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I am interested in best places to practice pain i.e best places to live, least malpractice, pain physician friendy areas, best family relocation areas etc...
Input appreciated.
Input appreciated.
best places to practice pain
- Thread starter cibuku
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Any state(such as Texas) which has torte reform is going to be more physician friendly in general.
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Does anyone know which are the states that have passed the Tort Reform. I would appreciate any suggesstions where to find the list of states that have passed the reform.DigableCat said:
Anyone will be much appreciated for the input.
Thank you in advance,
Cibuku.
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I don't think the question can be answered by most of us, even those of us who have been in practice for many years. How does one compare Florida to NY to Texas to California if one has not lived in all and practiced in all? Lifestyle is important, but in pain medicine, you can set your own hours and enjoy the locale outside work as much as you want. The question about the best place to practice pain is kind of asking "What do you think of the color orange?" No good answers, only preferences.
Big city...little city. Warm vs cold. Weather fears vs none. Kids vs no kids. Medicare population vs few Medicare.
Its all about priorities: write down what is important to you then make a list of these in order of importance, then begin your search.
Of course everyone knows Indiana is the best place to practice pain medicine. (JK)
Big city...little city. Warm vs cold. Weather fears vs none. Kids vs no kids. Medicare population vs few Medicare.
Its all about priorities: write down what is important to you then make a list of these in order of importance, then begin your search.
Of course everyone knows Indiana is the best place to practice pain medicine. (JK)
Actually Indiana is pretty amazing for medicine. From what i remember being told, you are judged by 3 other physicians in your field before any malpractce claim goes anywhere. COrrect me if im wrong. It is just too dam cold.
T
T
I'm also very interested in hearing answers to this question. Just as algos pointed out, I know chosing a city to live in is like asking what color you like...but more specifically, I'm wondering, which cities/states are more malpractice friendly, least saturated with other pain physicians, and with higher reimbersement rates.
I know AMA has listed 9 states as being "physician friendly" in terms of malpractice...Indiana ranked number 1 on that list. I can't remember the order, but some other notables were: Alaska, Oklahoma, Wisconsin, S. Carolina, California, ....that's all I remember off hand.
California b/c of tort reform...suppose Texas should also be on that list for the same reasons?
Alaska is also a non-HMO state...basically fee-for-service, and I know there is already a large spine group there practicing pain with about 15 pain physicians.
Would like to hear other comments on this topic.
I know AMA has listed 9 states as being "physician friendly" in terms of malpractice...Indiana ranked number 1 on that list. I can't remember the order, but some other notables were: Alaska, Oklahoma, Wisconsin, S. Carolina, California, ....that's all I remember off hand.
California b/c of tort reform...suppose Texas should also be on that list for the same reasons?
Alaska is also a non-HMO state...basically fee-for-service, and I know there is already a large spine group there practicing pain with about 15 pain physicians.
Would like to hear other comments on this topic.
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There is a full page ad in today's Chicago Tribune from the instituteforlegalreform.org where they list the best and worst legal systems.
Top 10: Delaware, Nebraska, Virginia, Iowa, Connecticut, New Hampshire, South Dakota, Colorado, Maine, and North Carolina. Indiana was #11.
Bottom 10 (#41 to #50): Arkansas, South Carolina, Texas, California, Illinois, Hawaii, Alabama, Mississippi, Louisiana, and West Virginia.
Here is a link of the ad:
http://instituteforlegalreform.com/harris/pdf/IL_Trial_Lawyer.pdf
Top 10: Delaware, Nebraska, Virginia, Iowa, Connecticut, New Hampshire, South Dakota, Colorado, Maine, and North Carolina. Indiana was #11.
Bottom 10 (#41 to #50): Arkansas, South Carolina, Texas, California, Illinois, Hawaii, Alabama, Mississippi, Louisiana, and West Virginia.
Here is a link of the ad:
http://instituteforlegalreform.com/harris/pdf/IL_Trial_Lawyer.pdf
Here's a link to an article talking about the physican friendly states as ranked by the AMA:
http://www.clarian.org/physicianrecruitment/includes/physicianFriendlyArticle.pdf
http://www.clarian.org/physicianrecruitment/includes/physicianFriendlyArticle.pdf
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jsaul said:
Care to share the inside joke?
Warning. Stalinism is alive and well in Oregon. It is quite prevalent in almost all of its regulatory bodies, not just the medical one. I speak with experience including living in other states. Anyone can pick up a phone any time and say any thing about a professional and make that professional's life a living hell. There is no due diligence at all and no requirement that a complainant sign an attestation under the penalty of perjury that what they say is true. Even a convicted perjury in jail who never had any encounter with a doctor....who could be the third cousin of a patient.....or a vindictive ex-spouse of a patient....could call even from prison....and the automoton ruthless, incompetent opus moderandi would be an automatic request for all records, answering allegations.....which the medical board itself adds additional allegations to and embellishes the initial allegation. It is amazing. I have never, ever in my entire life seen it like it is here.....except in third world countries and communist countries. This regulatory body behavior is consistent with self promotion job security of the regulatory agency. I had a patient who is a handyman....whose competitor filed a false complaint against him in Oregon. It cost him four days of his work time and 500$. Yet he had no recourse whatsoever against this false witness complaint. In fact, Oregon protects false witness complaints....in total contrast to civil law in other countries such as France....not to mention ancient religious texts..."Thou shall not bear false witness."
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I'd certainly raise your concerns to the OMB Executive Director. They take the issue very seriously.
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http://www.fdalawblog.net/fda_law_b...nt-challenge-concerning-deas-attempt-to-.html
ACLU Intervenor Patients and Prescriber Win a Fourth Amendment Challenge Concerning DEA’s Attempt to Subpoena PDMP Records
By Karla L. Palmer –
Last week, the United States District Court for the District of Oregon ruled that the Drug Enforcement Administration’s (“DEA”) administrative subpoena powers are not unfettered when it comes to obtaining protected health information (“PHI”) submitted by pharmacies to Oregon’s Prescription Drug Monitoring Program (“PDMP”). The Oregon PDMP challenged DEA’s attempt to obtain PHI based on a state statute permitting such disclosure only after the requesting party obtains a valid court order based on probable cause (and issued at the request of a federal, state or local law enforcement agency). ORS 431.966(2)(a)(C). Notwithstanding the statutory provision limiting access to PHI, the DEA issued administrative subpoenas pursuant to 21 U.S.C. § 876 to obtain prescription drug records from the state PDMP concerning a patient and two physicians. These DEA administrative subpoenas warrants are typically issued under the authority of a local DEWA official and are not self-enforcing. Oregon claimed (as it had several times in the past) that it could not comply with the administrative subpoenas absent a court order; thus it filed a declaratory judgment action asking the federal court to decide whether DEA could obtain access absent a court order.
The ACLU intervened as of right pursuant to Fed. R. Civ. P. 24(a) on behalf of four Doe intervenors and a Roe prescriber, raising arguments concerning the intervenors’ Fourth Amendment rights related to PHI. The intervenor patients each utilized controlled substances in schedules II-IV to treat various medical conditions. The intervenor prescriber asserted that, as a consequence of his patient population, he prescribes more scheduled substances than typical doctors. Nevertheless, DEA had interviewed and investigated him in the past. The doctor expressed concern that his patients’ records have been accessed or may in the future be accessed without a warrant, which affected his prescribing practices. The parties cross-moved for summary judgment.
The district court sided with the intervenors and granted their motion for summary judgment on Fourth Amendment grounds. The court noted that medical records have enjoyed a long history of confidentiality dating back centuries, and that privacy protection is rooted in both Oregon law and certain aspects of federal law. The court stated that the intervenor patients had a subjective expectation of privacy in prescription information, “as would nearly any person that used prescription drugs.” The prescriber also had a subjective expectation of privacy in his prescribing information. Importantly, the court found that “by reviewing doctors’ prescribing information, the DEA inserts itself into a decision that should ordinarily be left to the doctor and his or her patient.” The court “easily” concluded that the intervenors’ subjective expectation of privacy in prescription information was objectively reasonable. Although the court recognized no absolute right to privacy in prescription information (because patients and prescribers must expect physicians, pharmacists and other medical personnel to access their information), the court found that it is “more than reasonable for patients to believe that law enforcement agencies will not have unfettered access to their records.”
In addition, the court found that prescription drug information held by the PDMP is “intensely private” because it connects a person’s identifying information to the prescriptions drugs they use. Such prescription records are protected by a heightened privacy interest rendering the use of the administrative subpoena unreasonable. The court also rejected DEA’s attempt to hold any expectation of privacy unreasonable under the “third party doctrine,” which holds that an individual does not have an expectation of privacy in information held by a third party (here, the pharmacy or PDMP). Distinguishing other third party doctrine cases dealing with bank and telephone records, the Oregon court held that prescription records are “more inherently personal or private” than those types of records. Furthermore, the submission of information to the PDMP, unlike telephone and bank records, is required by law – the only way for a patient to avoid the submission is to forego medical care or leave the state. Deeming this “not a meaningful choice,” the court concluded that the DEA’s use of administrative subpoenas to obtain prescription records from the Oregon PDMP violates the Fourth Amendment.
This raises the question of whether and to what extent other state PDMPs will follow suit and require DEA to obtain a court order based on probable cause to obtain certain prescription records from state PDMPs (… and almost every state has a PDMP). Will this curtail DEA’s ability to quickly obtain information during an investigation into illicit activities involving controlled substances? Must DEA obtain a court order or warrant upon a showing of probable cause before reviewing prescription records located in PDMP databases or, more importantly, at pharmacies? Similarly, because the Oregon district court reached its decision on Fourth Amendment grounds (and not based on a Supremacy Clause analysis comparing the federal and state statutes at issue), this case could be a starting point for other states – and prescribers and patients – to attempt to curtail what they may believe is DEA’s intrusion into “intensely private” personal information.
ACLU Intervenor Patients and Prescriber Win a Fourth Amendment Challenge Concerning DEA’s Attempt to Subpoena PDMP Records
By Karla L. Palmer –
Last week, the United States District Court for the District of Oregon ruled that the Drug Enforcement Administration’s (“DEA”) administrative subpoena powers are not unfettered when it comes to obtaining protected health information (“PHI”) submitted by pharmacies to Oregon’s Prescription Drug Monitoring Program (“PDMP”). The Oregon PDMP challenged DEA’s attempt to obtain PHI based on a state statute permitting such disclosure only after the requesting party obtains a valid court order based on probable cause (and issued at the request of a federal, state or local law enforcement agency). ORS 431.966(2)(a)(C). Notwithstanding the statutory provision limiting access to PHI, the DEA issued administrative subpoenas pursuant to 21 U.S.C. § 876 to obtain prescription drug records from the state PDMP concerning a patient and two physicians. These DEA administrative subpoenas warrants are typically issued under the authority of a local DEWA official and are not self-enforcing. Oregon claimed (as it had several times in the past) that it could not comply with the administrative subpoenas absent a court order; thus it filed a declaratory judgment action asking the federal court to decide whether DEA could obtain access absent a court order.
The ACLU intervened as of right pursuant to Fed. R. Civ. P. 24(a) on behalf of four Doe intervenors and a Roe prescriber, raising arguments concerning the intervenors’ Fourth Amendment rights related to PHI. The intervenor patients each utilized controlled substances in schedules II-IV to treat various medical conditions. The intervenor prescriber asserted that, as a consequence of his patient population, he prescribes more scheduled substances than typical doctors. Nevertheless, DEA had interviewed and investigated him in the past. The doctor expressed concern that his patients’ records have been accessed or may in the future be accessed without a warrant, which affected his prescribing practices. The parties cross-moved for summary judgment.
The district court sided with the intervenors and granted their motion for summary judgment on Fourth Amendment grounds. The court noted that medical records have enjoyed a long history of confidentiality dating back centuries, and that privacy protection is rooted in both Oregon law and certain aspects of federal law. The court stated that the intervenor patients had a subjective expectation of privacy in prescription information, “as would nearly any person that used prescription drugs.” The prescriber also had a subjective expectation of privacy in his prescribing information. Importantly, the court found that “by reviewing doctors’ prescribing information, the DEA inserts itself into a decision that should ordinarily be left to the doctor and his or her patient.” The court “easily” concluded that the intervenors’ subjective expectation of privacy in prescription information was objectively reasonable. Although the court recognized no absolute right to privacy in prescription information (because patients and prescribers must expect physicians, pharmacists and other medical personnel to access their information), the court found that it is “more than reasonable for patients to believe that law enforcement agencies will not have unfettered access to their records.”
In addition, the court found that prescription drug information held by the PDMP is “intensely private” because it connects a person’s identifying information to the prescriptions drugs they use. Such prescription records are protected by a heightened privacy interest rendering the use of the administrative subpoena unreasonable. The court also rejected DEA’s attempt to hold any expectation of privacy unreasonable under the “third party doctrine,” which holds that an individual does not have an expectation of privacy in information held by a third party (here, the pharmacy or PDMP). Distinguishing other third party doctrine cases dealing with bank and telephone records, the Oregon court held that prescription records are “more inherently personal or private” than those types of records. Furthermore, the submission of information to the PDMP, unlike telephone and bank records, is required by law – the only way for a patient to avoid the submission is to forego medical care or leave the state. Deeming this “not a meaningful choice,” the court concluded that the DEA’s use of administrative subpoenas to obtain prescription records from the Oregon PDMP violates the Fourth Amendment.
This raises the question of whether and to what extent other state PDMPs will follow suit and require DEA to obtain a court order based on probable cause to obtain certain prescription records from state PDMPs (… and almost every state has a PDMP). Will this curtail DEA’s ability to quickly obtain information during an investigation into illicit activities involving controlled substances? Must DEA obtain a court order or warrant upon a showing of probable cause before reviewing prescription records located in PDMP databases or, more importantly, at pharmacies? Similarly, because the Oregon district court reached its decision on Fourth Amendment grounds (and not based on a Supremacy Clause analysis comparing the federal and state statutes at issue), this case could be a starting point for other states – and prescribers and patients – to attempt to curtail what they may believe is DEA’s intrusion into “intensely private” personal information.
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Emerging standard of care for opioid prescribing in OR for chronic non-cancer pain: 120MED.
1. OHSU, 2. Southern Oregon Opioid Prescribing Guidelines.
1. OHSU, 2. Southern Oregon Opioid Prescribing Guidelines.
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Looks good. Spent last 3 months weaning 80+% of my folks over the level and most are doing well without increased reported pain. I point to the guidelines out of WA and OR.
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I'm also recommending this to PCPs.
The Oregon initiative is remarkable. It is refreshing to see that it basically states: "we created the problem and we need to fix it". I firmly believe that the majority of the problem stems from the PCPs who find it easier to continue to prescribe than to talk to the patients and explain why opioid use is not a sustainable long term strategy. Then they look to dump this trash on us. If I didn't have to fight off the daily attempt to dump a patient on my doorstep my life would improve 100%.
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Specifically how do you say that to your patients? I tell patients these medications are highly abusable and addictive with substantial risk and they say, "Not me doc. I don't abuse my meds. I always take them as prescribed!" What's your guys' next line? "No you don't" Haha...Just curious
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If greater than 120meq we tell them they are 9x more likely to die just from being on that much medicine. If med not indicated we say: " That is not indicated for your problem, I'm happy to write it for you when we find the cancer has spread to your bone.
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I have canned couple of paragraphs that you can modify & use. I will post this in the private forum when I get back to the office on Monday.
BTW: The folks in Southern OR are amazing. Jim Shames stepped up to the plate
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I tell the pt we have a written policy that only allows us to prescribe under xyz conditions.
I too have a list of "canned" speeches that I will post shortly.
Again, I applaud the Southern Oregon people for stepping up to the plate. Having trained in the Northwest I feel strongly that medicine is practiced at a higher level there; at least higher than the northeast. Despite all of the issues with WA L&I, salmon is obviously brain food.
Again, I applaud the Southern Oregon people for stepping up to the plate. Having trained in the Northwest I feel strongly that medicine is practiced at a higher level there; at least higher than the northeast. Despite all of the issues with WA L&I, salmon is obviously brain food.
