Doctor≠Provider

UNBELIEVABLE. Vice President Vance just did a double take after hearing this wild stat dropped by Dr. Oz: "You're saying that we kicked off 800 fraudulent healthcare providers off of the Medicare system and not a single one of them called the government and said, 'hey, you made a mistake?'" "It's just completely insane."

There is no nursing shortage in America. There are more registered nurses licensed in this country than there have ever been. The Bureau of Labor Statistics has the numbers. 5 million nurses. What there is: a nursing pipeline designed to extract labor at the lowest possible wage, in the worst possible conditions, until the nurses leave or get sick — and then the system calls it a shortage. I worked inside the abusive machine.

Republicans will screw these things up just as often as Democrats. Which is why breaking up the health systems or the big health insurance companies would be a bad idea. We should go after the regulatory drivers of these monopolies (there are many) rather than use the big brother government cudgel to break them up.

Insurers are not directly the primary cause of health spending growth. But, with major insurers posting strong profits as health care costs grow, it’s reasonable to ask what value they provide for the overhead they consume.

One of the hardest things about practicing medicine is something doctors get virtually no formal training in: navigating friction in advancing patient care. Our health care system is a massive, complex bureaucracy; doing things that seem relatively straightforward—like discharging a patient—require checking dozens of boxes. There are lots of people in the hospital who facilitate this, but as the doctor, you’re the point person; you need to get the paperwork done, orders in, prescriptions delivered, insurance sorted, follow ups arranged, right people looped in, and so on. For every task you’re not directly in charge of, you have to ensure that the person who is in charge is on the ball. Doing this well requires having incredible organizational/management skills. But no one ever formally teaches you these skills; you learn (or fail to learn) them on the job. Having never gotten formal training in this, my prior is that these skills are hard to teach well. But if they *were* taught well to doctors, I suspect our health care system would run better and that health care workers would be less stressed out.

Imagine your surgeon preparing for your operation. They see you in pre-op, answer your questions, calm your fears, examine you, confirm the plan, and go get ready for the case. They review the imaging and think through the critical parts of the operation. Then a nurse interrupts them: “Doctor, your pre-op documentation isn’t good enough. You can’t just say you discussed the risks and benefits. You need a full H&P.” The surgeon points out that the H&P was already done in clinic. The note is right there in the chart. “No. That note is 31 days old. It has to be within 30 days. But it’s fine if you just copy and paste that old note.” Think about how insane that is. There is no new clinical information. There is no patient benefit. There is no improvement in safety or quality. The only thing being demanded is duplication. A pointless bureaucratic ritual to satisfy the machine. So now you have a frustrated surgeon, a delayed case, a bloated chart, and one more example of modern medicine confusing clerical box-checking with patient care. This is exactly what is wrong with the system. Endless note bloat. Pointless duplication. Administrative nonsense dressed up as professionalism. If there are no changes, there are no changes. Forcing a doctor to re-paste an unchanged H&P adds absolutely nothing for the patient. And the most insulting part is the tone. That smug, condescending “of course you have to do it this way” attitude, as if this is self-evidently necessary instead of obviously stupid. At this point, a lot of doctors would probably take a substantial pay cut to never touch a computer again. Cut the salary and use the savings to hire people to do the computer garbage. Epic. CDI queries. Coding queries. H&P updates. Order entry. Case booking. Inbox nonsense. All of it. Never touch Epic again. Never answer another coding query. Never update another unchanged H&P. Never place another order that a clerk or protocolized team could enter. Never do another ounce of hospital data-entry cosplay. Just let us be goddamn doctors instead of highly trained documentation technicians.

🔎 For the first time in 14 years, Medicare is ready to end the status quo. CMS just included a request for information on allowing physician-led hospitals to expand to make the TEAM model excel, and PHA President Carlos Cardenas, MD, is calling it what it is: a landmark moment. Physicians hold the highest level of training in the healthcare system, and it’s time they’re allowed to put that expertise to work in operating hospitals. Our nation’s seniors deserve the best care possible, and that comes from physician-led healthcare. Stay tuned for more from PHA and dozens of other healthcare stakeholders who are ready to enhance our nation’s healthcare system.

Doctors are the face of healthcare. They are the entity that must see patients. They are the first to take the blame for a broken healthcare system while others strategically hide and keep the profit.

Everyone thinks Stark Law prevents corruption. It does not. It prevents independent physicians from operating integrated clinical delivery models. Hospital-employed physicians face no such constraint. The law does not ban self-referral. It bans self-referral by the wrong kind of physician…

Healthcare is a basic right. Not a privilege. Not a luxury. This World Health Day, we stand for access, protection, and care for all.