Doctors and their Practices

After years of practicing neurosurgery within small, single specialty practices, I recently joined a multispecialty group as their first (and only) neurosurgeon.  The transformation for me has been stunning and immediate.  Of course, I was very fortunate that there was a high quality, doctor owned/run group in my community so I now have the best of the best.  The NY Times recently featured an article on this phenomena pointing out the dramatic shift nationwide from doctors in private practices to doctors employed by hospitals and large health care groups-now only half of all physicians are in "traditional private practices. From my experience I would say:

• Multispecialty groups do have the ability to provide more seamless, comprehensive care for patients-adding to efficiency and quality BUT this is not a given, as with any system, the devil is in the details (i could already give countless examples where patient care as dramatically benefitted in my group experience, perhaps a later post).
• Multispecialty groups allow doctors to be doctors and significantly free from administrative responsibilities BUT beware the groups run exclusively by business types, they won't understand enough about medical practice and how it differs, say, from selling knives.
• Multispecialty groups allow FAIR negotiations with insurance companies leading to reasonable reimbursement for physicians and greater access for patients (doctors can be in-network if fairly compensated).  The NY Times points out that this will raise the cost of healthcare! Perhaps but perhaps it should reduce the profits of insurance companies-after all, we pay our premiums for HEALTHCARE, ie doctors, nurses, hospitals, NOT insurance CEOs!
• Their are many potential problems: groups can get too big, hospitals don't really know how to run doctor's practices and are notoriously bad at billing/collecting (their last dalliance with employing doctors more than a decade ago failed miserably), health care organizations may develop competing priorities.

Stay tuned...will see how this movement along with recent Health Care Reform legislation plays out for doctors and patients.

Transplant and the Neurosurgeon

One of the things I love about blogging is how a link leads to a link leads to a great story.  SurgeXperiences 319 (available here ) related a link about Steve Jobs and his liver transplant. Most neurosurgeons spend a part of their residency learning the ins and outs of brain death testing-a critical link in the transplant world.  At first it may seem gruesome and unnatural but most of us quickly realize the how many lives are touched by an organ donor.  Since that time, I spent years working closely with the New York Organ Donor Network on public awareness and education programs because of the ever growing disparity between the need and availability of transplantable organs.  The fact is that the success of modern surgical transplantation has far outstripped our supply for these critically ill patients.  Once in a while, a celebrity like Mickey Mantle, grabs some headlines and we all hope that more universal acceptance of organ donation will take root.  Now, two giants-Arnold Schwarzenegger and Steve Jobs are taking the battle on.  Until technology leapfrogs us beyond the need for human organs, let us hope a much higher percentage of Americans will become designated organ donors-it only takes a minute!  Watch Job's video -it is inspiring.

First Meeting

ICU: First Meeting

Wash hands

Step over the red line

Irish gentleman

Stripped of dignity and clothes

"No stroke" I say

Small smile

Something else entirely

The tears collect

I dab his ruddy cheeks softly

Please tell my sons

"Surgery tomorrow" I say

No smile, tears again

Tell me now, I need to know

And so I sit and we talk

Holding hands

Mixed Musings

Everyone is busy. I make no excuses. Everyone has times when all the hats they must wear need attention at the same time.  This has been such a time for me.  The confluence of this week included a higher than usual surgical quota, a similar load of consults and office responsibilities, both kids home from college (one with a crisis of intense proportions), a dog having surgery and a new puppy on the way, and multiple regional and national executive board meetings while health care reform reached fever pitch (with no real relief from the SGR)!
Why should anyone care about what happens in my small orbit? The easy answer is, you don't and you shouldn't.  You all have your own challenges and probably don't have the time to waste reading a long diatribe.
But in the midst of this, I was struck again by a few things.

• Talking to a close colleague he said, "I am not trying to blow smoke up your a...but it has to be so much harder for you as a mother and full time neurosurgeon to deal with the challenges of kids" (this after a prolonged discussion about a number of clinical matters and then his own crisis kids!).  It is 2010 and yet being a mother is considered unique from being a parent and I have to shake my head and think, we've come a long way but...
• Being a parent is far  more difficult than being a neurosurgeon 
• During a crisis, trying to be a good parent can distract from the unending work of being a neurosurgeon
• My patients remain remarkably supportive of me as a person-respectful of my multi-dimensional needs (in fact, sometimes I sense they like me more because I am not JUST a neurosurgeon)
• Isolating myself as a doctor excluded from the socioeconomic aspects of medicine will never be fulfilling
• Thank goodness for dogs, their love is unconditional
• My husband is a saint, I couldn't be without him

Is there a lesson? Sure, always have a Plan B, always be seeking new opportunities, making new connections, exploring new avenues.

Frank Lloyd Wright: The present is the ever moving shadow that divides yesterday from tomorrow. In that lies hope.
Walt Disney: We keep moving forward, opening new doors, and doing new things, because we're curious and curiosity keeps leading us down new paths.


Coming soon: adorable puppy pictures!

Waiting Room

He rises from his seat
CNN rambles on from the wall
His book falls to the floor
No stooping to collect
He must catch my smile
Shoulders drop, breath exales
We shake hands

Teach your children well

Raising children has never been an easy job-I, for one, will admit it is far more difficult than being a neurosurgeon. And no matter what we think, each generation is as different from their parents as the parents were from their parents.  Difficult as it may be, being a parent carries with it important responsibility to help develop individuals who can become responsible, contributing members of society-to provide a framework of understanding, of commitment, of right and wrong.  Non-parenting is just not an option, not fair to the children, not fair to society.
While there is no right answer, we made the decision to raise our children during their early years with limited TV exposure and little or no computer access.  Many scoffed at us for a whole variety of reasons until the hard studies started to prove that curtailing this activity led to better school performance, fewer behavior problems, etc.
It is no surprise, then that increasing studies are emerging (Violent Video Games Bad) detailing the potential harm of violent video games-especially at early age, for prolonged periods, and those with the most realistic violence.

As a neurosurgeon, I have too often witnessed the sad results of violent youth-the wasted lives, the uncontrollable tears.  Certainly video games are not solely to blame, the problem is far more complex.  But why expose ourselves to any added risk of such devastating actions.
Maybe this "hobby" has become too ingrained in our culture to expect change...but they said that about many negative cultural phenomena in our past (slavery, segregation, women's right to vote, women as physicians/astronauts/lawyers).  Change can happen.

Lost Friends

Recently, I and all of neurosurgery lost two friends.  No death is ever easy but some losses are felt more acutely and for me this is true for the deaths of both Robert Ojemann, MD and Ilona Quest.  

Robert Ojemann
I only had the honor and privilege of interacting with Dr. Ojemann on a few occasions.  He was the quintessential gentleman, scholar and teacher.  During my training, his name was up there in the stratosphere. He was a master surgeon, researcher and administrator; one of the few to hold the top position in nearly all of neurosurgery's national organizations.  So when I encountered him,  I was prepared to be "brushed aside"-quite the contrary.  He went out of his way to comment on a recent talk he had heard me give and to compliment me!  It was obvious that he was still keenly interested in all that was neurosurgery and held respect for those who worked seriously and tirelessly to move the specialty forward to better help our patients.  For all his dedication, hard work, and enormous success, I showed me honest respect that helped propel me forward in my career. What a great role model. We will all miss his wisdom, intelligence and honesty.
Ilona Quest
No one I know that ever met Ilona Quest, the lovely and gracious wife of Donald Quest, MD (past-AANS president, ABNS, RRC, Senior Society, Professor Columbia), ever walked away feeling anything less than cherished. She was an amazing woman who provided the foundation that allowed her husband to flourish and succeed as a world class neurosurgeon.  But Ilona was more than just the woman behind the great man. She worked tirelessly to enrich our meetings in a multitude of ways.  I firmly believe she was also a great force behind her husbands unfailing support for women entering neurosurgery (for which he was recognized with the coveted "Friends of WINS Award" (Friends of WINS Award).  It was a cruel twist of fate that she succumbed to a neurosurgical emergency.  I last saw her in New Orleans-we hugged and talked while Don performed his jazz on-stage.  I was again struck by her ability to recount details about my family who she had never met and talk about the state of my career.  She made me feel very special-that is a great gift.  My thoughts and prayers are with her family and friends. Tonight I said Kaddish for her.

Medicare and the Neurosurgeon

Congress and the President decided to give physicians and the American citizens a month reprieve from the 20% Medicare cuts proposed.  This is a battle that has been waged for the last decade with the SGR (sustainable growth rate) equation being the focus of much debate.  Most years, Congress realizes such a cut will end medicine as Americans have known it and finds a way to reverse the cuts, and if we are "lucky" give doctors a 0.5-2% raise (still well below the annual increased cost of doing business).  Increasingly, specialists such as neurosurgeons are finding it impossible to provide Medicare patients with services at the reimbursements provided.  A close colleague, Dr. Ed Kornel, was recently interviewed by CNN and provides a concise, cogent discussion of the issues.  I encourage all to watch this piece-this is an increasing problem in our health care system that impacts ALL of us: physicians, patients, business.  With an increasing percentage of Americans over 65, this is not a problem that will go away.  If you are not over 65, I bet you know someone (parent, aunt, uncle, friend) who is!  Dr. Kornel on CNN
Dr. Kornel can also be heard weekly on his own radio show talking about the spectrum of back problems and the politics of medicine. http://backtalkonair.com/ and can be followed on his blog ezrielkornelmd.blogspot.com

Oustanding Art II

I love this picture because this woman seems so comfortable, so completely sanguine.  It makes me feel peaceful. I appreciate the animal because it has such a human feel while not divorcing the true animal.  I also adore the artist.  Shelly Timmons is a neurosurgeon with so much talent-as a surgeon, thinker, organizer, motivator, educator and then I find out...as an artist and writer.  No surprise she is also active outside neurosurgery as well (mother, wife, etc).  It has been such an honor to get to know this remarkable woman, to work closely with her within organized neurosurgery, and to be able to showcase her "other talents" in our book. I hope her art brings joy to others as it has to me.

Sofia Ionescu

The woman most often credited as “the first” female neurosurgeon is Sophia Ionesco (photo left), who trained and practiced in Romania (deceased March 21, 2008, age 88).  Her father preferred her to be a "young lady and housewife" but fortunately she had a supportive mother and when a close friend died from a brain infection, her career choice was set. She started medical school in Bucharest in 1939 and after training in neurosurgery, practiced for nearly 50 years before failing vision (!) forced her retirement. 
She was instrumental in establishing Romanian neurosurgery as part of "The Golden Team" (including her husband). 
She received numerous honors in her lifetime-and left a legacy that inspired many women to consider careers in neurosurgery, especially those throughout eastern Europe and the former Soviet Union (more on these inspiring women will follow soon).