Dr Bob Townsend

[Dr. Bob]

First of all, I want to say thank you for all you have been doing for the medical marihuana community. But I do have a few questions. Couldn't you get around the 'no records' requirement by becoming all of your medical marihuana patients primary physician? I have had back troubles before and when I went in to see a doctor, I was given a Rx for Vicodin (a much more dangerous drug) but did not have to have any 'records' indicating that I had any issues with my back. Also, I am wondering why a certification costs $150-$200? I guess I just do not understand why doctors make so much money in general. College loans are often given as a reason for the high charges (its about $150k to attend medical school), but I have loans from my bachelors degree too, but I could never get that kind of money for any services I provide. Is the high cost of health care due to the fact that about 60,000 students apply to medical school but they only accept about 20,000? Also, the AMA, from what I have read, does not allow any new medical schools. Less competition=More money? I am asking these in earnest...I have yet to figure out why our health care system is so expensive, but through much investigation have come to the conclusion that doctors get paid so much compared to the average worker because we limit the amount of doctors in the United States through monopolistic practices regarding who can 'Teach' medicine, and how many students we will allow to pursue medicine. It's not jealousy that motivates these questions, I am seriously wondering why it costs so much, and since your are within the business of medicine I figured you could shed some light on it. Thanks Dr. Bob for reading this, and I look forward to hearing from you on the questions I have asked.

 

Also, Couldn't you take insurance by becoming the primary physician for all of the folks you assist with medical marihuana certifications?

 

You raise some very interesting points. Yes med school is expensive and very competitive- I 'beat out' at least 5 or 6 well qualified college grads to get my seat in class. As for the politics of med schools, I can't speak for that.

 

The BEST certification comes from your family doc that has known you for years. It has the strongest basis, and is the most defensible. The problem is there is an environment of fear. Of 30,000 active physicians in Michigan, only 2200 or so have written even one certification, and of those most are written by 55 doctors like myself that 'specialize' in certifications. In many cases, getting a card results in patients being discharged by their primary doctors. I don't want to sound like a dentist handing out suckers, but I am seriously considering opening MMJ friendly pain clinics to care for those patients.

 

Medical insurance is nice for big ticket items like MRI's and Surgeries. When a medical practice takes insurance, especially Medicare, they have to give a 'price' for their visits. A new patient, first time visit, may have a 'price' of $135 for a Primary Care doc like me. More for specialists, but we'll use that as an example. Medicare with counter with some 'formula' that says the 'average going rate' for this is $100. Then they will pay say $60 in six months for that visit, with the patient paying a co-pay of $20. These aren't real numbers, just an explanation of the system.

 

In order to get that $60 in SIX MONTHS (though my rent and utilities and payroll are due TODAY) I have to hire one or two professional billers. I then have to fill out the forms (got to be RED forms) properly, filling in every box, including the ones with no explanation, and have them rejected several times. This costs money. Furthermore, if you come to my office without two nickles to rub together and I 'cut you a break', charging $60 in cash, I've just committed Medicare fraud and go to prison. As a result, I probably won't accept insurance, but will give you the information to send in. That way I can cut out all those costs and charge you a lower rate, but you have to pay it at the visit.

 

Back to becoming a primary doc again. Well as you can see from the above, I am considering it. But it will also restrict my movements and not allow me to range over the state, which leaves no one to replace me for YOUR cert. Unless we do it via telemedicine. I enjoy what I do, I do it right and set an example for other clinics to follow (though some are more marketing companies in it for a quick buck rather than actual clinics looking out for patients). The more of me, the less of them (the no record mills). That protects patients and the Act. In addition to meeting the overwhelming need for MMJ friendly pain clinics, setting them up gives me fixed offices and a little more 'legitimacy' in the eyes of the press and the courts. So there are good things in both aspects. What I really need is some help from PAs and NPs so I can do both, and I am working on that. If you know any, send them my way and I'd be glad to chat with them.

 

Dr. Bob

 

PS, in the meantime you can do your part by not attending these 'no record, no problem' clinics.

[Kevin]

Respect and gratitude to Dr. Bob.

[Dr. Bob]

Anyone that was certified by me from 2-1-10 to 8-1-10 please send a copy of your certification paperwork to me at fax # 989-317-3150. Let's make sure your records are with the doc you saw so I can defend you. I'll compare your paperwork to the charts I received from the marketing company to make sure your records are where they belong.

 

Dr. Bob

[+Silverblue]

Doc do you think you can have them shut down? Would it help if people complained about them? I have an idea, a letter explaining how these mills hurt our law so the reps or whoever can see it's NOT the patients that are messing it up. We also need to focus on the real reason for the mills, that drs aren't allowed to recommend it. THAT would put those mills out of business. If I were renewing, I don't know who I'd see who'd be my primary dr, I know mine is against it. This issue is the reason for the sig mills. I think most of us realize that, but we need to get the message across. If our community can get those places shut down, it could help our reputation.

 

OK here's something I've been thinking about for awhile that I think could be useful. Anyone can use the letter, the'd need to delete some parts and put in their own experiences and concerns but I think it may explain the situation well enough. I've shared similar letters with this community but I don't know if anyone used any of them; this one reflects recent uncovered activities of a particular signature mill. So here it goes:

 

Dear rep,

 

Because my primary physician will not recommend medical marijuana, I was forced to go to a hotel clinic. Although I had records, I was very uncomfortable and will never go there again. Some time later, I discovered why I felt that way, when I learned they were just a marketing firm and their doctors had marks on their records. This so called clinic also sent out postcards asking their patients to renew their cards, when it came close to renewal time. These cards were fully exposed, so anyone could see. Recently, I learned this firm was selling pre-signed certifications without a doctor even present on site. What this firm is doing is shameful and barely legal, if legal at all, yet they are still in business. Please don't punish the patients who genuinely need this medicine, because of the unethical practices of such operations. Many of these places even accept an applicant with no records. There's no follow-up, and little chance the doctor would be willing to defend a patient in court. These types of businesses invite abuse by someone who'd see an easy way to get certified, even if they had no real need. I know there are people who do have a need, but have no medical records or a primary doctor because many cannot afford to see a doctor, and many more have no doctor to confide in about their desire to use medical marijuana, nor would that doctor recommend it, often due to fear, although the law is supposed to protect doctors from prosecution, just as it's supposed to protect medical marijuana patients and their caregivers.

 

It is my goal to see these types of clinics shut down as soon as possible. They're causing more problems for our medical marijuana community, as well as the community at large. Many dispensaries are also connected with these clinics. The result is an overburdened registry program. Meanwhile, legitimate patients cannot afford to pay for these certifications, and hundreds more who genuinely need it, cannot afford a doctor or even find a primary care physician who's willing to recommend it, write a certification, offer follow-ups, or be available to defend the patient in court. There are legitimate doctors who are filling this need, but the bad clinics are causing the good ones to be put in the same category as them, though there is a clearly distinct difference between them.

 

I truly believe there is a solution that can satisfy everyone, while making it easier for those truly in need to have their doctor approve their use of this medicine, work with them to monitor their progress, just like they would for other medicines, and develop a solid case history that can be easily defended in any court of law if need be.

 

Sincerely._________

 

Sb

[Dr. Bob]

Well said SB, Well said.

 

Dr. Bob