humor, primary care

Odd Stock Photo Choices

I have informational brochures in my exam rooms.  They are about common medical conditions, and they are put out by this company.  Overall, I think they’re pretty good.  The information in them is accurate and easy to understand.  My patients seem to find them helpful.  I do, however, find the cover art of the brochures to be amusing.  Take this one, for example.

That guy looks awfully happy for someone suffering from gout.  Here’s a picture of acute gouty arthritis:

Now, does that look like something to smile about?  I didn’t think so.

How about this one?

Again, that is not what a child with an allergic emergency looks like.  A child with an allergic emergency looks like this:

And what is up with the picture on the bottom of the brochure?  Here’s a close up:

What is that? Is it a bunch of kids trying to hit a piñata?  What does that have to do with allergies?  My office manager and I were trying to figure it out.  His suggestion was that maybe they were swatting at a beehive instead of a piñata.  I thought that perhaps the piñata was filled with allergenic peanuts and shellfish.

Anyway, this is my favorite:

Yup.  The face of chronic constipation, right there.  Happy, joyful, not a care in the world!

Boy, it’s a good thing I went into medicine and not marketing.  The photos I would have chosen for chronic constipation would look nothing like that.

ABIM, primary care

Oh, Joy.

I’ve written before about how I’m in the process of re-certifying my Internal Medicine Board Certification.  This exciting process has taken about 18 months, and it culminates next week when I take my exam.  The entire process has pretty much been a pain in the ass, and an expensive one at that, costing $1675.00.  That doesn’t include review materials and the review course that I took.

One of the things that has kept me going through this process was the thought that it would be 10 long years before I had to do this again.

Until I checked my email this morning and read this email, with the subject line, “Coming in 2014: Important Changes to ABIM’s MOC Program.” My morning was instantly ruined.

Here are the important changes: basically, maintenance of certification is now going to have to be done on a yearly basis.  A certain amount of points will have to be earned every year.  The exam is still every 10 years.

Why are these changes being made?  Well, the Board claims it will help us “keep pace with the changes in the science of medicine.”  Whatever.  I can firmly say, on the cusp of completing my most recent MOC, that it served no value to my knowledge base whatsoever.  I already have to do 50 hours of continuing medical education a year to keep my license, and in reality I do much more than that.  This is just busy work.  Oh, I get to pay $200 a year for the privilege of doing it.

Here’s my opinion of the real reason.


There are roughly 250,000 ABIM diplomates.  Let’s say that 10% a year do MOC under the current requirements (probably a good estimate, since you have to re-certify every 10 years).  At $1675 a pop, that’s $41 million a year in MOC income.

Now let’s charge all 250,000 ABIM diplomates $200/year for MOC.  That’s an even $50 million.  Oh, look.  The ABIM just increased its bottom line by almost $10 million per year.  Just like that.  Over a 10 year cycle, they’re up $100 million.

I wish I could make money by just changing the rules on people.

So, in summary, all I have to say to the ABIM is, “You suck.  Really.  Thanks for NOTHING.”

medicine, primary care, specialists

AMA- Get out of my mailbox!

I’m not a member of the American Medical Association.  Never have been.  And I have no intention of joining.  Apparently I’m in good company- only about 25% of physicians belong to the organization.

I have multiple reasons for this.  The AMA, at its core, is really nothing more than a political lobbying group.  It exists to protect the interests of doctors.  That being said, their interests really don’t align with mine.  The AMA is incredibly geared towards specialists.  They created the RUC, which works with the Center for Medicare Services to determine payment to physicians.  The majority of RUC members represent specialties, rather than primary care, and very few will argue that it is not responsible for the huge disparity in payment.  I’ll take it a step further and say that we probably can thank the RUC and, by extension, the AMA, for contributing to the shortage of primary care physicians in the USA and the huge amount that we spend on healthcare.

Anyway, it is particularly galling to me that every month I get this in my mailbox:

Looks like a bill, right?  Even what’s inside looks like a bill, at first.
Yeah, that’s right.  These bozos want $420.00.  Sure.  I’ll get right on it.  For good measure, they send me one at home, too.
It does such a good imitation of being a bill that my husband actually tried to pay it once…which is exactly what I think the good folks at the AMA are hoping will happen.  Luckily, I caught him before he mailed out the check.
If you look at what else is in the envelope, it becomes a little more clear.

OMG!  I can get a FREE subscription (valued at $250!!!) to JAMA if I join????  Oh, now I’m sold.  Except…this also came in the mail today.

Yeah, it’s a copy of JAMA.  It comes every month, clogging up my mailbox.  I don’t read it.  I get a great journal summary every month that I read instead.  I never subscribed to JAMA, yet they continue to send it to me.  Every. Week.  For the past 10 years.  That’s over 500 magazines that I never asked for or wanted.  I’ve tried to get them to stop sending it.  No luck.

What’s even more ironic is this leaflet attached to the cover of the magazine.

Renew today or they’ll cut you off!!!!  Don’t delay!!!  If only.  I never send the card back.  And yet, like clockwork, the cycle starts again the next month.


I think that $420 a year probably goes to postal charges.