Endourology & Robotic Surgeon Prostate cancer • BPH • Stones CMO & Founder, @Notafid, connecting physician workflows across fragmented systems • Triple 🐊
Tampa, FL
Joined February 2011
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I’ve shared glimpses of @notafid with many of you in urology over the past weeks. Today, we officially launched our X page.
What started as an idea to fix the fragmented realities of urology call has become a physician-built platform we’re incredibly excited about.
Individual access is launching soon.
Follow @notafid — we’ll be sharing much more of what we’ve built in the coming weeks.
Jonathan Pavlinec, MD retweeted
The right BPH treatment depends on the anatomy, severity of the problem, evidence behind the treatment, and what the patient considers a successful outcome. More options are a good thing. The challenge is knowing which option makes the most sense for which patient.
#Urology #ProstateHealth
Jonathan Pavlinec, MD retweeted
The talking points have gone out to all the influencers to support the death of the -25 modifier
It’s a concerted push. People talking about this stuff have no clue what it means, just reading from a script
Give Dr. Oz credit on this one. This is what I voted for. Saving people money and cutting unnecessary waste.
Here is what has been going on. Medicare has been paying twice for overlapping work when someone has an office visit and a procedure on the same day. Those extra costs can eventually mean higher premiums and more out of pocket costs for patients.
@DrOzCMS is pushing a fix so Medicare is not paying full price twice for the same overlapping work. This is the kind of change I want to see in healthcare
Crazy misinformation all over the internet. 25-modifier allows me to actually spend time beyond the immediate procedure addressing various patient concerns.
Example-cystoscopy for a bladder lesion or BPH issues, yet patients will want to stay and talk about ED, kidney stones, or unrelated issues.
I’ll discuss in the procedure room, or often put them in an exam room and have a whole separate visit post procedure for several other issues.
Many patients have a hard time with transport or come from a fair distance away. I will often do no charge tests (ie uroflow) to save them a separate trip in trying to provide efficient, better care.
This initiative completely torpedoes what many of us are trying to do in saving unnecessary visits. Claiming this is “double billing” is one of the dumbest things I’ve seen on this app. The govt reimbursements for procedures or visits are so bad anyway that you can’t pay overhead from them, and this makes it even worse 😵💫🙄
Why do I feel like this meeting is not going to be good for doctors? Almost like an order came down from somewhere to destroy any remanent of private practices.
First the coordinated Psy Op trying to convince the public doctors have been “double billing” for overlapping services and now getting together to address “rising costs tied to out of network payment disputes”.
Jonathan Pavlinec, MD retweeted
🚨 5-yr BCR-free after prostate RT = functional cure? Depends who you are 🚨
@EurUrolOnco (RAPTOR)
👥 3,120 men, intermediate (89%) / high-risk (11%) #prostatecancer, 11 RCTs
📊 Post hoc IPD analysis, HDRT ± ADT, trials accrued 1997 to 2012
⏱️ Median f/u 124 mo (HDRT alone arm)
✅ Among pts BCR-free at 5 yr, adjusted 8-yr distant mets:
6.6% HDRT alone
11% HDRT + short-term ADT
16% HDRT + long-term ADT
✅ 10-yr PCa-specific mortality 2.5% / 4.0% / 3.0%
⚠️ Retrospective, BCR definitions varied by trial, pre-PSMA era; ≤10% was the prespecified "favorable" bar
🎯 One benchmark does not fit all risk groups.
🔗 doi.org/10.1016/j.euo.2026.0…
@AmerUrological @UroOnc @PCFnews @AmarUKishan @UrologyTimes @renalandurology
Jonathan Pavlinec, MD retweeted
Chef opens a restaurant. People really like it. He books out reservations for 3 months.
But now people are upset there’s a 3 month wait to go to the restaurant.
Then, the government decides to put price caps at how much he can charge customers. He still needs to pay overhead and staff and ingredients, though.
So he decides he needs to serve more customers to cover his costs. So he shortens the allowable time for meals. Of course, now the customers aren’t happy about having to rush through their meals. Many of them insist on eating at a leisurely pace, or they send their food back because they didn’t like it, or they show up late for their reservation and insist on being seated anyway.
Meanwhile, the chef is trying to keep up. He feels bad he can’t put the same attention into each meal he did before. But if he doesn’t serve enough people in a day, he will have to close down (or sell to the large restaurant conglomerate down the street).
Oh, and the government also decides that he now needs to do two hours of computer work for every hour he spends cooking. They force him to use a terrible, but expensive, computer system, too, not the one he wanted. So he needs to serve even more customers to cover those costs as well.
The customers are rightly upset. They’re waiting longer and getting less personalized service. The chef is also upset that he’s spending more on overhead but delivering worse meals.
Nobody is happy here.
Jonathan Pavlinec, MD retweeted
I spent a little over 2 hours clearing a large infectious staghorn stone with a ureteroscope. The patient came to me after an unsuccessful PCNL elsewhere.
Expected professional reimbursement: $365
Expected facility reimbursement: more than $6,000+
The facility has real costs. But my professional reimbursement was about 6% of the facility reimbursement.
Imagine a trial lawyer getting paid 6% of what a courtroom brings in. Where does the rest go?
Then we wonder why some doctors steer their kids away from medicine. I love what I do and wouldn’t change it for the world.
But the person doing the work shouldn’t get the least.
Now find me a top attorney who charges $180 an hour…
#IndependentMedicine
Jonathan Pavlinec, MD retweeted
Sometimes we might be late to an appointment because we were just telling another patient they had cancer and they needed a moment or two, sometimes we needed to respond to our other patient coding and nearing death 🤷🏼♀️
It's not always on purpose.
Replying to @fuqekgs
Although true if you put yourselves in the patients shoes and followed them around and saw how busy they were you would understand why they are so frustrated having to wait!
Jonathan Pavlinec, MD retweeted
How do people honestly think this works? If we saw less people a day, then people would complain that they have to wait 8 months for a specialist appointment.
Replying to @fuqekgs
Ok schedule fewer appointments then. You guys don’t have to all make 500+K a year
Jonathan Pavlinec, MD retweeted
Time is the ultimate currency so it really is hard to hear that some patients think we systematically disrespect theirs
My best practical advice is that earlier appointments are usually better to avoid the “snowball” effect of delays compounding throughout the day
Jonathan Pavlinec, MD retweeted
I’m not sure this framing advances the discussion.
Calls for level 1 evidence for focal therapy were reasonable and based in fact. Claims that radiation is the “new gold standard” over surgery deserve the same scrutiny. ProtecT did not establish radiation’s superiority over surgery and to the contrary actually confirmed equivalence. Our evidentiary standards should be consistent across treatments.
Surgery and radiation are both excellent options, with different side effect profiles. Patient preferences often guide the choice after informed decision making with both rad oncs and Urologists.
We owe our patients balanced, evidence-based counseling. Overstating the evidence risks eroding trust with both patients and colleagues.
Controversial statement by @SJFrankMD, informed by the ProtecT study results, for those who still think prostatectomy is the better treatment. #ASTRO26
Great discussion, especially for trainees and early career docs….two of the best to do it! Worth a listen
You can't see your own blind spots
No matter how smart you are, or how good you are at your job
In today's conversation with @SPuro88, we talk about knowing when to bring in outside perspective, whether that's on your money, your contract, or your practice
Listen on Apple or Spotify
Jonathan Pavlinec, MD retweeted
It is statements and ads like these are why focal therapy is being fought tooth and nail.
Surgery has its role and has definitely improved over the years
Radiation has its role and has greatly improved over the years
Focal therapy has its role as well.
Each has its role.
With a prostatectomy, the urologist is unable to see the difference between the apex of the prostate and the external sphincter. If a patient has an apical lesion and it is too close to the external sphincter, two things can happen:
buschcenter.com/tulsa-and-th…
#ProstateCancer
Jonathan Pavlinec, MD retweeted
This is misleading information: during prostatectomy, whether open or robotic, the difference between apex of the prostate and sphincter is clearly visible. @uroweb @AmerUrological @DoctorSotelo @dr_coops
With a prostatectomy, the urologist is unable to see the difference between the apex of the prostate and the external sphincter. If a patient has an apical lesion and it is too close to the external sphincter, two things can happen:
buschcenter.com/tulsa-and-th…
#ProstateCancer
Jonathan Pavlinec, MD retweeted
⛳ Golf as #ProstateCancer survivorship medicine? Small but neat feasibility data ⛳
@FrontOncology, GREENS single-arm pilot in men on ADT:
🏌️♂️ 15 enrolled, 10 completed a 10-wk group golf + exercise program
✅ 90% attendance, 98.9% within-session adherence
✅ Zero grade 2+ adverse events
✅ High enjoyment and satisfaction, mean 7/7 willingness to recommend
⚠️ Small, single-arm, no control or oncologic endpoints
🎯 Men stuck with the program and loved it & adherence is critical in this space
🔗 doi.org/10.3389/fonc.2026.18…
@AmerUrological @UroOnc @justindubinmd @UrologyTimes @urotoday @PCF_Science @PCFnews
Jonathan Pavlinec, MD retweeted
Replying to @DrDiGiorgio
I’m just coding my own solutions to this and building it from scratch and dude, it’s way way better.
We should just be building our own tools, just like we’ve done in medicine from pretty much the beginning of time.
Jonathan Pavlinec, MD retweeted
Despite (or in spite of) AUA guidelines - prebiopsy MRI is an absolute must. Glad US uros get it
Our latest in @JAMAOnc prebiopsy MRI is now used in ~2/3 of US prostate biopsies.
Up sharply since 2017 but still work to do.
With Stephen Rhodes and coauthors @SBasourakos @jimhumd @Chris_Barbieri1 @angela_jia_ @Soum_Roy_RadOnc @DrSpratticus @lponsky
@CaseUrology @UHhospitals @UH_RE_Institute @caseccc
jamanetwork.com/journals/jam…
Testosterone Therapy in Men on Active Surveillance for Prostate Cancer Is Not Associated With Increased Risk of Disease Progression | Journal of Urology auajournals.org/doi/10.1097/… @SaveYourSexLife @UrologyMSK @CAU_URO @HispanicUroNA @SMSNA_ORG @SMSNA4Patients