@DutchRojas I bought my practice. Run it independently. No PE, no corporate board. It gets harder every year. But the patients in my chair get my decisions, not a boardroom's. Some of us did build. We just did it quietly.
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Dr. Keith Tokuhara | Cataract Surgeon
159 posts
Dr. Keith Tokuhara | Cataract Surgeon
@DoctorTokuhara
Cataract surgeon helping patients see clearly again Clear, honest guidance on surgery, lenses & timing Rancho Mirage, CA ↓ Learn what’s right for your eyes
Rancho Mirage, CA Katılım Nisan 2026
252 Takip Edilen43 Takipçiler
Physicians keep saying the same things.
Private equity took advantage of us.
Venture capital stole our ideas.
The government hates us.
Health systems get paid more than we do.
Fine.
What did you build in response?
UnitedHealthcare, Cigna, Blue Cross, and the largest health systems in America do not care about morality.
They care about rails.
Systems.
Flow.
Precision.
Lobbying.
Data.
Capital.
Captives.
Contracting power.
They engineered the track.
Physicians are still arguing from the grandstands.
That is why you are getting lapped.
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@DrCorriel @DrCorriel I appreciate that. Medicine has changed, but the work still matters. Your project sounds timely. I'm glad people are talking honestly about what practice looks like now. Happy to take a look.
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How wonderful. Not the oath that it keeps getting harder, of course. The part that you’re sticking with it and fighting through. I’m building a show on practicing medicine in today’s age, called Modern Practice Playbook, and would love for you to check it out and possibly stay connected. First episode out this week.
doctorsonsocialmedia.com/modern-practic…
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Step 1 is admitting that physicians are being squeezed by design. Debt narrows choices. Corporate consolidation narrows choices. Insurance contracts narrow choices. Hospital employment narrows choices.
If we want better healthcare, we have to rebuild the conditions that let physicians remain independent and that means making private practice viable again, separating physician work from hospital and corporate ownership, and giving doctors a real path to care for patients without being forced to sell themselves to the highest bidder.
Mark Cuban@mcuban
If you want more doctors doing house calls, not selling their practices and going to work for the big HC conglomerates, make public med school free. A little gov intervention, so that rather than having 100s of thousands in debt guiding their decisions , they can do primary care or be a family physician and spend as much time with patients as they want. They can take cash. They can take chickens. If you had 250k after almost a decade of school, do you think that would impact your decisions ? And if you own a big HC conglomerate, does knowing they are drowning in debt impact your decision and how you compete and contract with them ? Fuck yeah it does. You pressure them till they have to sell out to you in an acquihire. They can’t afford to survive on their own and every huge HC company takes advantage of them About 32k students enter med school and DO school a year. 75k for a grant each. Thats 2.4b annually for each class. That’s it. You want better healthcare for everyone. That’s the place to start.
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@spartywrx @doctorandrew @mcuban @spartywrx Agreed. A mission needs funding. The harder question is what the funding rewards, and whether those incentives still serve patients first.
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@doctorandrew @DoctorTokuhara @mcuban No money, no mission
Even the most altruistic endeavors don’t happen without funding
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We accept that elite athletes can’t perform forever under extreme pressure. Yet many people expect doctors to absorb nonstop stress for decades without burning out.
Mark Cuban@mcuban
If you want more doctors doing house calls, not selling their practices and going to work for the big HC conglomerates, make public med school free. A little gov intervention, so that rather than having 100s of thousands in debt guiding their decisions , they can do primary care or be a family physician and spend as much time with patients as they want. They can take cash. They can take chickens. If you had 250k after almost a decade of school, do you think that would impact your decisions ? And if you own a big HC conglomerate, does knowing they are drowning in debt impact your decision and how you compete and contract with them ? Fuck yeah it does. You pressure them till they have to sell out to you in an acquihire. They can’t afford to survive on their own and every huge HC company takes advantage of them About 32k students enter med school and DO school a year. 75k for a grant each. Thats 2.4b annually for each class. That’s it. You want better healthcare for everyone. That’s the place to start.
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@402sld @DrDiGiorgio @402sld I understand the fatigue. When the economics punish independent practice, good physicians leave and patients lose options. That is not a healthy system.
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@DoctorTokuhara @DrDiGiorgio Why I’m selling. Rates are Medicare fees on 5 ft poster in lobby since 05. Those costs come out of my owner distributions. 20 yr practice. Everything needed replaced at once- slit lamps, OCT, field, topo 😭Medicare/ Medicaid pts. No premium IOLs. Won’t practice again. Done/ jaded
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You have no idea how much more physician capacity would be created if you just take away all the regulations stopping us from building.
There is no doctor shortage. There is only a regulation excess.
Palmer Luckey@PalmerLuckey
@mcuban The biggest hospitals etc are already running the system more or less as they want. The question isn't what they would do with less government control, it is what kind of competition would spring up. Doctors would be allowed to start/co-own hospitals again, for example.
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@mcuban @DoctorTokuhara Right! The surgeon’s bill is usually cheapest part of the entire procedure.
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@OckhamsRazor4 @OckhamsRazor4 I think you know what I'm referencing. More visits and higher cost do not always add up to better vision. The match between the lens and the patient matters more than the price tag.
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A woman came in for a second opinion. Another surgeon had put in the most advanced lens on the market. Multiple adjustment visits. Long drives. Months of frustration. Her vision still wasn't right.
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@SharonSharalike @mcuban @SharonSharalike That gap is the part most people never see. The physician doing the work often gets a fraction of what the system charges. Where the rest goes is a question more patients should be asking.
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@mcuban @DoctorTokuhara The bills for my angiogram reached almost $40,000. My cardiologist who was in charge of the procedure got $250.
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@402sld @DrDiGiorgio @402sld Exactly. When practices need extra staff just to battle software, claims, and compliance, that is not efficiency. It is administrative drag. Those costs always get pushed somewhere, and usually not in the patient's favor.
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@DoctorTokuhara @DrDiGiorgio We just had an office meeting about freaking Forum. The image lag and attachments before I can even go in and review. I don’t have scribes but an extra COT/ MA I don’t need. Extra lady just for fighting with rejected claims and 2nd doesn’t drop electronic. Plus $850 for DEA? Nuts
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@doctorandrew @spartywrx @mcuban @doctorandrew Helping people is the point. It just gets harder to keep doing that well when the system keeps pulling time and judgment away from the exam room.
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@bigblimper @mcuban @bigblimper I agree. Freeing physicians from debt helps, but it does not fix the layers that siphon time and money away from care. The bigger issue is incentives. If those stay broken, the system stays broken.
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@mcuban @DoctorTokuhara I like the sound of that. Idk how free med school would stop the whole system from getting screwed over by insurance companies or hospital admins, but I like your end goal.
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@DocBottsNY @mcuban @DocBottsNY Agreed. Real change usually comes from building a better model and showing it works at scale. Physicians also need a stronger, more unified voice when policy is being shaped.
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They will never give up. It’s called creative destruction. Build something better and force the hand.
Also, get docs to stop playing by themselves in the sandbox. Time to get together in a real, representative organization to lobby for change. At least until the electorate wakes up and disallows the buying and seeking of government and legislation.
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@DoctorTokuhara @mcuban In the beginning healthcare insurance was awesome until it became about profits.
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@marktom59 @mcuban @marktom59 Some do. Many are exhausted, fragmented, or financially boxed in. Real change will take physicians, patients, and employers pushing on the same incentives at the same time.
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@DoctorTokuhara @mcuban Do you think they care enough to fight? The battle is now on several fronts. Limited license practitioners have taken over.
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@MarketsnCharts @MarketsnCharts The comparison is not far off. When physicians are treated as billable units instead of clinicians, the culture starts to look a lot like those firms.
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@DoctorTokuhara 100%... Shocking to be honest considering they are physicians. Reminds me of the Big 4 consulting firms, but probably even worse.
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@mcuban @DoctorTokuhara In the Netherlands doctors do make house calls. They have an emergency sedan to respond to patients at home, if possible treat them in their homes. 50 years ago no one would have imagined what we do in pre hospital EMS care. Today we now are carrying whole blood on ambulance’s.
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@DocBottsNY @mcuban @DocBottsNY Agreed. When incentives are cleaner, physicians can spend more energy on care instead of navigating layers built around billing. The harder part here is not the idea. It is getting entrenched interests to give up control.
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@mcuban @DoctorTokuhara Singapore. Change the perverse incentives and put the dollars back in patients’ hands. Government safety net. Simple. Effective. Eliminate the middle men.
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@PdnewPaul @mcuban @PdnewPaul Stories like this are why patients feel the distortion so clearly. The gap between what care costs and how value is distributed in the system has become hard to defend.
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@mcuban @DoctorTokuhara My wife recently had an extensive lumbar spine surgery with screws and rods. Stayed 5 nights in hospital. Total bill $140k. Neuro surgeon $10k.
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