Live Long and Well with Dr. Bobby

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More of us are being seen by nurse practitioners (NPs) and physician associates/assistants (PAs); for routine care outcomes look similar to physician visits, but for complex, new, or worsening problems you should push to see the doctor and ask for clear oversight.
Key topics
Why this is happening: Longer waits and rising demand meet a physician shortfall, so systems lean on NPs/PAs to expand access. New-patient waits average ~31 days, varying widely by city and specialty (AMN
). Fewer people have a usual source of care, pushing visits to urgent care/ER (Milbank Scorecard
).
The scope shift: NP involvement in Medicare outpatient visits rose from 14% in 2013 to ~26% in 2019 (Harvard/Tradeoffs summary). Projections show rapid growth in NP and PA roles through 2030 (ValuePenguin analysis
).
Training differences (at a glance): NPs typically complete a master’s/DNP with ~500–700 supervised clinical hours and, in many states, can practice independently; PAs complete a master’s with ~2,000 supervised hours and practice with physician collaboration; physicians complete medical school plus 3–5+ years of residency (~10,000+ hours) and broad rotations—critical for complex differential diagnosis (AJMC overview
).
Quality of care, by the evidence: For common, protocol-driven issues, outcomes are generally similar. A Cochrane-summarized evidence base finds comparable results for blood pressure control, mortality, and patient satisfaction, with longer counseling time in NP visits (AJMC summary of RCTs
). Patients often feel PAs spend more time with them (JAAPA survey
). Diabetes care quality appears similar across clinicians (PubMed
); NPs tend to deliver more smoking-cessation counseling (AANP brief
).
Where this works well: Routine follow-ups (blood pressure, cholesterol, diabetes), protocol-based care, minor acute concerns (UTI, simple URI), post-op checks when all is going well—especially with clear physician involvement.
When to push for the doctor: New, unclear, or non-resolving problems (e.g., complex headaches, persistent back pain, ongoing fatigue or depression), multiple chronic conditions, many medications, or when a serious alternative diagnosis must be ruled out (e.g., “heartburn” vs. cardiac disease).
Advocate for transparency: Ask in advance who you’ll see, whether your case will be reviewed with a physician, and how escalation works if you’re not improving.
Takeaways
Access will keep driving NP/PA growth; use it to be seen sooner.
For routine care, NPs/PAs are often a solid choice with similar outcomes and more counseling time.
For complexity, insist on physician evaluation or documented oversight.
You have the power to ask questions, confirm the plan, and request escalation when needed.
Links mentioned in this episode
AMN wait-time trends →

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Madrone Springs Ranch and Bed and Breakfast Website

Summary:
I share five lessons that shaped an unexpected path—from physician-scientist to entrepreneur, Ironman triathlete, podcaster, and ranch/inn owner—and how you can use the same principles to build a life you didn’t plan but absolutely love.
What you’ll learn:
Why it’s smart to seek counsel—but essential to trust your own judgment.
How pairing medicine and business created a career at the intersection of evidence, incentives, and impact.
A simple way to identify your superpower (and your kryptonite) so you can build the right team around you.
The “big picture → incremental steps” approach that carried me from daily core work to marathons to Ironman.
How to move forward when you don’t have a master plan—just take the next best step.
The power of focusing on strengths and designing work (and life) around what you do best.
Why my podcast exists: translating rigorous evidence into accessible, agenda-free guidance.
Key moments:
Choosing medicine vs. business—and discovering it was never either/or.
Reframing a PhD: deliver peer-reviewed papers, not a door-stop dissertation.
From “don’t look old” to four full Ironmans and 15 70.3s—one step at a time.
Building Madrone Springs Ranch by following curiosity, not a 10-year plan.
Accepting getting "older": prioritize durability and finishing over speed.
The “Chief Beauty Officer” principle—surround yourself with complementary strengths.
Why I launched Live Long & Well: evidence first, no hype, no conflicts.
Takeaways:
Ask for advice, but trust yourself.
Know your superpower—and your kryptonite.
If you have a vision, work backward into small, consistent steps.
If you don’t, take the next best step and let the path reveal itself.
Build your life around what you’re genuinely good at.
Try this this week:
Write down one decision where your gut disagrees with the chorus—what is it telling you?
Make two columns: strengths and weaknesses. Identify one task to delegate or drop.
Pick one small step that moves your long-term vision—or your curiosity—forward.
If this episode helped you, share it with a friend who’s between Point A and Point B. And if you’re new here, follow the show so you don’t miss what’s next.

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Summary: I separate cold-season fact from folklore so you know what truly prevents colds, what (slightly) shortens them, what eases symptoms—and what to skip. Save money, feel better, and keep it simple.
What we cover
How common colds are and how long they last (2–3 per year on average; usually 5–7 days; cough can linger).
Prevention audit: 
Vitamin C doesn’t prevent colds in the general population (Cochrane), though it helped in physically stressed groups; 
handwashing probably helps (Cochrane) 
echinacea doesn’t pan out (Cochrane) 
garlic didn’t reduce colds but modestly reduced severity in one RCT (trial)
 gargling showed a very small signal (trial)

Grandma’s wisdom check: 
Short sleep (<6 hours) quadrupled cold risk in a viral-challenge study (study) 
cold exposure might matter (foot-chilling RCT: more colds in the chilled group, study
lab data suggest colder noses weaken first-line defenses (mechanism)
Shortening a cold: 
Vitamin C doesn’t shorten it when started after symptoms (Cochrane
zinc lozenges can trim 1–2 days if started within 24 hours (≈100 mg/day elemental zinc in trials, meta-analysis
chicken soup has plausible lab effects on white blood cells (study
Symptom relief: 
Oral phenylephrine doesn’t work; the FDA voted 16–0 that it’s ineffective (FDA review
Pseudoephedrine (the “real” Sudafed, behind the pharmacy counter) reduces congestion with meaningful effect sizes (evidence
Honey 30 minutes before bed improved cough and sleep in kids (not for <1 year) and is supported by a broader review (RCTsystematic review 
Humidifiers didn’t show clear benefit in trials (Cochrane
Voice myth: Whispering actually stresses the vocal cords more for many people—so speak softly instead (study
Flu vs. cold: Tamiflu is only for influenza and must be started within ~48 hours.
Takeaways
To avoid colds: prioritize sleep and handwashing; keeping warm may help.
To shorten a cold: consider zinc (start early). Chicken sou

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Summary: I walk you through the proposed shift away from universal newborn hepatitis B vaccination at birth, why it matters, what the evidence shows, and how parents can make a calm, informed choice—without reigniting every vaccine debate.
Episode highlights
I explain why hepatitis B is uniquely risky for babies: if infected early, up to 90% develop lifelong infection with later risks of cirrhosis and liver cancer. I also clarify that exposures aren’t only from mom at delivery—household contact and tiny blood exposures matter.
We review what happened after the U.S. moved to a universal newborn dose in 1991: childhood hepatitis B plunged dramatically, with no new safety concerns emerging from hundreds of millions of doses.
I outline the new proposal: keep the birth dose for babies of mothers who are positive or whose status is unknown; consider delaying to two months when mom tests negative—via shared decision-making with the pediatrician.
I describe why many pediatric and public health experts still favor the birth dose: it protects against documentation errors and early exposures, and it avoids added “friction” that can reduce on-time vaccination.
I address autism concerns with empathy and evidence: large studies and reviews have not found a link between vaccines—including hepatitis B—and autism.
My take: I would keep the universal birth dose because it’s safe, simple, and highly effective. But if parents delay, they should commit to the 2-month visit and rely on their clinician—not social media.
Key takeaways
The risk window is small but meaningful. Early-life infection can have lifelong consequences; the birth dose is a safety net.
Process vs. evidence matters. Policy shifts should be driven by strong data, not ideology or committee turnover.
If you delay, have a plan. Put the two-month appointment on the calendar now and follow through.
Know your status. Make sure maternal hepatitis B testing is done and documented correctly.
Resources mentioned (for deeper reading)
Hepatitis B clinical overview and long-term risks (CDC): cdc.gov/hepatitis-b/hcp/clinical-overview

U.S. policy history and early childhood burden pre-1991: PubMed 11694691

Impact of infant hepatitis B vaccination (MMWR): mmwrhtml/mm5125a3.htm

CTA: If this episode helped, share it with an expecting parent or grandparent. To get my weekly note on practical, evidence-supported longevity and preventive health, join me at DrBobbyLiveLongAndWell.com.

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Summary: Microplastics are showing up in our water, food, air—and in human tissues. In this episode, I unpack what the best studies actually show (and don’t), why risk is plausible but not proven, and the realistic steps you can take today without panic. 
In this episode, I cover:
What microplastics are and why they’re everywhere—from packaging and clothing to tire dust—and why production is still projected to rise ~70% by 2040 (OECD).
OECD+2
OECD+2
The signal that caught my attention: patients with microplastics in carotid artery plaque had a markedly higher 3-year risk of heart attack, stroke, or death (NEJM). Association, not proof—but concerning.
The Guardian+3
New England Journal of Medicine+3
PubMed+3
What’s turning up in the brain: autopsy work suggests rising microplastic loads in brain tissue, though causality remains unknown (Nature Medicine coverage).
Nature+2
Nature+2
Everyday exposure: a liter of bottled water can contain ~240,000 plastic particles—mostly nanoplastics—using newer detection methods (NIH Research Matters).
TIME+3
National Institutes of Health (NIH)+3
NCBI+3
Indoor vs. outdoor air: estimates suggest we inhale tens of thousands of microplastic particles daily, with higher indoor concentrations (PLOS One).
PLOS+1
My takeaways for you (progress, not perfection):
Respect the signal without catastrophizing. Human data are early, but cardiovascular and neurologic signals merit attention.
New England Journal of Medicine+1
Make the easy swaps: store food in glass, don’t microwave plastic, favor loose-leaf tea over plastic-based tea bags, and replace plastic cutting boards with wood or glass. (These trim exposure; they don’t eliminate it.) 
Air matters: consider a HEPA purifier for main living/sleeping areas and vacuum regularly; natural-fiber clothing sheds fewer synthetic particles. 
Water choices: where safe, use tap water with a quality home filter and a reusable (non-plastic) bottle—especially given the nanoplastic findings in some bottled waters.
National Institutes of Health (NIH)
Listener corner: You asked for more quick-hit myth busters (yes, we’ll do “Does chicken soup speed recovery?”), and thanks for the reminder to wear a