Effectiveness/Efficiency

On Becoming Chair of the ABIM: Why the Board Matters More Than Ever

On September 10, 1986, soon after I completed my residency in internal medicine, I “took the Boards” – the certifying examination administered by the American Board of Internal Medicine (ABIM). A few months later, I learned that I passed the exam, and that success, combined with an attestation by my residency program director, rendered me “board certified.” I was granted lifetime certification – my framed certificate implied that I was not only a competent internist at that time, but that I could be counted on to remain one (without any further assessment) until the day I retired. I was all of 28 years old. As the proud owner of ABIM’s lifetime seal of approval, I assumed that my thick envelope was the last contact I would ever have with the Board. I was wrong. Last month, I became chair of the ABIM. The organization has always been well respected in…

Measure Me, My Group, or the Hospital?

CMS is overseeing a physician initiative in four states, and you likely know little about it.  Additionally, you are probably unaware of the program it seeks to inform. In 2015, Medicare will begin to assess physician performance on cost and quality data.  Through a value-based code, our newly adjusted fees will reflect these measurements, relative to our peers—with the intent of raising the care delivery bar at the doctor level.  The public will have also access to this information. (more…)

Torture Data Until It Talks

I loved this cartoon because it graphically illustrates how science can mislead.  A trainee or non-EBM oriented physician can grasp the underlying meaning of why jumping on the p>.05 train, or churning for post-hoc significance can be hazardous to your cortex. (more…)

Observation Units: Its About the Patients

Recall your last credit card statement.  On it is the hotel charge from your last out of town CME excursion.  Below the total charge you were expecting, is a separate line item for a $75 "recreational fee."  You call the hotel, and they inform you that because of your use of the gym and pool—accessed with your room key—they levied the fee.  No signs, alerts, or postings to denote policy, and you innocently expected inclusive use of the facilities as a price of your visit. (more…)
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