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The role of humanity in healthcare is to cure disease and move on, not to promote disease and profit from it.
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Neil Floch MD
103.8K posts
Neil Floch MD
@NeilFlochMD
Associate Professor #DABOM @Yalemed #Obesity #SoMe Editor @soard_journal / bariatric surgery Tweets are my views and not my employer @yalesurgery
Connecticut Katılım Ekim 2013
99.5K Takip Edilen130.5K Takipçiler
Neil Floch MD retweetledi
And all patients and physicians were screwed by two men, McCain and Roberts.
If not for them, the ACA would have been eliminated.
Roberts caved to the left and harmed us all!
Neil Floch MD@NeilFlochMD
The ACA banned new physician-owned hospitals because the Obamacare law was written by an insurance industry insider who was intent on controlling physicians by changing the payment dynamics and diverting profits to the insurance industry verticals.
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@NeilFlochMD It's a crime how all the private practice docs I know have been forced to roll up with hospitals due to unequal reimbursement for services. All part of the grand design to consolidate and overtake healthcare to the detriment of patients and healthcare professionals.
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The ACA banned new physician-owned hospitals because the Obamacare law was written by an insurance industry insider who was intent on controlling physicians by changing the payment dynamics and diverting profits to the insurance industry verticals.
Dutch Rojas@DutchRojas
The ACA banned new physician-owned hospitals because doctors owning hospitals was dangerous. Luckily, health systems owning doctors, labs, imaging, surgery centers, insurers, pharmacies, and Congress is perfectly safe.
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This is the story directly for an NP: listen!
Tom@ThomasRGolden
In 2014, I began my NP career with a small, democratic EM group that valued my role and actively invested in ensuring my clinical competency. Today, the landscape has shifted. Private equity-backed groups are hiring new grad NPs (many online trained 😬) and throwing them straight to the wolves with zero safety net. It leaves unprepared clinicians floundering, which is a massive liability for patient safety.
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@X0_1_7ex @HeathVeuleman The ACA expanded Medicaid- good!
It mandated expensive, inadequate insurance for the middle class- global fail.
It forced doctors out of private practice and they lost all autonomy- system collapse
The architect: en.wikipedia.org/wiki/Jonathan_…
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@X0_1_7ex @HeathVeuleman Economists can attempt to make healthcare “affordable” but the problem that was avoided the power structure of the health system itself. It made the system a mess by emphasizing the power of hospitals and insurers and stripping doctors of all of their administrative abilities.
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Doctors share your frustration as well. Please don’t make the rules and the system, we have been marginalized and eliminated from decision making. Those with power believe we are overpaid and not cost-efficient so more Nurse Practitioners and Physician Assistants will be seeing more patients. They are intelligent people, well trained and competent but not at the level of Physicians.
Bryan Beal 🎧@bryanrbeal
If I have to see an NP instead of a real doctor, I want a 50% discount on my bill This is quite the racket healthcare providers have devised. Most of the time you go to the “doctor“ you’ll never see a doctor at all. You’ll see a nurse practitioner. But they’ll still bill you as if you had seen a doctor. Even though the nurse practitioners are far less educated and trained, and paid much less.
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This free market BS is ridiculous!! Capitalism (the basis of free market BS) is not the correct solution for social services. EVER! Once a social service system is implemented with a profit motive rather than a people motive, it is lost. Case in point, health insurance.
Mark Cuban@mcuban
Ok. Take government completely out of healthcare. No rules. No laws. No Medicare. No Medicaid. Hospitals, insurance companies, can do anything they want. What do they do ? If you were running any of the biggest insurance companies or hospitals, what would you do differently once gov was completely out of healthcare ?
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Med School free is great but does not solve the current problem: physicians are smart. We are being controlled by every entity: lawyers, government, insurers, hospitals, and industry. We no longer have the power to control the system in which we work- put us back in power- (with checks and balances) and the health system will improve. 🎤
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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.
Mark Cuban@mcuban
@MarkGabriele22 @DrDiGiorgio They can open up their own practice and do whatever they want. No one is stopping them. This is exactly how the direct primary care business has grown so quickly.
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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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this is the right instinct and the trial data backs you up.
the 2022 STEP 1 withdrawal study followed people after they came off semaglutide. they regained about two thirds of the lost weight inside a year, and the blood pressure and cholesterol gains came back with it.
the drug works. it just does not touch the environment it is fighting. stop it and the same food and living conditions are still sitting there.
prevention is the only part of this that compounds. everything else resets the moment the prescription stops.
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As a surgeon who makes their living by prescribing GLP-1 and doing bariatric surgery… what we ultimately need is to reexamine and research our food and living environments and pass laws and incentives to help prevent obesity. This will best control obesity for future generations.
Crémieux@cremieuxrecueil
We cannot allow a fat gap. Several countries that have never become obese like America has are going to skip it entirely and forever be skinny, even as they get rich. America must catch up. We need an easy-to-use, low-cost generic GLP-1, and we need it fast.
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1. Independent contractors such as CVS have opened clinics in pharmacies with NP to see patients, competing directly with private practitioners.
2. Hospital systems hire NP’s to work in the emergency room seeing patients and performing procedures for 1/3 the pay.
3. Nurse first assistants have already replaced surgeons to assist a primary surgeon or surgeons in training in community hospitals.
4. NP are hired to do competing clinical work as opposed to working under physicians in hospitals systems
5. Independent companies seek NP and other mid-level providers to do the work of physicians at a lower cost.
6. Social workers see psychiatric patients instead of psychologists as they are paid a lower rate
7. Clinical pharmacists see and adjust medications and prescribe medications semi-independently
All these mid-level providers are needed by the system and are very helpful but must work under the supervision of a doctor - the point is…. They should not work independently!!!!!
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@NeilFlochMD You are about to be surprised.
Give 2 examples.
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@NeilFlochMD As I have said many times, those who voted for Obama and the ACA share much of the burden. In my 40s and in the prime of my career, it was obvious to me that the ACA math didn’t add up. But hey, y’all bought into the Hope and Change nonsense…and here we are.
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As an NP, I completely agree. I’ve seen a massive shift in healthcare since starting as an RN in 2005 and transitioning to an NP in 2014. Working in Emergency Departments—from large Level 1 teaching centers to rural hospitals—I've watched this play out firsthand.
Surprisingly, NP/PA salaries in my setting have gone up 1–13% (depending on the company) since 2007 for those with similar years of experience. Yet, we are now expected to see a higher volume of patients with much higher acuity. Some sites even push us to perform procedures that were historically reserved for physicians. I personally push back on that; I'm simply not okay making ~30% of a physician's salary to manage patients who, a decade ago, would have strictly been seen by an MD/DO.
My care is billed at 85% of the physician rate (unless they also see the patient), meaning that massive profit margin is pocketed directly by hospital admins and private equity staffing companies. The real enemy here is corporate greed, PE, and insurance monopolies. Instead of pointing fingers at one another, we need to unite and push back against this broken system.
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Now you are mixing issues. Physicians want and need NP and PA to help them on a daily basis. Currently I write most all my prescriptions, answer my emails, write almost every note, bill everyone I see, operate, take night call, answer my cell phone (most patients have my direct number) and every other menial task as an employee. When in private practice, we had 5 surgeons and 20 employees. I now do much more work and less surgery- the system now does not help physicians it is inefficient and burdens them with menial tasks. Then empowers mid-level providers to do the higher level tasks such as primarily seeing patients. It makes no sense. Burnout stems from doctors who were trained to do complex surgery…. Now writing notes on a Saturday or Sunday when they should be producing and operating more for their health system. It’s all become an insane mess. Physicians and surgeons ran practices 100x better when they were independent. It was cheaper, more efficient, better care and patients were happier. AI is improving the time needed and efficiency of the menial tasks but the structure of medicine from 10-15 years ago has been destroyed by Stark, Hitech, and ACA laws.
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@NeilFlochMD Tell the truth do you really wanna waste your type prescribing antibiotics for strep patients? Why not just hand that over to NPs without complaining. They are doing you a favor!
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Medical AI making independent decisions must be under the control of a physician. For medico-legal reasons… a physician must withhold the responsibility. If NP or PA are responsible, their medical malpractice insurance will climb through the roof - making them much more costly. If software companies use AI autonomously… then they must have a medical license to practice and also have malpractice insurance unless they get an exemption. Can you imagine not being able to sue your artificial intelligence doctor when they give ther wrong medicine? All these problems need to be solved.
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@NeilFlochMD You haven't see anything yet in terms of marginalization. The full power and expertise of the Medical AIs have yet to be released.
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