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As a result of the increase in demand for botanical products, modern healthcare providers need to become knowledgeable about these products. This article provides a brief review of the use of botanicals, what role these products may have in contemporary medicine, the importance of understanding the interactions between botanical and conventional medications, the resistance of physicians to prescribing botanicals, and the use and safety of botanical products.

I have tried to stay abreast and on the cutting edge of new technology, ideas, and investments. However, NFTs—or non-fungible tokens—have so far eluded me. I have asked my children and their contemporaries, and no one has been able to explain it to me. When it comes to NFTs, or the emerging form of digital certificate that certifies an asset as one-of-a-kind, the medical community seems to be divided between pro- and anti-NFT camps. Those belonging to the former camp tout it as a novel approach to finance and ownership of digital data. Those against NFTs point to—among many other things—their devastating impact on global climate or their use of tremendous amounts of energy to compute the blockchain transfers of billions of dollars that take place regularly in the metaverse. On the other hand, NFTs represent a unique potential in the digital health age: that of patients, rather than companies, owning their digital healthcare data. With such a level of ownership, physicians and patients could leverage its advantage to monetize their data rather than have companies profit off them, as traditionally has been the case. This article walks you through the basics of NFTs, explains how they can further empower patients in the digital health age, and raises concerns pertinent to the technology.

Innovation does not come easily to healthcare. In many cases, a device or new treatment has been presented to the medical profession but does not receive widespread acceptance until years or even decades later. This article reviews a few examples of devices or treatment options that were made available to healthcare but did not receive clinical application or early adoption for many years.

Good doctor-patient communication can help enhance patients’ emotions, facilitate understanding of medical information, and better identify patients’ needs, perceptions, and expectations.

How will you fill your time after retirement? Begin making plans now by working with your partner to find shared interests that will be stimulating, enjoyable, and within your bandwidth of physical capacity. This is the final installment of the three-part series on retirement.

One of the most important strategies to prepare for retirement is to evaluate your finances and your nest egg. This, the second of a three-part series on retirement, provides a formula for determining how large your nest egg should be for a satisfying retirement.

A key element in business management is strategic planning, which can move a business/practice that is being buffeted by changing economic forces to one that shapes its own future. It is an organized, step-by-step review of the business, the economy, and the environment in which the business operates.

Physicians are well-educated in diagnosing and treating medical conditions but receive no guidance on how to exit the practice of medicine. As a result, few of us know when to leave the umbrella or the cocoon of healthcare. Even worse, we have no guidelines on what to do once we hang up the stethoscope and take down the shingle and how to go from working 60 hours a week to zero with nothing to fill the days.

Introduction Telemedicine (TM) will play a significant role in contemporary practices that diagnose and treat sexual medicine patients. Although only a small percentage of urologists, sex therapists, social workers, psychiatrists, gynecologists, and urogynecologists currently use TM, many more practices are going to embrace this technology in the near future. This article will discuss the process for implementing TM in sexual medicine with minimal time, energy, effort, and expense. We will also examine compliance and legal issues associated with implementing TM in practice and how to code for TM services based on regulatory guidelines. Objectives The purpose of this article is to improve the understanding of the concept and the trends of using TM to provide care for sexual medicine patients. Methods The study involves a literature review focussing on the new Centers for Medicare and Medicaid Services guidelines including the relaxation of the Health Insurance Portability and Accountability Act requirements. Results COVID-19 has changed the doctor-patient relationship especially in the area of sexual medicine. There are many patients with sexual medicine conditions that are amenable to the use of TM methods. Conclusion Virtual visit utilizing audiovisual telecommunications is a very attractive approach for sexual medicine patients. Many patients with sexual medicine problems are no longer going to accept the antiquated method of healthcare involving making an appointment, visiting a brick-and-mortar facility, and the requirement of having a physical examination. The new normal will be communicating with patients by utilizing TM. Dooley AB, Houssaye N de la, Baum N. Use of Telemedicine for Sexual Medicine Patients. Sex Med Rev 2020;8:507–517.

I’m sorry is one of the most-used phrases in any language. Most of us don’t think twice about offering an apology when we unintentionally bump into a stranger on the sidewalk. However, when we have made a medical mistake, which most of us have in our medical careers, apologies seem to get stuck in our throats and become difficult or impossible to articulate.

Burnout, the outcome of prolonged stress or frustration, manifests as both mental and physical fatigue affecting over half of healthcare workers. This article will discuss the etiologies, problems, and potential solutions to burnout related issues that are impacting radiologists. Factors placing radiologists at risk for burnout as well the impact of burnout upon the radiologist, the department, staff, and patients they serve will also be discussed. An emphasis will also be placed upon recognition, solutions, and a collective response to burnout. Readers should be able to perform a self-assessment of their own risk for burnout and understand what can be done to dissolve and prevent burnout amongst their colleagues. In doing so, our hope is that radiologists will develop greater insight, awareness, and ultimately empathy for the unique challenges that others in the radiology community may face.

Introduction Although telemedicine (TM) has been available for several decades, the recent increase in its acceptance due to the COVID-19 pandemic has emerged as a valuable solution for the delivery of health care that provides easy, affordable, and convenient communication with urologic patients. Objectives The objective of this study was to highlight limiting factors and provide successful practical solutions to assist urologists in incorporating and maintaining TM in their practices. Methods A thorough literature review was conducted utilizing PubMed, Cochrane library, clinicaltrials.gov , Google Scholar, and Web of Science. Search terms and keywords included “telemedicine” and “urology.” Only articles written or translated into the English language were included. Results A total of 12 peer-reviewed articles were identified that discussed barriers for incorporation of TM in urology. Articles exclusive to the use of TM during the COVID-19 pandemic were also included, as well as American Urological Association and European Urological Association guidelines and Centers for Medicare & Medicaid Services statements and policies regarding TM pertinent to urological practice. Conclusion TM is currently a viable option and fills an unmet need for most practicing urologists, especially during the COVID-19 pandemic, offering insight to the relative ease of transition to online clinical practice. OA Raheem, S Brimley, C Natale, et al. The Emerging Critical Role of Telemedicine in the Urology Clinic: A Practical Guide. Sex Med Rev 2021;9:289–295.

Introduction Although testosterone therapy (TTh) is the standard practice in otherwise healthy hypogonadal men, this therapy has historically been contraindicated in men with a history of prostate cancer. Recent evidence suggests that there is minimal or no prostate cancer growth in the setting of TTh administration in men definitively treated for non-metastatic prostate cancer. Objective To review the evidence supporting the safety and efficacy of TTh in patients previously treated for localized prostate cancer. Methods A literature review of the PubMed database was performed to identify studies evaluating the safety and efficacy of TTh in patients with a history of prostate cancer. Search terms included Testosterone Therapy, Testosterone Replacement Therapy and Radical Prostatectomy, Radiotherapy, External Beam Radiation Therapy, EBRT, Brachytherapy; Prostate Cancer and Hypogonadism, Low Testosterone; Bipolar Androgen Therapy. Results Available literature provides evidence for the safe application of TTh in patients previously treated for prostate cancer with either radical prostatectomy or radiotherapy. Furthermore, there exists evidence that severely hypogonadal levels of testosterone may lead to worse oncological outcomes. More recent research has begun to elucidate the effectiveness of bipolar androgen deprivation therapy in the treatment of prostate cancer. This mechanism of action increases the level of evidence indicating that the traditional management of maintaining testosterone levels at low levels may no longer be standard of care. TTh likely has a role in improved erectile function and other quality-of-life concerns in patients developing testosterone deficiency after being treated for prostate cancer. Conclusions TTh should be offered to select hypogonadal patients who have a history of definitively treated prostate cancer. Adequately designed randomized controlled trials are necessary to confirm the safety and efficacy of TTh in this population. Natale C, Carlos C, Hong J, et al. Testosterone Replacement Therapy After Prostate Cancer Treatment: A Review of Literature. Sex Med Rev 2021;9:393–405.

Introduction Although available treatments for erectile dysfunction (ED) have expanded, there has been a concomitant shift in the treatment paradigm. Newer treatment options focus on disease modification and improving overall erectile function. Objective The objective of this study is to review the evidence of 3 promising novel ED treatments. Methods A thorough review of the literature was divided into sections corresponding to low-intensity extracorporeal shockwave therapy (Li-ESWT), stem cell therapy (SCT), and platelet-rich plasma (PRP). Search terms included “erectile dysfunction” or “ED” plus “extracorporeal shockwave therapy”, “stem cell therapy” or “platelet rich plasma”. International Index of Erectile Function (IIEF) scores were the primary outcome measure. Secondary outcome measures included peak systolic velocity and intracorporeal pressure. Results Li-ESWT section includes 1 randomized controlled study, 2 prospective studies, 1 animal study, and 2 meta-analyses. IIEF score improvement was 3.54 (range 1.99–6.40). Authors concluded statistically significant short-term effect and improvement in erectile function (EF) with Li-ESWT. SCT section included 4 case series and 1 open-label study. Intraperitoneal, venous, and cavernosal SCT injections improved EF in animal models. 3 studies (n = 6–8) demonstrated 83–100% and 29–50% of patients regained erection and penetration ability, respectively. 2 studies (n = 12–16) found that all patients improved IIEF scores after SCT. Literature review for PRP yielded 3 animal, 1 retrospective, and 1 prospective study. Animal studies have shown that rats sustaining crush cavernosal injuries treated with PRP significantly improved EF and preservation of cavernous nerve axons. One retrospective analysis on humans showed mean improvement by 4.14 in IIEF scores. One prospective study on humans (n = 75) demonstrated improved peak systolic velocity (P = .005) and IIEF scores (P = .046) with PRP therapy. Conclusions This review reveals limited published evidence on current novel ED treatment options. Further research on Li-ESWT, SCT, and PRP therapy is necessary to elucidate the role of these therapies in ED treatment regimens. Raheem OA, Natale C, Dick B, et al. Novel Treatments of Erectile Dysfunction: Review of the Current Literature. Sex Med Rev 2020;XX:XXX–XXX.

A discussion of medical marketing often begins with the three As of marketing: availability, affaability, and affordability. Since all physicns think of themselves as availble, as likeablek, and as offering appropriately priced services, how do you differentiate youself from the competition? Using fancy sationery, a having a practice logo, or having a slick Web site will not do the trick. The mainstay of any successful practice is the patients you already have and the ability to attract new patients which includes referrals from other physicians. Maintaining positive relationships with both patients and colleagues is key to a successful healthcare practice. Specifically, establishing and preserving connections with physicians is essential to creating a strong referral network and a steady supply of patients. This chapter will discuss methods twenty-six ideas and techniques to enhance referrals from your colleagues.

Health care has encountered a situation where the demand for our services is greater than the supply of physicians. In the very near future, the shortage of physicians will become even greater. At the time of writing this book, primary care physicians are already in short supply. The American Academy of Family Physicians predicts a shortfall of 40,000 primary care physicians by 2020. Moreover, the US Bureau of Health Professions projects a shortage of 109,600 physicians in all specialties by 2020. One thing is certain – following the passage of the Affordable Care Act (Obama Care), 32 million additional Americans are going to have health insurance, and someone will need to take care of them. Who will provide medical care to millions of newly insured people? Upon passage of the Affordable Care Act, physician practices were overwhelmed by the increased demand. Many doctors stopped taking new patients; the concept of concierge medicine, also called direct primary care, has decreased the availability of primary care physicians, and those physicians who continue to accept new patients have seen waiting times for appointments lengthen significantly. Visits to emergency rooms have increased by 7%, adding unanticipated costs to the program. To resolve this situation, physician practices and hospitals must proactively add capacity to treat large numbers of new patients. This chapter will identify mid-level providers and describe the role they can assume to increase the care we want to provide our patients.

Today, more than ever before, the new physician has the opportunity to carve and sculpt their practice using ethical marketing techniques. This chapter will focus on the new physician and how to grow and actually use marketing techniques to create an ideal practice.

Double-entry accounting has been used since ancient times to properly account for costs and revenue. From double-entry accounting, we derive the three basic financial statements: income statement, balance sheet, cash flow statement. These basic financial statements are used to assess a business and to help plan strategy. In this chapter, we will discuss basic accounting principles and the use of financial statements relevant to a practicing physician.

Medicine is a great profession. But, like any other profession, it is a business, and proper understanding of business principles and practices is necessary to be successful. In this final chapter, we conclude with five essential metrics to insure success of any physician’s practice.

Doctors are highly motivated to be effective in their professional life, but maintaining a balance with their personal lives is a challenge for all of us. How you maintain this balance will ultimately determine not only your success as a physician but also your happiness. It is very common to occasionally feel discouraged about various aspects of your practice such as the vast amount of paperwork that must be completed in order to care for your patients or the continued decrease in reimbursements that is impacting nearly every practice. Most of our colleagues are experiencing the same feelings about their practices. It is easily to become discouraged after talking to physicians who complain about their practices and complain that their family is suffering because the practice is consuming so much of their time. Let’s not forget that medicine is a most noble profession that provides great satisfaction and gratification and that all that doctors need to do to be happy is to find techniques of putting balance into their careers. This chapter will discuss 10+ suggestions that may help balance the scale between your personal and professional life. Physicians who read this article will gain new insight into achieving balance in their practices and balance in their personal lives.

Sammy joined a five-man orthopedic practice following residency. He had an undergraduate degree in business with extensive knowledge in computer science, as he spent his younger years as an avid video game player and developer. The practice hired a high school student to convert the three-colored practice brochure into an electronic format and the student cut and pasted the document into the free WordPress.com website builder in less than 1 hour. Despite trying to have a presence on social media, the site has remained idle for more than a year. What is Sammy’s next action step regarding social media?

Physician burnout is reaching epidemic proportions. That is the bad news. The good news is that burnout is easily recognized and there are effective solutions to this common problem.

Understanding basic personal finance and investment concepts is an important skill for physicians, who are in the top 5% of US wage earners. This chapter will discuss the concept of risk and reward and will discuss stocks, bonds, and derivatives. The importance of having a diversified portfolio will be discussed as will the concept of money.

The three parts of a legal contract are offer, acceptance, and consideration. Understanding contracts is an important part of a negotiation. The most important aspect of any successful negotiation is to have information that allows you to negotiate from a position of strength. This chapter will discuss basic physician contracts and negotiating skills necessary to ensure the best outcome when negotiating a contract.

Moving from a training program to private practice can be a stressful time for any doctor. For your previous training experience, you are in a cocoon or bubble and are protected by staff and faculty from your training program. There are so many things to take into consideration when making that transition to practice. Balancing your current workload as a resident or fellow and then managing family responsibilities while attempting to start your new practice can often lead to mistakes and missed opportunities. This chapter will help make that transition seamless. The following suggestions are a compilation of advice from several young physicians who entered private practice within the past 3 years. They will share what worked for them and what they would do if they had a chance to start all over again.

Unfortunately, the marriage of a new physician with a medical practice or a hospital is often not a match made in heaven. What started out as a union between two entities does not work out resulting in the physician and practice parting ways. If this happens to you, do not despair; you are not alone. It is possible to extricate yourself from a situation where one or both parties decide that the fit is not quite right. This chapter will discuss the reasons doctors leave a practice and what action steps you must do in order to leave with minimal emotional trauma to you, your patients, and the practice you have decided to vacate.

The healthcare sector is ripe for disruption as healthcare expenditures account for an ever-increasing percentage of GDP. In this chapter, we discuss the theory behind technology adoption and then apply this theory to health care focusing on expected changes in clinical care, reimbursement, and payment models.

Many physicians do not consider themselves to be entrepreneurs, when in fact many of the things physicians do from opening a new office to creating a new educational program are entrepreneurial. This chapter will describe how to take an idea and convert it into a successful business plan in order to gain support for the idea.

It was not so long ago that the concept of branding referred to using a hot iron to make your cattle look different from all other cattle on the range so that you could distinguish your cattle from others. Today, in the business world, branding is used to create the perception that a product or service is superior to other business in the community, the region, and even the nation. Is your medical practice unique and special? Everyone believes that we are members of truly unique practice or organization but how do we convey that to our existing patients and to potential new patients? Branding is an opportunity to create a name, a term, a symbol, or design that identifies and defines your practice and will differentiate your practice from other practices. This chapter will define branding from a medical practice point of view and discuss the importance of branding a medical practice using inexpensive and ethical methods of branding for the contemporary medical practice.

This chapter is meant to reassure you that you have made a good decision to join one of the greatest and most enjoyable professions on this planet. However, in order to have that enjoyment, it will be necessary to have a modicum of business skills that you probably did not receive as a medical student.

The time value of money is the most fundamental concept in business and attests that money is worth more in the present than in the future as current money can be used immediately to fund opportunities that may not be available in the future. Additionally, because money earns interest, and because interest compounds over time, the present value of money is greater than the future value. This chapter will discuss the time value of money as it applies to financing a medical education.

Payment for medical care has moved from a fee for service model, to a capitated managed care model, to a model that is based on the value of services provided. This chapter will discuss the history of payment models for medical services. The chapter will conclude with a discussion of MIPS and MACRA and the appropriate use of the electronic health record.

As in other fields, technology has the ability to change how we practice medicine. This chapter will discuss emerging technologies in health care including the electronic health record, medical devices including wearables, precision medicine, telehealth, and the use of smartphone applications. The chapter will also provide information on how best to adopt technology into practice.