The Paradocs Podcast with Eric Larson

How do PBMs (pharmacy benefit managers) pass on savings to themselves and leave patients and insurance companies holding the bill? It's hard to answer that question without first understanding what a PBM is, how they work, and what their role is in the pharmaceutical market. Unfortunately, the PBMs intentionally cloud what they really do in order to continue ripping off patients and insurance comp...

This week's episode is a longer interview I did as a guest on the Gray Matters Radio Podcast with Mike DeVine. He had me appear in February as part of his series exploring the US health care system and its many dysfunctions. In this episode we explored the problems with the pricing system, group purchasing, economic scarcity, and why things are just so darn expensive. Of course they all get answer...

Only in medicine is discussing prices before providing care a revolutionary concept. Prices serve as an important signal to both providers and patients as to the relative scarcity of care. Whether that is time with a physician, time in the operating room, the cost of equipment necessary for procedures, or medications the price signal is important for both sides to understand the real cost of using...

How would you feel if someone who didn't know, was unfamiliar with your symptoms and story, and had never examined you dictated the way you were treated? Would you be upset if the people making those decisions were not specialists or maybe even had the same training as a physician? Unfortunately, this practice is very common today in every doctor's office in America and it is called prior authoriz...

If there were a conventional treatment for a disease in a traditional medical practice that worked only 10% of the time or less - would anyone feel comfortable claiming it was a fantastic cure? I suspect not, yet those abysmal successful treatment numbers are present in some areas of the mental health arena when it comes to addiction treatment. However, you almost never hear about the failure of t...

Today, the topic physician burnout and looking at the numbers at who is suffering and what the causes are. Medscape published its 2019 Survey of Physician Burnout, Depression, & Suicide that dives deep into the demographics and causes of the phenomena. However, what was notably absent from the possible causes for burnout was financial matters. What effect does a high personal debt have on physicia...

I have spent a lot of time discussing innovative ways of delivering medical care on this show and it has primarily been based around primary care. However, those who are specialists who traditionally practiced using third party payors (Medicare, Medicaid, commercial) are also beginning to strike out on their own and switch to cash pay. The reason for this is that the cost of using insurance and th...

What is the difference between a first year medical student and a senior in college? A lot of debt and neither knows anything about medicine. Contrary to popular belief, medical students don't know the first thing about the health care system, how it is delivered in the United States, or what challenges face physicians in caring for their patients. So all of the popular opinions floating around in...

For those who have encountered the health care system - the emergency room is the greatest mystery for charges. Although little of emergency care is truly emergency life threatening care (est. ~3%) the care is some of the most expensive in the hospital. Whether that it is imaging, laboratory, or professional services - patients and insurers are expected to pay the inflated costs. So how do we cont...

If there is one thing patients and doctors agree about when it comes to primary care it's that it isn't properly working for either one. Doctors have too little time to spend with patients, can only address one or two problems at a time, and spend most of the little face time they get staring at a computer screen than at their patient. Learn more about your ad choices. Visit megaphone.fm/adchoices

When it comes to working, we all have different goals on what to accomplish during our careers. However, almost everyone anticipates on retirement as the way they end their professional life. The FIRE movement is one which emphasizes achieving your financial independence and retirement at a younger than traditional age. With careful planning and goals in place at a young age, you can achieve the g...

One of the tasks assigned to physicians, and certainly not a task one thinks of when entering medical school, is to verify death. The first time you declare someone dead - for me, it was as a first year resident in the ICU - is a weird feeling because of the finality of it. As with anything you do as a physician for the first time there is some uncertainty that you aren't "messing up." But you don...

Direct Primary Care (DPC) is starting to gain some steam and popularity with established physicians, residents, and medical students. Patients are also beginning to learn about this alternative to traditional insurance based care. Instead of copays, deductibles, and limited visits and times with the physicians - DPC works as a monthly fee with unlimited access to the physician. Learn more about yo...

Physician suicide is an epidemic. How else do you describe 400 physicians per year ending their own lives which is over twice the national average? Why do so many doctors feel that the only escape from their pain is suicide? How do we end this epidemic and begin to heal the healers? Learn more about your ad choices. Visit megaphone.fm/adchoices

We can all agree - outside of a few overpaid pharma CEOs - that the American Health Care system is too expensive. In fact, one could argue that the system of delivering health care in America is designed to cost the most possible without any parts that can check its growth. If you were to try and design a more costly and inefficient system I dare say you would be unsuccessful. Learn more about you...

Who is that man or woman in the white coat? What is he/she thinking as you are being examined or operated on? Is that physician burned out? Suicidal? Feeling optimistic about his/her profession? The future? There is a lot going on between the ears of that physician that isn't devoted to healing people. Today, I take a deep dive solo-style into the results of the comprehensive 2018 Survey of Americ...

The opioid crisis has been in the news for a few years now and those to blame for it are many. Is it pharmaceutical companies who made easy to prescribe formulations of powerful pain killers? Is it physicians for over prescribing pain medicine for simple aches and pains? How about federal guidelines that encouraged the over treatment of pain? Or the creation of the fifth vital sign in the late 90'...

Social media is ubiquitous in our lives and doctors have a less than average presence within that sphere. The reasons are many but probably partly related to concerns about medical liability, their employers, and reputations as physicians. Dr. Dana Corriel set out to change that. She created the #SoMeDocs which encourages physicians to engage the world more and bring their unique perspectives to p...

Our discussion hopefully offers some insight into grief while being sincere with brief moments of humor. What to expect, what is comforting, what is not helpful, and how it has changed our lives. Specifically, we discuss the process of forgiveness, grace, and practical things you can do to help your family members or friends in dealing with the grief. My hope is that this episode will be a comfort...

Sometimes, the best way to understand your present is to view it through the lens of the past. HMOs (Health Maintenance Organizations) were a product of the 70's and exploded onto the scene in the early 80s. Specifically, he recounts the 'industrialization' of health care delivery where a cottage business of caring for the sick transformed into the business it is today run by large corporations. L...

HIPAA (or the Health Information Portability and Accountability Act) passed in 1996 and has been touted by legislators, physicians, patients, and health industry leaders as a law that protects patient medical data privacy. It turns out, as with the names of many laws that pass in Congress, the act does the exact opposite as what you might guess. The act allows for over 2.2 million entities in the...

Did you know that most hospitals (or hospital systems) enjoy a non-profit tax status? Despite revenues in the billions of dollars these entities operate within your city or community with a tax exempt status including all the medical offices, laboratories, imaging centers, and billing offices that they build and purchase. Does this give them an unfair competitive advantage over for profit imaging...

Few are aware of the practice of public reporting for health care and on its face, it seems to be an obvious goal for policymakers. However, comparing health care systems, hospitals, or individual physicians is incredibly complex and probably impossible to do in any sort of meaningful way. Traditionally, patients relied upon local knowledge with their primary care physician to refer to the best fe...

Maintenance of Certification (MOC) continues to weigh down physicians encouraging early retirement, burnout, and financial strains leading to all sorts of other personal and professional problems. The private specialty boards (ABIM, ABA, ABP, etc) are under the auspices of the ABMS which sets many of the rules that are ruining physicians' lives. Learn more about your ad choices. Visit megaphone.fm...

Certificate of Need (CON) laws are commonplace in the United States and affect every patient and physician who lives in one of the 36 states which have them in place. The laws stipulate that you need permission from one a government regulatory board proving a need in your community to open a competitive health care service like ORs, laboratories, imaging centers, or hospitals. Learn more about yo...