From revenue risk to resilience: A new financial model for rural physicians

Independent physicians in rural America are no strangers to adversity. An alarming 80% of rural America is medically underserved, and clinicians are feeling the pinch. In fact, between 2019 and 2024, the number of independent doctors in rural areas fell by 43%, and residents in rural areas had access to 11% fewer medical practices.

With many rural hospitals operating at a loss and at risk of closure, many small and medium-sized practices are now forced to shoulder a growing share of the patient care burden, without the financial infrastructure of larger systems. This financial strain is particularly acute in regions with older, diverse and low-income populations reliant on Medicare and Medicaid. Rural patients also have lower rates of employer-sponsored commercial insurance, resulting in higher out-of-pocket costs and greater financial pressure on physicians.


The proportion of U.S. adults classified as cost desperate, indicating an inability to afford necessary health care and medications, has reached a record high of 11%, with disparities emerging across demographic groups. Notably, Black and Hispanic adults, along with those from lower-income households, are disproportionately affected, exacerbating existing gaps in access to quality, affordable care.

The cost of traditional financial metrics

Historically, many health systems and private practices have used margin per patient as a benchmark of success. However, in rural care settings, that model can often fall short. Unlike urban, high-volume organizations that can prioritize profitable service lines, rural physicians must care for every patient who walks through the door, regardless of insurance status or income level.

When margins are thin and uncompensated care is on the rise, traditional financial models can push practices toward dangerous territory. Denying care isn’t an option, but delivering it without reimbursement isn’t sustainable. That disconnect isn’t just hurting the bottom line; it’s driving delayed care, skipped treatments and growing medical debt.

Medical debt is fueling the crisis

Unpaid medical bills are among the biggest threats to rural hospitals and their patients. Recent studies have found that a larger portion of adults in rural counties carry medical debt, higher than the national average and significantly higher than in urban areas. This debt doesn’t just sit on spreadsheets. It has real consequences: damaged credit, financial strain, skipped prescriptions and delayed treatment.

And it’s not just uninsured patients. High-deductible plans and rising out-of-pocket costs have made it harder for insured patients to manage their medical bills. In many cases, the bills they receive aren’t just unaffordable — they’re unpredictable.

This dynamic is especially harmful in rural areas, where many patients live on fixed incomes or don’t qualify for traditional credit. When affordability becomes a barrier to care, patients wait until it’s urgent. They often show up in the emergency room for a condition that could have been managed earlier and more affordably. These late-stage interventions cost more, strain the system and frequently go unpaid.

A shift in strategy: Financing with compassion

To survive, many forward-thinking rural physicians and other clinicians are adopting a different financial lens, one that prioritizes systemwide revenue margin and community economic health over per-patient profitability. One emerging solution is patient-first financing. Similar to retailers, this proactive approach introduces affordable payment options at the start, where the consumer, or in this case the patient, stands to gain 0% interest payment financing at the point of scheduling or care rather than months later when the bill arrives.

Instead of chasing payments after care is delivered or navigating an in-house system, physicians and their teams work with third-party partners to offer flexible payment plans based on a patient’s ability to pay. Providers are often paid within 48 hours of a procedure, even if the patient repays over time to the lender. That’s better not just for the books but for the patient. Studies show that when financing is discussed up front, patients are more likely to move forward with care and less likely to cancel or no-show due to cost. This approach also reduces the need to send unpaid balances to collections, protecting the patient-provider relationship.

Expanding the care model for long-term sustainability

Independent physicians are on the front lines of the rural health crisis and deserve financial models that reflect the realities they face, not just metrics designed for large, perfectly functioning systems. By rethinking success as “healthy patients, healthy practices,” small and rural practices can shift toward financial strategies supporting community well-being and long-term viability. This includes leveraging telehealth, expanding roles for advanced practice providers (APPs) and addressing critical gaps in physician availability.

Additionally, the American College of Physicians recently emphasized the need for policy makers to evaluate and implement investments to address rural health disparities and access challenges. Aligning clinical innovation with policy-level change can help ensure rural providers aren’t navigating this crisis alone. But as potential reimbursement cuts and regulatory rollbacks loom, health systems can’t afford to wait for policy change. They must focus on where they can take action internally, building financial resilience and expanding patient access through proactive care models.

Many practices are turning to advanced practice providers, including nurse practitioners and physician assistants, who can extend access and provide high-quality care, especially for routine or preventive services. At the same time, telehealth adoption, which surged during the pandemic, remains a powerful tool for maintaining access in hard-to-reach areas. However, broadband limitations, regulatory uncertainties and reimbursement inconsistencies still create barriers to broader use. Policy makers and health plans must continue supporting virtual care to ensure it remains viable for rural practices and their patients.

Patient-first financing is one of many steps toward that future, but it is a meaningful one. With the right tools, physicians do not have to choose between doing what is right for their patients and what is necessary for their practices.

Medical Office Supplies

 Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

If doctors were trained in leadership, the entire health care system would benefit

If we can agree that leadership means influencing behavior to achieve a desired result, then it becomes obvious that all doctors are acting as leaders in many different health care environments.

But as I see it doctors aren’t formerly trained as leaders or even taught about the importance of leadership—i.e. Influencing behavior to achieve a desired result— in their daily work. Leadership training is not a standard part of medical school curricula.

This gives us an opportunity to change that paradigm. Medical education can absolutely prepare doctors for the challenges of being a leader—starting on the first day of medical school. Additionally, leadership development can be a cornerstone of each physician’s professional development throughout their career. In a future state where every physician is educated and trained in fundamental leadership skills, the entire health care system would reap the benefits—nurses, technicians, administrators, finance departments, HR professionals, and doctors themselves. But the chief beneficiary would be patients.

Leadership is a core competency – and should be taught as such

As a core competency for physicians, leadership is just as critical as clinical skills. Influencing thought and behavior is essential to achieving desired results in patient care. Leadership connects directly with the Accreditation Council for Graduate Medical Education’s (ACGME) six core competencies, encompassing all of them, either directly or indirectly​.

Therefore, we have an opportunity to teach leadership as a core competency for all physicians. Leadership involves a complex interplay of professionalism, communication skills (especially listening skills), cultural sensitivities, etc. And we are not necessarily born knowing these things. Fortunately, leadership is a learned skill. It can be improved through study of the theory and practice of leadership and through practical exercises and feedback.

We owe it to our medical students and residents to: 1)be explicit that they have a role as leaders in the healthcare environment, and 2) prepare them to lead in various environments as members of multidisciplinary teams under high levels of stress, including the responsibility for people’s lives and well-being.

But medical students and residents typically acquire leadership skills only in an ad hoc, inconsistent way. Students may gain some leadership experience through observation and even extracurricular activities, but this is largely unstructured and varies widely between institutions and individuals. The lack of intentional, cohesive, progressive leadership development leads to gaps in physicians' ability to lead effectively within health care systems.

Setting standards and getting oversight bodies on board

In visualizing how leadership should be taught in medical school, consider presenting it as foundational, much in the same way we teach physiology, pharmacology, or how to tie a surgical knot. I believe we should recognize that influencing thought and behavior to achieve desired results is a critical enabler of physician success numerous times each day, and we should build a foundation in how to accomplish that.

A physician who is a less effective leader is a less effective doctor. If you don’t start thinking about leadership until you’re 50, you’ve lost a huge opportunity to gain that mastery.

My personal vision is that we develop a set of standards for the leadership aspects of a physician’s training. Eventually, this set of standards would be adopted and refined by the oversight bodies that guide physicians’ careers, such as the Liaison Committee on Medical Education (LCME), the American Council on Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS).

These bodies have prescriptive authority. They can say to medical schools and training programs, “This is what you need to be teaching and practicing,” and can work with these entities over time to ensure that all doctors have a common training in a fundamental leadership skillset.

Standardization would benefit healthcare system leaders, as they would know that newly hired doctors possess a base level of leadership competency, much as they now know that all doctors possess a base level of clinical competency. Every physician will have been thinking about leadership, doing self-assessments, undergoing 360-degree assessments, and refining his or her leadership skills for years. The organization can then build on that base set of competencies to further develop the physician leader.

Advancing the leadership conversation

That is the vision. But we are a long way from seeing that as a reality. I have no illusions that such a change will happen overnight. The medical establishment changes slowly. Incorporating structured leadership training into every medical school and GME program can take decades.

Implementation should aim at codifying a set of base-level skills that can be generally agreed upon as a good leadership foundation for all doctors. In the meantime, let’s advance the conversation. Let’s start addressing leadership topics at conferences and symposia. Let’s get to work within our own organizations to develop in-house standards for physician leadership. Let’s start creating leadership curricula and sharing it with other institutions and organizations. Let’s start developing courses, implementing them, and measuring results. Let’s start assigning leadership coaches and mentors to doctors in our system.

Doctors should be trained in how to lead themselves, other individuals, and teams. Those who show interest and potential should be further trained in organizational leadership. Medical schools can lead the way in establishing the conviction in young physicians that they are leaders—that they have influence and impact every day—and igniting the desire to be trained as such. By linking leadership skills to the improved performance of health care teams and better patient outcomes, schools can change the current culture in which student doctors relegate “soft skills” to the back burner as they focus on clinical training.

Realistically, we can’t take hours of instruction away from core clinical courses. Nor would we want to. So, the trick is to find places in the curriculum where we’re already teaching “leadership-like” topics and to organize and revamp that material in a more cohesive and powerful way.

Once medical schools are doing this, residency training programs, physician practices, and healthcare systems can build from there. The leadership curriculum should never end. Everyone in medicine should ideally continue to seek and receive leadership training and feedback throughout their careers.

Doctors who know how to truly lead make a difference

Doctors are leaders, whether we recognize it or not. Our only real choice is whether to embrace our leadership role and commit to doing it to the very best of our ability. Or not.

Great physician leaders exude a presence. They bear themselves with confidence, but not cockiness. They look people in the eye. They listen to their patients, absorbing everything they’re saying—and not saying. They treat colleagues warmly and respectfully. They speak with directness but also with compassion and sensitivity. They welcome questions, invite feedback, and are always trying to improve. They address doubts and uncertainties. They strive for consensus.

That kind of leadership presence has a direct bearing on the way patients commit to treatment and the way colleagues rally together as a team. Don’t doubt for a second that it affects patient outcomes. It does.

If you are a physician, you should want to be the kind of leader who inspires people through your words, your actions, and your presence. And if you are in health care management, you should want to have a staff full of physicians who possess this kind of leadership ability.

My hope is that medical school deans, residency and fellowship program directors, health care administrators, and leaders of physicians’ societies feel inspired to work together and take up the cause of teaching better leadership skills to physicians. In doing this, we will enrich the future of medicine, create higher-performing health care teams, and improve patient outcomes.

Medical Office Supplies

 Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

Two simple workflow tools cut physician message load by 16%

A new study from the University of Michigan shows that rethinking how patient portal messages are routed, and by whom, can significantly reduce the inbox load on primary care physicians, without additional tech or spending.

The study, published in the Journal of General Internal Medicine, tested a pair of workflow tools at a single academic internal medicine clinic. Compared with two control clinics, the intervention site saw a 16% reduction in monthly messages per full-time physician and a 65% drop in “carbon copy” messages that often flood physician inboxes.

The key change: assigning message responsibilities more clearly across the care team.

“We were able to significantly reduce the volume of messages by simply outlining roles and routing guidance for common issues,” said the study’s lead author and clinical assistant professor, Nicole Hadeed, M.D., in a university news release. “Focusing on getting the right message to the right place the first time was a simple and powerful intervention.”

A pandemic-era problem that never left

The volume of patient messages through electronic health record (EHR) portals surged during the COVID-19 pandemic — and has remained elevated ever since. That shift has increased administrative strain across primary care, where time spent managing inboxes is now a major source of burnout.

Researchers analyzed more than 340,000 messages across 31,000 patients over a one-year period. They found that a significant portion of message volume came not from patients but from internal routing inefficiencies, including duplicate messages sent to multiple staff or bounced among team members.

To address this, the clinic developed and implemented two simple tools:

• A set of “best practice standards” for managing and routing common messages.
• A “routing guide” clarifying which roles should handle what types of messages.

These tools were rolled out during meetings and huddles, and one staff member per week was temporarily assigned to manage the inbox on high-volume days.

Clearer roles and fewer clicks

Following the intervention, monthly messages per physician fell from 1,342 to 954. Messages sent directly to physicians dropped by 26%, and carbon copy messages declined from 4.4% of all messages to just 1.5%.

The percentage of portal message encounters involving physicians held steady, indicating the care team’s broader role in handling lower-acuity issues.

Survey data also pointed to improved team dynamics. Scores for clarity of expectations in portal messaging rose from 2.7 to 3.5 on a 6-point Likert scale. Staff reported that the routing guide, in particular, helped new team members get up to speed and made workflows more consistent.

“I like this document,” one medical assistant said in a post-intervention interview. “I feel like this document helps when you are orienting a new staff member to know the roles. It also says to you who gets what, where does this go.”

Staffing and sustainability challenges

The intervention did not come without complications, though. During the rollout period, the clinic faced a significant staffing shortage, which required physicians to take on more triage duties than anticipated. While the intervention still led to reduced message volume, the staff shortage may have skewed the degree of physician involvement.

“It’s pretty tough to route things to a team that is composed of one person who doesn’t have enough time to do their job,” one physician said.

Still, the study authors emphasized that the intervention’s success hinged not on added resources, but on clarifying how the existing team functions.

“While many clinician and staff reactions to the patient portal emphasize drowning under the brunt of clinical care happening over in-basket messages, it was evident that a significant proportion of messages are created by inefficient routing practices within the clinic itself, driven by a lack of transparency of each person’s role within the multidisciplinary team,” Hadeed said.

A model for inbox management?

The University of Michigan team believes their approach is both replicable and scalable. Unlike many tech-driven solutions, these tools require no EHR customization or new hires, just a clinic’s willingness to map its workflows and act on gaps.

The team plans to explore long-term sustainability next. While the initial intervention period lasted just four months, maintaining those gains as staff changes and workloads evolve will be key.

Ultimately, the authors suggest that other health systems take a similar approach to identifying local gaps in training and role clarification to enhance in-basket management, decrease volume and bolster well-being.

Medical Office Supplies

 Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

Access, coordinating care, communication — how can primary care physicians and oncologists improve their connections?

Successful patient outcomes can be a common goal for primary care physicians and oncologists, but achieving that goal can be a challenge, said a panel of health care experts that included two cancer survivors.

On May 6, the National Comprehensive Cancer Network (NCCN), a nonprofit alliance of 33 cancer centers, opened its 2025 NCCN Policy Summit: Primary Care and Oncology Collaboration for Better Patient Outcomes. The daylong meeting included panel discussions and speakers discussing health care practices and policies to fight the disease.

“We know how important this collaboration can be across the entire cancer care continuum, from screening and risk reduction through survivorship and end of life,” said NCCN CEO Crystal S. Denlinger, MD, an oncologist. “Unfortunately, we also know that there are quite a few challenges that come with this.”

The challenges

“If there’s ever been kind of a top 10 set of characteristics about the U.S healthcare system, it's that it’s fragmented,” said Clifford Goodman, PhD, a consultant on health care technology and policy. “And one of the things that we're finding people can often fall through the cracks, is between primary care and oncology, both at the sort of screening and diagnostic end and at the survivorship end.”

Goodman started “Pathways to Partnership: Strengthening Collaboration Between Primary Care and Oncology,” a panel discussion that lasted more than an hour with physician and expert speakers discussing the complexities of cancer care and the health care system generally.

Primary care physicians help the general quality of life and functioning of cancer patients from the moment of diagnosis to the end of life, said Veronica Panagiotou, PhD, director of advocacy and programs for the National Coalition for Cancer Survivorship, and a cancer survivor.

“And so why go through that rigorous cancer treatment, only to come out the other end and not be able to experience and function and do the everyday things that we take for granted, like walking to the mailbox, and showering without assistance for instance,” Panagiotou said. Those are the things that health care should be able to help patients with, she said.

Dorothy A. Rhoades, MD, MPH, professor of medicine at the University of Oklahoma Health Sciences, described her experience working with the Indian Health Service and patients’ misperception that it will take care of everything they need. She also is director of the Native American Center for Cancer Health Excellence at the Stevenson Cancer Center.

Redundancy can be a problem when a primary care physician and oncologist work in different health systems, said Andrea Porpiglia, associate professor and surgical oncologist at Fox Chase Cancer Center. Repeat scans or colonoscopies or lab work cause double the bills for patients. When patients don’t think their doctors are talking, they feel frustrated and abandoned, she said.

In patients, “we know that cancer doesn’t happen by itself,” said Linda Overholser, MD, an internal medicine physician at the University of Colorado Cancer Center. During cancer treatment, conditions such as diabetes or high blood pressure can get worse.

“There's missed opportunities there if care isn't coordinated to better control those comorbidities, and now that patients are living longer after a cancer diagnosis, I think it's really important to think about health promotion and implementing strategies we know that can reduce future comorbidities,” she said.

Skylar Taylor, MD, a medical hematology and oncology fellow at Mayo Clinic and a cancer survivor, echoed those concerns in describing management of blood pressure and diabetes in cancer patients, short- and long-term.

Successes in care

After elaborating on numerous challenges, Goodman also asked about successes, and the experts described examples as well.

Fox Chase Cancer Center started its Care Connect program that allows primary care physicians to get more involved with oncology care happening with their patients, Porpiglia said. It allows private practice physicians access to the cancer center’s electronic medical records (EMRs) for free. The network remains password protected but it makes it easier for oncologists to pass along patient updates via direct messages in the EMR, she said.

Taylor described his experience as a medical student seeing oncologists going door-to-door to primary care offices, and seeing a primary care doctor pick up the phone to call the oncologist to get an answer. That shows a lot of trust in front of the patient, he said, and he acknowledged those models are probably not scalable across the nation.

There are onco-primary models emerging at the University of Cincinnati, Duke University, and Kaiser Permanente in San Francisco, and those are exciting, Panagiotou said. “The idea that primary care is within the cancer center,” she said, and Goodman repeated the notion.

“Kind of, to the walking down the hall that Dr. Tyler just mentioned, the ability for primary care to see cancer patients solely and to be able to support their needs,” Panagiotou said.

American Indian and many minority populations have suffered from historical abuses within the health care system by people and research programs that were supposed to be trustworthy, Rhodes said. To counter those, there is orientation for people within the IHS, along with a pilot projects involving financial hardship screenings and supportive care huddles for physicians, other clinicians, health care navigators to coordinate care.

Health care navigators have benefited the communication between oncologists and primary care physicians, and the care coordination for patients, Overholzer said. She also discussed benefits of education for not just doctors, but for nurses, other medical staff, social workers, pharmacists, behavioral health specialists. “I think we need to keep in mind that we need to really be working with them too, to really fully support the survivorship,” she said.

The keys are communication, access and making sure primary care physicians know about resources available, Porpiglia said. “There’s things out there that could benefit the patients and making sure that the primary care is aware of that,” she said.

Medical Office Supplies

Manual Prescription Pad (Large - White) Memo Pad

Manual Prescription Pads (Light Blue) Notepads

Manual Prescription Pads (Light Yellow) Notepad

Manual Prescription Pads (Light Pink) Notepad

 Billing and Collection Supplies

 Business Cards and Stationary

 Chart Labels

 Medical and Rx Pads

Nearly 30% of early-career APPs leave their first job within 3 years, study finds

Nearly 30% of early-career advanced practice providers (APPs) leave their initial job within three years, according to a new study published May 5 in JAMA Network Open. As the APP workforce continues to grow — nonphysician clinicians now make up 40% of the U.S. health care workforce — these findings raise questions about the stability, retention and potential onboarding investments for APPs.

Researchers analyzed Medicare billing data from 217,487 nurse practitioners, physician assistants, certified registered nurse anesthetists, nurse midwives and clinical nurse specialists who entered the workforce between 2010 and 2021.

Turnover was measured by sustained changes in the tax identification number (TIN) under which clinicians billed — serving as a proxy for changing practices.

In total, 26.8% of APPs moved to a different practice during the study period, with a median time to departure of just 13 months. Movement within the same large organization was not captured unless it involved a change in TIN, and consolidation events, like mergers, were excluded to avoid misclassifying structural changes as decisions made by APPs.

Turnover patterns by role and setting

The study found that turnover rates varied significantly based on licensure type, gender, practice size and clinical setting.

• Physician assistants had the highest three-year turnover rate at 33.1%, followed closely by certified registered nurse anesthetists at 32.7%.
• Nurse practitioners had a turnover rate of 28.4% within three years.
• Certified nurse midwives and clinical nurse specialists had lower rates — 15.5% and 18.3%, respectively.

Male APPs were more likely to switch jobs than their female counterparts (29.9% vs. 26.2%), and those who moved were more likely to work in smaller practices. The median number of physicians in practices that experienced APP turnover was 16, compared to 57 among those that retained staff.

Turnover was also more common in certain specialties. Hospital-based clinicians had the highest turnover, with 43% moving within three years. In contrast, clinicians in obstetrics and gynecology and medical subspecialties had the lowest movement rates, at 23.3% and 30%, respectively.

One in seven leave within a year

The data show that turnover happens quickly for many early-career APPs. Within the first year, 14.4% had already changed practices. By year five, the cumulative rate rose to nearly 37%.

This rapid churn comes as the number of new APPs entering the field is expected to increase at five times the rate of physicians between 2023 and 2033, according to the Bureau of Labor Statistics.

The study notes that APPs face fewer regulatory and certification barriers to changing roles compared to physicians, which may contribute to the turnover, but specific drivers of turnover — compensation, job satisfaction, scope of practice, organizational culture — were not assessed in the study.

Regardless, for practices employing early-career APPs, the trend signals lost investments in onboarding and training, disruptions in patient continuity and added administrative costs for recruitment.

“Further work should investigate practice characteristics, specific tasks, remuneration and other potential factors associated with practice turnover,” the authors concluded.

Medical Office Supplies

Manual Prescription Pad (Large - Blue)

Manual Prescription Notepads (White)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pad (Large - White)

Patient Excuse Form Notepad (Blue)

$28.00

Appointment Reminder Cards (100 pack-White)

$44.05

Shaving, service and success

My previous blogs have looked at other industries, such as airlines, hospitality, and even toy companies, as examples of outstanding customer service. We can learn from these companies and often implement what these successful industries do into our healthcare practices. I have looked at the Dollar Shave Club (DSC) for this blog. One of us, SH, is a member of the "club," which began after watching their irreverent, R-rated YouTube video with more than 28 million views. The concept of the DSC is simple: pay a small monthly subscription fee, and four new razor blades are delivered monthly to your snail mailbox. If you become a member, you will never worry about running out of fresh, world-class razor blades.

Members of the DSC never worry about being without a world-class blade every month. This blog is motivated by the convenience of the DSC.
Making your practice more like the Dollar "Convenience" Club

Truth be told, there's nothing special about razor blades, but what makes DSC special is the customer experience built around convenience.

The DSC promotes convenience as much as, if not even more, than the razor blades and other toiletries.

Inflation and the recent tariffs have led to higher prices, but their customers still buy the razors.

Let's examine five reasons for the DSC's success and how this applies to healthcare practice.

Convenience: This is the reason they exist. It is important to ask, "Is your practice convenient?" Are patients able to obtain an appointment in a reasonable period? Are your phone calls and emails returned promptly? Practices with 2-3 months waiting for an appointment do not have easy access to the practice. Patients who have a study or lab test and must wait weeks to receive the results are not meeting the needs of the patients who want results in a timely fashion. Patients expect phone calls and emails to be answered in 24-48 hours. Any longer is below patients' expectations.

Quality products: The blades are high quality, and few members complain about their ability to remove the hair on their faces. Quality is important to DSC customers. Patients expect quality care from a physician who is perceived as an expert. Practices should start measuring outcomes and posting favorable results on their practice's websites. We know that quality is a difficult metric for the healthcare profession. However, there are examples of quality that are important to patients and that can be measured. The take-home message is that what gets measured gets done.

Price: Even though customers are willing to pay a premium for convenience, which is almost as compelling as the convenient experience. The time has arrived for price transparency in healthcare. We can no longer be like deer paralyzed when looking into the headlights and when patients ask about the cost of care. We know what an office visit should be for a new patient, an existing follow-up patient, and a newly diagnosed cancer patient who will require a longer appointment to discuss treatment options. By providing the cost of care to patients, we can avoid sticker shock when a bill arrives when no price discussion has been conducted.

For example, many practices use only 15-20 drugs most of the time. In that case, prices can be obtained from local and discount online pharmacies. One of us, NB, asks the pharmaceutical representative to find the cost of these prescriptions and update the list twice a year. This is very appreciated by the patients and allows the physician to discover if the cost is more than a patient can afford, then a less expensive drug can be prescribed.

Consistency and reliability: Customers know what to expect and when to expect it. The predictable schedule and consistent quality create trust and confidence in the product. If a patient calls with a question and the doctor plans to return the call at the end of the day, then it is helpful to give the patient an approximate time to expect a call from the doctor. This avoids that game of phone tag and encourages the patient not to be on the phone during that time.

Fun: This is a bonus, but who doesn't like a little fun? The experience is fun and may not be appropriate for everyone, but it may be for some medical practices. DSC's commercials are funny, which makes them stand out in a crowded razor blade market.

The DSC doesn't promise better blades; they sell a better experience. Suppose your practice does what it's supposed to, like diagnosing and treating disease, and you add the exceptional experience that patients want. In that case, you will have a successful combination.

Bottom Line: Emphasize what makes your patients appreciate you. That answer will get your patients to talk about your practice to family and friends, and, most importantly, loyal patients will return for their medical care.

Medical Office Supplies

Manual Prescription Pad (Large - Blue)

Manual Prescription Notepads (White)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pad (Large - White)

Patient Excuse Form Notepad (Blue)

$28.00

Appointment Reminder Cards (100 pack-White)

$44.05

Pros and cons of AI patient portal messages

Between increased administrative burdens and an influx of patient messages, many primary care physicians (PCPs) are turning to generative artificial intelligence (AI) tools to help draft patient portal messages. A new study suggests those tools can help — but they may also introduce dangerous errors that physicians fail to catch.

The study, published in Digital Medicine, found that most physicians missed critical mistakes in AI-generated message drafts in a simulated exercise. Some of the errors had serious safety implications.

“All but one physician ‘sent’ at least one fictitious response to a patient that contained an error,” the authors wrote.

A closer look

Researchers from MedStar Health, Georgetown University and the Naval Research Laboratory recruited 20 practicing PCPs in the Baltimore-Washington area. Participants were asked to review and edit 18 AI-generated responses to common patient portal inquiries. Four of the drafts contained significant errors.

These errors included:

• A typo in a medication name.
• Outdated COVID-19 vaccination guidance.
• A failure to recognize urgent signs of a possible blood clot.
• A missed case of diabetic ketoacidosis (DKA) in a child — mistakenly dismissed as a stomach bug.

At least 65% of participants missed each of the four errors, and between 35% and 45% submitted the problematic messages without any edits. Only one participating physician caught and corrected all four errors.

“Helpful” — But at what cost?

Despite these oversights, most PCPs responded positively to the AI assistance. According to post-task surveys:

• 95% said the AI-generated drafts were helpful.
• 90% said they trusted the AI’s performance.
• 80% agreed the tool reduced their cognitive workload.
• 75% believed the drafts were safe to use.

“I found the AI drafts to be helpful in responding to these [patient portal messages],” one survey statement read. Nineteen of the 20 participants marked it as true.

But the researchers argue that this trust — however well-intentioned — may lead to over-reliance.

“As the occurrence of automation complacency increases with reliability, the fact that most AI-generated drafts did not contain an error or patient safety risk may have resulted in vigilance decrement,” the authors noted.

The psychology behind the misses

The study points to several possible reasons why seasoned physicians may have missed obvious red flags:

1. Automation bias: Relying too heavily on AI tools.
2. Confirmation bias: Assuming the AI’s response aligns with their own.
3. Functional fixedness: Failing to see alternative diagnoses when the AI’s answer seems plausible.
4. Burnout and workload: Reducing diligence due to mental fatigue.

“These results highlight how physicians, as well as other stakeholders, understandably have a growing appetite for AI-driven technologies that can address workload burden,” the researchers wrote. “[They] may in fact be so overextended that any technology promising a reprieve is eagerly adopted despite the risks.”

Growing use, growing concerns

More than 100 health systems are already using generative AI to support clinician inboxes, including tools integrated into popular EHR platforms like Epic. The researchers behind this study argue that rollout may be outpacing safety testing.

While the AI drafts didn’t always include outright AI hallucinations, some gave incomplete or misleading advice. In the case of a child showing textbook signs of DKA, the Ai offered a generic response about stomach viruses — an omission flagged by only five of the 20 participating physicians.

Medical Office Supplies

Manual Prescription Pad (Large - Blue)

Manual Prescription Notepads (White)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pad (Large - White)

Patient Excuse Form Notepad (Blue)

$28.00

Appointment Reminder Cards (100 pack-White)

$44.05