Dr. Leslie Greenberg's Blog

Getting squeezed by health insurance premiums? Is your insurance covering less? Charging more premiums? More in copays?

You have options!

Consider direct primary care! Here’s a fascinating Bloomberg article. Cobble together coverage that works for you.

https://www.bloomberg.com/news/features/2018-08-22/priced-out-of-health-insurance-americans-rig-their-own-safety-nets

At what age should you really (!) start a screening colonoscopy? 45 or 50?  The American Cancer Society (ACS) recently released an updated guideline that colorectal cancer (CRC) screening begin at age 45 for patients at average risk.

Researchers have demonstrated a favorable benefit-to-burden balance of screening beginning at age 45.  The new guideline differs from the latest recommendation by the U.S. Preventive Services Task Force released June 2016.

ACS has acknowledged that this recommendation is considered a “qualified recommendation” in that this conclusion relies on the use of modeling without evidence from clinical trials.  Most published studies clinical studies regarding screening for colorectal cancer are in those 50 and older.

Did you know that there has been a steady decline of colorectal cancer during the past twenty years in patients 55 and older due to screening that results in removal of polyps.  Conversely, there has been a 51% INCREASE in colorectal cancer in those younger than 50.  It is thought that this increase in colorectal cancer is that screening begins at 50.

What is the harm of starting screening at age 45?  It may be that the number of lifetime colonoscopies will increase and with every procedure there are potential harms.

When the screening age for colonoscopies was first decided to be at age 50, the rate of colorectal cancer was the same as it is now for 45 year olds.  It is suggested that recommendations are constantly revisited.

If you are considering your first colonoscopy before age 50, confirm with your individual insurer that this will be a covered benefit.

Want more information?  http://www.pressroom.cancer.org/releases?item=770

It’s July 1, and new interns have already earned both an undergraduate degree and completed 4 years of medical school. What else do they need to do before “hanging their shingle” and seeing patients as an attending physician? Read on…

July 1 traditionally marks the start of residency and fellowship for new doctors and doctors who have completed residency.

On this momentous day, I am so excited to welcome the new interns into one of the most noble professions. It is the continuation of a crazy ride but an incredibly awesome and humbling one.

For those who don’t know what an intern, resident or fellow is:

-A resident team means you have a team of committed physicians, all looking over you and your chart, all under the supervision of an attending physician (like me!).

-Even new interns have already had at least 5000 hours of hands-on clinical training before arriving on July 1.

-New interns have already passed 2 of the 3 “steps” required to be licensed in the US: 3 days of testing, nearly 600 multiple choice questions, and 12 standardized patient encounters including assessment of history taking, physical exam skills, communication skills, and ability to form a plan of action based on findings.

-Intern year ( with an estimated 4000 hours of work!) is just the beginning of post medical school training.

-After those 4000 hours, your average pediatrician, family medicine physician and internist (all primary care physicians) will complete an additional 7000-8000 hours of training before taking their respective board exams (an additional 8-10 hours of testing).

Your average general surgeon will complete an additional 16,000 hours.

So, when you see your primary care physician, specialist, or surgeon, know that they’ve spent more than 10,000 hours of training to help you stay healthy.

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