Nip/Tuck gets "nipped" by FX - thank you God!


The insufferable (vaguely) plastic surgery -related drama, Nip/Tuck , has been terminated by the FX network. From the LA Times,

"When "Nip/Tuck" made its debut in 2003, it broke cable-viewing records and instantly distinguished itself with its stylized look, tongue-in-cheek tone, gorgeous stars and fresh take on America's obsession with beauty and youth. Those qualities earned it a Golden Globe for best drama, critical acclaim and water-cooler buzz that lasted for most of its first four seasons.

But when one of FX's signature series quietly wrapped last week on the Paramount lot, it did so without the usual fanfare associated with the end of a noteworthy show. In part, the silent send-off was because TV viewers won't see the "Nip/Tuck" finale, which finished shooting on June 12, for a long time, probably as late as 2011, making it tricky to publicize. Behind the scenes too, during the last week of production, there was an awkward sense that the end had already happened, since much of the crew had already moved to creator Ryan Murphy's new Fox musical, "Glee," last year, and Murphy himself was out of the country location-scouting for an upcoming movie.

....In the five seasons that have aired, the doctors, who are in their 40s, have almost died several times, slept with dozens of women, broken up their partnership a few times and dumped a dead body in the Florida Everglades. In the 19 new episodes, which will probably air over two seasons and may begin in January, the series will become even more operatic and dark, elements that, critics say, have diminished its pleasures over time.
"


Plastic Surgeons, will uniformly celebrate the demise of this tawdry show which did little to accurately portray or advance our field. While less offensive then Dr. 90210, The Swan, Miami Slice, and other "reality" shows, Nip/Tuck was painful to watch. Other then having supermodels throw themselves at me weekly, I just can't can't relate to this show ;)
(just kidding Honey!)

Rob

Those pesky septuagenarians just say the darnest things!

It's ironic that President Obama's longtime personal physician in Chicago, 71 year old Dr. David Scheiner, is on the record (see here) saying that the president does not understand the healthcare system or the changes that will be required to fix it.

He spikes the president on a number of issues including
  • having close advisers who have no healthcare experience

  • getting in bed with the trial lawyer's on killing malpractice reform


  • failing to understand the economic concerns of physicians and fair reimbursement


Rob


Employee compensation is a tricky subject. During medical school and training you really don't get much background in running an office and you rely upon senior partners and "on the job" training to keep the office running. In this environment, many practices are tightening their belts and finding innovative ways to compensate employees. It's common at many hospitals to offer signing bonuses for new nurses, but in this economy they're exploring alternatives to.

Which brings us to a story about a clinic in Prague
AN understaffed Prague clinic has signed up nurses by offering boob jobs, liposuction and tummy tucks as a bonus.
Nurses, doctors and secretaries who sign up with the small private clinic for three years can choose their free plastic surgery.

"It has been a success," Jiri Schweitzer, a manager at the Iscare clinic, said, adding the establishment was now fully staffed and had to reject dozens of beauty-hunting job applicants.

Petra Kalivodova, a 31-year-old nurse who has been working at the clinic for four years, has had a breast implants - the most popular choice among nurses - so she underwent liposuction for her signing on perk.

"I have mentioned this to colleagues and friends, and the interest in working here is huge," she said.

The clinic charges up to 75,000 koruna ($5060) for a breast implant, almost three times the average nurse's monthly wage, and up to €1880 ($3380) for liposuction.

Many Czech nurses have been tempted out of the country by higher wages offered in western European nations and the Czech health system now needs about 6000 nurses in addition to the 90,000 it already employs, according to official data.


Rob

AMA comes out against single payor and NY Times audience erupts


While the New York Times is rightfully known as the nations' newspaper (sorry USA Today), their articles bring out the worst in it's audience when healthcare articles are feature. Witness last weeks article "Doctors’ Group Opposes Public Insurance Plan" which describes the American Medical Association's (AMA) on the record objections to some of the single payor plans being floated by President Obama's administration and by Democrats in congress. As I write this, there are well over 600 comments to this article on the website, with 99%+ full of fury direct towards doctors.

I don't think most of these commentators actually read the AMA's position carefully to understand what they fear.

1. Crippling of the system by an influx of uninsured or newly covered participants

2. Forced participation by physicians in government plans at below market rates

3. Monopolistic pricing to exclude any competition from private plans

4. No attempts to address the malpractice climate

We've already seen what happens when you mandate universal coverage and then don't fund it adequately in Massachusetts. Similar problems exist in Canada and Great Britain where national health systems infrastructure teeters on the brink of collapse. There's a disconnect about how much money we're talking about to make something like this work and most of the New York Times' crowd thinks it's greedy doctors' fault.

No plan or option is going to actually save ANY money, it's actually going to cost a great deal in taxes to expand coverage. That's fine, but it's a decision you have to make in context of a budget. If you spend it on healthcare it's going to come from social security's money pot in all likelihood. Right now there is a distinct lack of discussing of the cost shifting that's going to occur and the consequences thereof.


Rob

Manhattan's new office surgery rules causing surgeons headaches


New York doctor comrades, I feel your pain!

On July 14, all medical offices in New York performing surgery requiring anything other then local anesthesia will have to be accredited by one of the major ambulatory surgery regulatory boards. While this is imminently logical, it does create special problems in an older city like New York with mostly preexisting structures and high real estate costs. Many physicians are scrambling to find places that can be brought up to code when they get the sticker shock for potential remodeling costs, assuming their current space can meet code at all (which may not be possible in some buildings). Click here to read a feature on this in the NY Times.

Having just finished the build out of an office surgery suite in a blank shell, the easiest way to incorporate the special design needs of a modern O.R., I can attest to the fact of how complex it is. Out of the 4000+ sqf we have in our build out, almost 50% is just to accommodate the workings of a single O.R. Imagine trying to renovate a prewar building in Manhattan, many of which also have co-op boards to deal with as well.

Despite the headaches, it is a good move by New York to require this. Office O.R.'s and the doctor's who use them need closer scrutiny!

Rob

I was inspired to choose a picture of the two-faced Roman god, Janus, to place next to this post. In ancient Rome, Janus was used to symbolize change and transitions, but also associated with the later metaphors of being two-faced or speaking out of both sides of your mouth. Our silver tongued commander in chief managed to do that very well in an anticipated speech before doctors today.

In thee speech before members of the American Medical Association (AMA) today, President Obama was booed. What set that off? His position that any element of true tort reform for medical malpractice was off the table. Up to that point he was being well received and was discussing some fuzzy notions of medical tort reform and the concepts of standardized practices which could offer some imaginary shield of immunity.
"Don't get too excited yet," he warned the cheering AMA members. "Just hold onto your horses here, guys. . . . I want to be honest with you. I'm not advocating caps on malpractice awards."

That last sentence shows his lack of backbone and highlights the way that trial lawyers are one of the tails that wag the dog of the Democratic party. (Screwing Chrysler bond holders last month by ignoring established bankruptcy law to favor labor unions showed us one of the other tails BTW). There has been feverish lobbying on this issue by lawyers to ensure that Democrats protect their interests in medical malpractice and medical product liability cases.

Hell even the logical idea that if a physician adheres to broad standards of care established by their peers they're by definition not committing malpractice is already being fought. The American Association for Justice, which represents trial lawyers and has met with Nancy-Ann DeParle, Mr. Obama’s liaison for health reform issues, to express its concerns. Linda Lipsen, the association’s chief lobbyist, said medical practice guidelines have been established by 'unregulated' medical societies and “should not be conclusive” in a court of law. GIVE ME A BREAK!

From today's Wall Street Journal editorial, "Obama's Malpractice Gesture",
The trial bar and its Democratic allies say that the threat of lawsuits promotes better care and assures accountability. But they've fought even modest changes that would offer liability protection if doctors adhere to evidence-based guidelines. Mr. Obama showed again with his AMA speech that he's willing to nod at the concerns of his political opponents and take media credit for brave truth-telling, only to dump his conciliation if it offends liberal interest groups.

In a nutshell, if you do not explicitly remove the jackpot justice aspects of medical malpractice thru strict caps on non-economic compensation then you've achieved nothing. There's a brand new review of torts by Lawrence McQuillan of the Pacific Research Institute and it discusses what specific maneuvers and reforms have achieved true reduction in frivolous lawsuits. Click to read "Tort Law Tally"

The cost of defensive medicine, unnecessary tests and procedures designed to mitigate malpractice claims, is elusive but has been estimated at over $125 billion per year. That's real money folks. If even 15-20% of that could be saved annually, it goes a long way towards making the math of financing Pres. Obama's plan more plausible. Right now we are being LIED to about the cost of any major healthcare shift and LIED to about what steps would be required to fund it. (Hello rationing and the VAT tax).

I ended my last post with the comment that, "It's this attitude and the distorted liability culture that Obama, et al. are going to be working against to make any gains in health care reform. We are our own worst enemy!". Once again I feel vindicated in that.

Rob

Exhibit A in why we won't be able control health care costs


If you're looking for tangible evidence of

1. how some people feel unbelievably entitled
2. just how distorted people's views of what health insurance is for
3. how distorted our legal system is

Then look no farther then one Tess Sosa, one of the blessed to have ever survived a forced water landing by a commercial airliner. She and her family were passengers on the US Airways flight 1549 which crashed into the Hudson River outside New York City after striking a flock of birds this past winter.

You think Mrs. Sosa and other passengers would count their blessing to be alive and be thrilled with the $5000 check US Airways issued each passenger in compensation (which they didn't even an obligation to do). Apparently this was not acceptable to Mrs. Sosa who is demanding the airlines insurer, A.I.G., pay for all costs associated with her psychotherapy for post traumatic stress disorder, the unprovable sinkhole of psychiatric diagnoses.

From the New York Times,

Tess Sosa, who was aboard Flight 1549 with her husband, 4-year-old daughter and infant son, said she suffered a mild concussion during the landing, and her husband was treated for a leg injury and hypothermia. The family, from New York, continues to get hospital bills, she said. But her top priority was getting the insurer to pay for therapy to reduce the risk of post-traumatic stress disorder for her and her daughter.

Ms. Sosa said Sophia “remembers everything. I just want her to walk away from this knowing that we did everything we could to make it make sense.” A.I.G. agents have told her that for therapy she should use her own health insurance, but it has a $3,000 deductible for mental health care.

“Why should we be paying out of pocket?” she said. “That’s why they’re there. They’re the insurer.”


WTF! She's upset that she's being forced to apply this $5,000 windfall towards her copay and deuctible. Incredible! Also mentioned in the article are other passengers who are refusing to accept settlements in hopes they'll get larger offers. Why do these people feel they're entitled to anything? There was an "Act of God" event that people miraculously escaped alive from, end of story. It's this attitude and the distorted liability culture that Obama, et al. are going to be working against to make any gains in health care reform. We are our own worst enemy!


Rob

According to iScrub, Plastic Surgery 101 is now the 3rd best plastic surgery blog on the web. I demand a recount :)

Writing a blog has been an interesting discipline. It can be real hard to come up with something that I think is worthwhile talking about. Unlike some medical related blogs which seem more like Twitter level entries, I try to put enough effort to make it worth coming back to. With the new office and little league consuming most of my free time, I haven't been able to be as consistent with output as compared to a few years ago. In the "draft bin" I've got nearly 50 blog posts or ideas that I've not gotten around to finishing.

For plastic surgery blogs, I'd really like to celebrate Dr. R.L. Bates' "Sutures for a Living". I have respect for the quality, consistency, and complete lack of self-promoting B.S. that Dr. Bates brings to her blogging. Toni Youn's "Celebrity Plastic Surgery" & Joe DiSala's "Truth in Cosmetic Surgery" blog are about the only other one's I check on from time to time. Joe's was the first blog out there, followed by myself and Toni a few years ago. Most of the other blogs by Plastic Surgeons are extensions of their marketing campaign with little interesting original writing.

Rob

From the Dow Jones Newswire comes a thought provoking observation,

Ezekiel Emanuel, a bioethicist with the National Institutes of Health and brother of White House Chief of Staff Rahm Emanuel, put into perspective the more than $2 trillion spent on healthcare in the U.S. every year.

"People don't have any idea of what a trillion is," said Emanuel, pointing out that healthcare's steady increase will theoretically consume the entire economy one day.

He gave a shocking math lesson:

How long ago was a million seconds?

Less than two weeks ago.

How long ago was a billion seconds?

About the time when President Richard Nixon resigned from office in 1974.

How long ago was a trillion seconds?

30,000 B.C. - which was 15,000 years before the first human stepped on North America.


There's a collision course of sorts that's been playing out in medicine for the last 25 years. As the costs of health care have consumed more and more of GDP, the system has become unsustainable. Physician salaries bore the brunt of early cost containment with effective pay cuts of 50-60% in real income since the mid 1980's. More recently it's been the patients on the receiving end, with more employers dropping coverage and more people enrolled in high deductible/high copay plans.

An article in the New Yorker Magazine, "The Cost Conundrum - What a Texas town can teach us about health care" profiles McAllen, Texas. McAllen is the most expensive place in the country in terms of annual expenditures on medicare beneficiaries. It illustrates the law of unintended consequences and reinforces the notion that anyone who thinks health care costs will come down with universal coverage is foolish. More coverage = more utilization, particularly when patients do not bare much of the costs themselves out of pocket.

The article also features the behavioral changes of physicians as they've become more entrepreneurial. It's profiled as a negative in the article, but it really should be encouraged. In modern medicine, if you do not run your practice like a business, then your practice will fail. Physicians should be encouraged (when able) to align their entrepreneurial interests with their patients. In many instances this will run you head first into government bureaucracy and established interests as in the case of my office surgery suite. Don't even get me started on the fact that I'd be able to do some procedures in my soon to be accredited office O.R. at 40%+ discounts to Medicare and Blue Cross for what it costs to do in a hospital. You'd think this would be of interest to Medicare and the state of Alabama as it would likely save several hundred thousand dollars annually, but instead it's like talking to a brick wall.

Cosmetic Plastic Surgery practices has been the attentive to economics for a long time, and you're forced to be cost-conscious to maintain that kind of practice. The revenue from the cosmetic procedures I do affords me the opportunity to maintain a busy reconstructive practice on cancer patients.

Rob
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