Month: July 2018

What Idiot Would Choose A Career In Medical Practice Today?

Start out passionate-end up disappointed or worse.

Never in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today. These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.

They’re not retiring. They’re adapting. Extended hours to see more patients to make enough income to stay financially solvent is just one highly stressful necessity causing eventual burnout. Coupled with the recognition that private medical office practice for most doctors is not lucrative enough to reach their original goals and dreams for their careers, reasonable satisfaction with medical practice becomes a moot point.

Profound disappointment increases as they realize it will take them a couple decades to pay off their education debts (avg. $150,000 plus), let alone make enough revenue to support a family and cover office overhead. If you have missed the obvious, doctors the day they graduate, are financially hamstrung right from the start. The roots of this dilemma are found in the medical education program itself.

Discouragement intensifies dramatically when they are faced with malpractice litigation. You know…it’s the penalty for using all their best medical knowledge, skills, and judgments to prevent and to treat illness, yet isn’t enough. The most well trained and experienced doctors are subject to malpractice lawsuits, even when they haven’t done anything wrong in their medical practice treatment of patients.

Governmental fee restrictions and intrusions are constantly increasing, which is firm validation that it will be harder to financially survive in practice. Their future practice income for the majority of physicians will barely keep them in the middle class of Americans. For those minority of physicians in the highly profitable surgical specialties such as plastic surgery, orthopedics, cardiac surgery, and anesthesiology, most do quite well in their practices.

The easy solution for most medical school graduates is to join a managed care group as an employee where they at least can earn some money right away. Once they become aware that they aren’t able to practice medicine the way they intended to, they try private practice.

The path into a medical practice career has other unexpected potholes:

Upon entering college and into their pre-med curriculum the idea of becoming a doctor is challenged repeatedly. The high competition for getting into medical school is strongly influenced by their grades. The hard studies and required courses weeds out many pre-meds. Of the one’s who make the grade after four years, there is no guarantee they will even be accepted by a medical school. Who wants to academically struggle for four years only to discover your dreams have just been squashed on the rocks?

Individuals not accepted to a medical school may keep re-applying yearly with the expectation of being accepted later. Rather than wait and hope, pre-med students can apply to dental schools where the competition is considerably less, with the idea they can get into medical school later.

The way things are today, they’d be a lot better off being a dentist for many reasons. So, here’s a student who wanted to become a medical doctor and is often left stranded without a backup career in mind-didn’t think he needed one.

Once accepted to medical school, a student is expected to graduate in four years. In days past some medical schools apparently had programs for planned attrition the first year-like the bottom 10% of the class would be dropped from the school. I’m not aware of any of the 142 medical schools in the USA doing that today.

Medical students eventually choose the area of medicine they want to practice. Some choose a surgical specialty and discover they don’t have a surgical talent or skill. Others, for the first time, begin to understand what they are talented to do, as opposed to what they think they want to do. This tendency may lead a student to becoming a specialist in something they are not skilled to do, but manage to practice in a career in that medical category anyway. It’s not a rare circumstance.

After all of these hurdles have been accomplished, the new set of hurdles comes into view-specialty training and/or medical practice. Let me paint a mental picture of this new doctor’s situation at this time in his/her medical career path.

1. The average new doctor now has an educational debt to pay around
$150,000 or more.

2. The new doctor does not have a job, but may have some connections.

3. To open a private practice requires either family money or bank loans-estimated to be around $50,000 at the very least. Debt is now $200,000 plus. How long would it take you to pay that debt off?

4. Common practice choices are:

A. Private solo practice if the money is available to get started.

B. HMO managed care organization if spots are open.

C. Group practice if one is available.

D. Contract partner with another physician already in practice.

E. Hospitalist (employee)

F. Join the military, get further training there.

G. Concierge practice (Cash only).

5. Often, they are supporting a spouse and children.

6. The geographical area where they will practice, and the situation they will practice in often is not even close to what they intended or wanted.

7. Surveys by the AMA indicate that about 14% of doctors move their practice, or move to another area to practice each year. It means their first choice was not good enough—but who can predict outcomes?

The tragedy is in having no reliable options that guarantee any degree of medical practice success (whatever that is to you):

Like all professionals starting in any business, there are no guarantees. The hope is that with one’s passion, entrepreneurial attitude, and persistence will inspire the survival of their medical career. Those aspirations at their most earthshaking levels must not only be maintained for the duration of a medical practice career, but also must be fortified intermittently with signs of professional progress and practice profitability for those inspirational drivers to continue to exist.

Unfortunately, passion dissipates with time; hope falls short of the mark and medical professional careers relapse into mediocrity because of a doctor’s expectations for their highest career potential turns to, “I’ll just have to settle for what I can get from my practice.”

At this point in their practice, usually about 5 to 7 years after starting medical practice, 95% of physicians have absolutely no idea how to go about improving their practice income. That’s because they have never been educated in successful business management and the business knowledge required to reach their full potential. Without it they simply limp along doing the best they know how-they don’t know what they don’t know.

The highly regarded business expert, Michael Gerber, describes the realistic dynamics of this in his book, The E-Myth: Physician. It should be required reading for every pre-med student.

WAIT-There may be a couple secrets that can salvage the medical careers of the majority of the medical professionals in trouble.

First, for any health care provider in June 2011 and disregarding the ominous December 21, 2012 prophecies, understanding that medical practice is a business, provides a proven foundation for success. The most profound whitewashing of that one fact by the medical schools today should be punishable by law. It should also be extended to all pre-med programs across this nation.

Every successful small business owner in the world understands that their business profitability and survival depends on the foundational business principles and time validated concepts that must, not should, be followed. It’s rare to find a doctor who has been educated in business strategies and the more complex issues of how to use them profitably and efficiently.

Can you rationalize with any degree of intellectual logic why there is such a widespread neglect by the medical academicians to institute business education as a primary curriculum element for all physicians? There isn’t any today! If medical practice is a business, then why should anyone expect a doctor to survive in medical practice with no academic knowledge about business? It defies logic and common sense.

Second, why should any physician or other health care professional expect to do well, earn a good income, have a successful business from medical practice, or even survive financially without any, even basic, business knowledge?

The traditional belief, “if you hang up your shingle, patients will come,” is the greatest mental deterrent to successful medical practice that exists. You might wonder why so many medical practices today are failing because of financial deficiencies. What could possibly be the cause of that?

Third, considering the tsunami of attrition of medical doctors and their medical practices happening today, you must be aware of the causes. If we were able to eliminate the many current devouring parasites destroying medical practice today and deal with the one issue of physicians lacking even basic business knowledge, practices would continue to fail.

Doctors would be exactly in the same situation as they are now in-living with mediocre, or just plain lousy, medical practice profits and unable to fund a retirement plan.

It’s an acceptable fact that the parasites of malpractice, law tort reform, litigious patients, and governmental control of health care will not change from how they are today or in the foreseeable future. It seems quite obvious that I will find rare supporters who believe as I do.

Time to eliminate private practice altogether?

A tour spent on an HMO medical staff will convince any doctor that private practitioners should hang around a while longer. Concierge medical practice does seem the safest of all the private medical practice models for a doctor to use in the present medical political environment.

With the increasing pressure and restrictions by our government on private practice doctors, even the smartest business and marketing experts such as Dan Kennedy are forecasting the quick rise in numbers of the cash-only models of medical practices.

Comparisons with other professional career choices show a significant difference in profits and satisfaction between a medical career and almost all others. For the time spent in academic education, cost of education, the skills, talent and intelligence required, the stress of long hours and critical actions, among others, doctors are at the ultimate bottom of the income and lifestyle list. The reasons for that are many. The solutions to that dilemma are unresolved-just floating along with the current.

And, now I’m back full circle to my original premise, what idiot would ever consider a career in medical practice? If they would take the time to investigate what’s in front of them, it would be a blessing to them.

Winston Churchill made a point about a crisis during WWII, which seems appropriate here-“It’s not enough that we do our best; sometimes we have to do what’s required.” Private medical practice is increasingly required to bend to the external forces that make the rules, but that doesn’t mean there aren’t other alternatives.

Alternatives more enticing are those in other businesses separate from medical office practice. This is especially disheartening when physicians discover that most successful business owners earn much more income than physicians. And, they need much less education and spend much less on education than medical doctors. More disturbing than that are the thousands upon thousands of people who barely made it through high school or dropped out of college who now earn three times the income of doctors, and work much less.

The question really is, why are there still college students who will continue on into the medical profession knowing all these drawbacks of the profession? Would you judge them dedicated, just masochistic, or plain ignorant of the issues?

The practice of medicine is a highly honorable profession to be a part of. No question about that. However, honor attained at the detriment of so many sacrifices being made, may not be a virtue, but an illusion.

These health care warriors seem undeniably capable of withstanding the perpetual onslaught of our society, which dwells on them as prey. One has to wonder what it is that makes them think it’s worth compromising most everything in their lives, from family to free time, just to continue a struggle against everything that can destroy them and their private medical practice at any point in time.

Myth Buster: The Truth About Medical Coding From Home

Medical coding has been around for a long time but recently it has gained quite a bit of attention.

It has been sold widely to the public that this is an “easy work from home, data entry job that has little requirements and high earning potential”. This statement is only partly true though.

Before you invest time and money into an education and certification, take a moment to investigate this field and its potential a little more.

Myth 1: Coding is Easy

Most individuals who hear about medical coding for the first time believe that it is easy to learn and/or perform. Most individuals who have attempted to learn, or who do medical coding would disagree.

To be a medical coder you must be very detail oriented and organized.

Medical coders must also have a broad knowledge base of medical billing, medical terminology, gross anatomy, insurance policies, practice management, coding guidelines, HIPPA regulations, how to use each coding manual, and more.

In addition to being knowledgeable, medical coders must also have the ability to read and understand detailed, lengthy medical records and operative notes. Communication skill with physicians and insurance companies are also imperative.

Myth2: Work from Home

Many individuals hear that medical coders work from home and so they enter this field based on this alone.

While many individuals do medical coding do from home, there is more to it than what if often advertised.

In order to do medical coding from home individuals must first become certified as either a CPC or CCS. Following certification individuals must then gain on the job experience.

The majority of companies that allow medical coding from home require 2-3 years of on the job experience as a minimum.

Most coders who do medical coding from home are also independent contractors. Independent contracting should also be researched and considered prior to investing in this career.

Myth 3: Data Entry Job

Medical coding is a learned skill. The only thing data entry and medical coding have in common are the fact that both utilize 10 key.

Performing medical coding requires a knowledgeable individual to first read, interpret, and understand the medical record and/or operative note. They must then determine what information is pertinent and what is not. The pertinent information must then be translated into codes by utilizing three large manuals.

Translating this information into codes requires medical coders to know how to use the coding manuals as well as apply coding guidelines which determine things like; when a code can and cannot be used, sequencing multiple codes in the correct order, linking codes with other codes, when multiple codes are required for a single piece of information, etc. etc.

Medical coders must also know insurance specific coding guidelines as well and determine which guidelines should be applied in each situation.

Myth 4: Little Requirements

The government has not yet mandated any specific requirements that one must first meet in order to be a medical coder.

However, employers have taken action of their own. The majority of employers will not hire an individual as a medical coder without at least a CPC or CCS certification. Many employers also require at least some on the job experience in addition to this as well.

Individuals who wish to become a medical coder and/or do medical coding from home must make themselves employable.

To become employable in this field, individuals must follow a career path similar to those of many other careers.

Proper education is the best place to start. Taking a medical terminology and gross anatomy course should be the first step, followed by taking a medical coding course that will specifically prepare you for one of the two certification exams.

Once education has been obtained individuals must then sit for either the CPC exam that is offered by the AAPC, or for the CCS exam offered by AHIMA. Any other “medical coding certification” will not be recognized by employers.

After earning either the CPC or CCS credential individuals must then gain on the job experience. Similar to most other careers, starting out as a medical coder will require individuals to start in entry level positions and work their way up.

Due to the sensitivity of this work and the direct impact it has on revenue inflow and reimbursement, often newly certified coders find they must take unrelated positions while they learn from the medical coders in the coding department. Only after they have proven themselves do they begin to gain medical coding duties and receive promotions.

Working as a front desk receptionist in a physician’s office, working in the medical records department, or doing data entry in the medical billing department are common ways newly certified medical coders start out.

Myth 5: High Earning Potential

Earning potential varies due to many factors, such as geographic location, years of experience, type of specialty, economics, etc.

Starting out as a medical coder in an entry level position often pays very little.

If individuals are able to stick it out though, earn a less than desired pay, and gain that critical 2-3 years of experience, the flood gate will swing wide open.

Currently the medical coding field is experiencing something of a phenomenon. The market is lacking in experienced medical coders and positions are going un-fulfilled. This is causing employers to offer a high rate of pay in order to bring experienced workers into their organization.

In response to this need many individuals have taken educational courses and earned their certification. This action has caused an over saturation of newly inexperienced coders in the job market.

Newly certified coders are finding that gaining their first coding job is becoming a competition. In addition, entry level positions that they are seeking are also being filled by over qualified experienced individuals due to a sluggish economy.

As a result, newly certified coders are becoming disgruntled due to the fact that they have incurred expensive education, invested time, and cannot afford to invest more in a low paying position.

In the current market, gaining the first medical coding job is the key. If a newly certified coder can obtain an entry level position, do whatever is required of them, and earn the 2-3 years of experience employers are looking for, there will be no limit to both your career and income potential.

Example: Personally, I started out as a front desk receptionist. My first entry level coding job paid $10 -$12 per. hour. After gaining the required experience I chose to do medical coding from home where I earn over $50 per. hour.

In conclusion, medical coding is not exactly the “easy work from home, data entry job that has little requirements and high earning potential” career that it is often sold as, but there are some truths to this statement.

Medical coding is similar to most other careers, requiring education, dedication, hard work, and expertise. The harder one works the more they will succeed.

For those who have the single goal of doing medical coding from home, remember to research this field prior to investing time and money. Ensure this is the right job fit for you and that you can and are willing to make the necessary requirements to become a medical coder.

The Medical Record

The medical record is one of, if not THE, most important documents within the delivery of healthcare services.It is what tracks the course of a patients care. It allows medical providers to review a patients medical history as well as plan a course of care for the future.

It is a communication tool that not only provides clinical data regarding a patient’s current and past medical history, but is also used in the reviewing and reimbursement of insurance claims, and to review utilization and quality of care.

The Contents of a Medical Record

* Face sheets, encounters for each visit
* Vital Signs
* Physician’s orders
* History and Physical forms
* List of Medical Problems
* Medication Lists
* Progress Notes
* Discharge Summary
* Authorization Forms
* Diagnostic Testing
* Laboratory Testing
* Operative Reports
* Pathology Reports

Documentation

Documentation is the most critical function regarding keeping accurate medical records, as it records all of the important details and facts regarding a patient’s care.

Documentation:

is legal documentation
includes a patient’s medical history
chronologically documents a patient’s care
allows physicians to plan and evaluate a patient’s care
provides continuity in care
allows all physicians involved in a patient’s care to communicate with each other
provides evidence of care provided in legal cases
assists in claims review and reimbursement
assists in meeting accreditation requirements

Centers for Medicare and Medicaid Services (CMS) regulations regarding documentation

Documentation MUST include:

evidence of a physical examination performed no more than seven days prior to admission or within 48
hours of admission

results from patient consultations and the findings from such evaluations

all orders, progress notes, medication records, radiology procedures and results, laboratory results,
and vital signs

the admitting diagnosis

a patient’s medical complications

any relevant risk factors

information that reflects the CPT/ICD-9 codes that were submitted to the patient’s insurance

consent forms signed by the patient

the discharge summary which summarizes the outcome of the admission, disposition of care, and
plans regarding follow up care

The S.O.A.P. Model

Subjective

Subjective information includes information given directly by the patient, such as how they are feeling, their opinions on their care, and why they made the appointment. It represents the patient’s point of view of their condition.

Objective

Objective information represents the physician’s point of view. It includes information that was observed and measured by the physician during an examination or test.

Assessment

The assessment identifies the main diagnosis that is specific to the visit, and includes the physician’s interpretation of that condition. When a patient has multiple diagnoses, a physician will dictate their assessment based on the patient’s complaint that particular day.

Plan

The “Plan” segment is when a physician makes a plan of action for a diagnosis, usually the condition specific to the visit of that day.

Challenges within Documentation

Every organization should ensure that each page within the medical record contains the patient’s name or identification number (the patients first and last name, first initial and last name, social security number, or personal identifier).

It is also necessary that all entries within the medical record include identification of the author.

Any known drug allergies should be prominently noticeable within the record, preferably on the front of the chart.

If any issues are unresolved from a previous visit, they should be addressed in subsequent visits.

Legibility

The most common challenge within medical documentation is legibility. It is vital that the contents of the medical record are legible to someone other than the author because 1) documentation has a significant impact in resolving legal claims and 2) poor legibility can lead to misunderstandings (i.e. if a pharmacist misreads a prescription and dispenses the wrong drug to a patient).

It is recommended that organizations and physicians utilize transcription services. It is also recommended that organizations and physicians use computers to print orders and prescriptions.

Verbiage

Medical record entries should NOT include any gaps or inappropriate language. This would damage the integrity of the rest of the medical record.

Entries should NOT reflect judgment that something unexpected happened. Words such as “unintentionally”, “inadvertently”, and “unexpectedly” should NOT be used within dictations.

Entries should also NOT use words that are unspecific and cause doubt, especially in the case of a legal claim. Words like “appeared” and “apparently” should NOT be used.

Entries should NOT contain ambiguous words or phrases such as “doing well” or “eating better”.

Claims Reimbursement

Documentation is the best support in proving “medical necessity”. Poor or minimal documentation can lead to the denial of a claim.

Documentation Rules

Correcting Errors

To correct an error within an entry, the author must draw a single line through it so that the original content is still visible. If there error is completely covered or blacked out, it will cause concern and the worst may be assumed of what it may have been. The correct documentation should then be written above the error and should be signed, dated, and the reason for the correction should be noted.

Hearsay

Any statement made by anyone other than the author of the entry, should NOT be documented as if it were fact. The source of the statement should be noted and the statement itself should be in quotation marks.

Telephone Calls

Under no circumstances should medical advice be given over the phone unless it is certain who is on the other end of the call. There should be policies in place that dictate who may give advice over the phone (i.e. nurses, physicians… NOT receptionists) and what the limits are of what type of advice someone other than the physician may provide.

ALL phone conversations should be documented and placed in chronological order within the medical record.

Countersignatures

A countersignature is a signature from a physician who reviews a record after the primary physician has signed it. The countersignature implies that the physician understands and agrees with the care described by the dictating physician.

It is important to acknowledge, that when a provider signs an entry within a medical record, that they are responsible for whatever is contained in the entry.

Abbreviations

Although abbreviations save time, many are ambiguous and can be misinterpreted by other physicians. Only standard abbreviations should be used to avoid any misinterpretation.

Documenting the Termination of a Physician/Patient Relationship

ALL issues of patient non-compliance should be objectively documented within the medical record. Any action taken, reinforcement or education, should also be noted.

When a physician intends to notify the patient of the termination, they should be told verbally. A certified letter should then be sent to the patient outlining the reasons of termination and time frame in which the relationship will terminate. A copy of the certified letter should also be kept within the record.

Record Retention

The length of time in which medical records must be retained differentiates between statute of limitation regulations and individual state statutes.

However, everyone organization MUST enforce clear policies and procedures regarding maintaining and retaining medical records.

Release of Records

Records may only be release as authorized by individual state and federal laws.

Organizations must also have clear policies regarding the release of medical records that should determine:

* who may request and receive a copy of a patient’s medical record
* who is authorized to release medical records and to what parties
* how the practice will protect protected health information
* how releases of records will be monitored and documented

Strong policies on the above greatly assist in avoiding liability.

Ownership of Records

The ownership of medical records is a unique situation, as both the patient and the medical facility have ownership interests. The facility owns the physical record however the patient owns the information within the record.

Therefore, the record MUST remain within the medical facility, and the facility should ensure that the patient’s information is protected.

Patients have the right to any information within their record, however such rights differentiate between states.

Legal

When legal claims arise, medical documentation is relied upon to determine the standard of care that was provided. Little or no documentation regarding the course of treatment strongly supports the claim of negligence.

Medical records may expose:

– the series of events that led to a patient’s injury and subsequent claim

– inefficient use of information within the medical record

– poor communication from on doctor or department to another

– illegible records or orders

iPracticeConsultant.com is a comprehensive website addressing managing a medical facility. iPracticeConsultant focuses on the financial aspects of operating a medical facility, human resources guidelines in managing staff, marketing information specific to healthcare, and healthcare risk management. iPracticeConsultant also provides various financial calculators to allow managers to conduct quick and accurate financial analysis.

What Is Medical Tourism? Medical Tourism Facts Explained

Medical tourism is the practice of travelling to different countries to get quality and affordable healthcare services. It is also referred to as global healthcare, health tourism, and medical travel. The term ‘medical tourism’ was created by the media and travel agencies to popularize this form of practice. Today, medical tourism has grown to become an official industry in more than 50 countries.

Why is Medical Tourism Popular?

So, what exactly are the benefits of medical tourism and why do people travel abroad for simple and complex medical procedures? The main factor that encourages medical travel is undoubtedly the high cost of medical care in developed countries like the United States. Most medical travel destinations offer surgeries at almost one-third the costs of developed countries. This translates into bigger savings for a person who has to undergo a complex medical procedure like a liver transplant or even for a cosmetic surgery procedure.

Another reason is the high costs of medical insurance in western countries which have led to many people not opting for any medical plans. The high unemployment rates in the U.S and other European countries are another major contributing factor. Today, due to the deteriorating unemployment levels millions of people can no longer afford health insurance. So, a person not covered by health insurance has very less options other than seeking cheaper treatment elsewhere. As a result, medical travel has gained rapid acceptance and popularity in a short period of time.

Medical Tourism Costs Comparison

Here are some surprising cost comparisons which justify the existence of the medical tourism industry. A liver transplant in the U.S would cost close to a whopping $300,000, while a person who opts to travel to Taiwan would end up paying just around $90,000. This translates into savings of around 70 percent. Similarly, a heart valve replacement costs about $10,000 in India, whereas it costs around $200,000 in the United States. Women who plan to undergo complex cosmetic surgery have to spend a fortune in the U.S. In this case, a full facelift in South Africa would cost just around $1250 compared to about $20,000 in the United States. These glaring price cost savings are the most important reason for the huge growth in the medical tourism industry

Pros and Cons of Medical Tourism

Medical travel abroad isn’t just popular because of the cost savings. There are many other benefits too. For example, the waiting times for medical procedures in the U.K are long and cumbersome. On the other hand, in medical tourism, a patient’s entire procedure is planned and scheduled well in advance. Once the patient arrives in the host country, there is little to no waiting time. Here is another example to illustrate this point. In Canada, during the year 2005, more than 750,000 Canadians had to wait for an average of 9.5 weeks to get their medical procedures done. Canada also sets long waiting benchmarks ranging from 16 to 26 weeks for non-emergency medical procedures like cataract and hip replacement surgery.

While the medical travel industry has its benefits it also has its share of drawbacks and concerns. For example, a medical tourist can easily be susceptible to many diseases in the host country, where high standards of hygiene may not be available. A person from the United States may have low to no natural immunity levels to these diseases. These diseases could hamper or complicate existing health conditions. Some of the diseases that could weaken or complicate the recovery of the person are amoebic dysentery, influenza, typhoid, and tuberculosis. Health complications could also arise during travel due to cramped seats in airlines and long distance flights.

Even accredited hospitals in countries like India lack adequate complaint registering policies. This leads to a lot of patients being totally dissatisfied with the services offered. There are also many legal and ethical issues involved during organ transplantation in India and China. This primarily is due to the large-scale illegal purchase of tissues and organs in these countries. Despite these shortcomings, medical travel seems to be the way forward unless countries like the United States can manage to cut their medical costs drastically or start providing medical tourism insurance.

Popular Medical Tourism Destinations

Many people are on the lookout for both simple and complex procedures like cardiac surgery, hip and knee replacement, dental surgery and cosmetic surgery. For these procedures the most popular medical travel destinations are India, Argentina, Cuba, Hungary, New Zealand, Saudi Arabia, South Africa, The Philippines, Ukraine, Lithuania, and South Korea. High quality cosmetic surgery at affordable prices is available in countries like Argentina, Brazil, Mexico, Costa Rica, Turkey, and Colombia. Over the last few years, South American countries like Brazil, Argentina, Colombia, and Bolivia have become a hot destination for world-class plastic surgeries. These countries boast of talented and experienced cosmetic surgeons of repute. Most medical tourists come from countries like the United States, Canada, the U.K, and Japan.

Implications for the Healthcare Industry

Medical travel has created implications in countries from where they originate. In 2007, more than 750,000 Americans sought healthcare services outside the country and more than 1.5 million are expected to seek offshore healthcare in 2008. This has resulted in the United States health care industry losing billions of dollars and is set to lose even more in the future. According to a Deloitte Consulting report of 2008, medical tourism in the United States could most likely increase by almost 10 times in the next decade. This trend is alarming and can hardly be ignored by the healthcare industry. While this may spell trouble for the healthcare insurance industry, it could also be a motivating factor for the healthcare industry to lower its premiums to stay competitive. This major shift towards medical tourism has opened the doors for medical tourism insurance. Currently, very few medical insurers cover medical tourism. However, there is a growing demand for medical tourism insurance and we might soon see major healthcare insurance providers offering people the option to travel abroad. This would definitely be an important step in making healthcare more affordable.

Monitoring Industry Best Practices

To ensure higher standards of healthcare quality a growing number of international healthcare accreditation organizations are now certifying international hospitals. This accreditation is awarded based on the level of healthcare services and quality of medical procedures provided. Since 1999, the Joint Commission International (JCI), a non-profit organization based in the United States has been authorized to certify and accredit hospitals and medical facilities outside the country. Medical tourism providers in many countries are now seeking accreditation to keep on track with healthcare best practice norms and gain patient confidence and trust.

The medical tourism industry is growing and will continue to rapidly surge unless healthcare providers and insurance companies make sincere efforts to lower the costs of health insurance. Medical travel is not a problem; it is an answer to cheaper medical solutions. And unless the healthcare industry in western countries finds answers to reducing costs, medical tourism will definitely be the most convincing answer.

The Three Top ADHD Medication Pitfalls and How to Avoid Them

One of the most effective management strategies for minimizing the challenges and symptoms of ADHD is medication. This might not be the most popular statement I have ever made, but research over and over again has shown that ADHD medications can “level the playing field” for adults with ADHD. Medications can be effective in helping adults with ADHD increase their focus on less interesting tasks, reduce impulsivity of actions and words and calm inner restlessness. I often hear clients describe the experience of being on the right medication as similar to having “the fog clearing”, “the water globe settling” or a “light switch being turned on”. They feel more focused, energetic, calm and productive. However, many adults never have the chance to experience the full benefits of ADHD medication due to three problem areas that I call “ADHD medication pitfalls”…taking the wrong medication, the wrong dose or taking medications at the wrong time.

“Medication Pitfall” #1

The first of these ADHD medication “pitfalls” is that many Adults with ADHD are not on the right medication. For good or bad, there is not a lot of variety in medications used to manage ADHD. In fact there are really only three. The good news is that with such limited options these medications have been studied over and over again for the past 50 years and we know the long term effects. The bad, is that there is a very limited choice of medications when it comes to treating the core ADHD symptoms.

ADHD medications can be divided into three categories: 1) Stimulants, 2) non-stimulants, and 3) “other”. Even though stimulants tend to be the most effective in decreasing the key symptoms of ADHD in adults, many people tend to avoid these due to real or feared side effects of the ADHD medication. Medications in this category include: Ritalin, Adderall, Dexedrine, Vyvanse, Concerta, etc. These medications are designed to “stimulate” the dopamine neurotransmitters of the brain; the key neurotransmitter that seems to be functioning ineffectively or in insufficient amounts in the brains of people challenged with ADHD. This category of medications is typically very effective in decreasing hyperactivity, distractibility and impulsivity.

The second category of ADHD medications is non-stimulants. These include such medications as; Strattera, Wellbutrin and Effexor. These typically increase the levels of norepinephrine and serotonin in the ADHD brain and can help increase the mood, energy and motivation of people with ADHD. The third category is what I call “others”. These include such medication as: klonopin, Tenex or Provigil. These ADHD Medications are typically prescribed to reduce ADHD symptoms such as impulsivity or to increase alertness (as in the case with Provigil). Each of these categories of medications works differently to help manage symptoms of ADHD.

“Medication Pitfall” #2

The second pitfall is not taking the right “dose”. The experience of ADHD is different for every adult and everyone’s experience of taking medications is a bit different. There are guidelines prescribers follow, but the dose that is right for you may not be right for someone else and vice versa. If you are on too low a dose of medication you will not get the full positive benefit of the medication. If you are on too high a dose, you may experience more negative side effects than you have to. The goal is to find just that right dose that balances the positive effects and minimizes negative side effects.

“Medication Pitfall” #3

The third pitfall is “wrong time”. You can be taking the right type of medication, at the right dose, but if you take it at the wrong time, you may not be experiencing the most benefit. Some medications work best taken when we wake to help get us started with the day. Some need to be taken multiple times a day at specific intervals to get their full consistent benefit. And finally, some medications, when taken at night, may help us sleep more soundly.

When you are trying to find the right ADHD medication for yourself, it is important to work with a prescriber who is knowledgeable about adult ADHD and ADHD medications. This may sound simple, but it’s not. You want your doctor to help you understand how the medications work, which ones might work best for you and support you in understanding your choices. Find out as much as you can for yourself about what choices are available and keep a consistent daily ADHD medication log or ADHD medication record to help you determine what medication works best, at what dose and at what intervals.

Stabilizing Chronic Health Conditions Depends On The Compliance Of Medical Treatment

Aging brings with it several problems, including many chronic health conditions that can require regular care. One of the important parts of this care is making sure to properly comply with the medical treatment prescribed by doctors and caregivers. This may include regular intake of medications, routine medical check-ups, and scheduled testing. Whether it is a chronic medical condition like diabetes or hypertension, or problems related to sleep, anxiety, and so on, adhering to the advice of doctors and caregivers is absolutely essential.

Challenges Faced by Caregivers with Regard to Compliance

One of the biggest challenges faced by caregivers is seniors who refuse to comply with their recommended medical treatment. Caring for the elderly, especially those with chronic health conditions, can be quite daunting, given that most of these people prefer their independence and often balk at having to take medications. Non-compliance can happen both when a person doesn’t fill his or her medication as prescribed by their medical practitioner, and when they neglect (or refuse) to complete the recommended dosage. In any case, before going on to finding ways to ensure compliance with medical treatment, it is important to identify the exact reason for such non-compliance.

Reasons for Non-compliance

In the case of seniors, non-compliance with the recommended medical treatment or procedure occurs due to multiple reasons:

– Forgetful nature: One of the main reasons why many senior citizens forget to take their medicines and miss their checkups or other medical tests is simple: they forget. The aging process reduces the ability of the person to remember things. Under these circumstances, it is natural for older individuals to forget that they need to take medications or go to a doctor’s visit, which results in non-compliance. Having a medical alert system set up with reminders goes a long way in ensuring that they will not forget these important things.

– Non-belief: Another reason for non-compliance is that the elderly often do not believe that the drug in question is actually working. For instance, when a senior citizen has to take medications for blood pressure or cholesterol, chances are that there is no immediate sign of the drug working. In fact, these drugs take a long time to show actual results, which makes the patient feel that the medications are pointless, and encourages them to forego their recommended dosage.

– Side effects: The presence of actual side effects, as well as the fear of side effects, also leads to non-compliance in the elderly. Medications taken for various ailments by the elderly often cause certain side effects, which, given their advanced age, can be quite alarming to experience. When such a situation occurs, the senior in question refrains from taking the medications rather than experience the side effect. Add to this the fact that the independent nature of the senior will not allow him or her to actually talk about such occurrences or fears to the caregiver.

– Multiple prescriptions and medications: When the senior citizen is swamped with numerous medications that need to be taken, non-compliance is a commonality. This occurs either due to the overwhelming nature of the sheer number of drugs, or the inability of the senior to keep track of each dose and its timing.

Disappearance of symptoms and the need to save money are two other factors that contribute to such non-compliance. If an individual believes that the symptoms which caused the doctor or practitioner to prescribe the drug do not exist, non-compliance sets in even if the dosage is not complete. Additionally, when the elderly person believes that there is a need to save money, which can be achieved through stopping his or her medications, non-compliance rates shoot up.

Tips for Improving Compliance

Once the reasons for non-compliance are identified, the next step is to determine how to ensure compliance. Here are some simple tips that will help in this endeavor:

– Set a daily routine: Forgetfulness is the most common cause of non-compliance in elders. This can be overcome by setting daily routines with the help of the caregiver. For instance, medications could be taken in relation to another activity, such as while eating meals or right before going to bed. Once this routine is established, the senior in question will automatically take the medicines at this time.

– Using aids for boosting memory: Another simple way to ensure compliance is through the use of memory boosting aids. Medical alert systems are perfect companions for seniors who live independently and need to remember their medication dosage and timings. These units can be programmed in advance for the exact dosage that needs to be taken, as well as the time of taking such a dose. It is important to note that medications, especially those related to the central nervous system, need to be taken at exact times to ensure proper effect. These alert systems can be used to make sure that the senior is reminded of the medication at the appropriate moment.

– Reminder services for filling prescriptions: Similarly, medical alert systems can be used for programming reminder services for filling prescriptions. Non-compliance often occurs because seniors don’t fill prescriptions on time. With the help of such services and alarms, elders can ensure absolute compliance by filling their prescriptions on time.

Since adherence to recommended medical procedures and treatment is vital for stabilizing chronic health conditions, the above mentioned tips can be used along with medical alert systems to ensure compliance.

Safe Medications Management At Home

Realizing the importance your medication plays in your treatment will help you get the most benefit from your prescription. It is important to take an active role in your health care by being a participating member of your own health care team. Work with your doctor, nurse, and pharmacist to learn as much as possible about your prescription.

Here are some questions to ask your doctor or pharmacist when you are prescribed a new medication, and suggestions on how to safely manage medications at home.

1. Ask for the name of the medicine, including generic and brand name. This can help avoid prescription mistakes. When your doctor prescribes you a new medication, disclose the names of all the medicines you are currently taking, including all supplements, over-the-counter and prescription medications. State any allergies to any medication.

2. Ask for indications, exactly what is this medication prescribed for.

3. Ask for possible side effects and what to do in case of an adverse reaction.

4. Ask for dose and frequency to be taken.

5. How is the medication to be taken? The most common routes for medication’s administration are orally or by mouth, injection; or topically or locally applied such as creams or eye drops.

6. Are there special instructions while taking this medication such as foods, use of alcohol, other medicines; or activities you should avoid while taking this medicine? Ask about any specifics such as take with food, take on an empty stomach, do not crush or activities to avoid such as driving, use of machinery, swimming or exposure to sunlight.

Is there any written information you can take home? Most pharmacies have information sheets that you can use as an at-home reference.

If a doctor is prescribing a medication that is to be taken multiple times a day ask if it can be substituted for a prescription that is equally as effective but given only once or twice a day, thus reducing chance of forgetting to take the medication and even be more cost effective.

Ask if the medication is available in both generic and brand name, ask the pharmacist the difference between the two and decide based on that information. In many instances is more beneficial to request the generic name versus the brand name.

7. How many refills of the prescription are allowed? Some drugs and medication’s management plans have the option to purchase multiple refills at once, up to three months’ supply, for medications that are to be taken for a long-term or are part of the patient’s permanent treatment plan. Usually this system is more cost-effective for the customer.

Ask the doctor for samples, especially if it’s a medication that will be for short-term use, or if you are doing a trial.

8. What should you do if you miss a dose? What should you do if you accidentally take more than the recommended dose?

9. Ask for alternative’s prescription form that best suits you or your patient’s needs. If your child cannot swallow pills, request the medication on liquid form if available. The same applies for the elderlies or adult patient who has difficulty swallowing.

Do not change the form of any medication without speaking to your pharmacist. Some medications can be crushed, chopped and mixed with apple sauce or juice whereas some medicine is unsuitable in any other than the original form. Always ask before altering a medication’s form. Sustained release pills should not be crushed, and some capsules should not be opened.

During your treatment, you may want to schedule a follow-up visit with your physician in order to monitor your progress. Make sure to report any problems or side effects you are experiencing with your prescription.

Drugs and medications safety management.

One in three hospital discharge results in re admissions due to noncompliance with medication’s regimen or miss uses of medications after discharge from the hospital.

Two in five pediatrics Emergency Department visits are related to medications use, misuse or accidental ingestion.

Millions of elderlies and disabled people are being over medicated due to the lack of a centralized system that will monitor patient’s prescriptions and treatments.

A few simple precautions to avoid medication’s incidents, whether in adults or children

1. Keep all medications away from children reach.

2. Use child proof caps on medication’s bottles if possible. Some adults may have difficulty opening bottles with child-proof caps due to pain on their hands, weakness caused by a stroke or other conditions.

3. Medication’s labels should be clear and easy to read. If the labels on the bottles are worn off, take the medication bottle to the pharmacy and ask for a new label.

4. When the patient is discharged from a hospital admission, ask the clinician to reconcile all the patient’s medications to be taken at home.

5. Ask questions to the pharmacist before leaving the pharmacy after picking up the medication.

6. Make good use of a medication dispensing system such as a pillbox.

7. Make good use of medication’s reminders. There are many medication’s reminders systems in the market; many of them are free services. Many pharmacies offer services for refill reminders.

8. Create a medication record listing all the medications used, update it frequently and carry a copy with you at all times. Take the medications list to every physician’s appointment and share it with the attending physician and specialist.

9. Follow the golden rule while taking or administering a medication.

• The Right Patient

• The Right Medication

• The Right Dose

• The Right Time

• The Right Route

Ileana Perez is a Registered Nurse and Health Educator. She is the founder and CEO of thecaregiverconsole.com – an e-coaching website designed specifically for caregivers of the terminally ill and elderly. Ileana has amassed over 40 years of experience working as a Registered Nurse in the emergency department and operating room, as well as working as a home-care nurse. Having served as the caregiver of her late parents, Ileana knows firsthand the struggles that a caregiver faces while providing for the elderly.

Understand the Options for Choosing Diabetes Medications

Do you ever wonder how your physician chooses an appropriate medication for you? Do you feel overwhelmed by the sheer number of available medications? These tips will help you understand the choices that are available. In subsequent articles, there will be more information about each class of medication.

While there are hundreds of medications and combinations of medications available, there are seven different classes of medication. Each class works in a different way. Your physician uses his knowledge about you as well as your specific type of diabetes to first decide if you need any medication, and if so, which class to use. He then chooses a medication from that class. If you require medication from more than one class he may choose to prescribe more than one medication or a combination pill which has two or more medications contained in it. This article will provide a brief overview of the classes of medications and how they work.

1.) The oldest class of medication is the sulfonylureas. Until the mid-1990s, this was the only class of oral medications available. Your body must be able to produce insulin in order for these to be beneficial, as they work by stimulating the beta cells of the pancreas to secrete insulin. Some examples of the first generation of these medications are: Tolbutamide (orinase), Tolinase (tolazamide), and Diabinese (chlorpropamide). Some of the second generation medications are: Glipizide (glucatrol), extended release Glipizide (glucatrol XL), Glyburide (Micronase, Diabeta), Glynase (micronized glyburide), and Glimepiride. These medications are distinguished by how long they last in the body, and whether they are cleared by the kidney or the liver. There are two other drugs in this class: Prandin and Starlix, which can be used before meals because they last for a very short time.

2.) The biguanide class has just one medication, called Metformin. Other names are Fortamet, Glucophage, Gluymetza, and Riomet. This medication works by decreasing glucose production in the liver, and it also causes a small increase in glucose uptake by skeletal muscle. If there are no contraindications, the American Diabetes Association as well as the American college of clinical endocrinologists recommends using this medication first.

3.) In the mid-1990s, the Thiazolidinedione class of medications (also known as glitizones or TZDs) was developed. Their primary mechanism of action is to increase insulin sensitivity, which leads to more glucose being taken up by skeletal muscle. Three medications were developed. The first, Rezulin (troglitazone), was taken off the market because it was suggested to cause liver problems. The second, Avandia (rosiglitazone), was withdrawn from the market in Europe but was allowed under selling restrictions in the US because of an increase in cardiovascular events. The third medication, Actos (pioglitazone) had sales suspended in France and Germany because a study suggested it may increase the risk of bladder cancer.

4.) Drugs that affect the incretin system are divided into two subclasses:

a. The first division is composed of injectable drugs which mimic the effect of natural incretins produced by the body. Medications in this class include Byetta (exenetide), Bydureon (long acting exenatide) Victoza (liraglutide), and Symlin. They work by increasing insulin secretion in response to glucose (sugar), decreasing the rate at which the liver puts out glucose, decreasing appetite, and by slowing the rate the stomach empties. These medications have become quite popular because they can help with weight loss, and have an extremely low incidence of hypoglycemia. However, these medications have been in the news because they have been associated with pancreatitis, and may lead to a slight increase in medullary thyroid cancer.

b. The oral medications in this class work by blocking the enzyme which breaks down the incretins. While the level of natural incretins increases somewhat, these drugs are not as effective as the injectable ones. Medications in this class include Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta. They are being observed to watch out for complications similar to the injectable medications. They very rarely cause hypoglycemia and do not cause weight gain. They are all being evaluated for a potential cancer risk.

5.) There are three Alpha Glucosidase Inhibitors: Acarbose (Precose), Miglitol (Glyset), and Voglibose. These work by preventing digestion of carbohydrates in the intestine. By preventing carbohydrates from being converted into simple sugars and absorbed into the blood stream from the intestine, this class of medications can help keep the blood sugar from rising after meals.

6.) The newest class of medications is the SGLT2 inhibitors, which block absorption of glucose by the kidney. By increasing the amount of glucose lost through the urine, and decreasing the amount of sugar absorbed back into the blood stream, blood sugar may be decreased. Because none of these medications has been approved by the FDA, the names of the medications are omitted from this article.

7.) Insulin must be used for people with type I Diabetes and is often needed for those with type 2 Diabetes. There are many types and delivery systems which will be discussed subsequently.

With a thorough understanding of your specific type of diabetes, your physician can wade through all the options to select the best match for you. More detailed information about each drug class will be presented in subsequent articles here, and on my website, diabeticsurvivalkit.com. Please feel free to visit at any time for information about medications, cooking videos featuring diabetic meal and dessert recipes, and current news articles.

And now, Dr. Kramer invites you to her website, which she operates with her daughter Tova. There, you will find cooking videos featuring recipes appropriate for people with diabetes, a blog containing diabetes news and other interesting content, and the ability to connect directly with Dr. Kramer. She and her daughter would like to know how they can serve you!

How To Properly Utilize a Medical Alert System While Alone During a Medical Emergency

There are ways to use just about any device improperly. Lack of knowledge is typically one of the most common reasons why devices are improperly used. For devices that are created with the intent to be used in a medical emergency, such as a medical alert system, the difference between proper and improper use can be life or death.

Do you know how to react in a medical emergency? With or without a medical alert system in your home? One of the hardest things to do in a medical emergency is to not panic, but unfortunately it is one of the most common things people do in these types of situations. Panic is just the simplest response to an emergency because it is instinctual and it is done without thinking. People also panic because they have no idea what else to do! This is very sad because panicking is the most dangerous reaction a person could have in an emergency situation. People who panic can cause a lot more harm than good during a medical emergency. One of the best ways to keep yourself from panicking during a medical emergency is to know how to handle one, especially for when you are all by yourself. Here are some great tips to help you know how to handle a medical emergency and get through it in the safest way possible.

Press Your Medical Alert Button
For the most part, since you have equipped your home with a medical alert system, you can easily call for help by hitting your medical alert button located on your medical alert bracelet, necklace or pendant. This will automatically dial a care center where a trained help advisor will be on the line in just seconds, ready to call your family members, friends, neighbors or send emergency assistance to help you with any medical emergency. The help advisor will also stay on the line with you until help arrives. However, if you are out of your home, or maybe you have unfortunately not invested in a medical alert system, you will need to call 911. In cases where you are alone, reaching the phone may be difficult to do if you are injured after a fall and you are unable to move. That is why a medical alert system is very valuable to have, especially during a medical emergency when you are all by yourself.

Some people don’t call 911 first because they are trying to assess the situation, and not bother 911 if the emergency is not that dire. This can cause the person to lose valuable time that is necessary for helping them survive the situation. Do not wait to call 911 or press your medical alert button. Even if the emergency turns out to not be that serious, it could have been, and hesitation is another enemy of medical emergencies.

If Physically Injured, Try Not to Move
Many times when people fall, they try very hard to get themselves back up or move around to attempt to find a comfortable position. This is the absolute worst thing a person can do in the case of a medical emergency when a fall is involved. You may not realize, but you may have a neck or spinal cord injury. Moving can cause even more harm and possibly cause you to become paralyzed.

If you have a medical alert system in your home as you should, you will be able to call for help with such minimal movement because you will only need to move your hand to press the medical alert button on your medical alert bracelet, pendant or necklace. Not having to move much to call for help during a medical emergency in which you are alone is a very important aspect of trying to maintain mobility after the fall.

If you do not have a medical alert system and need to try to get to a phone, you run the risk of injuring yourself further. If you have nearby neighbors, try to shout for help and hope someone hears you. Otherwise, you can either wait until someone finally comes, or risk injuring yourself further by trying to move and get to a phone to call 911.

Keep Medication With You
Some people take many medications that can help them immediately in the event of a medical emergency. Obviously, sticking ten different pill bottles into your pockets will never be practical, but keeping a small pill case in your pocket with a few of each important pill in it is good practice just in case of a medical emergency. This way, you can have the medication you need in seconds.

When you are alone, you can not exactly ask anyone to get your medication for you, so if you collapse due to a issue that one of your medications can fix, the pill case in your pocket will be your best friend. However, if you have not prepared for this situation, a medical alert system can act as another person in your home and call medical personnel to help you promptly. Without a medical alert system, it will be difficult to tell how long you might be without your medication, or if you will even survive the situation.

Medical emergencies can happen at any moment, even when you are alone. It is vital that you prepare yourself before they happen and not after the fact. Being knowledgeable about how to handle a medical emergency will be the best way to prepare yourself to combat one. Having a medical alert system in the home will even further help the situation since it basically acts as another person that can help you get the help you need.

Reasons Why Your Medical Career Crashes

Once you become a doctor, it marks a turning point at which most doctors start slipping backwards. There’s a reason! 
Your burning passion and rugged determination for your medical career goals is not enough to overcome the barriers to your planned and expected maximum success in medical practice. It’s a reality that you shouldn’t have to face, and that you don’t deserve.

There are reasons why and what you can do about it. It’s one of the most distressing, yet understandable, factors leading to career failure. The meaning of failure as used here is the complete inability of over 95% of doctors to reach their maximum potential as a doctor.

It also includes your inability to create and maintain a medical practice that will ever reach the profitability potential it has the capacity to foster. In clearer terms, unless you are prepared to do what needs to be done to reach those highest levels of accomplishments, you will fail to a significant degree.

The inability refers to the absence of training and education that are required to rise above the others. As a result you are effectively programmed to fail by the institution that qualified you to be a doctor.

Consider a few factors that lead you to this unholy position: 
You have not been provided with the essential tools to run your medical practice business efficiently and profitably. It means you have no business or marketing training or education.

A challenge to your intellect and common sense:
Is it possible in our present economic environment to create a successful, constantly growing, medical practice business when the doctor owner has no real knowledge about how to do that effectively without expert help?

A “no” answer indicates you are quite comfortable about extracting from your medical career just enough abundance and satisfaction to make do. In other words, you are a hostage to your circumstances.

A “yes” answer indicates that you have not yet matured in business far enough to recognize that all of your sheer-brilliance in medical knowledge is never enough to create a maximally productive medical practice business-just enough to get by with for a while.

You have “educational burnout” without even recognizing it. The evidence of this is obvious when you consider these issues:

  • Why is it necessary to require doctors to complete CME hours for maintaining medical licensure?
  • Why is it compulsory to recertify for specialty credentialing?
  • Why is it that once you start medical practice there is no urgency or self-implied obligation to voluntarily maintain and continually update your medical knowledge?
  • Why is it that the need to have a business education is such an unnecessary and objectionable necessity that is totally ignored by most doctors? Yes, you promised yourself there would be no more burning the midnight oil again.

What possible reason would medical education pundits have to neglect the need to provide a business as well as medical education to medical students? Could it be that they knew about the educational burnout phenomenon and didn’t want that to happen during your medical education and training? But was it OK if it came afterwords?

Your passion for practicing medicine gradually becomes crowded out of your mind. That’s because once you become aware of the fact that your medical career is not able to provide you with the higher goals you had in mind at the start and turned out to be only a pipedream in reality.

For those doctors who already have wealth and adequate funding, there seems to be no real concern about these kinds of issues. However, for most doctors that is not the case. My concern is about the latter.

The real life examples of how these arcane factors are born:
The sequence of ominous changes in your passion for your medical career is one of the most distressing, yet understandable, factors leading to career failure. It begins with graduation from medical school, sometimes even sooner. It’s something older doctors see in their rear view mirror.

Prestige, recognition, fulfillment, happiness and expectations in your medical career seldom increase with time but rather fade with time. As you proceed in your medical career goal setting beyond medical school, the bright lights, celebrations and spectacular accomplishments disappear in the sunset. It starts almost immediately on entering your medical practice.

The day you completed your internship, were you given a loud sendoff, glory and recognition that would shake the pillars of medicine? Did you deserve that? Absolutely… but it doesn’t happen.

The revelation suddenly hits you in the face that there will be no more public pats-on-the-back. From now on your dedication to your obligations and career success becomes an investment in personal satisfaction.

Your reward for completing a residency in your specialty is simply whittled down to a medical certificate of residency completion, not a rousing cheering crowd. Your self-esteem benefits, but your wallet suffers.

Either you are headed for private medical practice of some nature, or you are feeling the overpowering need for security by becoming an employed physician.
Right here at the end of all your formal medical training, you are at the highest level of your medical knowledge with the incredible skills and ambition to take-on any of medical practice challenges put in front of you. From here on you are on your own.

No one is there to push or inspire you further and higher, except yourself. Previously, you had back up. Now you don’t. Even your family that has not lived in your shoes themselves can’t really help you much in your medical career choices and goals.

The next step in your career is even more stressful. And it’s outrageously insulting to all new doctors. Why? Because you don’t deserve this second step of disappointment as your reward for years of sacrifice and struggle.

Medical practice becomes your next teacher and mentor:
This new environment of medical practice has a bundle of harsh lessons to teach you. Of course, no one has discussed these things with you in any depth because they didn’t want to discourage you. These soft lies of omission leave scars. It leaves you naïve and vulnerable, which is much worse than giving you the truth to begin with.

This one thing is far more damaging to your medical career than you can believe. Every medical doctor is affected to a significant degree during his or her career as a result of being forced to adapt to the persistence of unexpected events that they could have prepared for if someone had told them what’s ahead.

Can you imagine how much stress in your practice over the years could have been prevented by knowing and preparing?

What are your options for avoiding or resolving these destructive factors regarding your medical practice career?
As with the activities and strategies required for success, there is no one simple laser-guided response for every person to follow to arrive at their personal highest level of achievement that they call “success.”

However, there is only one commonality found among the successful people that you may not care to hear about.

“It is a stronger, deeper, more unrelenting commitment to success far beyond what most ever marshal.”
(Source: No B.S. Marketing Letter, GKIC, Dan S. Kennedy, Nov. 2012)

This simple golden rule of success implies that we must reach a point in time when our minds become aware of the chain of events, predictable side effects, and consequences that are adherent to your decisions. Thus, it enables you to correctly ascertain whether a decision you make is complimentary to your objective, diverges from your objective or is in direct conflict with your objective.

Your decisions about your medical career are even more complex than any you have previously made. It involves making good decisions at the start but doesn’t exclude good decisions being made throughout your medical practice years.

For most doctors and other medical professionals who haven’t lost their desire to perform at maximum levels, it will often require one or more of the following:

1. You must know yourself:
What are your skills, talents, interests, activities that create satisfaction, biases, and toleration limits, among others? You need to spend a few hours quietly putting these attributes in order, even in priority. Sometimes it takes several sessions with other people (usually parents) who know you quite well and listening to what they see in you that you don’t see.

Many college graduates are unaware of who they really are inside, and what capacity they have to succeed. Therefore, they stumble along relying on their “above average” intelligence to keep them on track to a few objectives.

If you aren’t aware of what you need to do to be happy with your life and profession by the time you finish college, you are likely not to discover that later on. This factor becomes a life long millstone around your neck.

2. You must continue to set goals to be accomplished during your whole life: 
Without goals, you lose your passion and determination. Over 95% of doctors are hamstrung because they either have no idea what they are really capable of accomplishing, or have fears that prevent them from moving to higher levels of accomplishment such as:

  • Fear of being taken advantage of-easily led astray-analytical minded.
  • Fear of not being a success-of failing.
  • Fear of not fitting in-ostracized by peers-not a leader-hidesin the herd.
  • Fear of lack of approval of peers and friends-always social, energetic and fun-loving are the cover-up features.

You don’t set goals because of these same fears. It’s why so many great people tell you to face you fears and go right on through them no matter what.

3. Don’t expect a blueprint for success: 
Lee Milteer, professional highly regarded business mentor, says, “Success Is an Inside Job”. She teaches that you create your own success using the path from “visualization” to “mindset”. If you don’t understand that process, you need to find out how it works and trust it.

4. Create a laser focus on one primary objective: 
When you dilute your path with multiple goals, you are multitasking and are constantly changing decisions. You have set yourself up for a watered-down life and career.

If you find you have chosen the wrong objective, then move to a new focus on another primary objective. Never focus on more than one.

5. Real success in your medical career often results from maintaining your family obligations: 
Your level of success is corrupted when you neglect your family relationships. Divorce, broken homes, financial disasters, and lack of a religious heart results in not being able to fully enjoy your success when and if it arrives.

6. Make your personal integrity the basis of your career: 
Your integrity creates your character that others see and respect. You maintain the principles you live by under all circumstances in your profession. When your “word” is unreliable, you corrupt everything around you one way or another. You then live off the garbage other people discard.

There are many more examples of solutions you probably have experienced and know the value of that may be just as important as the ones I’ve mentioned above. If you thought I was going to give you a 1-2-3-4-5 answer to gaining total control of your medical career, you haven’t been reading between the lines of this article well enough.

Business experts universally agree that medical doctors are set-up to fail. If you care to debate the point, you should start by reading what Michael Gerber, business expert and author, has confirmed by working with many doctors over many years. He presents that in his best selling book, The E-Myth: Physician. Give yourself a huge dose of reality! Then swallow it with a gracious flow of genius.