Chat recap: Radiologist discusses book about health care system

January 11, 2012

This chat has already taken place. Read the transcript below.

Dr. Kipp Van Camp

Dr. Kipp Van Camp, an interventional radiologist in Topeka, will be available Jan. 11 to discuss his new book, “Misdiagnosis: A Practicing Physician’s Case Study in Health Care Reform."
He said the book covers the history of how we got to where we are, identifies what’s wrong and right with the system, provides details about the Affordable Care Act, and provides solutions.
Dr. Van Camp owns a radiology company called Critical Imaging Associates in Topeka. He also is owner and medical director of Rejuvenate Medical Spa, providing minimally invasive cosmetic medical procedures. He serves as an adjunct professor at Washburn University and Kansas University.
Van Camp is one of two hosts on a medical radio talk show called Doctor’s Orders, which airs on stations in Topeka and Kansas City.


I would like to thank Dr. Van Camp for taking time to participate in our chat today. I am health reporter Karrey Britt and I will be moderating today's chat. First, can you tell our readers why you decided to write a book.

Dr. Kipp Van Camp:

I like to write. I have observed plenty of problems with our current health care system, so I decided to toss my opinions, thoughts and observations into the ring. This is my second book. The first book is Always Allie, a completely different's about pets, and how they improve our lives from a medical standpoint.


What are the most common misconceptions with the new health care law?

Dr. Kipp Van Camp:

There's way to much to list, so I'll give you an overview. There are several right off the top of my head. One misconception is that the PPACA will be affordable. Americans love technology, and therefore this will be extremely expensive to pay for. Can we afford unlimited health care for ALL of society? It would be nice, but extremely expensive. And so, if it's going to be this expensive, will there be limitations regarding how much care or what services you receive. Unfortunately, there will have to be. Should a committee in Washington, or the HHS sec. have the power to decide who will get what services. The conception is all citizens will receive any and all medical care they need. That's just not true. There will have to be limitations due to cost...and ultimately that's rationing of care.


I think there should be a "public option" expansion if Medicare in order to provide meaningful competition to private insurance, and also allow the federal government to bargain with drug companies to bring down the cost of drugs. Do you agree?

Dr. Kipp Van Camp:

Before I answer, let me toss out a caveat...I only have a limited amount of time, and so inorder to answer as many questions in the shortest amount of time, please excuse any typos or grammatical errors. I won't be spell checking this.

Now your question: you raise an interesting point. This seems like a logical direction to find the most cost efficient method for paying for medications. So, yes, I hope behind the closed doors of CMS these discussions are being had. We do need some competition to keep cost down, or there's always a concern that one group will develop a monopoly.

There may be a loosening of our strict FDA process for gaining FDA approval, too, which should allow for drug companies to release their newest drugs sooner along in their developmental stages. This could be beneficial for a blockbuster drug, and could decrease some of the overall costs, but there's a risk that the drug being approved, may have some potential side effects or drug interactions that have been uncovered yet.


What impact do you think the massive average debt a new doctor comes out of school with has on the quality of care in the US? After the brutal schedule of training in the US for doctors, and with over $200,000 in educational debt for many young doctors, the drive to focus on maximizing profitability in a practice seems to have overwhelmed the drive to maximize quality of care.

Dr. Kipp Van Camp:

Good insight. I had $189,000.00 worth of debt after medical school, internship, and my first residency. About the time I had the debt down to $60,000, I returned to residency and reaccumulated the once retired debt. I finished my second residency and fellowship at age 39. Thats 4 years undergrad, 4 years med school, 1 yr. internship, 3 years family medicine residency and then 4 years of a second residency (radiology) and 1 year fellowship. By the time I really had a career, I was already OLD! My wife and I owed $190,000 after the second round of training.

Who would ever do this again, unless they loved what they were doing (which I certainly have enjoyed my career....fortunately!)

Yes, this ways heavily on who will become doctors now and in the future. Yes this affects the overall cost of medicine. Thats one of the ways the PPACA hopes to address the years and the debt load for doctors...make the NP and the PA the primary care provider. They can pay a lower fee schedule to NP's and PA's, and they have 1/2 the debt load, and anywhere from 3-8 years less training depending on their specialty.


David Johnson, CEO of the Bert Nash Community Mental Center in Lawrence, sent me a couple of questions for you. The first: Do you think health care is a right or a privilege?

Dr. Kipp Van Camp:

Wow, that's right to the heart of the matter. You ought to read my book, Misdiagnosis, and you'll see exactly where I stand on that. If it is a right, what number does it fall into. I'd say the first three needs are food, shelter and clothing. The fourth need is probably education. And the next need is likely health care. I founders said "the right to life, liberty, and the pursuit of happiness." I believe we, as a society, out of convenience, pass over the difficult discussions like what is a right and what is a privilege. I believe that health care is a privilege.

That said, I could possibly be convinced that some level of health care might be a right. Something like each citizen will receive this basic level of meidcal care, But, who decides that, Congress? That's when I get really concerned!


Here is a comment and second question from Bert Nash CEO David Johnson: I suspect that a 57% increase in Texas new physician applications just means doctors moved, not more people became doctors. Texas may treat doctors well, but not so much the disabled. How do we shift resources from specialty to primary care, from acute illness to chronic disease?

Dr. Kipp Van Camp:

Texas has passed very aggressive medical tort reform, and therefore doctors are flocking to Texas. I wish that Congress would get serious about tort reform. Doctors in large percentages (>90%) in masot polls admit to practicing defensive medicine. So we do need tort reform! But, Congress refuses to have a serious discussion about that. What practicing defensive medicien means simply is that I'm afraid of getting sued, so I order extra tests to make sure I don't miss something (I may trust my skill set, but I'm afraid of the lawsuit) regardless of the cost of the test. This is how medicine is practiced in America today. If doctors take an annonymous poll and they hands down admit that they practice defensive medicine, then they probably do. And I'm here to tell you, ALL drs I know do practice defensive medicine!

As far as how to shift attention to primary care, reward the PCP with higher reimbursement, which CMS has tried to do recently. We have a shortage of PCP's in America, so give them payment for medical school, means of retiring debt, incentives to go into family medicine, and we'll see an increase in the nbr of PCP's.


Dr. Van Camp:

I surmise from previewing your book on that you are no fan of the Obama plan. How do you propose giving self-employed people access to affordable health insurance coverage?

Dr. Kipp Van Camp:

First, we need to have different levels of coverage. A person should be able to have a catastrophic plan, or a preventative plan, a pregnancy and childcare plan, a woman or a man's health plan (to name a few) that pays for these needs or these catagories of care...and if the insurance can get enough patients to participate, that should make these tiered plans more affordable.

Secondly, we need to provide people ways to pay out of pocket in a manner that it promotes budgeting and incentives. For example, health care is still a goods and service. If you are self-employed, or even un-employed, and you want to buy a HD TV, you'll save until you can afford it. We should keep the flexible spending accounts, and health savings accounts (which Congress is trying to get rid of) and give people tax breaks when they use their own cash for health care.

Also, doctors are beginning to look at ways to keep their patient's costs down, when the pt agrees to paying cash. But, the government says it's illegal for a doctor to charge one price for a pt who agrees to pay cash, and another price for a pt who has insurance. Or better stated, if a Medicare pt gets a chest xray for $55.00, I can't say to the pt, if you pay cash, I'll take $25.00 for that chest x-ray...unless I as a dr opt out of Medicare. Which leads to fewer doctors participating in Medicare and a whole new set of problems!


Thanks again for participating in this chat. I know you have to get back to your patients. Maybe you would consider doing this again. I would be interested in learning more about the pet/medical connection.

Dr. Kipp Van Camp:

Thanks again. You can catch me on Doctors Orders radio Show, 3-4 Friday afternoons at 1510 am and we can continue this discussion. Also, I'll be happy to come on again and continue to discuss health reform and what's in the PPACA.

Thanks to LJWorld, WellCommons, and to each of you for allowing me to be on this chat board. Great questions. I'll be happy to do this again!


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