Up? Peter Suderman puts it very succinctly, much like my previous guest Dr. Hooman Noorchashm, the bureaucrats like Fauci don't trust average people to understand or be able to figure out how to respond to the virus on their own. The authorities rely on a "science" based top down centralized solution that carries the risk of not coming to the correct conclusion. In that scenario, a wrong process or judgement has enormous repercussions because there isn't any other way of finding a solution to the problem. Decentralized systems use a discovery process that appears messy but usually comes to a more nuanced and useful conclusion in a faster period of time. This is the fatal conceit that bureaucrats like Fauci are plagued with - trusting the public. Peter Suderman is managing editor of Reason Magazine/Reason.com and specializes in writing about health care, the federal budget, and culture. show notes Episode 130: Today's show Imperfect Dad MD Podcast: Dr. Toffle's show. Reason.com: The site for Reason magazine @petersuderman: Peter Suderman's twitter handle Reason Roundtable Podcast: The weekly news show that Peter Suderman stars on . Episode 128: Dr. Hooman Noorchashm talks about how the CDC is misdirecting who should get vaccinated. Episode 123: Why vaccine passports are a bad idea. Episode 087: The deception by our leaders on the coronavirus. locumstory.com: Today's sponsor for the show on locum tenens for physicians. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Perfection. We all strive for it. Some more maniacally than others, but we all look to be better versions of who we are. In medicine, we tend to be high achievers so, of course, we want to 'conquer' parenthood and be the best we can. But being perfect isn't any more possible in parenting any more than it is in medicine. Human relationships are messy and raising children up to be the best versions of themselves has no handbook. The push and pull of you trying to get your kids to be who you think they can and should be is often at odds with who they think they should be. What are the Keys to Being a Good Dad? Although he focuses on how to be a good dad, my guest today, Dr. Jeremy Toffle, says we can't expect that. Instead, we should focus on the six B's of parenthood Brain Body Beliefs Better Half Business Bucks To be a successful father, one needs to focus on all six of these aspects of our lives to be the best we can be. Each one is important and requires attention and work. Oh, and no matter what you can't be perfect in any of them! Let's Look at a Few of His B's - Beliefs Beliefs. We all have beliefs and thoughts about how we should raise our kids. We have values and we usually want to instill those same values into our children. But how do we do it? How do we teach our kids to work hard, get up after they've fallen, and deal with disappointment? Dr. Toffle says there are two ways this is done. One is by direct teaching. This is simply telling  the child what to think. An example would be telling your child, "we don't fight. We forgive seek forgiveness when we are wronged or wrong others." Indirect teaching of beliefs would be asking others for forgiveness in front of your children or maybe with them. They indirectly learn how 'our family' responds to things by the way you behave. What About Bucks & Business? Although these seem the same and may be related, they are not identical. Business is a reflection of how you work. How do you act when you have to go to work or what do you say about working. Are you positive or negative? The children will be affected by whether work makes you happy or frustrated as your emotions will spill into other parts of your life. (Some of these strategies we've discussed before on the show here, here, and here. Likewise, bucks is how you handle money. Are you miserly? Are you a spendthrift? Do you worry all the time about whether you have enough money? Do you gamble it all away? How you handle the bucks in your life obviously can affect everything else including your relationships with your children and spouse (or ex-spouse). Can I Be Perfect? Simply put, no you cannot. You can only react to the situation you are in which is unique to you and your family. Staying aware of how you react, what influences you have guiding your decisions, and recognizing when you have made mistakes so that you can be better in the future. Dr. Jeremy Toffle is a pediatrician in Omaha, NE and the host of the Imperfect Dad MD Podcast. show notes Episode 129: Today's show Imperfect Dad MD Podcast: Dr. Toffle's show. Dr. Noorchashm's Medium Page: This is the easiest way to find the writings of Dr. Noorchashm including his letter to the FDA and President Biden. @mdimperfect: Dr. Toffle's twitter handle. Imperfect Dad MD: Facebook link to Dr. Toffle's show. Episode 033: Dr. Leif Dahleen in the FIRE movement (Financial independence and retire early) Episode 038: Dr. Cory Fawcett in how financial decision affect physician burnout. Episode 097: Dr. Anzalone in investing in real estate.  panaceafinancial.com: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Today's guest on Finding Freedom is Dr. Eric Larson. Eric is a Clinical Assistant Professor of Anesthesiology at Michigan State University College of Human Medicine. Eric is in private practice and is board certified in anesthesiology where he specializes in ambulatory , perioperative acute pain, and general anesthesia. Eric is also the host of, The Paradocs, fun and lively discussion with a couple of docs on the practice of medicine. it's occasionally serious, usually lighthearted, and accidentally informative. Eric has done a fantastic job of talking about the pandemic on his podcast and on social media in a non-partisan way. On today's show Eric and John discuss how SARS-CoV-2 is slowly evolving into the common cold, the controversy surrounding vaccines and Eric shares why he thinks everything (All the things) should be open by June 1st with ZERO restrictions. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today’s guest on Finding Freedom is Dr. Eric Larson. Eric is a Clinical Assistant Professor of Anesthesiology at Michigan State University College of Human Medicine. Eric is in private practice and is board certified in anesthesiology where he specializes in ambulatory , perioperative acute pain, and general anesthesia. Eric is also the host of, The Paradocs, fun and lively discussion with a couple of docs on the practice of medicine. it's occasionally serious, usually lighthearted, and accidentally informative. Eric has done a fantastic job of talking about the pandemic on his podcast and on social media in a non-partisan way. On today’s show Eric and John discuss how SARS-CoV-2 is slowly evolving into the common cold, the controversy surrounding vaccines and Eric shares why he thinks everything (All the things) should be open by June 1st with ZERO restrictions.

  Now that we are entering the last transition phase of COVID-19 in the United States where we are moving from an epidemic to endemic for the SARS-CoV-2 coronavirus, we need to focus on how safest to get there. Clearly, the introduction of a highly effective vaccine is abbreviating the time it would normally take to get our population immunity to this novel virus. What would have taken 2-5 years with multiple outbreaks throughout the country will now be less than 18 months before we get to a point where we no longer have massive spikes of cases, hospitalizations, and deaths from COVID-19. Who is Dr. Noorchashm? My guest is public health expert, Dr. Hooman Noorchashm of Philadelphia, PA. He is a retired cardiothoracic surgeon and PhD immunologist who gained prominence in the public eye over the battle he and his wife had with the FDA. Their story is both inspiring and sobering as his wife Amy, a critical care trained anesthesiologist, fell to cancer in 2017. She underwent a routine laparoscopic surgery for a stage I (least dangerous) uterine cancer. At the time, a morselator was used to grind up the uterus in the abdomen and avoid the need for a larger incision. Sadly, the morselization process itself would create a metastatic spread of the primarily benign cancer. Fortunately, the odds of this outcome were very low (~1/350-400 surgeries). However, when you look at how many of these procedures were done for this condition it amounted to hundreds of women each year who were significantly harmed. This led Dr. Noorchashm and his wife to advocate for all the women in the future who might be affected in the same way she was. Their argument was that there were other ways of accomplishing a hysterectomy that didn't involve the risk of spreading the cancer, however small, that could be used. Bringing risk to a small minority of people was simply unacceptable and violated one of the core tenets of medical ethics - First Do No Harm. Who Should Get the Vaccine? The most important question we have to ask ourselves is who should get the vaccine? Initially, the question was who had the highest priority to get the vaccine which was in a limited supply. Now, however, there is far more mRNA vaccine available than demand for the vaccination. So now the question comes down to who should get the vaccine, or rather, who shouldn't get vaccinated? This is where Dr. Noorchashm argues that anyone who has had COVID-19 and cleared the disease should not get vaccinated. There are no other cases where we vaccinate people against a disease after they have successfully fought it off (flu doesn't count since there are many different types of flu that are different). In fact, most recently, when the chicken pox vaccine was introduced, one of the first questions asked was whether the child had already had chicken pox. A near immunological certainty is that once you have cleared a viral infection, you have immunity that is at least if not more robust than immunity you can acquire from a vaccine. Vaccines clearly create immunity, but it is obviously not the only way to acquire immunity. People who have been infected with SARS-CoV-2  also have immunity and will receive no benefit from a vaccination. So if you receive no benefit from a medical intervention and can only be harmed (however unlikely it may be) then it is unethical to do that intervention. The FDA and CDC Guidance is Not Only Wrong, But Unethical. Strangely, the FDA and CDC have issued guidance that all people eligible for vaccination receive them whether they have had COVID-19 or not. But this guidance is flawed and only puts people at risk who will gain no benefit from the vaccine. This is bad science, a lack of understanding of basic immunology, and not looking at current studies which show definitively that people who have been infected get antibodies. By definition, if you are doing something that only provides risk, no matter how small, is unethical and wrong. Dr. Noorchashm states clearly that the American people can handle complicated instructions and don't need to be put at risk by our health experts unnecessarily. What Should We Do About Vaccinations Then? Instructions for vaccinations should be fairly straightforward. If you have had COVID-19 and cleared the infection do not get vaccinated. If you are unsure whether or not you had COVID-19, get an antibody titer drawn to see if you have immunity. If not, get vaccinated. If you do, don't get vaccinated. Get vaccinated if you haven't had COVID and don't suspect it or have no reason to suspect an asymptomatic infection. (Front line health care worker, point person in retail, close family members or friends who had it) Pretty simple.   Dr. Noorchashm is an immunologist and public health advocate residing in the Philadelphia area. He is pictured here with his late wife Dr. Amy Reed and their family.   show notes   Episode 128: Today's show Episode 086: When does the pandemic end? Episode 096: From pandemic to epidemic. Episode 099: Myocarditis isn't real from asymptomatic COVID-19. Episode 101: From Killer to Common Cold Episode 114: We're in the Transitional Phase now doctorpodcastnetwork.com/larrykeller: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

We're talking about COVID and our American Independence Day from SARS-CoV-2 on June 1, 2021. There is some additional background information that we will leave off but I would suggest that you listen to episodes 101 and 114 for a deeper dive into the science. The first thing I need you to do is look down and if you're wearing a red shirt, take it off. Not just one sleeve, take it all the way off. Likewise, if you're wearing a blue shirt, I need you to do the same thing. There are no red teams or blue teams here. We're just Americans. We're also only discussing the US. The rest of the world is in a different situation than us in the United States. It's time to open up because we have plenty of a really miraculous vaccine. The mRNA vaccines, I believe, will revolutionize many medical treatments going forward. But the point is that right now we are entering the last phase of the transition from a pandemic/epidemic to endemic for this virus in our country. Why do I say this? Aren't you still potentially at risk of reinfection or breakthrough infections if you've had the vaccine? Won't we still get outbreaks until we hit herd immunity? Let's briefly talk about numbers. As of this recording, we are looking at 247 million vaccine doses administered in the US. That is 147 million who have had at least one dose and 105 million who are fully vaccinated (both doses). That is 44% and 31.8% of the entire US population respectively. Further demographic breakdown comes to 56.3% of all adults (those 18 or older) have had at least one dose of the vaccine while 40% are fully vaccinated. Of those elderly (65 and older) who we know are at the highest risk of morbidity and mortality, they have 82.8% with at least one dose and 69.7% fully vaccinated. But we know that this is only part of the story with immunity. We also need to add in those who have had the infection and survived and now have immunity that we know is at least as good as the vaccine but probably better. A conservative estimate is between 20-30% of the American public has had COVID and recovered. Factoring those numbers in puts us at 87% of the elderly have immunity and 67.2% of adults in the US. We also know that reinfections or breakthroughs of the vaccine with COVID are usually much less severe and don't often lead to hospitalizations, ICU stays, and death. So on June 1st, 2021 we should declare it as our American victory day over the virus. All restrictions, mask mandates, lockdowns, gathering limits - all of it - should go away! I don't care if you think the lockdowns worked or not - it doesn't matter. I don't care if you think masks provide great protection or you refer to them as face diapers - it doesn't matter. I don't care. Those are debates we can (and should) have over the next few years. But right now, we need to move forward together. No politics. No Democrats, Republicans, Libertarians, Greens, Independents, whatever. Just as Americans. You need to recognize a few things: No matter what, there is no way to be 100% safe in life. COVID will never, ever, ever go away. There are animal reservoirs and it will be with us forever as an endemic virus. If you have been vaccinated or had the infection, you will almost certainly have significant immunity even with future infections - which will happen. We will never reach 90% immunization rates of adults in the US unless we use force. No future COVID outbreak will overwhelm our hospital systems at this point. They have not come close to being overrun like in some other countries and with the immunity rates, there isn't enough 'fuel' for the virus to infect at this point. There will be other outbreaks and spikes. There will be further cases, hospitalizations, ICU stays, and even deaths. As of today, any adult can easily obtain a full set of vaccines. Supply has now outstripped demand. In fact, in a week from now, children down to the age of 12 will be eligible for the vaccine. If everyone who wanted a vaccine goes, they will be vaccinated by the end of May. This means that every person who wants real protection from the virus can have it. And that means that all the reasons for restrictions will be gone. Why do I say that? Well, we've already established that you can't be 100% safe whether you've been vaccinated, previously infected, or not infected yet. No matter what, you can still get COVID. But if you've had the vaccine or previous infection - you are unlikely to get as sick. If you're a kid, you rarely get very sick. It's almost lightning strike odds of becoming deathly ill. Even if you are still very scared and fearful with immunity, you can always choose to avoid groups and situations that you perceive as more dangerous in getting infected. But if you're vaccinated or had a previous infection, you should feel safe to move about in crowds, etc. There should no longer be a worry about starting a surge in cases locally that will overwhelm the hospitals. There shouldn't be as much of a concern for getting extremely sick. And if some choose to get their immunity by getting infected (which will happen since SARS-CoV-2 is endemic) then that is their choice. The rest of us shouldn't be restrained any longer. It is wrong. It is unnecessary. We need to declare our independence from this virus. And if you believe we need to reach some specific vaccination rate - that isn't based on science. That doesn't take into account the people who have naturally acquired immunity through infection. It would wildly underestimate the immunity rate within the community. People who want real protection will be able to have it so we can go back to normal life. If folks decide to change their mind at some point, the vaccines will always be there for them to get. There is no reason - scientific or epidemiological - to keep things shut down. This is America. We don't hog-tie people and jab them in the arm. We persuade and let them do as they feel is best for them. Let them choose and live with the consequences of their decision. So on June 1st, 2021 let's all declare our independence from COVID for good. When it comes to children, I recognize your fear and understand your concern. Losing a child is the worst thing I can imagine happening to a parent. I've lived it. On August 15, 2018, I lost my 14 yo son Andy in a car accident to a distracted driver. There was nothing I could do. I understand the impulse to protect our kids. I understand the fear parents have. I understand the difficulty in making decisions without perfect information. It's agonizing. But life, as I've learned, is sometimes brief and comes with no guarantees. I had to decide early on if I would ever drive again. Driving is a very risky activity. I had to weigh the risks of driving in a car versus no participating in life. Would my children have fulfilling lives stuck at home? Not going to school, work, seeing friends, doing sports, or other activities? Would life be as rich? Would that be living? Ultimately, we chose that risk and life. We are all faced with decisions that we have to make without knowing the future. Most importantly, you will have to figure out where you set the boundaries for life and risk. But this should not be a political decision. It is a personal one made by individuals. Recognize that we all weigh these risks and benefits individually with imperfect knowledge so please respect others' choices whatever they may choose. That is the defining principle of America. Let's celebrate together the end to this pandemic on June 1st and we can go back to wearing our team blue and red shirts another day.   SHOW NOTES Episode 127: Today's show Episode 086: When does the pandemic end? Episode 096: From pandemic to epidemic. Episode 099: Myocarditis isn't real from asymptomatic COVID-19. Episode 101: From Killer to Common Cold Episode 114: We're in the Transitional Phase now doctorpodcastnetwork.com/larrykeller: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.      

  Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. We've talked about the corruption of the American Board of Internal Medicine, the shakedown by the neurology and psychiatry board, and general state of MOC in America. If you're a doctor, you know all about the unfairness of this system which requires more money, paperwork, money, testing, money, time away from patients and families, and money. It contributes to physician burnout and stress as it is an unwavering pest over our shoulders every day we practice. For patients, it is why your doctor might retire early, look stressed out, or be unavailable when you need him or her most. In this episode, we delve into the details about why the medical boards which oversee maintenance of certification are borderline corrupt.  What is Maintenance of Certification? Briefly, every physician today goes through residency specialty training. That training is standardized within each specialty by a board (eg, American Board of Pediatrics, American Board of Internal Medicine, etc.). If you pass their requirements for completing a residency and testing you are board certified. Prior to the 1990s, this certification was a lifetime certificate. But beginning in the 90s, the boards began requiring testing in cycles and the certifications were awarded in a time limited fashion (usually 10 years). Over the years, the boards have required more and more components to fulfill your maintenance of certification including increased fees, courses, CMEs, in person sessions, research projects, quality improvement projects, and increased testing. How are the Specialty Medical Boards Ripping Off Doctors? Most insurance providers and/or hospitals require physicians to be board certified or be in good standing with their maintenance of certification. This means that the doctors are beholden to the rules, requirements, and fees of their medical boards. There are no recognized alternative boards (the NBPAS is not recognized by most insurers or hospitals) which means it is a monopoly system where doctors have no choice but to comply. Initially, the boards had a fairly loose recertification process just demanding a few thousand dollars every 10 years and simple test to stay certified. But in mid-2010s many of the specialty boards were becoming financially unviable and were in financial 'death spirals', as my guest today explains. The maintenance of certification fee schedule brought in an infusion of needed cash. So much so that the boards don't appear that they knew what to do with it. They began spending it on real estate, massive compensation for executives, and setting up fully funded retirement accounts and pensions for their employees. They are now so awash in cash that they really don't need any revenue for a few years and could significantly cut fees or suspend fees if they wanted. Who is Watching the Boards? My guests today, Charles Kroll and Elizabeth Tremblay, are following the money for these boards. They are investigating all of the corrupt transactions, off shore accounts, and exorbitant executive fees. Their research is helping other physicians challenge the legitimacy of the boards and their financial grip on doctors and their ability to practice medicine. Charles P. Kroll, CPA is a forensic accountant who has been chasing the money and uncovering corruption at the various medical specialty boards. show notes Episode 126: Today's show WikiMOC: This is the site where you can find all of the financial information about the various specialty medical boards, their assets, and their compensation. GoFundMe: This is the link to help financially support the efforts of Charles and Elizabeth in exposing the finances of the boards. Twitter Feed for Kroll: To follow the MOC finances in real time be sure to follow Charles here. Episode 001: What is MOC and why should you care? Episode 009: Dr. Wes Fisher and the corruption at the ABIM. Episode 020: Dr. Meg Edison explains the state of MOC reform across the country. Episode 092: Dr. Sepah describes the problems at the Board of Psychiatry and Neurology. doctorpodcastnetwork.com/larrykeller: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Health care, according to today's guest Dr. Eric Bricker, is filled with euphemisms. One you hear a lot is value based care. The claim is that we need to restructure insurance plans to reward health systems that provide care focused on outcomes instead of activity. Conceptually, it makes a lot of sense that you would reward the people providing superior outcomes with better pay. Unfortunately, this scheme has been tried before and failed. It's unlikely the outcome will be any different this time around. What is Value Based Care? Value based care essentially is paying for outcomes. It is meant to change the process from paying for services to paying for desired health outcomes or metrics. Hospitals and physicians would then be paid based on measures of health or preventative outcomes like ER visits, complication rates, and readmissions. In theory, hospitals or physicians who do a better job of caring for the patients would get more compensation and those that don't would get penalized with poorer pay. The goal is to get more quality care for less expense. In reality, this doesn't happen. What Really Happens with Value Based Care? Value based care has been tried before except it was called capitation then. Essentially, systems get paid for caring for patients independent of how much or what they do. This is in contrast to fee for service where they get paid for every encounter and intervention. This cost saving approach was tried in the 90s. It failed in large part because systems adapted to maximize revenue under the new system eliminating any possibility for significant savings. Instead of providing real savings, the systems in place adapt to find other ways to achieve the same revenue stream and nothing significant changes. Who Wins and Loses with Value Based Care? As with any new payment scheme, there are winners and losers. With value based care (or capitation) primary care doctors are the big winners. Instead of driving so many patients into their clinics to maximize revenue, they are incentivized to keep them out since their payment is based on a per patient schedule - not how many visits they generate. In contrast, the losers in a system like this are the specialists who will not receive any payment unless they perform some service. Those services will probably dry up a bit as the capitated doctors don't want to have their patients get extra procedures or visits which would penalize them in their pay. Dr. Eric Bricker is the CMO and founder of Texas Family Insurance and AhealthcareZ.com. He is an expert in the US health care system insurance based payment system. show notes Episode 125: Today's show AhealthcareZ.com: This is Dr. Bricker's tutorial series where he describes various aspects of the health care insurance payment system. Eric Bricker's YouTube Channel: A collection of Bricker's health care videos. Episode 111: Why unbundling your health insurance can save you lots of money as an employer. doctorpodcastnetwork.com/doc2doc: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Today, we depart from our pandemic of SARS-CoV-2 to discuss what was easily the number one killer of colonial Americans in the Revolutionary War - infectious disease. Ten times as many died from small pox than died as a casualty of fighting in all the battles of the war. It is estimated that battle casualties totaled 5-6,000 while disease (infections like small pox and the like) killed between 40-50,000. The toll paid by the civilian population was even worse as loose estimates put the death toll at 100,000 from infection.  Why Was Small Pox so bad? Small pox is a fairly infectious virus that can only survive in humans. It is also very old. as remains of the poxing has been found in mummified remains of ancient Egyptians. The mortality rate in the late 18th century was around 10-20% of the population in Europe which was more urban that other parts of the world. Small pox, as its name implies created pustules all over an infected individuals skin which would burst and exuded infectious pus. Aside from the obvious skin manifestations, there was sometimes severe breathing difficulties and blindness that could result from a course of small pox. If an individual survived the disease, they would be immune for life. What was life like in colonial America in the late 1700s? It's important before talking about the impact that small pox had on British and American forces to look at what life was like with infectious disease in colonial America in the late 1700s. There were obviously no antibiotics, there was no understanding of germ theory - only that small pox seemed to spread from infected people to those not infected - and there was no health care system to help people while they tried to recover. Basically, death was a common occurrence in colonial America. More than half of all people born would not see their 16th birthday. 12% of children died before they turned one. Death was common, suffering was complete with almost no medications available, and luck was a key to survival. Most of the Deaths in the Revolutionary War Came From Disease - not Guns. War and civilian casualties are not precise but it is estimated that battle deaths accounted for between 4-5000 throughout the war. Death to soldiers from disease (which was usually small pox) was 40-50,000. Civilian deaths to small pox are though to have been as high as 100,000. The reason small pox became such a big problem in the colonies was that a normally rural population suddenly began living in close quarters with other people. The nature of the militia was a big factor as well because the soldiers would travel back and forth from the army to their homes and towns effectively spreading small pox into places where exposure would ordinarily have been very rare. What Effect Did Small Pox Have on the Fighting Forces? Small pox played a large role in reducing the size and effectiveness of the armies in the colonies. In fact, the colonial army launched a campaign to invade Canada early in the war and managed to capture Quebec. Unfortunately, small pox infections and deaths were so bad that 1/3-1/2 of the fighting force died meaning that they could not hold Quebec and had to retreat. In fact, about 12% of all British soldiers died in transit either to or from the colonies because of small pox and scurvy which was caused by a lack of fresh fruits and vegetables. Did they Vaccinate in the War? A process called inoculation was used by the British on many of their troops. It consisted of giving the soldiers a very small dose of the small pox virus and hoping that they would gain immunity. The process had an estimated success rate of 98% but left the soldiers bed ridden for weeks or months. The British recognized that inoculation was an effective means of having a good fighting force in the wars they fought in Europe earlier in the century. The colonial army initially didn't have soldiers signed up to serve more than a few months at a time which made inoculation impossible. However, by the middle of the war, George Washington began signing soldiers up to multiple year contracts and began the inoculation to the army at Valley Forge. The vaccine was not developed until nearly the end of the century by Edward Jenner by using cow pox pus. Michael Troy is the creator and host of the American Revolution Podcast. He lends his expert analysis on the role infectious disease posed to troops and civilians in the American Revolution. show notes Episode 124: Today's show American Revolution Podcast: This is Michael Troy's podcast which explores in depth the American Revolution starting with a brief history of colonial America from its founding leading up to the war for independence. doctorpodcastnetwork.com/contractdiagnostics: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Although the idea of vaccine passports have been floated about for at least half a year, the concept has really begun to pick up steam over the last month. Public health advocates have been pushing for their adoption as a means for 'returning to normal' for Americans. Also, the concept is starting to gain some popularity not only in people who will develop the app (and make money with its adoption) but also in certain large spectator venues like sports arenas and concerts as a way to get quick state approval to reopen to near capacity. What is a Vaccine Passport? Vaccine passports, at least how they are being described, are NOT just a traditional passport that you need for international travel. This would be some sort of electronic app that would store your immunity (either through natural infection and maybe antibodies or vaccination to SARS-CoV-2). In theory, you could present this to certain private venues where the public gathers to allow you access to a safe. It would be an electronic app that you could put on your smart phone to allow for easy access into all sorts of private and (probably) public facilities. One could imagine more than large scale public venues requiring a passport to keep their patrons safe. Essentially, the passport would be used in a domestic manner for commercial access to events, dining, shopping, traveling, etc. Although one could imagine it also required by some countries for international travel, it is likely that they would continue accepting proof of vaccination to travel as they do now for other infectious diseases. This electronic vaccine passport would almost certainly just be required for moving domestically. Moving on any sort of plane, train, or bus would probably require this passport after a time. What are the Practical Limitations to the Passport? Let's begin with the practical limitations to a vaccine passport. First, would be how you define someone as immune to SARS-CoV-2. Would it be vaccination? How recently? Would you require antibody proof? How about if someone had a native infection with the coronavirus? Would you require antibody verification or would a positive PCR test suffice? If so, how recently for the test? One could imagine you could devise an algorithm to answer those questions but it would not be based on any sort of science which will be unknown for years. Second, how would people prove their immunity if they don't have a smart phone or don't have the app? There are millions of Americans who don't have smart phones, would you deny them entry into domestic travel or businesses? What if you forget your phone? Or it loses its charge? Or you lose cell service for not paying a bill? Will you be able to go purchase groceries at the store or enter the restaurant or ride a bus? Finally, how would information be corrected and altered if it is entered incorrectly or changes? This is a non-trivial question if you have ever encountered an electronic medical record and looked to make a correction. It is a clunky and not so simple process. If you want an accurate system how do you verify the data is from a trusted source? In the US, by the Time We Develop Vaccine Passports they Will Be Useless. The strongest argument against the creation of a vaccine passport is that they will be obsolete before they are really ever implemented. Ostensibly, the reason for the passports is to ensure people who are entering that airplane, venue or business that they will be amongst others who cannot transmit SARS-CoV-2 to them. But we have a highly effective vaccine with 95% efficacy in preventing severe disease in those at highest risk - an amazing accomplishment. Also, within about 2 months we will have well over 75% of the country either vaccinated or immune from natural infections putting us near or at herd protection from large exponential outbreaks. The chance of a significant wave of serious infections will be incredibly small except in children who are the least likely to end up in the hospital anyway. If the whole point of the the passports is to signal that people who are vaccinated or had natural infections that it is safe to move around and gather in large groups of people - that will already be the case. There will always be infections and reinfections of SARS-CoV-2 because it will become endemic in mankind but our immune response will almost certainly become more and more benign as we encounter it again and again in our lives. We've discussed this on the show before here, here, and here. This pandemic, although tragic, will come to an end soon in the US and much later in the rest of the world. However, the stress that it puts on our health care system will wane significantly this year and be, at worst, a nuisance in 2022. What Civil Liberty Concerns are there for a Vaccine Passport? Outside of the practical problems of the passport and the fact that it will be useless for controlling or 'keeping people safe' are the very serious civil liberty concerns that a passport like this will present to Americans. Never before have we had to 'show our papers' to move about in our normal activities in the country. A government regulated private app would make it 'official' and one could imagine large heavily regulated industries demanding that people present their proof of vaccination to use their services. It would begin with large scale travel in planes, cruise ships, trains, and concerts and sports gatherings. But this requirement would soon be insisted upon by other businesses as they are concerned with liability and seek a passport requirement as a way to prevent getting sued by people who contract SARS-CoV-2 and are harmed. You can easily see this happen with large chains like Costco or Walmart and soon move to smaller yet large grocery stores or restaurants. The restrictions on domestic movement would be real. It is also unlikely that the passport would just be used for SARS-CoV-2. Soon after it would be convenient to add your other vaccinations (which would also be required to use businesses). Not long after, one enterprising legislator would suggest that we store other health information on this passport like allergies or emergency medical conditions in case you are in an accident. Maybe mental illness could be added allowing for easier background checks for the purchase of firearms or alcohol or other drugs. On top of all this, all your private health information would be held by a private company who could have the data hacked or sell it to third party vendors using HIPPA measures which allows for the quick and easy movement of health records. This could be us in a few months carrying our 'papers' around with us to have access to travel, banks, grocery stores, and restaurants. show notes Episode 123: Today's show doctorpodcastnetwork.com/mrinsurance: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  One gigantic headache that both patients and health care providers face is getting reimbursed for out of network claims. If a particular doctor or health care professional (physical therapist, psychologist, etc.) does not have a contract with an insurance company, then the care they provide is considered out of network. This doesn't mean that the visit or therapy won't be paid for but just that the claims process will not be streamlined for the patient. Essentially, it is left to the patient, or helpful practitioners, to fill out the paperwork and submit to the insurance company for reimbursement. Why are People Out of Network? Getting your care from someone out of network doesn't necessarily mean that you are going to someone who is on the fringe or provides unusual care. It simply means that they do not have a specific contract with your insurance carrier. Sometimes this is because your carrier has a very small market share so it isn't worth the trouble to negotiate an agreement. Other times, it is simply that the carrier doesn't bother contracting with certain types of specialists because there are too many (like physical therapists or laboratories) in a certain area and it is simpler to just have patients or those providers file claims. Being out of network is very common but can present problems when it comes to getting reimbursed for your health care expenses. What is Filing an Out of Network Claim? Filing a claim is similar to asking for reimbursement for some expenses you incurred on a business trip. Usually, you submit receipts from restaurants, airlines, and hotels when you return from a work trip. You spend your own money up front and then later receive compensation from your employer after they process the receipts. Out of network billing works in a similar fashion except it requires more details and specialized forms to complete. Each form requires the usual personal information (name, birth date, etc.), a diagnosis code or ICD-10, and a procedural code or CPT.  What Is so Hard About Filing Claims? The difficulty in filing claims is exactly as you'd expect with any bureaucratic process. It is sometimes slow but can easily be rejected if something is filled out incorrectly. It also requires time obtaining the form, figuring out where to send it, and filling it out. All of these are hassles that drive patients to not bother submitting the claim or avoiding people who are out of network. This last point is a problem for independent doctors and others who are trying to get by but don't have the capacity to be negotiating contracts every day with insurance carriers.  What is Reimbursify? The problem of people not knowing how to file claims caused all sorts of difficulties with my guest today, Dr. Vatsal Thakkar (previously of episode 112 where we discussed Vitamin D). Psychiatry is often out of network with insurance carriers so driving patients into a practice can sometimes be very difficult. Dr. Thakkar began to offer the service of filing claims for his patients which, much to his surprise, drew a lot of patients to see him. He realized that if there was a way to automate the claims filing process for out of network billing, the he could provide a ton of value to both patients and health care professionals. Therein, Reimbursify was born. What Does Reimbursify Do? In the simplest explanation, reimbursify does all the claim filing for the patient. For a small flat fee it will take all the information required and make sure it goes where it is needed. It verifies that everything is filled out correctly and relieves the user of their anxiety from rejection from the insurance carrier. Health professionals can also sign up for the service which waives the flat fee for their patients' filing. In a way, this can serve as a way of replacing a billing office that would ordinarily be filing these same claims with in network insurance providers. Of course, the cost of this service is orders of magnitude less than what an actual billing office or staff would actually cost. Dr. Thakkar is the Founder and CMO of Reimbursify as well as an outspoken advocate for the routine treatment of vitamin D deficiency. show notes Episode 122: Today's show Reimburisfy.com: The out of network company Dr. Thakkar founded to take away the pain of filing out of network claims for patients and health care professionals. Illicit Perks of the MD Club: This is the New York Times article published by Dr. Thakkar. Vatsal Thakkar Wesbsite @VatsalThakkarMD: Dr. Thakkar's twitter handle. doctorpodcastnetwork.com/mrinsurance: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

This is Episode 80 of The Changed Physician Podcast with returning guest, Dr. Eric Larson of The Paradocs Podcast discussing SARS-CoV-2 & COVID-19 in regards to their perspective and vision of its impact now and in the future. Due to video challenges, no images of the speakers were available for this episode. Timeline: 1:10 Eric's take on SARS-CoV-2 (COVID-19 disease) 03:15 Some relations to OC43 [Human coronavirus OC43 (HCoV-OC43) is a member of the species Betacoronavirus 1, which infects humans and cattle; common cold] 05:30 SARS-CoV-2 is likely here forever 06:00 Kevin's take on SARS-CoV-2 and vaccination 07:20 Eric's counter to Kevin on whether booster vaccines needed or not 09:15 The challenges to get everyone vaccinated 10:50 Melissa's discussion of eradication of smallpox and rinderpest 12:20 Eric's discussion of Dr. David Graham's From Killer to Common Cold 14:30 Kevin's take on vaccination efforts with respect to COVID19 and polio effort 17:00 Decreased risk from vaccination exposure versus wild-type, symptomatic infection 19:20 Kevin's flu experience 21:00 Melissa's discussion of fear, beliefs, and knowledge surrounding vaccination 22:50 Eric - Hysteria & society's ability to change en masse (e.g. masks) 24:00 Kevin - hope for comfort with masking 25:40 The pros & cons of masks and profound difference in pediatric practices 27:00 The complexity of immunity 30:20 Medicine is always learning and why we need more data 31:00 Initial reasons behind the initial COVID-19 lockdown 33:00 How good are we at science? 35:00 The need for transparency and admission of uncertainty (& its challenges) 40:00 What is the cost for what we are doing? 41:00 Eric's take on social isolation & early COVID-19 shutdown implications 43:00 Elephant in the room: implications of at-risk children during pandemic 45:00 Private vs. public school experience with Eric's children during pandemic 47:00 Eric's wife's (pediatrician) experience in her practice Dr. Larson's Paradocs podcast can be found at: http://theparadocs.com/ The book that Eric did audio narration for is here: https://www.amazon.com/Killer-Common-Cold-Protection-Transitional-ebook/dp/B08K3PRCXN #sarscov2 #covid19 Learn More About the Community at:

  It is now a year into the SARS-CoV-2 pandemic where we began locking down the United States. Churches, restaurants, health care facilities, general retail, schools, and entertainment were sidelined for much of 2020 and even 2021. We have struggled to understand the new coronavirus strain and predicting how the pandemic will progress. Now that Americans are getting the revolutionary vaccine, we might be facing a new wave fueled by COVID variants. Lockdowns and Mandates haven't worked There is so much evidence right now that shows that the virus spreads and bursts into regional epidemics independent of local measures to contain it. This doesn't mean that masks do not work for individuals to prevent infection or protect others. However, it is pretty clear that laws don't affect containment much in the spread of the virus. Comparing states to one another shows that there is little difference in the extent of outbreaks based on their policies - but more dependent on where the state is located. California, Arizona, and Nevada have infection curves,  deaths, and hospitalizations just about the same as far as timing despite having dramatically different policies, rules, and regulations. The Vaccines Have Changed the Game  But Not Where We're Going Just as we have discussed in previous shows, SARS-CoV-2 will become the fifth endemic coronavirus and we will deal with it for the rest of our lives. Also, we may speculate that like other coronavirus infections, we will have waning neutralizing immunity and become infected many times by this coronavirus. However, it is also probable that we will retain latent partial immunity relegating the virus to a harmless cold especially as kids grow up to be adults. Likely, this coronavirus will just be a nuisance for future generations. We Need to Open Up in a Few Months Once all Americans have had an opportunity of getting vaccinated, it will be time to remove all restrictions on life in the US. This should be mid-summer. There will still be plenty of people getting infected by SARS-CoV-2 for months but the likelihood of swamping the hospitals will diminish over time. The only caveat is that children will not be able to get vaccinated until the Fall (at the earliest) so they will still be getting mini-epidemics. Fortunately, children do not seem to be affected very often in getting as sick and at risk of serious illness. show notes   Episode 121: Today's show Episode 116: PCR testing in COVID Episode 114: David Graham discusses the transitional phase of COVID-19. Episode 086: Dr. Graham Episode 096: Dr. Graham discusses his book Episode 101: Dr. Graham talks about COVID doctorpodcastnetwork.com/contractdiagnostics: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

I encourage you to reach out to me at katemangona@medicinemarriageandmoney.com with any questions, concerns, or suggestions! Want a free copy of The Medical Marriage Survival Guide: An Instruction Manual For Physicians in Love E-book/Workbook? → Visit https://library.medicinemarriageandmoney.com/waitlist and I will send it to you! Want to be on the Women Physicians Medicine, Marriage, & Money Group Coaching Waitlist? →  Visit https://library.medicinemarriageandmoney.com/waitlist now! Want to work with me 1:1 to take your relationship to the next level? → sign up at https://www.medicinemarriageandmoney.com and click “I AM READY” for a free 60-minute introductory coaching consult! I will do the rest!   WHAT YOU WILL DISCOVER IN THIS EPISODE Medicine:  Eric’s plan to get noticed by Marcy at the bookstore and sharing a microscope How Eric broke his arm during medical school Why returning to medicine after the loss of Andy looked different for each of them Marriage:  What Andy ate before marriage and why they likely got married so quickly How they supported each other through the grieving Supporting each others’ podcasts  Money: Why we need to “Thank God for the accountant” and how this helped on Eric’s journey of healing Why we need to all have an emergency fund Grief: Why accept the feelings during grieving How anger and guilt can become poisons Why forgiveness matters and how forgiving is so powerful    TAKE HOME POINTS FROM THE LARSONS Loss and grief are universal. We all experience some sort of loss and grief at some point in our lives. Whether we are going through the loss of a young child, an older child, a parent, or a spouse, it hurts. It is absolutely painful. It just feels wrong. There is no sense in comparing which experience or which loss is worse. We are all on our own journey and that is okay. We can still go through our own journey alongside the support and companionship of others. No need to compare. Just accept that it is hard. Be aware that this is normal.    If we cannot forgive others, we have often not forgiven ourselves.  Sometimes what is right for us is not right for our spouse. Our answers do not have to be everyone’s answers. This is normal. Once you accept this and learn to just be present and supportive in whatever way is needed, the pain may worsen.  Telling our children they are enough. WALK AWAY ASKING YOURSELF Do I sincerely ask for forgiveness when it truly matters? How can I forgive myself when I need compassion and grace? How do I process grief? What does my emergency fund look like? FEATURED ON THIS SHOW Eric’s Website: www.theparadocs.com   Marcy’s Website: www.andysmom.com Eric’s Facebook: www.facebook.com/TheParadocsShow  Marcy’s Facebook: www.facebook.com/alwaysandysmom Instagram: @alwaysandysmom @theparadocsshow Twitter: @theparadocsshow @alwaysandysmom   *This podcast is a member of the Doctor Podcast Network SPONSOR: doctorpodcastnetwork.com/contractdiagnostics or 888-574-5526

  Trust is essential in medicine. Not only between a doctor and patient but between a community and the health care system. A unique difference between the United States and Africa is the relative recency of colonial powers controlling the country. Our colonial past is distant dating back to the 1700s. For Africa, it's as recent as the late 20th century. But how does history of recent colonialism affect current attitudes towards medicine? How Colonialism Bred Mistrust Today's guest, Dr. Sara Lowes has spent a lot of her academic career trying to better understand the intersection of governance and economics in central Africa. One question she and a colleague posed was to better understand why some parts of central Africa were more resistant to modern medical care than others. Specifically, they tried to understand why some people were more likely to refuse free medical care or vaccinations than others. What they found is that the more interventions that occurred by the colonial powers many decades ago created more distrust generations later in that same community. One reason for the mistrust was that a lot of those treatments were done without any consent and at the end of a gun. Also, many of the treatments had side effects like blindness which led many to fear the appearance of these colonial medical teams. Mistrust Persists There are a number of childhood diseases which can be effectively prevented with simple vaccinations. Dr. Lowes and her colleagues found that the more a community had a contact with these treatments, the less likely they would vaccinate even many decades later. This even extends to simple medical test like blood draws for HIV. What is so amazing is how even 50+ years later the colonial actions by France caused a perpetuating mistrust of the modern medical system. Traditional Medical Practitioners a Solution? Many central Africans, especially those in rural regions, first visit with a traditional healer for their health concerns. These healers rarely have any formal training outside of an apprenticeship. However, they are often a more trusted source of healing within their village so perhaps they are the solution to rebuilding trust in modern medicine. By becoming advocates of some modern treatments like vaccines, Dr. Lowes speculates that they might be the key to fixing the modern medicine mistrust. Sara Lowes, PhD is an Assistant Professor of Economics at UC San Diego. Her research interests are at the intersection of development economics, political economy, and economic history. show notes Episode 119: Today's show The Legacy of Colonial Medicine in Africa: This is one of the papers we discuss on the show. Traditional Medicine in Central Africa: An abstract of the second paper we discuss in the show. SaraLowes.com:  This is Dr. Lowe's website with her writings. Twitter for Sara Lowes: @sararlowes doctorpodcastnetwork.com/LarryKeller: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Today is a departure from a direct discussion of the medicine or the US medical system. We delve into food. Food, is medicine in a way since it has physiological effects on how our bodies function. There's also a lot of rules and regulations around food that prevent people from being as healthy as they could. Finally, what's the deal with eggplants? Where Your Food Comes From is Important It is no longer a secret that the source of our food is an important bit of knowledge worth having. If the food is locally sourced it has many inherent advantages like improved 'ripeness' at harvesting, decreased transit time and chance to spoil, and it supports a local food network. Supporting local food sources creates a more robust supply chain which should offer protection if and backups in the events of disasters or a disruption in transportation of products. Unfortunately, many forms of government work to prevent the local sourcing of food through their regulations (usually written by massive food producers.) The regulations favor large operations that are probably less safe in some ways because they mix all sorts of products together in one centralized location. It may add convenience and some lowering of costs by scale but presents risk. One example would be mixing many different cows in a collection of ground beef. Contamination of just one of the cows could potentially spoil millions of pounds of beef. In contrast, buying your meat from a local farmer doesn't risk infecting an entire food supply - just one family. Also, with the farmer working with just one cow it is a lot easier for them to recognize problems and treat them. Is Aquaculture Common? To my surprise, Dann spoke about how common aquaculture for seafood is. On average, 50% of our seafood and fish come from farms all over the world. These environments are of dubious safety  for the animals and the potential for disease is much higher with these creatures penned in together in abnormal living conditions. What's surprising is that a large collection of seafood can be grown in aquacultures like shrimp, mussels, oysters, tuna, and salmon to name but a few. Unfortunately, it is very difficult to determine where your seafood came from if you're at the store. The only reliable way is to ask the employee at the fish counter if the fish was fresh caught or not. Although the US has a number of restrictions in place to prevent the movement of seafood from countries with unsafe aquaculture practices, it is not uncommon for them to move the seafood to another country and package it there in order to change the 'country of origin' label. Only by seeking out fresh caught can you be certain of the fish being from a sanitary environment. What's the Deal with Eggplants? Before the interview in jest, I sent Dann a question about why would anyone want to eat an eggplant. I've always seen eggplants as pretty but inedible. Dann surprised me in sending in all sorts of reasons why I should not only eat eggplants, but why they are an amazingly versatile vegetable (berry really) for cooking. Eggplants are a rare food that maintains its structure despite being cooked thoroughly and also absorbs all the flavors from the spices and other foods it's cooked with. Our discussion almost made me want to go out and buy an eggplant. Almost. Dann Reid is the host of the Culinary Libertarian podcast and has extensive experience throughout the food service world. He has worked as a cook, executive chef, and everything in between.   show notes Episode 119: Today's show Culinary Libertarian: This is the hub for Dann Reid's activities. Access the podcast, writings, and recipes here. doctorpodcastnetwork.com/MedEvolve: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  One thing few outside of medicine realize are the unique challenges doctors face in their personal relationships. Marriage, especially to someone without a background in medicine, can be especially difficult due to the unique responsibilities and expectations placed on doctors for their jobs. In some ways, life isn't all that different for physicians trying to juggle work and home life except that work can be extremely chaotic and unpredictable. Unusual hours, call, and administrative work that can find its way into the home is stress that can strain any relationship if the couple isn't careful. Your Thoughts Are Key to Winning Marriage According to my guest, Dr. Kate Mangona of the Marriage, Medicine, & Money Podcast, the most important takeaway in her experience is realizing that the relationship will be exactly how you perceive it. This means that you need to understand your partner and recognize that they may be seeing a situation in a different way than you. You have to be empathetic to their viewpoint and also intentional about communicating with them to understand why they feel the way they do. Maybe you just need to ask them what they are feeling to period since guessing often leads to disagreements and hurt feelings. Don't Be Defensive Fundamentally, how you are feeling will shape your relationship. If you think someone is controlling then you will become defensive. In fact, being defensive is a perfectly normal and predictable reaction to many situations and conversations we have that have any element of disagreement. But we must try our best to understand our partner and their point of view because maybe they aren't being controlling but protective for some reason we don't know. A great example is someone who is upset every time we make a purchase and complains that we are wasting money. Perhaps they are just being cheap but maybe they were mentally keeping track of expenses so that the two of you could afford to go on a special surprise vacation. It is important to better understand the situation and partner rather than jump to becoming defensive. What Are the Stakes? All of these strategies are so important because we rely on each other for support through the unending stressors that accompany life. Whether it is at work, the children, or extended family, we will encounter challenges that are so much easier to handle with someone trusted at your side. Strong relationships take work and understanding but come with a lot of joy and fulfillment that make it worth while. Failure to be mindful of our personal relationships and marriages in medicine can lead to divorce, substance abuse, and even suicide as we have discussed previously on the show here and here. Dr. Kate Mangona is the host of the Medicine, Marriage, and Money Podcast and also serves as a relationship coach. show notes Episode 118: Today's show Medicine, Marriage, & Money:  This is Dr. Mangona's website for her podcast and coaching service. Facebook Link: Dr. Mangona's Facebook group Instagram for Mangona Episode 036: Dr. Fawcett discussing burnout and Depression for doctors Episode 030: Dr. Wible on the epidemic of physician suicide. doctorpodcastnetwork.com/Resolve: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Entrepreneurs are funny creatures. Some seem to be born to innovate and create businesses. Others, like today's guest, create new businesses out of necessity because they can't find a system that works for them. Dr. Rick Rosenfield is an OB/GYN who enjoys gynecology surgery and having the ability to work the way he wants focused on patient outcomes and providing personalized care. He didn't feel that he could do that in his first job with a large health system so he struck out on his own and started doing something no one else had thought to do - outpatient laparoscopic hysterectomies. What is the advantage of Outpatient Laparoscopic Hysterectomies? Twenty years ago, the thought of doing a hysterectomy (removal of the uterus) as an outpatient procedure would have gotten you laughed out of the room. But Dr. Rosenfield thought it could be done if you did it laparoscopically and refined the process around medications, anesthesia, and postoperative care. So he built a free standing surgical center and just started doing it. What started as an experiment quickly became a much larger movement within the gynecological surgical realm where laparoscopic hysterectomies are becoming more and more common. The advantages are obvious with shorter recovery times, resting at home, and significantly reduced costs. Also, by specializing in gynecological surgery he had much larger surgical volumes which led to lower complication rates and improved outcomes as he became much better than the average OB/GYN who might only do 5 hysterectomies per year. By keeping patients out of the hospital he improved patient satisfaction while providing tremendous cost savings to health plans or self insured patients. What is Pearl Precision Surgery? After the creation of Pearl Surgical Center in Portland, Oregon, Dr. Rosenfield became connected with large employers looking to decrease their health care costs. Naturally, they saw his surgical center as a solution especially since he had great outcomes. Unfortunately, large national employers couldn't always get their employees all the way out to Portland for surgery so he created Pearl Precision Surgery. Pearl Precision Surgery matches patients and employers with high volume, quality, and lower cost surgeons in other parts of the country. Now a chain like Albertson's groceries can find solutions for their patients no matter where they are in the US. Dr. John LaGrand from episode 046 of the show is one such example with his work in Grand Rapids, MI. Now, Dr. Rosenfield is hoping to increase the reach of Pearl Precision Surgery into other specialties and further growth by helping connect high quality surgeons to patients in cost effective surgical centers all over the United States. Dr. Richard Rosenfield is the CMO and founder of Pearl Precision Surgery. He is an OB/GYN who was one of the pioneers in outpatient laparoscopic hysterectomies. show notes Episode 117: Today's show Pearl Precision Surgery:  This is Dr. Rosenfield's business where he matches patients and employers with high quality affordable surgery. Pearl Surgical Center: This is Dr. Rosenfield's surgery center based in Portland, OR. Pearl Women's Center: This is Dr. Rosenfield's comprehensive women's health center in Portland, OR. @PearlWomensCntr: Twitter handle for the Pearl Women's Center LinkedIn for Dr. Rosenfield Email Dr. Rosenfield: rrosenfield@pearlprecisionsurgery.com Episode 046: Dr. LaGrand and his discussion on how he is changing the way he delivers babies and how it has lowered his c-section rate. doctorpodcastnetwork.com/mrinsurance: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  One thing you can be certain of with COVID-19 is that there is no shortage of controversy. Whether it is lockdowns, treatment, vaccines, or testing there have been volumes written about what should or should not happen. So today, we're going to learn about the most common test in the middle of the controversy - the PCR. What is PCR? "PCR (polymerase chain reaction) is a very sensitive test that can detect down to one molecule of DNA or RNA," said founder and CSO of Medicinal Genomics, Kevin McKernan. I contacted Kevin to help us get to the bottom of what PCR is, its limitations, how to interpret results, and what is the best path forward to use the test in the midst of a pandemic. PCR is an inexpensive, quick, and very sensitive test that amplifies the target proteins in the sample. By running multiple cycles, the target is doubled each time until it is detectable. Once a sample turns "positive," the test runs a few more cycles to verify the positive result. Usually, the PCR for SARS-CoV-2 (the virus responsible for COVID-19) returns to patients as either positive or negative. Why Does Cycle Time Matter? The number of times a sample has to be cycled through the doubling process is a way of determining not only the presence of a particular protein, but also its prevalence. Low cycle times suggest that there is a lot of the target while high cycle times suggest that there is not nearly as much. Since we are doing doubling you can imagine that for every 3.16 cycle times you have 10 times as much target substance. For today's SARS-CoV-2 PCR tests patients and clinicians are only given a qualitative answer of positive or negative. But, it is almost certainly true that the cycle time is important for understanding how infectious an individual is. The human body will shed inactive virus particles for sometimes months after an infection which can be detected by the PCR. This means that one could have a positive result even though it has been months since you could transmit the virus to others. As you can imagine, cycle times offer a window into how likely you are infectious (have enough targets suggesting an active infection) and perhaps we should insist the lab provide a qualitative and quantitative result for us. What are Other Concerns  About the PCR test? One of Kevin's concerns is that we are centralizing the testing of PCR by only having it occur in a few locations. This groups both symptomatic and asymptomatic people together causing a potential hot spot for transmitting the virus. Additionally, by centralizing and not allowing home testing, the costs for the PCR test are driven up. Finally, part of the quality control for PCR tests is to determine if the host DNA is acquired in the sample (this shows that the test was done properly) and there is not usually any way of knowing whether the DNA is being stored (something I talked to Twila Brase about before with regards to HIPAA). Kevin McKernan is the Chief Scientific Officer and Founder of Medicinal Genomics. He has years of expertise in PCR testing and provides insight into the PCR testing issues surrounding SARS-CoV-2. show notes Episode 116: Today's show Medicinal Genomics:  This is Kevin's company that he founded and serves as the CSO. They specialize in testing cannabis products. @Kevin_McKernan: Kevin McKernan's twitter handle. Assessment of SARS-CoV-2 Test Results: Journal of American Medical Association by Liotti, et al discussing the infectivity with PCR tests. Episode 023: Twila Brase discusses the problems with HIPAA and how it doesn't do anything to protect your medical privacy. doctorpodcastnetwork.com/alpha: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

S1-E7 The paraDocs are Fran Battisti, Ph.D., Distinguished Psychology Professor, former Executive V.P., and Chief Academic Officer plus Helen Battisti, Ph.D., RDN, CDN, Assistant Professor, Health Promotion Specialist, Research and Clinical Registered Dietitian Nutritionist. They share their insights into human behavior and potential that are gleaned from their many experiences.Learn the early advice each received and how following it shaped their futures.Look for issues of "The Zone" newsletter that are filled with great advice for business and living. The newsletter is always presented in a concise, easy to read format including bulleted Key Takeaways, Best Practices, and Things To Limit.Request your newsletter here: battistifrancis@gmail.comRequest Fran and Helen for presentations and more for your organization here: https://www.battistimanagement.com/Fran on LinkedIn: https://www.linkedin.com/in/battistinetworks/Helen on LinkedIn: https://www.linkedin.com/in/helen-battisti-66510829/

  Dr. Diana Bitner describes herself as a survivor. As an OB/GYN, she had what one would describe as a typical practice. She was employed in a large multi-specialty physician group that later got acquired by a large health system. But within this traditional insurance based practice, Dr. Bitner looked to deliver care to her OB/GYN patients in a different way. She thought of herself as an 'intropreneur' where she was continuously trying to innovate processes within the large health system. Can You Innovate in a Large Health System? We've discussed on the show doctors who have developed a new model for care in women's health and plenty of discussions about direct primary care. But we've not had a guest like Dr. Bitner who started innovative processes for patient care while part of a large health care network and then left to better implement them on her own. Doing so was not easy. Although she had institutional support to start the health care process, once it became bigger and wasn't operating on enough of a margin, they dropped support and her brain child died on the vine. Dr. Bitner learned two valuable lessons while creating women's health wellness processes within the large health system. First, the products and intellectual material created while you are employed is owned by your employer - not you. Second, she learned how to run a business within a business by creating the process and making a break even and seeing patients the way she wanted. However, once the system chose to abandon her innovative wellness model she had to fight with lawyers to reclaim her intellectual property. So What Is Bitner's Innovative Wellness Approach? The model adopted by Bitner is based on membership and developing products (apps and written materials) that assist in patients's understanding and the efficiency of clinic visit. She has various levels of membership for her True Women's Health practice where she focuses on helping women navigate the changes their bodies go through with aging. These changes include perimenopause, meonpause, and sexual health/dysfunction. By addressing the hormonal and age related changes to women's bodies, Dr. Bitner is helping her patients achieve health goals they previously thought impossible. A great way to get started learning about how to address these health changes can be found in her free eBook, SEEDS. Dr. Diana Bitner is the founder and CMO of TrueWomen's Health which is a membership based women's health clinic. The clinic specializes in all aspects of women's health including menopause, sexual health, and post-cancer care.   show notes   Episode 115: Today's show True Women's Health:  This is Dr. Bitner's practice. You can find her transparent membership pricing, written materials, and the services she provides. @bitnermd: Dr. Bitner's twitter handle. Episode 047: Dr. Herkelroath and her women's health specialty clinic. doctorpodcastnetwork.com/contractdiagnostics: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  In his excellent book, From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19, Dr. David Graham lays out the upcoming evolution from pandemic to endemic for SARS-CoV-2 virus. Although published months ago, the book has proven to be right on with how the virus is progressing and we now find ourselves in the transitional phase of the pandemic. The virus is transitioning from a global pandemic to one where it will live forever (until we can eradicate it) in the worldwide human population. What is the Transitional Phase of SARS-CoV-2? Dr. Graham and I have discussed the evolution of the COVID-19 pandemic in previous shows. We first spoke about how the pandemic will end, how it transitions to endemic, the evolution and nature of coronaviruses, and now how this entire transitional phase turns out. The discussion today recognizes that we have now definitely entered the transitional phase where the virus is starting to lose its foothold. There is now a race between the virus and uninfected individuals getting vaccinated. Once the virus moves out of this deadly phase of affecting new immune systems, it will become more benign. If we look at past coronaviruses that made the jump into humans (most recently OC43 in the late 1800s) we can guess that it will soon just become another ordinary cold for most people.   What Vaccines Will and Will Not Do One thing is fairly certain, we will not eradicate this virus any time soon. In fact, the multitude of variants in existence and the ability of other coronaviruses to evade our immune system after time will allow SARS-CoV-2 to persist forever in humans. We will continue to infect others whether or not we have the vaccine. Immunity will wane and because there is so much SARS-CoV-2, we won't be able to dodge it forever. Most adults and children will end up seeing this respiratory virus many times again in our life times. SARS-CoV-2 will become endemic and circulate in the respiratory tracts of children and adults but we will all build up natural immunity to prevent us getting anything more than a bad cold. Why is No one Talking About the Transitional Phase? Well, it turns out that scientists are starting to introduce the idea that we can't stop SARS-CoV-2. We can only hope to contain the bad effects like ICU stays, death, and hospitalizations. We have to start getting the public to recognize that COVID-19 will be around and will just be less deadly. We have to learn to deal with the virus and accept that it isn't going away. We need to start having realistic and rational discussions about the trade-offs with school reopening in the cities and beginning to regather. We need to set out realistic expectations for the presence of COVID-19 living with a very small chance of risk since we can never eliminate its presence. Dr. David Graham is an infectious disease specialist, author of the book From Killer to Common Cold, and runs the FIPhysician website.   show notes   Episode 114: Today's show FI Physician:  This is Dr. Graham's website where you can find his writing and more about him. Montana & COVID: Dr. Graham writes about his home state of Montana early in the COVID affair. 90% Vaccine Effectiveness is Wrong: Why the 90% headline is the wrong headline for the vaccines. Canary in the Coal Mine?: How bad coronavirus was in late 2020 in Midwest and plains states. Will Montana Have a Second Wave: A good read for any state really. @fiphysican: Dr. Graham's twitter handle. Episode 086: Dr. Graham Episode 096: Dr. Graham discusses his book Episode 101: Dr. Graham talks about COVID doctorpodcastnetwork.com/ontimemd: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Pain. We all experience it. It is as much a part of life as breathing itself. But what is pain? Is it physical? Is it mental? Is it emotional? Is it mechanical? Also, how does pain become chronic? One of the few things experts on pain can agree on is that our ability to treat pain - especially chronic - is not very good. What is Pain? My guest today is Dr. Melissa Cady, an anesthesiologist who is pain fellowship trained. She wrote the book, Paindemic, which describes her journey to explain what pain is and why she felt she could never open a pain practice. Pain, according to Cady, is a combination of physical, mental, and emotional impulses that congregate in our brain to give us a sensation of pain. It is not objective which makes it impossible to measure precisely. Most importantly, unless you address all of the aspects of chronic pain, Cady says you will never be able to effectively treat it. Much of what drives chronic pain is fear. Fear from moving. Fear that the patient will never get better. Fear that whatever may have caused the pain will occur again. Therefore, procedural and pharmacologic interventions may not be effective since they do not address the core of the pain. What is Diagnocentricty? The term that Dr. Cady coins in her book, is diagnocentricity. Basically, this means that the patient becomes referring to him or herself as a diagnosis instead of a whole unique person. They define themselves as "back pain" or Parkinson's disease instead of the many people they really are (mother, professional, hobbyist, loving, funny, etc.) This self-pigeon holing makes it very hard for them to climb out of the pit of chronic pain since their identity is now wrapped up in a diagnosis instead of a fuller picture of themselves. The epigenetics of Pain This definition of ourselves as just a diagnosis is similar to the belief that we are products of our genes with no ability to affect our outcomes. But much as I discussed with Dr. Jason Fung, our notions of how genes work and are expressed is terribly outdated. We have an immense ability to change our gene expressions with diet, activity, and other environmental factors. A simple way of thinking of this is that although there may be a gene regulating your height, it is impacted by your nutrition status as a child. If your diet lacks calories, you will not be as tall as someone who receives a nutrient rich diet in their years of growth. What is an antiPain Lifestyle? Boiled down to its most basic, and antiPAIN lifestyle is simply a wellness program. It means you should move as much as possible to prevent worsening of pain and help with fitness. The most important emotion to overcome is fear of further injury or exacerbation of pain. That is often the biggest limitation to an improvement physically and mentally. It is why it is so critical to have a doctor evaluate the pain to rule out something serious and then work with a trainer or physical therapist to increase strength and stamina. Dr. Cady is the author of the book, Paindemic, which describes the nature of chronic pain and how patients and physicians should approach it. She is also the co-host of the Changed Physician Podcast with Dr. Kevin Cuccaro. show notes   Episode 113: Today's show Challenge Doctor: This is Dr. Cady's website where you can find her book, writings, videos, and generally what she's up to. Changed Physician Podcast: This is the podcast co-hosted by Drs. Cady and Cuccaro where they visit with physicians who are doing creative things outside of a traditional medical practice. @challengedoctor: Dr. Thakkar's twitter handle. Episode 058: Dr. Wayne Jonas discusses his support for self care. doctorpodcastnetwork.com/medevolve: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  As COVID-19 continues to rage across the globe, everyone has been trying to figure out how to protect themselves from getting infected. People wear masks, avoid gatherings, travel, and work from home to prevent the disease. We also know that there is a lot of discussion about COVID and what are the correct measures and what we should do which we have talked about on this show here, here, and here. Although we know a lot about what puts people at risk (age, diabetes, heart disease), not much is talked about as far as preventative care goes. That might be where we should begin our discussion about vitamin D. Perhaps this common vitamin is a linchpin to preventing severe disease and maintaining immunological health. Where Does Vitamin D Work? My guest today is Dr. Vatsal Thakkar, who is has written extensively on vitamin D deficiency in prominent publications like the Wall Street Journal. Evidence continues to mount showing that the fat soluble vitamin is involved in all sorts of biological processes in our body. Most know that vitamin D is necessary to regulate calcium levels and prevent osteoporosis. However, new research shows that it is critical to our immune function. Vitamin D works on immune cells to modulate our immune response to infections. It provides a dampening effect on the response to prevent an over-reaction of inflammatory chemicals which lead to conditions like cytokine storm. Vitamin D also works to regulate fibrinogen which is a key substance in the clotting process. Without vitamin D, we can enter a slightly hypercoaguable state (too much clotting) which can put many of our organs at risk of damage. This could be seen with strokes or pulmonary emboli (clots to the lung causing breathing difficulty or death). Both cytokine storm and clotting disorders are important stages of severe COVID-19 infections that lead to significant death and disability. From Where Does Vitamin D Come? Vitamin D is an extremely common fat soluble vitamin that is most commonly produced in our bodies when exposed to UVB sunlight. We can also obtain the vitamin from consuming it in our diet, although, it is fairly uncommon to get enough unless you have a diet very high in fish. Thousands of years ago, humans spend the majority of their days outside in the sun hunting for food or growing it. Vitamin D was plentiful and we suspect few people were deficient.  Today, we spend most of our days indoors and spend very little time in the sun when the UVB light is most prevalent - the middle of the day. Once the sun goes down, the atmosphere filters out UVB light so any sunlight we obtain is unable to convert to vitamin D. Also, those living above the 35 parallel will not get any vitamin D converting sunlight for months during winter. So even sun exposure on a warm day in November won't be of any use for boosting our vitamin D levels. What Is Vitamin D Deficiency? Vitamin D deficiency is simply a condition where you have levels of vitamin D so low that your biological functions don't work as well as they should. Most people in the world are vitamin D deficient at least during part of the year. An insufficiency is usually defined as a blood level of below 30 ng/mL and a deficiency is less than 20 ng/mL. An insufficiency or deficiency puts you at risk for all the above described conditions. Those highest at risk for a deficiency are people with darker skin, low sun exposure, winter time, and live at higher latitudes. How Do You Prevent & Fix a Vitamin D Deficiency? Fortunately, preventing and fixing a deficiency is simple and inexpensive. Appropriate vitamin D levels can be achieved simply by daily supplementation. The authors at VitaminDforAll.org recommend 4000 IU daily and if someone is extremely deficient to take 10,000 IU per day for two weeks until a proper blood level is obtained. Fortunately, vitamin D is an inexpensive supplement. Why Should We Care About Vitamin D? So the big question is why do we care whether people have a deficiency in vitamin D? This is where today's guest explains that there are two different studies (one placebo controlled, the other not) which showed a dramatic difference in ICU admissions from those treated with vitamin D to those who weren't. In a Spanish study, nearly all the patients were vitamin D deficient on admission for COVID-19 those treated aggressively with vitamin D showed a 90% reduction in admission to the ICU. Essentially, vitamin D deficiency is extremely common, simple and inexpensive to treat, and poses very low risks as an intervention. It is also something that everyone can do so that if they get infected with SARS-CoV-2 they will be less likely to get as sick. It is a simple intervention that may have profound effects on the overall mortality and morbidity of this virus. Dr. Thakkar is the Founder and CMO of Reimbursify as well as an outspoken advocate for the routine treatment of vitamin D deficiency. show notes Episode 112: Today's show Vitamin D for All Open Letter: This is the letter signed by hundreds of researchers, scientists, doctors, and public health officials stating their support for treating vitamin D deficiency as a way of preventing morbidity and mortality in COVID-19. It also gives their recommendations for supplementation. Vitamin D and Coronavirus Disparities: Dr. Thakkar's piece in the Wall Street Journal  Don't Let Patients Die with Low Vitamin D: Dr. Thakkar's joint opinion piece with former surgeon general Carmona this January 5, 2021. Vatsal Thakkar Wesbsite @VatsalThakkarMD: Dr. Thakkar's twitter handle. doctorpodcastnetwork.com/resolve: Today's sponsor for the show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  The most obvious statement we can make about the US health care system is that it's a mess. It's complicated, expensive, and rarely delivers what patients expect. A large part of the problem is because we use employer based insurance products where there is little incentive to control costs or provide the kind of care the patient wants. It's all about incentives and they are placed a long ways from those receiving the care - the patients. The unserious answer to how you fix the health care system is to blow it up and start over. As the largest sector of the economy that hires the most people, there are far too many interests in keeping the system just as it is. Although there might be a sizable electoral will to change things - there isn't any genuine appetite within the industry or politicians to truly start from scratch or honestly address the problems. The solution will have to come from entrepreneurs, employers, and patients. How Can Employers Fix Health Care? Katy Talento is a health care consultant at Allbetter.health and KFT Consulting with an extensive career in federal health care policy. She worked for 5 US senators and early with the Trump administration serving as the head of the domestic health care policy team. Simply put, she understands the US health care system. She knows the players and the hurdles faced by those looking to reform it. Through this extensive experience, Ms. Talento brings a lot of innovative ways to save money for employers and create a better experience for their employees. We all know that people have to pick their insurance either on the marketplace or through an employer. We've discussed the right way to pick insurance options before on the show. But Talento brings a way for employers to specifically save money by unbundling all of the components of the traditional insurance plans offered by carriers. What is Unbundling? Talento allows businesses of various sizes to self fund the insurance care for their employees by bidding out all of the aspects of a traditional plan. This means she acquires a company for processing the claims, a pharmacy benefit manager (that doesn't take kickbacks), deals with hospitals, specialists, imaging centers, and finds a cadre of direct primary care physicians to provide the bedrock for coordinating care. Savings from this technique usually save at least 20% for employers and often provides much better coordinated and personalized care. Also, the care can happen with much more reasonable deductibles and other incentives which will make the employees much happier. How Can You Protect Yourself? Finally, Talento says if you go to the hospital or emergency room, it is important to protect yourself from hidden or unexpected charges. Few people know that when you sign the release form entering the ER that it also includes a provision where you agree to pay your bills at whatever the hospital and their agents charge. She recommends that you fill out a battlefield agreement with the hospital or emergency room. Essentially, you agree to pay no more than 1.5 times the Medicare rate for any services you receive in while getting treated. An example emergency consent form can be found here. Katy Talento is a health care policy analyst with extensive experience dealing with the US health care system. She has worked under five US senators and a presidential health care policy team. She runs allbetter.health which provides solutions for businesses looking to save money and provide better care for their employees. show notes Episode 111: Today's show Allbetter.health: Katy Talento's consulting business. @KatyTalento: Katy's twitter feed. Episode 076: A PBM not looking to rip you off with Vinay Patel. Episode 007: Dr. Kevin Wacasey tells us how to pick the right health insurance plan. Episode 042: My earlier synopsis on how to fix the US health care system. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Direct primary care (DPC) is a style of practicing medicine we have discussed many times on the show. The way DPC works is that instead of using insurance to cover the cost of doctor visits with copays, patients contract directly with the doctor – usually on a monthly basis. This allows them to establish a nice long term relationship where they intimately know their patients. Paying doctors monthly is great for this long term, continuous care. But what happens when care has to be episodic like with a pregnancy? And if you're that doctor covering all the patients in your panel for 24/7/365 how do you ever take time off if one becomes pregnant and needs to be delivered? Can You do OB in a DPC Practice? The short answer is yes and quite a few do it. I am not aware of any pure obstetrics practices that use fully transparent pricing and membership (that would be quite the commitment to need years of pre, peri, and post natal care!). The long answer is that if you're a family practice doctor who chooses to do DPC and include pregnancy in your practice you need one thing above all others: friends. In my interview today with Dr. Nicholas Tomsen of Wichita, KS that is his biggest piece of advice for doctors starting out looking to do maternal care. Find either some other physicians in your practice or the community who are willing to provide the coverage you might need at times to allow you to go on vacation. How Do You Recruit Indebted Doctors to Join Your Group ? Now that DPC is entering its toddler years and leaving infancy, it needs to solve some problems related to growth. How is it best to grow in a time where most new residents enter the work force with $200,000 in debt from medical school and undergraduate? Large hospital systems and employers (including the government) can afford to forgive that debt and start these new physicians in a busy practice with plenty of patients. But for a small independent practice without piles of capital one must be creative in finding solutions. Fortunately, as DPC groups become established and successful they are finding ways to solve this problem by offering employment agreements paying new grads the same as their resident salary while letting them moonlight while building up a patient panel. Dr. Nicholas Tomsen is a family physician and co-owner of Antioch Med in Wichita, KS. Antioch is a DPC practice that offers obstetrical services to its patients.   show notes Episode 110: Today's show Antioch Med: Antioch med is Dr. Tomsen's DPC practice where he is co-owner. Episode 002: Belen Amat on why she went into DPC Episode 004: How to start a DPC with Dr. Chad Savage Episode 031: Dr. Nitin Gupta in a pediatrics DPC Episode 067: Dr. Josh Umbehr in the liklihood of DPC becoming a dominant player in primary care. Episode 105: What is the one question you wish you knew about DPC before starting? Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Welcome to another episode of Action and Ambition. Today's guest is Alex Pollak. He is the CEO and President of ParaDocs Worldwide Inc a global medical company that provides on-site medical services for events and venues. Most recently ParaDocs has shifted focus to help businesses and events return safely by providing covid compliance, health screenings, and covid testing. Alex is an NYC paramedic, holds an MBA in Finance and International Business, and is a Lean Six Sigma BlackBelt. You're going to love this episode.

  Well, it finally happened, the COVID-19 vaccines have started to arrive and get administered to health care workers in the United States. The first out of the gate is the Pfizer vaccine which will almost certainly be followed soon by the Moderna vaccine. Both vaccines use a revolutionary new technology for inducing an immune response, messenger RNA (mRNA). As millions of doses start rolling out throughout our hospitals and nursing home care workers we need to reflect on whether the vaccine is effective, safe, and how it should be distributed. My discussion today is with Dr. Tim Hindmarsh who is the co-host of a fellow Doctor Podcast Network show called BS Free MD. Dr. Hindmarsh has extensively studied the vaccine and faces questions every day from his patients about whether or not they should get the vaccine. Is the Vaccine Safe? The preeminent question that everyone asks me in the OR or on social media is whether or not the vaccine is safe. The simple answer is yes. A more nuanced and accurate answer is almost certainly but perhaps time and millions of doses will lead to a more robust feel as to how safe the vaccines really are. Obviously, there is no long term data because there hasn't been enough time passed to gather data. What we know of short term results is that the vaccines seem very safe. The usual vaccine related complications that people really worry about (Guillan Barre, transverse myelitis, etc.) occur within the first six weeks or so of vaccination. Those haven't been seen in the trials so far with tens of thousands of volunteers. But that doesn't answer the broader question of what the potential long term complications of the vaccine might be. I believe by the time the vaccine gets to the public distribution phase we will have a very good idea if there are any side effects that just aren't being picked up right now. Since that is months away we will have more than enough time and doses given to evaluate its long term safety. Does the Vaccine Work? Again, we can answer this questions two different ways. Short answer: yes. Long answer: yes and maybe. The studies clearly show that the vaccines minimize the likelihood of developing severe COVID-19 disease. And functionally, that is all that really matters. Yes, the chance of you getting a severe infection to COVID isn't 50% but it is also much greater than zero if you are older. And even quoting survival numbers is not that helpful if you end up sick and unable to work for months or some complication to the virus which happens even to those who survive. The other question that we don't know is if you can still get infected if you've been vaccinated and transmit the virus to others. The studies weren't designed to find that answer so it will be months before we know the answer. It is possible that the immune response triggered by the vaccine prevents the presentation of symptoms but that you still get infected and spread the virus. A good example of this would be the oral polio vaccine which allows for infection but it prevents the devastating paralysis effects (the US no longer uses the oral vaccine but an inactivated injection now).  Should I Get the Vaccine? Here the answer is it depends. If you're elderly or have any of the now well known co-morbidities (heart disease, diabetes, pulmonary disease) then getting the vaccine should be a no-brainer. Contracting COVID-19 will almost assuredly be a worse chance of survival than any theoretical risk from the vaccine. Also, those working in that population or coming in contact with patients should probably get it too. Having that much exposure just puts you at a risk that probably makes the chance of severe COVID too high when compared to theoretical risks. The tricky answer lies in what to do with a healthy 25 year old. I suspect that by the time that individual has the opportunity to get the vaccine we will have more knowledge of any complications and make a better assessment at that time. For now, just remember that even if you get COVID-19 and survive or have mild symptoms of fatigue and fever it's not any fun. Just as I don't believe the flu will kill me I still don't want to get it because I won't be able to work and I will feel miserable.  Dr. Tim Hindmarsh is a family physician and the co-host of the new podcast, BS Free MD. show notes Episode 109: Today's show BS Free MD: The show with Drs. Tim & May Hindmarsh giving you a straight talking truth to medicine. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Access to reasonably priced health insurance is a big reason a lot of people stay in their unfulfilling jobs.  It's one of the reasons I stayed at my old employer as long as I did, because I knew how expensive health insurance was on the open market, and I didn't want to go without.  And if you're an uninsured adult you're looked upon as though you are irresponsible, so I was astounded when I listened to an episode of The Paradocs when Dr. Eric Larson & his wife Marcy discussed their year spent without health insurance.  After the episode I still had a few questions about their experience, so I invited Dr. Larson on to ask those questions & have a discussion about the health care industry. Full show notes can be found at www.justaddliberty.com/9

  What does it mean to feel grief? Is it sadness? Anger? Resignation? Unfortunately, life will almost certainly present you with grief at some point. Where there is love there will also be grief when the love is lost. It might come unexpectedly or slowly over years. But always, grief is a human emotional state that we will all have to struggle with before our life is over. As a physician, one treats not only physical illness but also mental anguish. We see people at their worst and lowest points when they are scared, angry, and anxious about the future. To meet them in their place with empathy is difficult and it is important to know how to deal with them  Additionally, it is important to know how to support your colleagues, friends, and family if they are suffering too.  What Can You Do to Help Those in Grief? The most important thing one can do is to recognize that someone is suffering and don't feel like you are obligated to make them feel better. It is almost certain that you can't make the pain go away. One liners about suffering being eased by the loved one probably won't help either. The best thing to do is acknowledge the loss and say, "I have no words for your loss."  Just as important is to mention the name of the lost loved one. Even if it seems to bring a tear don't feel as if you have done anything wrong. From there, see what the patient or friend wants to do. If they want to talk follow their lead, if they speak about something else be comfortable that that is ok too.  It is critical that physicians don't lose their humanity. It is a good thing to feel pain and sadness along with our patients so long as we are not the ones who need comforting from the patient. Walking with someone on their journey even for a few minutes - will be appreciated by the person in grief. Dr. Marcy Larson is a general pediatrician and the host of the podcast, Losing a Child: Always Andy's Mom. show notes Episode 108: Today's show Episode 100: Our episode together discussing what we've learned through the first 100 episodes. Episode 025: Marcy and I discuss the loss of Andy soon after his death. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Cancer. It is a word that evokes feelings of fear, pain, hopelessness, and loss. It also brings to mind images of chemotherapy, nausea, weight loss, hair loss, and loved ones suffering in pain. Cancer is all of these things and so much more. But what is more interesting is why do people get cancer? Why do all cancers end up looking the same despite originating from different parts of the body? And why is something so common that it is a leading cause of death in the United States still so difficult to treat? The Origin of Cancer Dr. Jason Fung visits again today but instead of talking about intermittent fasting, he joins me to discuss his new book, the Cancer Code. The book focuses on all of the new discoveries made in the field of cancer over the past 20 years. A lot has been learned which has fundamentally changed our view of cancer's origins which affects our focus on treatments. Only by understanding where cancer comes from and why it exists can you effectively treat it. The short answer is that cancer is simply a normal multicellular cell that decides to become unicellular. What is Cancer? Our understanding of what cancer is has evolved over the years. Cancer has been around for as long as recorded history and can be found in almost every multicellular organism from hydras to birds to whales. Originally, cancer was seen as abnormal growth so the therapy focused on stopping the growth. That means surgery and chemotherapy. Next, we learned about DNA and recognized that the abnormal growth came because of mutations so we directed therapy at specific genes. Finally, now we see cancer as primarily a failure with the immune system. Why do we get cancer? Now that we know cancer is abnormal growth of cells with genetic mutations not destroyed by our immune system we can focus on therapies and preventative strategies. A lot of abnormal growth signals come from insulin which is a hormonal growth factor - not just a metabolic growth factor. And which patients have the highest levels of insulin? Diabetics who are predominantly obese. Despite our efforts to prevent cancer by aggressive anti-smoking campaigns and removing asbestos from buildings we are losing the war against cancer because obesity is increasing at an enormous clip in the United States. The discussion we have is wide ranging and will be useful and interesting to anyone with or without deep medical knowledge. Everyone has intimate knowledge of cancer with someone in their lives and the show will give you a deeper understanding of what it is and maybe what you can do to prevent it. Dr. Jason Fung is a nephrologist and the author of the new book, the Cancer Code. show notes   Episode 107: Today's show Episode 102: The previous show with Dr. Fung regarding intermittent fasting and treating obesity and diabetes. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  It's been a while since we have discussed medical liability on the show but malpractice is a large and expensive part of what doctors have to face in today's medical landscape. Physicians are often under attack not just from frivolous lawsuits but also attacks from disgruntled patients online or office disputes. It is important for doctors to understand the risks they face both to their careers and personal reputation and to their practice and business. Malpractice is common which is obvious after you realize that 99% of surgeons will be sued at least once in a 30 year career. Traditionally, malpractice insurance carriers work to defensively protect physicians and their assets. Playing Offense This is where Dr. Segal and his company, Medical Justice, differs from your traditional legal defense firm. Medical Justice is a company that is membership based and protects doctors from not only malpractice lawsuits and online reputation attacks, but also is there to serve as a guide to help you survive any employee or patient dispute. He also says that unlike the typical insurance company, his will work offensively against the parties bringing the lawsuit with countersuits, etc. Practically, this means the doctor has someone who will work proactively defeat the plaintiffs,  but more importantly, to provide the advice necessary to prevent the lawsuits from happening in the first place. Much of the mitigation process when medical errors or misadventures occur is to achieve an appropriate level of communication with the patient or family. This is often best handled with someone who is experienced who can provide the best course of action for lots of situations. By establishing this relationship ahead of time with an advisor, you can head off a lot of problems before they become really big problems. Jeff Segal, MD, JD is a trained neurosurgeon who is the founder and CEO of Medical Justice. The company serves to monitor and protect doctors from frivolous lawsuits and unfair online attacks. show notes Medical Justice: This is the link to Dr. Segal's medical liability mitigation company. Pricing, links to his podcast, and an explanation of benefits for the program can be found on the site. Episode 106: Today's show Episode 008: Dealing with Malpractice, Suicide, and Depression with Dr. Stacia Dearmin. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

This is Episode 44 of The Changed Physician Podcast. Timeline: 00:30 Why she went into medicine 04:00 Losing her mother & her impact 08:30 Medical school realizations 11:00 Meeting her husband in medical school 14:00 How they navigated couple's match for residency 16:30 Her take on having children during training 22:50 Pros and cons of dual physician marriages 29:15 Private practice and Life-changing car accident 32:30 Trying to go back to work after tragic loss of son 34:00 Taking leave of absence for grieving process 34:30 Finding a calling when couldn't find help for herself 36:30 How losing your child is so different than other losses 38:00 How her podcast has helped her get back to medicine 38:40 How her empathy has magnified for childs' parents 40:50 Increased compassion after child loss tradeoff 44:30 Be okay with being present with uncomfortable feelings 47:00 Things to consider doing and saying for those in grief 48:00 Being comfortable with being uncomfortable 51:20 Losing patients and recognizing your own humanity 54:05 Showing strength when expressing feelings (compassion) 55:45 Needing better medical training in strength and compassion 57:00 Show Your Feelings, but Not Lose Yourself Podcast, Losing a Child—Always Andy's Mom: iTunes: https://podcasts.apple.com/us/podcast/losing-a-child-always-andys-mom/id1478067472 Website: www.andysmom.com You can reach Dr. Larson at marcy@andysmom.com Her interview with her husband, Dr. Eric Larson is on Episode 25 of The Paradocs podcast regarding the tragic loss of one of their sons: http://theparadocs.com/2018/10/21/episode-025-two-doctors-grieving-the-death-of-their-son-with-dr-marcy-larson/ Interview of her husband (Dr. Eric Larson) on The Changed Physician: https://youtu.be/42G8YqUm6cc Learn More About the Community at:

  Direct primary care (DPC) is a movement that is growing quickly in the United States. Patients and physicians are looking to bypass the traditional box store medical practice and deal directly with one another. The DPC relationship is personal, small, and simple without middle men (or hospital systems). Instead of relying on copays and insurance for receiving care, patients sign up for a monthly membership with a doctor and usually get 24/7 access to a doctor. Often, the doctors provide extra value for membership by providing medications at wholesale prices, discounted laboratories and imaging studies, and unlimited visits. All of this is for an affordable price that is much, much less than the cost of an insurance plan. But the shift to this sort of practice can be scary for a doctor. If you're newly out of training and carrying hundreds of thousands of dollars in medical school loans - can you make it? Will you find patients? What do you need to know? In order to answer some of these questions I asked nine DPC practices from around the country what is the one question you wish you knew before you started a DPC practice? (The quotes below are actually paraphrases from our conversations both on and off air.) Marketing Dr. Rebekah Bernard of Gulf Coast DPC in Fort Meyers, FL says that you should watch out on what you spend for marketing. "The advertising sales people are great at selling their products and getting you to buy to grow your practice. But I found that they weren't that helpful and the best way to grow was on my own through social media. There really isn't a need to spend a lot on advertising since the best kind is free."     Trial Memberships Dr. Deepti Mundkur of My Happy Doctor in San Diego, CA was surprised that a number of potential patients looked to receive free trial memberships for her medical services. "I was surprised by people calling to see if they could get a free month trial period for my medical services.  I wasn't really prepared for it and it caught me off guard. I understand how direct primary care may seem similar to a subscription service like Netflix and YouTube. "With the medical liability and importance of good care I had to gently say that I didn't provide free medical service as an office policy. Then I explained what I offered and its value but added they could try to find that sort of service for free elsewhere in San Diego. I doubt any of them did."       Empathy and Trying to Run a Business Dr. Matt Falkiewicz of Nova DPC in Grand Rapids, MI says the most difficult question he and his partner have faced is being empathetic to those hurting financially while still running a business and staying profitable. "We were not ready for the problems that come from people who can't pay for care and services. There were a number of times when they didn't pay the lab fees or monthly membership that we ended up having to pay for those costs. It is still a discussion we have to have to decide whether we cover some costs or delay payment. "We went into medicine to care for people and help them. But we also have to be mindful that it is a business and we can't always do things for free. So we are more careful by charging ahead of time for labs and the month of membership. But we still talk to each other whenever the question of need comes up to decide what to do for patients in specific circumstances." There is No Cookbook for DPC Dr. Nitin Gupta is the owner of Rivertowns Pediatrics in Westchester, NY and practices pediatrics in the metropolitan New York City area. He said the most important question he wished he knew before launching his practice was that there is no cookbook. "I followed the all the 'rules of DPC' before starting out. I posted all my prices. I touted direct primary care as the model. But I really struggled getting off the ground. I kept having conversations with potential patients and spent a lot of time explaining to them what direct primary care was. Eventually they'd say something like, 'Oh, it's like concierge medicine.' "I realized that I was spending too much time confusing people with the term direct primary care. So I started calling myself concierge and it changed everything. Now I was having conversations about what I could do for patients, not a payment model. I also learned that by removing the transparent pricing off my website that I had a lot more people reaching out to me and signing up. This is probably not the right thing in every area but it is in my market. You need to understand your market and adjust even if the model is the same as other DPCs." Learn from Others Dr. Belen Amat is the owner of DPC of West Michigan in Grand Rapids, MI (and happens to be my doctor). She says that flexibility and a willingness to learn from others would be what she wished she knew before starting. "There are so many things that I didn't know and it turns out that most people had the answers. Whether it is to not waste money on marketing or which licenses to get, I wish I knew to find out more from those willing to help early on. Facebook groups are now a great place to find out information on what you should know. "There is no reason to pay for a lot of that information but you have to accept what you don't know and be flexible. I tend to be stubborn and have to learn on my own the hard way but you don't need to do it that way any more. There are so many more practices out there now and doctors who are happy to help you get started. There are plenty of patients so there is no one too worried about competition." What to Buy My next guest, Dr. Katie Edson, is the owner of Edson Family Practice in Christiansburg, VA and says she wishes she knew what to buy for medical supplies before starting her practice. "When you're in training or working for a traditional practice the medical supplies are just there. You don't have to think about them or even know what they're called. You also have no idea what quantities or anything that you might need are. "I realized when I started that I needed medical supplies so I purchased a lot of things for every possible medical procedure that I could imagine doing. Later, I realized that I had too much and a lot of things that I didn't need." I Wish I knew About DPC Earlier Dr. Christine Hoffman of Vanguard Family Medicine in Murfreesboro, TN had a very simple answer to the question of what she wishes she would have known before starting a DPC practice. "I had practiced medicine for 20 years and just wish that I had known about DPC sooner. It has made medicine fun again and I've gone from a doctor ready to quit to one who loves practicing medicine again."         Buy Exactly What You Need Dr. Julie MacNeil is a pediatrician and the owner of Anchorage Home Call Pediatrics in Anchorage, AK. She wishes she knew that you can order exactly what you need. "I thought when I started that you had to buy everything in large quantities for medical supplies. I also thought that it would be difficult getting supplies living in Alaska so that the shipping rates would force me to buy in large amounts. It wasn't until later that I discovered I could buy just very tiny numbers of things like 5 syringes and needles. This has helped prevent a loss of inventory as products and medications expire. "Even in Alaska, there are lots of options that don't cost a fortune if you take the time to look. So now I buy exactly what I need for each procedure and don't usually have to wait very long either." Believe in Yourself and DPC Finally, Dr. Eric Kropp of Active Choice Health Care probably has the answer to the question at the forefront of anyone thinking about starting a DPC practice. "The question I wished I knew before starting a DPC practice was that it would work. I only wished I had confidence to have started earlier because I can now practice medicine and care for my patients the way I want. "I was in a traditional practice for only 5 years when a senior partner suddenly passed away in his sleep. My reaction wasn't of empathy or concern but of anger and frustration as I knew I'd have to care for those patients on top of my current ones. I realized that if that's the reaction I had then I had better do something better for myself and my patients. I heard about direct primary care and thought it sounded right. Now that I am doing it I am no longer missing my kids and family and am back to being a doctor treating others with the empathy they deserve." show notes DPC Mapper - This is a great website and resource for anyone looking to find a DPC practice in your area. It is also a great way for doctors to reach out to others who have made the leap. Episode 105: Today's show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

This is Episode 40 of The Changed Physician Podcast where Dr. Melissa Cady and Dr. Kevin Cuccaro explore the journey of anesthesiologist-podcaster Dr. Eric Larson from premed days to private practice, the tragic loss of his son, and his own wife's shift into podcasting as well. Timeline: 00:30 Why he went into medicine 03:00 Medical school experience 09:00 Realizations during residency/practice (pre-podcast) 10:00 Post-podcast realizations 11:00 Why he started a podcast 13:30 How the podcast has affected his current practice 15:55 How his perspective shifted by seeking out guests for podcasts 20:00 Intention behind his Paradocs podcast 25:30 How podcasting has impacted his family's tragic loss of their son 27:30 How he helped his wife create Andysmom.com & her podcast 28:00 How tragedy changed him as a physician 31:30 The impact of losing his son 35:00 Being more accepting and compassionate Dr. Eric Larson's Paradocs podcast can be found at: http://theparadocs.com/ Episode 25 with his wife discusses the tragic loss of one of his sons: http://theparadocs.com/2018/10/21/episode-025-two-doctors-grieving-the-death-of-their-son-with-dr-marcy-larson/ You can learn more about his wife Marcy and her podcast at: https://andysmom.com/ Learn More About the Community at:

  The Story In late Summer of 2019 my wife and I had to make a difficult choice - to buy traditional health insurance or go without. We are both physicians so it is sort of expected that we have traditional health insurance for us and our family. In fact, it is quite funny to see the shock on someone's face when I tell them that we don't have health insurance while working in the operating room. My wife is a pediatrician and I am an anesthesiologist. The circumstances that led to this decision were strange but like most people, our insurance coverage is tied to our employment. Well, we had always gotten our health insurance through my wife's pediatrics practice. The partners provided insurance as a benefit to themselves by paying most of the premium out of their practice. It was a benefit that you either took advantage of or  bypassed but she was basically 'paying' either way out of the group's overhead. Well, life changed dramatically for us in August of 2018 when our middle son, Andy, was killed in a car crash. Although I went back to work, it became impossible for my wife to see children in the clinic while dealing with the grief of losing her child. Since she hadn't worked in quite a while, her office was no longer able to cover her with insurance leaving us with two options: take my group's insurance or go without. Initially, we purchased insurance through my physician practice. The expense was full, however, as we have structured our group so you get whatever benefit you want but you pay for it ahead of time as a business expense. So, although you can write off some of it by paying pre-tax, it is still a sizable cost which is why it always made sense before to choose my wife's insurance. After two months we were approaching open enrollment in November of 2019 and I was looking at the expense of the insurance. Earlier that month I had done an episode on health sharing and I happened to have lunch with another physician who told me about his health sharing ministry. His pleasure at the coverage, structure, and expense of the plan convinced me to research it. I knew our loss of insurance for my wife's employment would be temporary once she started working again but it presented us the opportunity to 'try no insurance' for a year.  To be fair, we have a comfortable income and unless something went catastrophically wrong with the sharing, we could financially survive. Additionally, if things got too difficult we would always have the option of buying insurance through my private practice group. The Plan Our plan was built on two parts. One, to put the family on the same doctor who was operating a direct primary care. This is essentially an affordable membership based doctor who allows you 24/7 access with many other valued benefits. Ours provides medications at wholesale prices and finds significant discounts for laboratory and imaging if needed. Second, we selected a health sharing ministry to provide the coverage should we find ourselves with a large medical expense. Health sharing ministries aren't exactly insurance. You basically sign up and agree to pay someone somewhere a set payment to help them cover their medical expenses. Then if you ever need payment for procedures or doctor visits or treatments others send you checks in the mail to cover your costs. These sharing ministries won't cover any pre-existing conditions and make you pay the first $250 or so for any new diagnosis.  I have included a chart (link below) detailing our expenses for the year with medications, sharing amount, labs, imaging, and doctor visits outside of our DPC doctor. I tried to be as faithful to actual costs as I could estimate since I knew some of the cost of medications purchased through insurance and some of the copays with a traditional HMO/HSA family with $3000/$6000 deductible. The Punchline There were a number of questions I had going into this year long experiment. I was pleasantly surprised that the answer to them was positive. We saved probably around $3000 in a calendar year despite having to pay extra for a doctor. The health plan option after the tax benefit was about $200 more per month. However, with the savings we received through the DPC doctor on medications easily drove up our savings. We quite possibly saved even more money with our procedures in November of 2019 because we paid cash and didn't pay the inflated 'discounted' insurance deductible cost.  Additionally, we became much better shoppers of medications, laboratory work, and medical resources. Admittedly, we didn't use a lot but we thought about price so much more than ever before and saw even more in depth how broken, crazy, random, and dumb the medical billing system is. The part I was most worried about was how comfortable would I feel in my 'coverage' should something bad happen. I can say, whether it was because Samaritan Ministries was unique or not, was that I never felt worried. We dealt with a claim right out of the box and saw that it would be handled quickly (once I figured out how to do it) so it made sense and seemed like a prudent choice. Ironically, we will enter onto my wife's insurance again now that she has restarted working simply because it is so much less expensive. However, we will keep our DPC doctor because the service was a million times better and we get some savings from medications. Cost Comparison of Sharing/DPC vs. Traditional HMO/HSA Insurance Options - One Year     show notes Episode 002: DPC doctor (mine) Dr. Amat discusses why she switched to DPC. Episode 061: Dr. Wacasey on how to select health insurance. Episode 048: Matt Bellis on Liberty Health Share and how they work. Episode 056: Getting Ripped Off by Insurance Episode 071: Why Medical Bills are Crazy Expensive Episode 093: Scriptco - Subscription generic medication service which can massively lower your bills Episode 088: Randy Lovell hand surgeon Episode 104: Today's show Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

On this edition of Bagels and Broadway, meet Alex Pollak, founder of Paradocs, a company that provides medical staff for film and television sets among other locations,  Danielle Oteri, from Arthur Avenue Food Tours in the Bronx bringing the sites and smells of this great food region in NYC to customers virtually, and Al Cattabiani, publisher of Now With Purpose, a new digital magazine that celebrates positivity and kindness. See omnystudio.com/listener for privacy information.

On this edition of Bagels and Broadway, meet Alex Pollak, founder of Paradocs, a company that provides medical staff for film and television sets among other locations,  Danielle Oteri, from Arthur Avenue Food Tours in the Bronx bringing the sites and smells of this great food region in NYC to customers virtually, and Al Cattabiani, publisher of Now With Purpose, a new digital magazine that celebrates positivity and kindness. See omnystudio.com/listener for privacy information.

I recently had Dr. Eric Larson of the ParaDocs Podcast on the show. Similar to what I do on the Doctors Unbound Podcast, he interviews different physicians every week. He focuses on the barriers in the healthcare delivery system and has created a community for doctors to learn from one another.  Check out the show, and then head over to theparadocs.com to learn more about Dr. Larson's mission. https://www.doctorsunbound.com/podcast/the-paradocs-of-the-healthcare-system 

A conversation with Dr. Larson of the ParaDocs podcast about what we know and what we don't about COVID-19. Is a vaccine around the corner? Who is likely to die? Is there an obvious reliable pattern to explain which cities and states are most affected? Please check out the Paradocs podcast. http://theparadocs.com/ Twitter @TheParadocsShow My episode on the paradocs http://theparadocs.com/2018/11/08/episode-027-the-opioid-crisis-and-whos-to-blame-with-dr-howard-grattan/

Dr. Eric Larson returns to the show today, and with all that's going on in the life of a certain friend of his (cough Justin Amash cough), I thought it best to get an insider scoop into who the Congressman really is, focusing specifically on his libertarian credentials and his vision for the Libertarian Party and the greater liberty movement at large. Also, we dig into Eric's new podcast, "The Amash Files", and also do a quick update on life in the medical world, focusing specifically on life as a doctor who mainly deals with elective procedures. Find Dr. Larson online: https://twitter.com/EricLLarson Find "The Paradocs": http://theparadocs.com/, https://twitter.com/TheParadocsShow, and https://www.facebook.com/The-Paradocs-2103034463249509/ Find "The Amash Files": https://www.amashfiles.com/ Support The Brian Nichols Show Learn more about your ad choices. Visit megaphone.fm/adchoices

  We're back at it again discussing the Coronavirus pandemic. The shutdowns/lockdowns continue in the United States and the tenor of the debate or discussion had changed within the media and culture. At the beginning of the pandemic the focus was on flattening the curve. Today, it is about stopping people from 'catching' the coronavirus. This is a mistake. Our leaders through the media are either intentionally misleading people or foolishly  changing the goals of the fight against the pandemic. Because of this, people are seeing no way out and those making decisions are forced to use arbitrary guidelines for how to combat it. This leads to distrust from the citizens and people violating the orders - even the sensible ones. In the episode I will discuss the exponential spread of disease, what we know and don't know about coronavirus, and what we should be doing. Eric Larson, MD is the host of the Paradocs. show notes The CIDRAP Viewpoint: This is the paper referenced in the episode that goes through the epidemiology of what is known about the virus and things to do. Episode 086: My discussion with infectious disease specialist Dr. David Graham about Montana and how he believes this pandemic ends.  Episode 085: What Michigan is doing wrong during the pandemic response and what it should do. Episode 084: The bungling of the outbreak with Michel Accad. Episode 083: Surviving coronavirus without health insurance. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  Pharmacy Benefit Managers (PBM) have been the villains in a number of earlier episodes of the Paradocs. Basically, PBMs are some of the largest health care corporations in the US and exert tremendous lobbying pressure in DC and state capitals. Although their role in health care is to efficiently settle claims with insurers, patients, and employers - that's not how they make the bulk of their money. Actually, they make their billions through a complicated series of kickbacks and rebates from drug companies meaning they pay more attention to that revenue stream than their core mission of serving to keep costs low for their clients. My guest today is Vinay Patel, a pharmacist who was frustrated by the actions of the PBMs and decided to do something about it. He saw that there was an opportunity to carve out space in the market for a PBM that is transparent to its clients. They are harnessing independent pharmacies around the country to keep costs low. Thanks to the internet it is easier than ever to collectively coordinate pricing for these pharmacies to help them compete against the large big box national chains. However, the big PBMs which comprise 80% of the PBM market, won't go down without a fight. They are continuing their price gouging and use their influence to move friendly regulations to the detriment of the upstart PBMs fighting for market share. Patel and his partners are hoping to break the stranglehold on health care from these big players in the pharmacy and PBM market with Mako Rx. The basic business model of Mako is to provide the adjudication process as a straightforward fee per transaction removing the incentives the larger PBMs have for driving up costs to employers, etc. According to Patel, Mako Rx is nearing the launch of its app that will help consumers find low cost drugs from the independent pharmacies in the US and hopes to expand to cover the entire country in a few years. Vinay Patel is the founder of Mako Rx - a pharmacy benefit manager company committed to bringing increased transparency to the market as well as strengthen independent pharmacies all over the country. show notes Mako Rx: The company website for Mr. Patel's PBM company. MakoRX: Mako on LinkedIn. Episode 005: How PBMs are largely responsible for drug shortages. Episode 043: How PBMs jack up drug prices with Dr. Feldman. Episode 071: Why that medical bill is so expensive. Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

This is a wide ranging discussion about the current state of US medical system, Ron Paul's campaign, the few good congressmen that followed Ron Paul and Eric Larson's hard work and effort to keep liberty alive. He and I discuss the improvements in society that are ongoing and the positive things we see in the future. Find him at www.theparadocs.com and keep his podcast going at https://www.patreon.com/theparadocs

  One of the most common questions I get asked about the health care system is why are medical bills so enormous? It seems strange that the explanation of benefits you receive after getting care or services are so obviously inflated. Yet those charges which the hospitals, health care professionals, and pharmacies post are there to see which they clearly have no expectation of getting paid. Why does this happen? And why do insurance companies - which one would expect to have incentives to keep these charges low - seem to be ok with them?   The answer lies primarily with the following four points which I will describe: Hospital Charges: Hospitals are encouraged to inflate their posted charges even though they have no expectation of collecting them because of a payment system known as Disproportionate Share Hospital Charges. Hospitals routinely contract with insurance companies for much lower payments for services which are sometimes less than 10% of posted charges. The reason is that the uncollected amounts the hospital will then claim as uncompensated care, ie, care for the indigent or charity care. This program funnels billions of dollars into hospitals nationwide (in 2017 it was $17.1 Billion). Insurance Charges: One would expect that insurance companies would balk at these massively inflated charges but they don't because they too benefit from large posted prices even when they contract for lower prices with the hospitals. Oftentimes, a percentage of the insurance's business is a bounty they receive from employers for providing "savings". This means that in an inflated charge where they pay only 10% they count the 90% as a savings to the employer who will then turn around and pay an extra amount to the insurance company. For this reason, so long as the insurance company can get good contract rates it is in its best interest to have larger and larger posted charges. Health Professional Fees: Similar to the insurance companies, health professionals (physicians, laboratories, physical therapists, etc.) have reasons to inflate their charges beyond what they can expect to receive. This is because small insurance carriers occasionally pay a per cent of charges rather than a set fee for certain services like Medicare/Medicaid. Therefore, the higher the charges, the greater the revenue (55% of $100 is bigger than 55% of $50). Pharmaceuticals: Finally, pharmaceuticals are expensive because they rely on pharmacy benefit managers (PBMs) to get on hospital and pharmacy formularies (which are then used for insurance companies). These PBMs are very concentrated and hold a lot of leverage in getting drugs to the physicians and hospitals so the manufacturers of the drugs cut "rebates" to the PBMs in order to make it onto the formularies. Unfortunately, these rebates rarely make it back to the insurance companies or patients to allow for smaller premiums. Instead, the PBMs pocket these percentage rebates and use them to help their bottom lines. It also creates a perverse incentive for the PBMs to have expensive drugs when cheaper alternatives might be available. An example is that a 50% rebate on a $1000 drug yields the PBM $500 profit where an equally effective drug priced at $200 would only give them $100. It's important to note that medical care is not solely expensive because of these four factors and there are a lot of things which make care so expensive. This is simply an example of the four most common reasons our bills are so inflated and the contribution to the high prices in health care is due to so many more distortions in the market. To learn more about why health care is so expensive, continue tuning in to the Paradocs where we discover together the problems and some innovative solutions people are discovering to provide high quality, low cost care. Dr. Eric Larson is the host of the Paradocs and an expert on health care policy. show notes The state of Michigan Report on Disproportionate Share Hospital Verifications: You can see here from this example report the massive amounts of uncompensated care provided by hospitals that they then bill Medicare and Medicaid at year end. Episode 005: How Pharmacy Benefit Managers rip you off with Dr. Mass. Episode 029: Why American Health Care is So Expensive with David Hyman Episode 031: My previous discussion with Dr. Nitin Gupta before he became famous on the CBS evening news and received the Paradocs bump. Episode 042: How to fix US Health Care system Episode 043: How PBMs Jack Up Drug Prices with Dr. Madelaine Feldman Episode 056: Getting ripped off by health insurance where I discuss my recent problems with insurance charges. Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

  If you own your own business, which physicians who are independent or run concierge or DPC practices do - you need to focus part of your time on branding and marketing. For direct primary care doctors, their business model is so new that most potential patients are not only unfamiliar with the practice but also the terminology. What words you use to describe yourself is critical to success and an important part of marketing and branding.   My guest today is pediatrician Dr. Nitin Gupta who we met on Episode 31 when he was just starting his practice. He is now a year in and through marketing is seeing real success. But it wasn't until he pulled the prices off of his website and branded himself as concierge that the patients started coming. In New York, the term concierge is a common one people are familiar with to describe doctors who don't take insurance. So by selling his personal care, accessibility, and value he now commands a growing patient list without focusing so much on price.   Whether this strategy would be successful for other DPC groups or not is something to see and probably depends on the area of the country and relative wealth of communities.    Dr. Nitin Gupta is a DPC pediatrician at Rivertowns Pediatrics in New York. show notes Rivertowns Pediatrics: Dr. Gupta's practice in New York. Rivertowns Peds on Facebook Episode 031: My previous discussion with Dr. Nitin Gupta before he became famous on the CBS evening news and received the Paradocs bump. Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Dr. Eric Larson joins the podcast to give us deep insight into Rep. Justin Amash, his strategy and why lovers and liberty should be excited. Also, Star Wars or Star Trek? Then we talk about "The Paradocs" podcast and, the situation with American healthcare and where the problem started. Listen to his podcast >>> theparadocs.com, Matt Gurtler episodes mentioned, bit.ly/tr_58 and bit.ly/tr_61 and Support the podcast >>> patreon.com/rebellionpod

  Problems with health insurance is certainly nothing new and my recent experience is not unique. Recently, I received a bill for a test at a 2000% markup over what the company would have accepted had I paid cash! But because I decided to submit the claim to my health insurance company (which denied it) I was sent a bill for an astronomical amount. Obviously, I won't pay the jacked up price but the whole episode got me thinking, is it ever a good idea to use your health insurance to pay for 'little tests and maintenance?"   The whole affair began after I had an episode of syncope while on call. I bumped my head, had to get stitches, etc. On returning back from Spring Break I went to see my direct primary care doctor.  We felt like a holter monitor was a reasonable test to be sure I didn't have sort of dysrhythmia (heart rhythm problem). Because she is a DPC doc, she knew the cash price was $250 but asked if I'd like to submit it to insurance anyway since they might cover it. I agreed and wore the device for a week.   I received a bill in the mail six weeks later for $5000! They would have charged $250 at the outset but had jacked up the price when submitting to my insurance carrier. My doc then called the testing company who said that this was a common practice for the insurance company to deny payment a few times and then they'd send me a bill for around $250. The episode highlights so much of what's wrong with the 'system' as it is set up today: Patients (me) are looking to get their care for free and don't think about prices much. There are entire departments of people paying (insurers) and people charging (testing companies, pharmaceuticals, hospitals, physician offices, etc.) who spend their days and resources sending back and forth communications that serve no one. Insurance companies arbitrarily deny payments of reasonable tests because it is ordered by the 'wrong' person. The testing companies charging increase their prices to insurers hoping they will pay. Even with discounted prices acquired by the insurance companies, it is often better to negotiate or pay for these smaller routine test and medications out of pocket without disclosing the presence of insurance.   Dr. Eric Larson is the host of the Paradocs and was much younger when this photograph was taken.     show notes Twittering for Eric Larson: @theparadocsshow Episode 002: Dr. Amat, the direct primary care doctor mentioned in this show, describes what it is like as a DPC doc. Episode 007: Dr. Wacasey describes his method for picking insurance and why insurance is a bad way to pay for most things in medicine. Twitter Thread on Described in the Episode: This is the twitter thread I referred to in my show. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

When Justin Amash decided to leave the GOP last week, my first thought was how big of mistake this was going to be for his career. But like any good reporter, I decided to do a deeper dive into the life and career of Justin Amash and I must say how wrong I was about him and his intentions behind his stunning decision. This is a guy who has won very difficult elections since 2010 and winning them by making his campaign about taking the dirt out of elections and even trying to make governing about what is best for the people rather then what is best for the party. So when he wrote his OpEd in the Times declaring his independence from the GOP, it was true to form for this congressman. In declaring his independence, he made a decision that he could no longer serve his district and be part of a political party and on his way out the door he put both parties on notice that he was not alone and more was possibly to come. I had to know more about this man and what he has planned and luckily for us our good friend Dr. Eric Larson of the Paradocs podcast is best friends with Rep Amash and was allowed to stop by The Gray to help us understand the man behind the decision and learn what we can all do to support a true patriot like Rep. Amash.

Episode Notes Physician families often enjoy mom or dad stitching them up and avoiding the long ER lines at hospitals.  It's nice to have a parent that can give medical advice.  As physician parents, we know how to help our kids.  So when the worst happens, how does it affect your family? In this episode of Married To Doctors, physicians Marcy and Eric Larson share their story of losing their teenage son in 2018. They share the anguish they felt at the time of his death as well as how it continues to make an impact on their lives.  Marcy is a pediatrician and Eric is an anesthesiologist.  You can learn more about Eric and Mary by checking out Eric's podcast, The Paradocs.       

On this week's Electric Libertyland Brian welcomes in Dr. Eric Larson, host of the Paradocs Podcast and longtime friend to Rep. Justin Amash. Eric shares his firsthand insight into why Amash went independent, his plan going forward and what party he might choose should he decide to make a POTUS run for 2020. We got inside baseball here, folks! Then Brian takes the show home by talking about Jefferey Epstein's "lotita express", Bill Clinton, Trump and the rest of the elites who visited Pedophile Island, and what could be the golden domino falling. Show notes at http://www.lionsofliberty.com/ell132  

In this episode of Eyetrepreneur, Dr. Eric Larson dives into the current state of the healthcare system, including the direct primary care model, business models of hospitals, and so much more. In This Episode: [5:42]  The Paradox Podcast [7:06] The advantage of the direct primary care model. [12:20] How to help people realize that they can pay with cash instead of always through insurance. [15:10] Seeking care despite a high deductible plan. [16:45] The business model of hospitals and what's going on in health care consolidation. [22:20] What happens when a patient needs more days in the hospital. [24:30] Are we repeating history when it comes to hospitals and healthcare systems becoming more vertical? [27:30] Efficiency in third party payers. [43:50] Are drugs cheaper outside of the US? [50:05] Are physicians saying enough is enough? [56:10] Maintenance of certification. [1:00:15] Systems that work for healthcare. About Dr. Eric Larson: Eric Larson, MD is a Clinical Assistant Professor of Anesthesiology at Michigan State University College of Human Medicine. Eric is in private practice and is board certified in anesthesiology where he specializes in ambulatory, preoperative acute pain, and general anesthesia. He serves as the president of the Kent County Medical Society and practices anesthesiology in a large independent single specialty group in Grand Rapids, MI. He works in the Grand Rapids, MI area and is married to a pediatrician with whom he has three children and one foster son (now grown and soon moved out of the house). He is the host of the popular new podcast, Paradocs. The show covers a range of topics related to medicine and the delivery system. Specifically, Dr. Larson interviews another doctor (usually) where they discuss the issues facing physicians in medicine and how it affects their practice and patients. You can find the Paradocs on all podcast software or at his website, www.theparadocs.com. Important Links: The Paradocs Podcast Check out the show notes page at eyetrepreneur.com!

  Physician wellness has come to the forefront today as health systems deal with ever increasing numbers of physicians dealing with mental illness and even suicide. There is no shortage of explanations nor ways the health systems are trying to fix these docs. Dr. Sanchez Wohlever has personally dealt with burnout and offers her own prescription for solving the problem. Its systematic approach is both simple and personal.   Unfortunately, for those seeking a one size fits all algorithm, Dr. Wohlever makes the case that helping these physicians requires an individualized solution. It begins with self reflection and the physician finding what it is that he or she really needs. Sometimes that isn't easy to figure out so the best step is to start with something very small. Usually that means examining your day and finding some small change to your routine that lets you take control or fix something that causes you frustration. Maybe that is clumping patient questions into three times a day rather than a constant interruption throughout your office hours. Whatever the specific solution, her book offers many strategies and techniques.   As you work your way through the book, Dr. Sanchez Wohlever offers other ways to help physicians not only straighten out their own personal and professional lives, but ways to help others. This is through either personal relationships with colleagues or political action in medical societies. Using her upbeat and positive attitude, Dr. Sanchez Wohlever can't help but inspire the reader to take action.   Dr. Sanchez Wohlever is the author of the new book, Recapturing Joy in Medicine: A Coaching Manual for Physicians to Live Well and Lead Effectively. show notes Faithful MD: Dr. Sanchez Wohlever's website where you can find her writing, speaking, and ways to access her personal coaching. Episode 15: Dr. Sanchez Wohlever's first appearance on the Paradocs. Episode 30: Dr. Wible and I discuss the epidemic of physician suicide. Episode 008: Dr. Dearmin and physicians dealing with malpractice and depression. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Hey everybody. Stephen Ignoramus here and welcome to Call Me, Ignorant. So pleased you could be with us. Call Me, Ignorant is a live conversation show. Whether with an interesting content creator, an expert in a field, a controversial figure or with a fellow human being trying to spread a message, Call Me Ignorant will try to solve the problems of the world, conversationally speaking. On the program today I have Dr. Eric Larson. He is an anesthesiologist and the host of "The Paradocs" podcast. The Paradocs is a fun and lively discussion with a couple of docs on the practice of medicine. Occasionally serious, usually lighthearted, and accidentally informative, the Paradocs is a show for physicians to learn more about what is going on and a great place for them to direct their friends and family to better understand the challenges they face. Links for Dr. Larson:www.theparadocs.com/bloghttps://www.facebook.com/TheParadocsShow/https://twitter.com/TheParadocsShow________________________________Streaming "The Daily Ignoramus" around midday every weekday. News, History, Idiocy, Call-in's. All set to original music my yours truly. Call in using Discord: https://discord.gg/KyBTmqu "The Know-Nothing Party" live music stream random Wednesday's 8PM Eastern "Call Me Ignorant" is my interview/podcast show, I try to do it 3x a week. You can find it on Spotify, Apple Podcasts, Google Play and Podbean (links below) Follow on twitter @IgnoramusSteveAll other Social Media: Stephen IgnoramusEmail w/questions, ideas, collabs: StephenIgnoramus@gmail.com Streaming and Videos:Youtube: https://www.youtube.com/channel/UCWjJeSvwztALX2HuPu401mgBitchute: https://www.bitchute.com/stephenignoramusDLive: https://dlive.tv/StephenIgnoramusMixer: https://mixer.com/StephenIgnoramusTwitch: https://www.twitch.tv/stephenignoramusPeriscope: https://www.pscp.tv/StephenIgnoramus Podcast:Podbean: https://stephenignoramus.podbean.com/Spotify: https://open.spotify.com/show/6gPqpCLKQDq6gSfuCfHOy7?si=WyuNC4LjScmL1MA1PskHgQGoogle Play: https://playmusic.app.goo.gl/?ibi=com.google.PlayMusic&isi=691797987&ius=googleplaymusic&apn=com.google.android.music&link=https://play.google.com/music/m/I5kph3etuhhvphbsykohdslvkgy?t%3DCall_Me_Ignorant%26pcampaignid%3DMKT-na-all-co-pr-mu-pod-16More to come! Support:PayPal: https://www.paypal.me/StephenIgnoramusStreamlabs: https://streamlabs.com/stephenignoramusBitBacker: https://bitbacker.io/user/stephenignoramus/Patreon: https://www.patreon.com/StephenIgnoramusSubscribestar: https://www.subscribestar.com/stephen-ignoramusBTC: 3Q8GL2w52hWVYfWwc8B2zf1ngvCLknA7ehLTC: MLmurVpEyJxVfVGpdouwWffMeaJjSnen47ETH: 0xd9c6b80068Cc0e38938B9ab4234F0a6fe5C759E6 Go Inform Yourselves.

  There has been no shortage of ink spilled arguing how we fix our broken US health care system so today I will use the spoken word instead. Fundamentally, we all want the same things from the system: Quality care, Affordable care, and Access to care. The real question is how do we move from here to there? Are there people who have fixed these problems even on a small scale that we can use as guides to work things out? Finally, should we look off shores for solutions to our woes?   I feel that there are a few fundamental problems within our current framework that need to be recognized as the problems so that we can focus our solutions appropriately. The large problems are: 1) a lack of transparency on costs, 2) regulations that impede access to affordable care, and 3) a disconnect between the patient and the person and/or entity providing care. In my view, it is not reasonable to look to adopt systems and solutions from other countries as there are too many differences between our cultures, demographics, wealth, and economic infrastructure to expect the adoption of other countries' health systems to work in the US any more than our way of life would work in those countries.   It is also not obvious how much we should spend on the care we receive. In that, I mean to say that there is no ideal GDP figure that we should target because you have to spend money on something and  who is to say what the right amount is? We spend significantly less on feeding ourselves now than in the past which has freed up money to pay for other products and services - some of which are health care. I certainly don't mean to imply the amount we spend on care is correct right now but simply that using a random GDP per centage should not be a gauge for success. If we spent 30% of our GDP on health but we lived healthy and productive lives to age 150 thanks to gene therapy no one would think we were overspending.   However, with that said, it is clear that we are not getting value for what we spend on care. By that token, we are paying too much for what we are getting and need to find ways to achieve the goals set forth above. I believe we have actually been shown some solutions that are already working that don't require significant legislative action and can be implemented today that will improve health, lower costs, and improve access.   First, primary care could be delivered through the direct care model. Even specialized care could be administered this way. Physicians have shown that they can radically reduce the price of care to patients and provide them superior care than through traditional insurance third party pay plans. Second, we could switch from a third party insurance system to measures that control costs and put patients back in control of the shopping of services with health sharing or HSAs. Finally, we could move for a decreased regulatory burden on pharmaceuticals allowing patients to get medications from anywhere in the world and reduce the testing required by the FDA on efficacy (which would reduce the time and cost for new products to come to market.)   These ideas simply provide a framework for changing the landscape of health care but are proven to work and would certainly put us on a more rational path while freeing up resources to take care of those who are unable to pay.   Eric Larson is the host of the Paradocs. show notes Episode 10: Mary Ruwart describes how changing the FDA would free our market Episode 12: Dr. Keith Smith tells us how his full price transparency lowers the cost not just for his patients but patients everywhere. Episode 34: Dr. Lee Gross explains how direct primary care is a proven game changer in the lives for those without much money and is providing better care than expensive health plans. Episode 48: Matthew Bellis of Liberty Health Share goes over how health sharing ministries provide an affordable option for those seeking health coverage. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Direct Download Link

Why hello there! Thanks for stopping by for this week's episode of The Brian Nichols Show! As always, it's my goal to bring you guests who will educate, enlighten, and inform, and this week is no different, as we are joined by Dr. Eric Larson! Eric is a Clinical Assistant Professor of Anesthesiology at Michigan State University College of Human Medicine and host of The Paradocs Podcast, which is "a fun and lively discussion with a couple of docs on the practice of medicine". This week, Eric joins The Brian Nichols Show to discuss the biggest challenges that doctors face in the healthcare industry and what the best solution to overcome those challengers. Later, Eric gives us some insight into the life and times of one of his dear personal friends, one Congressman Justin Amash. Eric provides us some insight into what drives Congressman Amash as a person and as a liberty warrior and then concludes the episode discussing the potential Amash candidacy for POTUS as a Libertarian. Bio: Eric Larson, MD is a Clinical Assistant Professor of Anesthesiology at Michigan State University College of Human Medicine. Eric is in private practice and is board certified in anesthesiology where he specializes in ambulatory, perioperative acute pain, and general anesthesia. He works in the Grand Rapids, MI area and is married to a pediatrician with whom he has three children and one foster son (now grown and soon moved out of the house). Find Dr. Larson online: https://twitter.com/EricLLarson Find "The Paradocs": http://theparadocs.com/, https://twitter.com/TheParadocsShow, and https://www.facebook.com/The-Paradocs-2103034463249509/ Support The Brian Nichols Show Learn more about your ad choices. Visit megaphone.fm/adchoices

  Who is that man or woman in the white coat? What is he/she thinking as you are being examined or operated on? Is that physician burned out? Suicidal? Feeling optimistic about his/her profession? The future? There is a lot going on between the ears of that physician that isn't devoted to healing people.  Today, I take a deep dive solo-style into the results of the comprehensive 2018 Survey of American Physicians by the Physician's Foundation.   There is no shortage of insights into the lives of physicians found within the study. Most provide data backing up a lot of what we have been discussing in the prior episodes of the Paradocs. The reason physicians go into medicine and stay in medicine is the patient-physician relationship. In fact, nearly 80% of physicians mark that as the number one point of professional satisfaction. Not surprisingly, any impediment to the relationship becomes a very big dissatisfier and point of contention. The two most commonly cited were electronic health records and regulatory burden/insurance rules.   We also get some fresh insights into the work habits of young physicians which shows that they work more hours/week (54.73) versus older physicians (49.8) yet see less patients per day. Another finding is that because of the adoption of the electronic health record, nearly 15 hours/week is spent on non-clinical paperwork. Not only is this something to make physicians unhappy but it significantly affects the access patients have to getting care from doctors whether primary care or specialists.   [caption id="attachment_1475" align="aligncenter" width="300"] Physicians are pessimistic about the future of health care. Maybe it's time to triage.[/caption]   Direct Download Link show notes 2018 Survey of American Physicians:  The comprehensive survey of physicians' attitudes, practice types, and demographics. Episode 027: Discussing the opioid crisis with Dr. Howard Grattan. Memorial for Andy Larson: This is the donation link to honor Andy's death with the Grand Rapids Choir of Men and Boys where he blossomed and served as a head chorister. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.

Dr. Eric Larson is an anesthesiologist in private practice in Grand Rapids, MI, and host of the podcast Paradocs. He joins us to talk about his experience with immigration, and he also shares some helpful information on what non-physicians need to know about the medical industry. 

Episode 108 is Alex Pollak. Alex is the President of ParaDocs. ParaDocs is a global event medical providers with over 1,600 medical professionals nationwide including doctors, nurses, paramedics and EMTs. It is designed and implemented mobile emergency triage/treatment tents for large events across the country. Alex's path to creating ParaDocs goes through being a street medic in New York City, obtaining his MBA and his entrepreneurial spirit. As a paramedic, Alex was part of the EMS response to the 9/11 attack and Miracle on the Hudson. We talk about both these incidents, ParaDocs creation and the need for venues to have EMS and medical personnel at their events. Alex also speaks about taking chances and leadership.

Featuring ‘Fun with January Jones and her Paradocs' (Paradox) Dr. Bob Ruotolo and Dr. Ed Feyereisen Dr. Bob and Dr. Ed created and own MotivCreations (MC) [Explain MC's history,  purpose (Happiness & Wellness) and the MC-365 Program] “People often say that motivation doesn't last. Well neither does bathing that's why we recommend both.” Zig Ziglar Today's show you will learn two tools/techniques from the MC-365 Program.  Refer to web and 50% off on your membership.  http://www.januaryjones.com    

Wat zijn andere, manieren om documentaires te maken en te vertonen? Het Vlaams cultuurhuis De Brakke Grondin Amsterdam laat samen met het IDFA verrassende experimentele manieren zien. Anne Martens licht deze week een vijftal projecten uit. Vandaag spreekt ze met Joost Daamen, de curator van Paradocs, over de installatie My name is Jorgen Leth ter ere van de [...]

I spoke with George Ruge, a partner with and co-founder of Paradocs, a company that creates e-briefs and deposition digests for law firms and corporations. We discussed the adoption by courts across the country of electronic briefing and streamlined pleading management, as well as the benefits to judges and practitioners.

I spoke with George Ruge, a partner with and co-founder of Paradocs, a company that creates e-briefs and deposition digests for law firms and corporations. We discussed the adoption by courts across the country of electronic briefing and streamlined pleading management, as well as the benefits to judges and practitioners.

I spoke with George Ruge, a partner with and co-founder of Paradocs, a company that creates e-briefs and deposition digests for law firms and corporations. We discussed the adoption by courts across the country of electronic briefing and streamlined pleading management, as well as the benefits to judges and practitioners.