Primary care physicians are the back bone of US health care system .Currently health care is facing an acute shortage of primary health care physicians [PCP].Predictable shortage by 2020 is about 20,000 physicians Aging population , population growth and Affordable care act , they all contribute to it.Nurse practitioners and Physician assistants alleviate this issue to some extent but the overall picture is grim 

Physician burn out rate is high and ever increasing . In 2014 , Family physician burn out rate was around 63 %. 

Primary care physicians are the default dumpsters of health care .They should be capable of treating all medical issues with the most little help from specialists [Managed Care ]. They should practice corporate medicine with EMR documentation [15 min , each patient ]. They should have an expert opinion about whether patient can drive , keep a pet , lift 20 pounds , climb up to the first floor [anything that can have any remotest legal implication ]. They should be rhino skinned and be ever forgiving to the frustrated patients.

Not to mention the hostile legal environment 

Sad part … There is no legal  platform that addresses physicians issues 

Physicians are life savers but not Gods 

And  human beings do need help 

 

Its  a moment of introspection for all of us .  We witness , societal maladies are overflowing like a river above its danger mark .When the call for justice is not met judiciously , repercussions are not always pleasant .

These  happen in the  world over,  time to time . This time its closer home

We are very lucky that we have freedom of speech and these problems are being openly acknowledged and not  being brushed under the carpet .That  is  a step closer to finding a solution .

The mantra for peace and prosperity is  integration and not segregation

The mantra is love  and brotherhood and not hate and violence .

Science and technology has always bonded mankind .Digital era has  united the humanity .Globalization and free trade has  helped  prospering us .

We need behavioral modifications and de conditioning  .Integration should begin at the most basic level .There should be mandatory  reservations for minorities at the grass root levels like schools ,colleges , training institutes , clubs , jobs,local bodies  and so on and so forth . Those voices should be heard and be made a part of the decision making process

If color of skin is still a criterion in 21 st century then its  most reprehensible and retrogressive .

 

I finished a decade being a H-1 B candidate as I still wait for that magical day when my priority date becomes current . Priority date is the date when US immigration services approves of your presence in the queue for application of green card .Green card is a step closer to  citizen ship .

India is the only country which has  years of back log in the process . At the moment , priority date is current for conversion  to green card for applicants of 2005 .It is even worse for people who do not have a masters or doctorate .

Visa candidates always need sponsorship from their employees which puts them in an unfavorable position in job market . They cannot start a business or own a home as they do not know where the next visa is coming from and so on and so forth….

Most of us are legal immigrants .They are one of the most successful minorities in the US .They contribute in one of the most meaningful way in the US society , both economically and socially .

Then why this antique rule of quota system for each country ?

From what I have gathered it is not even a partisan issue . !

We  need accomplished   and   sane  Americans if  we want America to continue its position  as the World leader . Stumbling blocks do not help in any way.

 

With  the Brexit ,  rest of the World and a part of GB[Great Britain] is sad . Another world wide recession is being anticipated .As per experts , recession can  happen cyclically every eighth year . Such unprecedented events like Brexit can accelerate recession

We are still ambiguous about successful  recovery of US  of its recession .Healthcare is considered one of its topmost culprit .Primary care has a vital role to play in cutting down the costs .

There is  an undeniable funding crunch . Most accessory services are being discontinued like counselling , education , care coordination which is costing us in more than covert ways .

Each community health center has an administrative wing attached to it . Most of the times they have a plush office whereas a physician does not have a decent office to call their own .Their main job is to scrutinize physicians .In some states , they have started pilot cases , where a group of Community health centers  are   under one administrative head .

I consider it a very good idea , where physicians would get a respite from high handed administrators and funding would be rightly channelized where it is needed most.

Electronic Medical Records[EMR ]  is both  a curse and  a boon . It was introduced to be an important arm in Accountable care to provide evidence based quality care . It was supposed to help  to tide over insurmountable cost of health care . EMR   helps with a better connectivity between various physicians , specialists and other medical support systems so that   every body is on the same page and there is no wastage of resources .

But we still do not see the light at the end of tunnel as there is a big piece missing in the puzzle , Tort reforms

This makes physician practice defensive medicine  and put endless burden on health system.

Some thing similar crossed my mind as we all helplessly saw innocent human slaughter , last week , in Orlando by a disturbed man . We again get confounded by the logic of such acts . During the media reporting ,it resurfaced again and again , there were many clues and many chances that concerned authorities could have picked up and could have avoided this massacre

The time is running out . Grass root intelligence need to buck up their act .Social media should take  voluntary responsibility for sharing and processing information As fellow human beings , we all owe it to ourselves to do every thing possible to put a stop to these heart wrenching events .

But as I said , there is missing piece in this puzzle too – I don’t have to spell it out

In New Delhi , the national Capital region , we get a lot of students from other developing countries who are interested in pursuing higher studies .India is a cheaper destination and this endeavor gives them a head start to pursue other things in life .As to my knowledge, ingenious population is very  diverse and very friendly

But lately a disturbing fact was noted that students of African nationality were being the object of racism by a certain section of populace .

It was the most  bizarre  news to  swallow

Till date , Indians themselves have been the victim of racism wherever they have been as economic immigrants .Then how can this  type of behavior be encouraged ?

We had a very appropriate reaction from all the vocal part of the society . Politicians , media  elites have all condemned this openly .Strict disciplinarian actions were announced against those who were perpetrating such acts .

Education , awareness and strict regulations need to be called for such shameless acts .These stray incidents should never get  to become norm in one of the most tolerant countries of the world

 

In India , when a child  is accomplished and is expected to have a bright future , it is prophesied , Oh ! You will go to America and have a good life .

If any one is not getting their dues in adult life in their respective field , there is hope that he can make a life  in America .

There is a destination and possibly a pot of gold at the end of rainbow .

There is a country which is held at a financial pedestal .ethical pedestal and regulatory pedestal  and one is willing to invest all ones intellectual property in it .

But the current political scenario  seems  to be contrary  .Most unconventional nominees are surging ahead and the world gawks .

Would the only hope wither away

Well , the time will tell .

The  doctor patient relationship is considered fiduciary . Doctor should have only patient’s welfare in mind and the patient is supposed to have  faith in doctor’s judgement .

The real picture is very different

There is a deep distrust in the air ,as every where .

As there is no tort reform , doctors have to practice defensive medicine . Patients are sometimes viewed as potential litigators .Doctors have to deal with EMR ,extensive documentation , administrative hassles ,shortage of manpower .

On the other hand , patient are caught unaware about newer regulation about controlled substances .As doctors are the face of these multiple agencies like insurance companies , Corporate hospitals , physicians are viewed as an allies to them . Unfortunately , that is far from truth .

Some times the anger and frustration is so extreme that they would not even stop using cuss words for the doctors

Back home in India , they go a step further .

If there is an unfortunate outcome , they would take law in their own hands . Violence against doctors , arsons at the hospitals  are not infrequent

We need to redefine and retrospect on this fiduciary relationship .

A  Physician is  not God  or Santa

Wish lists cannot be always  granted

 

During my last years of residency , not too long ago , when I was job searching , I was made to feel guilty again and again for asking for a decent pay packet as I was inexperienced . I was not supposed to expect much as I  was  wet behind the ears .On top of that , I was a visa candidate .

Over the years , visa status has not changed . India is the only country languishing in the queue for priority date to become current . But the demand for experienced primary care has gone down .

Fresh MD’s are being welcome with open arms They are ready to book you in your final year of residency with a stipend . All the more better if you are a Nurse practitioner .

After a few years in your job , your job demand does not resemble your old contract any more

In the end , Its Money , Money , Money ;Its the bottom line , Honey ;All that matters to a Compaaa…ny

 

 

Drug menace is omnipresent in the world . In America , drug overdose deaths resurface time and again . CNN dedicated its prime news hour to this issue which was  moderated by distinguished panel . Thanks , CNN

As physicians , specially as primary care providers , we have a major role to play as most of the time it is in  their office where this problem is initiated . Community health centers get to see this cross section of population who use , misuse and may be sell on the streets .

But not too long ago , physicians were answerable to dropping  patient satisfaction , decreasing patient numbers and all in all non impressive  bottom line . Physicians are sandwiched between patient’s  wrath and unaware administration .Even if one of the physicians join administration , they do not take time to change colors .

More public awareness , stricter guidelines , more grants for behavioral health issues are required for this ongoing public menace