my account is secure and under my control again. apologies to anyone that received a strange message from this account while it was compromised.

Pain on the outside of your hip is one of the most common problems I see in my practice. Walkers get it. Runners get it. People who've never been to a gym get it. For decades, we called it bursitis and injected it. We were treating the wrong thing.

James Van Der Beek passed away today. I’m a healthcare guy and I post about healthcare. Now I want to talk about James. He was special, he was 48 years old, a Father of six, a Husband. He was man who spent his final chapter teaching the ultimate guide to real life. James was part of my growing up. Dawson’s Creek. Varsity Blues. The 90s. He was just there, woven into the background. What he did over the last few years was bigger than any of that. He recorded a video on his last birthday. Cancer had taken everything he used to define himself. He couldn’t be the husband who helped around the house. He couldn’t pick up his kids and carry them to bed. He couldn’t work. He was too weak to prune the trees on his own property. And he sat with that. He asked himself the question most of us spend a lifetime avoiding: If I am none of the things I do, who am I? His answer was simple. Devastating. Beautiful. “I am worthy of God’s love simply because I exist. And if I’m worthy of God’s love, shouldn’t I also be worthy of my own?” That’s it. That’s the whole thing. We spend our careers building identities around what we produce, what we control, and what we can point to. And then life has a way of stripping it all down to the studs. James Van Der Beek faced that moment with the courage. He said cancer was the best thing that ever happened to him because it taught him how to live. He left behind his wife, Kimberly, six children, and a message that every father, husband, and man chasing the next thing needs to sit with. Watch this video. Then call someone you love. Thank you for your contribution. Rest easy…

This is such an important point. People don’t realize that the reason for high administrative costs in healthcare isn’t private insurance. It’s Medicare. That’s right. The endless bureaucratic needling all adds up. Just the Medicare approved electronic medical records costs this practice $10k a month. Then add in all the staff needed for billing, coding, quality metrics, and other compliance. For a hospital, multiply those tasks by 1000. None of that shows up on balance sheets for CMS’s admin costs. It’s just offloaded onto private doctors and hospitals and all the Medicare for all advocates can go on claiming that Medicare has low admin costs.

THIS is why they never get on my recommended lists for insurance, even if a given product of theirs is good. Not because the agents are “bad.” They are not. This company’s culture is SO dangerous for clients and agents alike.

Huge momentum on here today. Thanks for likes, follows, and reposts. #patientsfirst #scrubsnotsuits Of course the suits we are talking about are bureaucrats that never studied science or medicine yet tell some of the smartest, sincere, empathetic, caring, and generous people in the world how to do their job. Let’s keep it going. Like, share, follow, tag, repost. Let’s keep the #doctorcommunity growing @realdocspeaks @AriReddy @JahangirAsgha10 @mass_marion @DutchRojas @txsportsdoc @iSpineDoc @BrentAWilliams2 @rustyrockets @LighthouseDPC Tag your top ten and keep it going.

Been a surgeon for 21yrs, have built a hospital and few ASCs. I think I know a little about healthcare, but the @DRsLoungePod is like getting graduate degree in healthcare every week. If @POTUS @DrOz really want a real solution to replacing Obamacare with better more affordable care. Give them a listen. 🙌

Sadly, I’ve seen a lot of this firsthand amongst physicians. Docs - Please please stop believing insurance products are investments. They are not.

Proposed LCD for peripheral nerve blocks and pain procedures changes will be disastrous for IPM. ASIPP has created a petition for you, your staff, and patients to sign. We will send to all Medicare Directors. Deadline to sign is Nov. 3! SIGN HERE: ow.ly/ns7K50XiH2k

Restore Medicare Access to Procedures —End Discrimination and Geographic Inequality - Sign the Petition! c.org/FkwbYTNfRM via @Change

Things your broker who’s being paid by the insurance company also won’t tell you: if you develop a pre-existing condition while on Medicare advantage — you will be stuck on their narrow network. You can’t go back to traditional Medicare Medigap supplemental.

#MayoPMR90 Did you know that the first PM&R Residency program was started at Mayo Clinic in 1936? It's been going almost 100 years! 😮 #mayoclinichistory @mayopmrres #physicalmedicine

This week hit me hard for two reasons. First, I got one of the many emails that I get every October that breaks my heart. The one where a physician - who just finished training - reaches out after hearing my story about getting denied disability insurance after an insurance agent gave me bad advice, and how because of that bad advice I cannot ever get disability insurance. Similar to my situation, this doc has medical problems that preclude them from getting “normal” disability insurance because if they went through underwriting, they would get denied like I did. So they need to get the Guaranteed Standard Issue (GSI) disability insurance, which ignores your medical history and allows you to still get own occupation disability insurance. … but the problem is that there is a catch with the GSI. The GSI is only available in training and for a very brief period right after training (90 days), which means if you don’t get disability insurance by the end of September in the year you finish… well, you can no longer get it. And this doc finished 108 days after they finished training. So, like me, this doc will now have to go on without having individual disability insurance, which brings me to the second thing that happened this week: I had shoulder surgery on Friday and it was much more extensive than we thought it would be. We thought it would just be a distal clavicle excision… but it turns into two labrum repairs, a full thickness rotator cuff tear repair, bicep tenodesis, and the origins distal clavicle excision. Now, I am out for 6 weeks, and this is serving as a very real reminder of me not having disability insurance, and the real risk that posed for my family. Not a lot of peace of mind to be found at the moment. So please, please, please make sure you get disability insurance while you are in training so that if you need the GSI (like 40-50% of docs do) it is available to you. Don’t wait. This isn’t something to put on the back burner. That way, when you have a medical situation pop up, you can rest easily at night knowing you and your family are financially secure. Trust me when I say that, as someone who doesn’t have it right now, peace of mind is worth a lot. And if you are an academic attending, make sure your trainees know about this, too. Financial stress is a very real thing that impacts academic performance, burnout, career, and life decisions. Don’t let them make the mistake of not getting disability insurance while in training. #MedTwitter #MedX

If you don’t already have your copy of the revised and expanded edition of The Simple Path to Wealth, this is your chance to get it on sale for Amazon Prime Day on October 7-8 at the lowest price it’s ever been. Or to give the gift of financial freedom to someone you love.

New attendings - Here's how I'd direct your paycheck destinations in order of priority: 1) pay off credit card and other high (10% ) interest debt 2) fill up emergency fund (3 months) in a HYSA (or money market) 3) max out HSA (if applicable) 4) max out your primary employer retirement account (pre-tax) - this could be a 403(b), 401(k) or if self-employed a solo 401(k) 5) max out personal Roth IRA (via backdoor method) 6) max out supplementary employer plans (457b, 401a, ARP, if applicable) 7) if you have student debt that is not in line for PSLF, figure out a payment plan that works within your budget as well as the above priorities (some want to be more aggressive with student debt payoff so there's some wiggle room here) 8) Assuming you've figured out the needed savings rate (what % of your gross income to put towards retirement savings) needed to achieve decision/career freedom by a given year, ascertain how much remains to be saved towards retirement and fill that gap via a taxable brokerage account and invest in a tax-efficient way (minimize taxable income-producing assets).

Looking for medical students, FMIGs, residencies, that would be interested in direct primary care lunch and learns (free lunch) ;)

The doctor shortage is a myth. What we have is a system that pushes physicians out and calls it progress. @DutchRojas sat down with @DrDiGiorgio, @anish_koka, @sdixitmd and @drdanchoi to break down: • The residency bottleneck • Physician burnout by design • Why H1B visas won’t fix anything • What happens when doctors aren’t allowed to own medicine anymore This is the episode every policymaker must hear because the system isn’t under-doctored, It’s over-controlled. For more episodes check us out here: tinyurl.com/mwvpe885

Just started fellowship? Still don’t have a GSI policy? You have the advantage of still being able to access your residency program’s GSI or your fellowship’s GSI. Chances are better that at least one of the programs has a GSI! Reply or message me if you need direction.

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