Podcasts

Invest in What You Know with Jeffrey W. Ross, MD, MBA

Jeffrey W. Ross, MD retired in 2017 from a successful first career as a fellowship-trained Interventional Radiologist and a board-certified Diagnostic Radiologist to become the founder and managing director of Vailshire Capital Management, LLC and Vailshire Partners, LP. Passionate about investing wisely and teaching others to do the same, Jeff is a former contributor for The Motley Fool and current contributor for Seeking Alpha.

We start out by defining terms like mutual fund, hedge fund, venture capital, angel investing, and private equity. He teaches us the importance of diversifying beyond the market and investing in what we know, which is why many of his investments are in the healthcare and healthtech space. He retired from being an interventional radiologist, but after a year and a half away, he is back to teleradiology. After being away from medicine, even for a little while, gave him some perspective he was able to share with us.

The previous Secretary/Treasurer of Colorado Springs Radiologists, P.C., Dr. Ross also sat on the Board of Directors as co-owner of Penrad Imaging in Colorado Springs, CO. In addition, he was an active member of the CSRPC Investment Committee, Executive Committee, Radiology Peer Review, and Penrose- St. Francis Hospitals Cancer Committee. He went to med school at University of Minnesota – Twin Cities and then did residency and fellowship in radiology and interventional radiology at the Medical College of Wisconsin. After being in practice of 10 years, he got his MBA from the University of Colorado – Colorado Springs.

Vailshire.com

@vailshirecap on Twitter

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Healthy Habits in the Age of COVID-19 with Dr. Monique Tello

COVID-19 has turned the world upside down and although prevalence may wax and wane, we are going to have to get used to living, knowing that it is out there. We are going to have to develop new routines and habits in order to minimize our risk of getting it. We can’t eliminate our risk, but we can mitigate it and when developing habits that stick, simplicity is key, so on today’s podcast, we have internist, author, and habit expert, Dr. Monique Tello, who has previously been on our show to discuss her book, Healthy Habits for your Heart. We talk about staying safe in the grocery store, actionable advice we can give our patients to decrease their risk of COVID complications, how to work physical activity into the day and why we should consider getting a pet.

Dr. Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a med-peds residency at Yale and after residency, she earned an MPH and GIM research fellowship at Hopkins. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

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Healthy Habits in the Age of COVID-19 with Dr. Monique Tello

COVID-19 has turned the world upside down and although prevalence may wax and wane, we are going to have to get used to living, knowing that it is out there. We are going to have to develop new routines and habits in order to minimize our risk of getting it. We can’t eliminate our risk, but we can mitigate it and when developing habits that stick, simplicity is key, so on today’s podcast, we have internist, author, and habit expert, Dr. Monique Tello, who has previously been on our show to discuss her book, Healthy Habits for your Heart. We talk about staying safe in the grocery store, actionable advice we can give our patients to decrease their risk of COVID complications, how to work physical activity into the day and why we should consider getting a pet.

Dr. Tello is a primary care physician at Massachusetts General Hospital in Boston, Massachusetts and instructor at Harvard Medical School. She practices part-time internal medicine at Women’s Health Associates, a small MGH-based primary care practice with all female providers that serves predominantly female patients. She is originally from the Boston area, and graduated from Brown University and the University of Vermont College of Medicine. She completed a med-peds residency at Yale and after residency, she earned an MPH and GIM research fellowship at Hopkins. She writes a popular blog, generallymedicine.com, about her life as a doctor and a mother and contributes to many other blogs, including Mothers in Medicine and Harvard Health Blog. Her writing focuses on work/life balance and healthy lifestyle.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

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Addressing the Vaccine-Hesitant with Dr. Gretchen LaSalle

Gretchen LaSalle, MD FAAFP is a board-certified family physician with a passion for preventative care, from which vaccine advocacy is a natural extension. She is an active writer and public speaker on the topic and, in October 2019, published a book with Wolters Kluwer Press titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. In a growing climate of vaccine hesitancy, her primary mission is to keep patients from falling victim to vaccine misinformation and to decrease the frustrations, while increasing the successes, that clinicians have in getting patients vaccinated.

We discuss how to have the most fruitful discussion with the vaccine hesitant. She has a system for addressing these patients and parents and no surprise, it starts with listening. The hesitation comes with all sorts of concerns, from stories they have heard, to potential side-effects, to simply indecision and she has a well thought out discussion for all of these. We get into the cognitive biases that may be at play and end on her experiences on social media with the vaccine averse, who are the vocal majority, but really the minority vs. someone who is simply hesitant.  

She completed her medical school training at the Tulane University School of Medicine and her residency at the Oregon Health and Science University. She has practiced at MultiCare Rockwood Clinic in Spokane, Washington for the last 13 years and serves as a Clinical Associate Professor for the WSU Elson S. Floyd College of Medicine.

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Addressing the Vaccine-Hesitant with Dr. Gretchen LaSalle

Gretchen LaSalle, MD FAAFP is a board-certified family physician with a passion for preventative care, from which vaccine advocacy is a natural extension. She is an active writer and public speaker on the topic and, in October 2019, published a book with Wolters Kluwer Press titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. In a growing climate of vaccine hesitancy, her primary mission is to keep patients from falling victim to vaccine misinformation and to decrease the frustrations, while increasing the successes, that clinicians have in getting patients vaccinated.

We discuss how to have the most fruitful discussion with the vaccine hesitant. She has a system for addressing these patients and parents and no surprise, it starts with listening. The hesitation comes with all sorts of concerns, from stories they have heard, to potential side-effects, to simply indecision and she has a well thought out discussion for all of these. We get into the cognitive biases that may be at play and end on her experiences on social media with the vaccine averse, who are the vocal majority, but really the minority vs. someone who is simply hesitant.  

She completed her medical school training at the Tulane University School of Medicine and her residency at the Oregon Health and Science University. She has practiced at MultiCare Rockwood Clinic in Spokane, Washington for the last 13 years and serves as a Clinical Associate Professor for the WSU Elson S. Floyd College of Medicine.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

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Is Single Payor Really Bettor? with Dr. Kwadwo Kyeremanteng

Dr. Kwadwo Kyeremanteng is the founder of the Resource Optimization Network and a critical care and palliative care physician. He is also the host of the Solving Healthcare Podcast. He is also Canadian, so we discuss the Canadian Healthcare System, which, on its surface, looks like a comprehensive, all encompassing, federally administered single-payor system, like what some of the democrats are discussing in the US. We discuss why this is not the case, and get into some of the details about what isn’t covered, how it is more of a provincial system and what are the differences in provinces. We discuss how the money flows through the system and how private insurance can play a role in some ancillary services. And true to the name of his podcast, at the end, we solve healthcare.

Dr. Kyeremanteng was born and raised in Edmonton where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa where he did his Internal Medicine residency training at the University of Ottawa followed by a two-year fellowship program in Palliative Care and Critical Care. He stayed after his training and is now an Assistant Professor in the Division of Palliative Care and Critical Care Medicine. He also has research positions with Ottawa Hospital Research Institute (OHRI) & Institut du-savoir Montfort as a Senior Clinician Investigator.

His academic interests include the integration of Palliative Care in the Intensive Care Unit as well as health services research and cost evaluations. More information regarding his current research interests and projects can be found here.

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Is Single Payor Really Bettor? with Dr. Kwadwo Kyeremanteng

Dr. Kwadwo Kyeremanteng is the founder of the Resource Optimization Network and a critical care and palliative care physician. He is also the host of the Solving Healthcare Podcast. He is also Canadian, so we discuss the Canadian Healthcare System, which, on its surface, looks like a comprehensive, all encompassing, federally administered single-payor system, like what some of the democrats are discussing in the US. We discuss why this is not the case, and get into some of the details about what isn’t covered, how it is more of a provincial system and what are the differences in provinces. We discuss how the money flows through the system and how private insurance can play a role in some ancillary services. And true to the name of his podcast, at the end, we solve healthcare.

Dr. Kyeremanteng was born and raised in Edmonton where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa where he did his Internal Medicine residency training at the University of Ottawa followed by a two-year fellowship program in Palliative Care and Critical Care. He stayed after his training and is now an Assistant Professor in the Division of Palliative Care and Critical Care Medicine. He also has research positions with Ottawa Hospital Research Institute (OHRI) & Institut du-savoir Montfort as a Senior Clinician Investigator.

His academic interests include the integration of Palliative Care in the Intensive Care Unit as well as health services research and cost evaluations. More information regarding his current research interests and projects can be found here.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

 

EPISODE TRANSCRIPT

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Dr. quanto caramon Tang is the founder of the resource optimization network and are critical care and palliative care physician. He’s also the host of the solving healthcare podcast. He’s also Canadian. So we discussed the Canadian healthcare system, which on its surface looks like a comprehensive all encompassing, Federally Administered single payer system. Sound familiar, kind of like what Medicare for All is supposed to be. Which is because why this isn’t the case in Canada and get into some of the details about what isn’t covered, how it’s more of a provincial system. And what are the differences in some of the provinces we discussed how the money flows through the system, and how private insurance can actually play a role in some ancillary services, and true to the name of his podcast. At the end, we solve healthcare. Dr. Sherman Tang was born and raised in Edmonton, where he did his medical school at the University of Alberta. He and his wife then moved to Ottawa, where he did his internal medicine residency training at the University of Ottawa followed by a two year fellowship program in palliative care and critical care. He stayed after his training and is now an assistant professor in the Division of palliative care and critical Care Medicine. He also has research positions with the Ottawa Hospital Research Institute. And I apologize for the pronunciation Institute disavow your forte as a senior clinician investigator. His academic interests include the integration of palliative care in the intensive care unit, as well as health services, research and cost evaluations.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Dr. Quadro Carmen Tang, thanks so much for being on the podcast.
Bradley. Thank you for having me.
So, Canadians seem to think that American ambulances are going to check your credit score before they’re willing to take you to the hospital. And on the other end, you’ve got Americans thinking that Canadians have having a heart attack need to wait in a Soviet Cold War, breadline get into the hospital, right? Clearly, neither of these things are true, but this is how we view each other systems. Yep. American we’ve got multi payer private insurance with a little bit of government assistance and Canadians you’ve got this concept of single player. That being said, it’s it’s a bit more complex or a lot more complicated than that. So we’re gonna get into it. To start, how long has Canada been on single player and how did that system end up starting?
Yeah. Great question. Bradley. It’s, so officially this all started in 1968 ish. And so it was Put about by Tommy Douglas, from sketching. So one of our Western prairie conference provinces and yeah, Canadians being Canadians wanted universal health care that was accessible, complete, publicly run. And so with those principles, they produced the universal health health care in the mid in the late 60s and basically would find the federal government would fund provinces to say, you know, this is what our principles are, and you guys decide where their money needs to go. And, but like it in the big picture has to adhere to some key principles. And so, the Canadian Health Act was produced in 1984, which kind of solidified the principles of what Canadian healthcare was all about. And so, the key elements of that was that it was publicly run. That was accessible that was comprehensive, comprehensive, was universal and portable. And so since then that’s been officially documented and so legal document and yeah, and since then we’ve been running a publicly a universal single payer system
since 1968. That that, yeah, that sounds like a really civilized place to live.
And I gotta tell you, Brad, it is a civilized place to live yet because I get a lot of it’s like you said like those worries that if you come in with a medical problem that you are going to wait forever for, for things to be addressed. And to be honest with you. There are some areas in medicine where you are waiting a long time like if you depending on what province you’re in. If you are waiting for a hip replacement, you might be waiting a long time if you were waiting for any other orthopedic, elective procedure, but if you come in with any Thing urgent. Okay, so whether that’s you’re having an EMI you’re having trouble breathing, you need urgent surgery. Like doesn’t matter where you’re from doesn’t matter what card you have in your wallet, you get treated the same and you get treated urgently you get treated with respect and, and that’s key principles for Canadians and and we abide by that
well and they’re also I would imagine ways to kind of game the system, right? If you’re an orthopedic surgeon and you’ve got a patient who you think might need a knee replacement, I’m sure there are ways to kind of put them in line so that it makes it seem like it’s a six month Wait, but in reality, it’s really not that long of a wait because they they know the patients that are likely to need it and the patients that are likely to not so you don’t ultimately waiting, you’re waiting that long.
Yeah, exactly. As you put it like that. You can adjust a priority like if you think somebody needs a procedure sooner than later you have that prerogative If and so it’s like, there aren’t, I don’t want to make it appear like there’s millions of people suffering waiting for some procedures to happen. But I think what is consistent is that if something needs to be addressed sooner than later
it’s addressed. If it’s elective, it’s elective and urgent. It’s urgent. Okay, exactly. So is it? Is it really a federal system? Or is it more of a provincial system that utilizes federal funds?
I think the latter like is a better way to put it. So literally, the federal government gives payments to each province based on population based on need, and the provinces decide how they’re going to distribute funds. So for example, in Alberta, when I was still living there, there would be about I think, eight or nine health authorities and the government would give the provincial government would give each money, each Health Authority a pocket of money, and they decide whether that’s should be more focused on outpatient impatience or whatever. Ever, like community resources, like whatever they felt was of higher need in Ontario now they’re just in the process of trying to establish a system similar to that, but every province is variable. But the principle though is that federal government gives money to the each province and the decide how its allocated.
So you mentioned it’s based on population and it’s based on need How is need assessed? Is it based on the idealization?
Yeah, so once again, it’s it depends on the province, but I could speak to Ontario because that’s where I’m at right now. Part of the funding model for each hospital is based on it used to be on based on need, like if you’re seeing more volume of hip replacements, then we’re going to fund that are going to give you a certain amount of money, certain amount of intensive care admissions will give you a certain amount of money. Now they’re using it on quality metrics, like so if you’re, if you’re meeting specific quality metrics within each sector in medicine, like within the orthopaedics within general surgery, then they will provide a certain amount. So basically, they’re rewarding hospitals that are of higher quality. But this is something that’s always changing in healthcare, like I think Ontario now is, is trying to go towards that Alberta model that I was describing earlier where there’s a health authority, we’re going to provide you with money in that health authority. And you as the Health Authority, decide where you want to put your money and how you want to put your money into your area,
but more regional control, if you know that exactly. That happens in American in Medicaid, you have these private companies, where the if the patient qualifies for Medicaid, they can get their insurance through a managed Medicaid provider. So the provider or the the insurance company will get a lump sum per patient that they take care of, and they will decide how they’re going to administer that. And that kind of takes the government out of the loop because, you know, I think government does something Well, but it’s not the most efficient, the private industry tends to be more efficient. So it’s a way to capitalize on both of those strengths. So that’s what it sounds like you give more regional control. And now the federal government doesn’t need to be involved in the minutiae of what happens in that province or even within the region of that province.
Exactly. And this is obviously just my opinion, I do feel like it’s probably a wiser approach, you know, like almost like a bottom up approach where you in your region, you know, where the needs are, like, you might be a region that has more and more elderly population, you might have a population that has, you know, more youth and having some more resources towards that specific patient population might make more sense. And so I, my bias, personally is like, this is the way to go because you get so much variability in in these approaches to how we fund healthcare and, and in my humble opinion, Brad like, the more government that gets involved, the more I find administrative positions or being involved in the more inefficient everything becomes so I love the idea of it coming from like a bottom up approach and be more regional and I think where you’re thrown down makes a lot of sense. I forgot what
it’s called. It’s it’s someone’s law based based on a some British ship captain where bureaucracy fills the space it’s given. Like you said, If you set a meeting for two hours long Parker’s meeting will let Parker’s nice I’m impressed. Yeah, by. Like, if you set a meeting for two hours long that meeting will last for two hours, even if you could get everything done in an hour. So yeah, Parkinson’s Law.
We talked a little bit of pre interview about some of our similarities. And I think one thing I must reinforce is efficiency. Like we’re both busy people. So yeah, the Parkinson’s Law is and I know you’ve been in these medical meetings too, like they are. Most people just like to hear
themselves talk. Exactly. I got stuff to do.
Yeah, go see patients got some family. Got some costs of health care. That’s right. Yeah.
Out of South Africa, or so we’re trying to do here. So so one one attempt at the American government to solve healthcare was Obamacare. Right, the Affordable Care Act and one aspect of the Affordable Care Act is that insurance needs to have these 10 essential benefits in patient care, outpatient care, medications, emergency department, maternity and newborn Mental Health and Substance disorder, physical and Rehabilitation Services, labs and imaging. I’m not sure if I’ve named them all i don’t think that was 10. But but you get the idea, right? All these different aspects of health care. If you’re going to have insurance, it needs to cover all of them. So But the Canadian healthcare system, right? It’s it’s single payer to some degree, yes. But it hasn’t covered all 10 of those things in their entirety, right? Because that would just be to expect to have all of that paid for in its entirety for every single person in your country. Just the the costs would end up skyrocketing. So that’s not how it works in Canada.
Exactly. What says
what is paid for,
it’s about 70 to 75% of healthcare related costs. So it’s essential services, actually, it’s probably easier to just say what’s not covered. So typical allied health like physiotherapy, occupational therapy, optometry is not covered drugs, unless you unless you’re elderly in most provinces aren’t aren’t covered. So there’s a good chunk of services that aren’t covered within the healthcare system and it’s as you said, like, we Pay this I would need to check a reference. But somewhere between 45 to 50%, I think of our GDP goes to goes to healthcare related expenditures. So we spend a lot. And that’s my whole area of research, to be honest with you is how we can be more efficient with our spending. But yeah, it is not complete. And so some argue do should we be covering more like one of the hot topics in Alberta, or in Canada, we just had a an election was pharmacare and having within the universal health care initiative to have drugs covered, and no party was really diving into details on how this would be approached. But it was certainly on the minds of Canadians of having more complete coverage of some of the medication. So yeah, but you nailed it, Brad, like we’re not it’s not, we’re not covering 100% of health care’s use, or their private insurance companies that come in to fill the gaps like You pay us this amount per year and you’ll get this percent of your rehabilitation services or medications or long term care or whatever it is that’s not being covered. Are there private insurance companies that are trying to fill those gaps? 100% So, the I’m in a government town capital of Canada, Ottawa here. And a lot of for example, government employees have a very complete insurance packages where, you know, a large portion of medications, a large portion of massage therapy, physiotherapy, optometry, all those have to be covered. And usually there’s limits but there’s, that is absolutely true that there’s private health care companies that supplement Yeah, so
a lot of single payer system that that makes it
illegal. I guess a single payer for essential services is the way I would look at it. Okay. But for the, you know, the non essential services like dental, for example, didn’t mention that as well. You we all have most of us have insurance, separate insurance for that.
Yeah, I’ve been in the situation I’m in. I’m an EMT. So I’ll have a patient that comes in with a neck abscess. Right? So I get called by the emergency department to assess this patient. They’ve got an abscess, where’s the next neck abscess coming from what’s coming from an infected tooth. So the tooth needs to be pulled? Well, this patient doesn’t have dental care, they have Medicaid, so their emergency department stay is going to be covered. But if we call a dentist to take out their tooth, not covered. So you know, they’re kind of stuck having to pay out of pocket even though they have you know, they’re, they’re a certain percent below or I think it’s like 135% above the poverty line qualifies for for Medicaid. Right. So they’re not coming in with much of pay for this dental care, but now they’ve got to pay for a dental extraction out of pocket. So it’s dental dentistry is I think sometimes is frequently forgotten about in these insurance plans. But it is, it’s sometimes critical. Yeah.
And I mean, we kind of touched on this earlier about some of the myths of, you know, within Canada, everyone, it’s very, you have a heart attack, you’re gonna have to wait. But, you know, one of the, like, a true common concern when we hear about some of the scenarios in the states is that if you for example, and correct me if I’m wrong, okay, because I don’t you know, this is just from what I’m hearing from my colleagues is, if you have you know, minimal insurance and you come in with a problem, say you have a cancer related a head neck, malignancy, and you need x medication to be able to, to cover or to go to chemo or to have an adjuvant therapy, you might not have, like, if you don’t have insurance, you might not be able to afford treatment. And so what we often hear about us people having to do, you know, their second mortgage on their house, just to Ford
most common cause of bankruptcy in America medical bills. Absolutely. So, so what, you know, the whole pre existing condition debate, right, that’s something that that came out in the Affordable Care Act is that if you had head neck cancer before the Affordable Care Act, you couldn’t afford insurance. So what would need to happen, you’d need to pay for it out of pocket until your funds are so depleted, that you would qualify for Medicaid, and then you’d go on Medicaid, and then the government would pay for the rest. But meanwhile, you’ve you’re, you’re just depleted. You’re just depleted your future, right? Yeah. So so but now with the Affordable Care Act, you can now apply for private insurance. However, it’s not on a rolling basis. You can’t just apply for it right now. You need to apply for it when it’s available, and I can’t remember if it’s quarterly or once a year, but you’re you know, in that interim, you’re either just gonna have to wait for your cancer to progress waiting for insurance, or you’re gonna have to pay out of pocket until until that happens and end up in that in that similar slip. scenario. So preexisting conditions doesn’t mean you can get insurance just when you need it. Oh, wait till you get pneumonia and then apply for insurance? No, you should. It just prevents you from when you make that decision to get health care. It can’t or health insurance, right? It’s not the same thing to get health insurance that they can’t stop you from getting it, which can also make premiums go up for everybody else because now you have to pay for the possibility of someone with an expensive condition that’s going to end up on your plan. And that’s what insurance does, it spreads out the risk. That risk needs to be spread up beforehand, but you’re totally right. It can. You can you can end up bankrupt from a condition but you did have the ability to pay for insurance. The problem is that some people end up with plans frequently that they don’t understand. Meaning like yeah, I have a high deductible. And so I have low premiums but I have a high deductible which means that my monthly payments if I don’t go to the doctor are low but If I do go to the doctor, then it’s I’m gonna have to pay out of pocket, probably 100% until I meet my deductible. So it seems like I don’t have health insurance, because people think that it’s going to cover everything. But really, it’s, it’s in a lot of ways just for those disasters that you’re referring to where, if you didn’t have it, you would end up bankrupt. Yeah, those are some plans or you end up with a high premium plan and the low deductible it just, you know, but you’re when you’re choosing it, you it’s hard to understand all the nuances of it.
Yeah, cuz it sounds like there’s a lot of nuance. You know, just to contrast that with us. It’s, you know, there’s some provinces that have you pay a small premium for your insurance from like your provincial health care insurance, usually somewhere between than what’s and forgive me if this is mildly wrong, but it’s usually between 50 to $400 a year kind of thing. But regardless whether you if you didn’t pay it, you still get treated. You might get a bill for the government versus you had to pay for your insurance premium, but you’re still getting treatment. And I, I think, when we hear stories like that, like, I could speak for almost all Canadians, when we hear, you know, someone’s has to bankrupt their house in a time of need, when, you know, they just need optimal care. It just breaks your heart, especially, you know, we’re talking to clinicians here we got in this game because we want to help people, not break people. You know what I’m saying? So it’s, it’s it’s tough to hear
scenario scenarios like that.
But it doesn’t mean that you Yeah, the American system is just, it’s preposterous. Yeah. I had an interview a little while ago with an evolutionary biologist. And one thing that we the whole theme was, the human body just doesn’t make sense. It’s kind of cobbled together over time. And things are built on other things like the fact that our hand has is like a bunch of rocks, like Put together and then our fingers extend out of these like eight different buttons. It doesn’t make sense. And that’s kind of what the American system is. It’s not like it was built from the ground up. It started kind of with in World War Two there because there was no workforce, there was caps on salaries. And so they they started offering other benefits like pensions and health insurance. And that was the start of the American system. So it’s based on it’s an employer based system, which just if you’re going to build it from the ground up doesn’t make sense. It doesn’t mean that single payer is the way and the only way. But I think you and I are on the same page and that we believe in universal coverage. So you know, so everyone has something so that stuff like this doesn’t happen. And I think most Americans are on the same page with that, that like health care is a right. You know, I’m of the belief that there is a role for the private sector and for individual payers, you know, for individual people, if you want to pay for more care, then and you want to pay for foster care and you want to pay for that, you know, great have a way to get private money. For those that can afford it, to just inject more money into the system, rather than just having it be single payer, everybody gets the same because it’s just, it’s just not going to be as as efficient. But that’s my personal. That’s actually what happens in I think, Germany. If you make less than 30% above the poverty line, you get health insurance, you just you just have it. You don’t don’t, I don’t think you have to apply for it. You just have it. And above that, yeah, you have to pay for private insurance. And there are a bunch of different systems out there and you choose which one that works for you and in fine. So that’s, that’s my, that’s my soapbox.
And Brad like, honestly, it’s a hot topic in Canada to like privatization, you know, cuz you bring up a lot of good points. Like it’s not, it’s not the most efficient system in the world. And like, like I said earlier, there are people that have long wait times for some elective procedures and there’s people out there that want to be more functional and not wait 18 months or are a year for their hip to be done.
And also you’re spending a ton you’re spending a ton there’s more efficient ways to spend the money. I mean, it’s great that, that you have the system but, you know, American is America is much more efficient with the spending, but but Canada, also you got the person that you said, I think it was 50% of GDP. Like, that’s
just a tremendous, it’s like,
it’s high. And like, and once again, this is my personal belief, too. I actually legit feel like there’s a role of privatization in healthcare, even in Canada. And the worry is that, you know, one of the common words that you hear mentioned in debates is having that read, like resource drain where, you know, the best surgeons, the best EMT surgeon is now just going to work in the private sector and, and you know, not not, so it’s going to be kind of like a two tier system. Well, yeah, the rich get a better service. But you know, there’s like everything else like you just got to be a little bit nuanced about it, like Say, if that EMT surgeon is only allowed to work 25% of their time or 50% of their time in the private sector, that will offset some of that, you know, concern that the, like the quality drain is is happening. And so I just think we got to be, we just got to think through it a little bit more. And use util because we have the capacity we have, like I can speak for the our orthopedic surgeons, like we have guys that are on their third, the third fellowship, they got some of them even got PhDs because there’s no work. Right. And if you think about what’s happening in North America, throughout the world, we have an aging population, baby boomers are getting into the height of resource utilization. There’s tons of people that need work like that need to have treatment, and it’s just we don’t have enough money to fund a wars for 24 hours or for you overtime and so on. But if there was a private element to that, where, you know, people that could afford it are willing to pay there were 20 to 25 K to get their hip done earlier. Yeah,
wait times go down, and that money is going to be used to offset the cost for those who don’t have that type of
exactly. Yes, exactly. So I think there’s, I think resolving
right now, right, we’ll get right.
But yeah, no, I do. My bias is there’s a there’s a role.
So we got a little off the rails and that both you and I, we know how to self healthcare if someone would just listen to us. Yeah. So but there are some things that are done well in some promises, and maybe a little more poorly in another. How do the promises differ in how they administer health care and which province is your favorite? It’s
gonna give me a trouble
So, in terms of different provinces will have a more regional approach. So bottom up where, you know, they fund the region and region decides where the resources go, some are not regionalised. And, you know, the provincial government decides how much money a hospital is going to get based on either a volume based on quality. I got to go back to Alberta, like I really, they went away for a while from the regionalize approach, and I think it in some ways, made care worse. The function functionality of the province worse, they’ve been not totally adverse to privatization so you could get your an MRI CT scan, you can get that done and pay for it privately in a bat doc did that quite early. The reimbursement for their physician services is is I would Say, more than appropriate. So if you if I had to say one, I would, I would, I would, I would lean on Alberta. And sorry for my Ontario folks that are listening. But like I said, they’re they’re moving towards a more regionalized approach as well. And I’m optimistic that things will start to be more efficient and, and, and care will improve. But we also one of the things that I don’t know if it’s fair to talk about, but I’ll do it anyway, one of the things that really irked me about how things were handled in Ontario was from physician pay perspective, they made some unilateral cuts. So some specialties For example, some cardiologist based on if there were heavy diagnostic practice, they they could have lost up to like 20% of their income from these unilateral cuts. And I I gotta tell you, I was not happy with this approach because, you know, we this is a clinic, a physician audience, but you We hustle, we do what we need to do for our patients. We take the brunt of, you know, Dr. Google, of administrators of unhappy patients, we do our best to try and serve. And then for the organization to just unilaterally, you know, take the wheels out and make these cuts. It was it was upsetting for, to say the least. And so that left the sour spot and a lot of clinicians for sure, and things have gotten better in terms of now there’s arbitration between our Ontario Medical Association and, and the government. So the process is better. But when you do that, you know, I guess just, it’s just a big slap in the face, like our specialty lost about about 5%. And, and I’m all about, you know, if there’s areas where it needs to be tweaked, because yeah, there was some specialties that Some opinions would say is overpaid and or the fee schedule is outdated. And, you know, I think that’s fair. But it’s got to be discussion. It’s got to be a by, like both parties to decide what, what’s the best approach. But so that left of real. Ah, that was upsetting.
Yeah. And that happens that happens in the states too, where an insurance company can just make this unilateral decision. And, you know, if you’re a big hospital system, then maybe you have some leverage, but then then you’re leaving a lot of patients out in the lurch if you just decide, you know, what, we’re not taking your insurance anymore. So you know, it gives the insurance company a lot of leverage, just make these heavy handed decisions. And, and there’s very little recourse other than just not taking that insurance and ultimately, in that situation, it’s the patients who suffer. So how does the money flow? Like, how is it that doctors get paid to that you said, you know, in a lot of provinces, it’s Regional, it’s a bottom up, you’re given a lump sum. So So is it? Is it your a salary? Is it fee for service? Is it come some combination
of the two? I’m glad you brought this up. So most provinces, it’s a combination, it’s a combination. So most provinces regardless of whether it’s mostly regional or not, it’s actually going to be the province that decides a fee schedule. And it’s agreed upon that every physician in the province is going to be paid that same within that specialty the same further based on the fee schedule. So most specialists, our our our bill, essentially the Ministry of Health or the government, the provincial government, and would be reimbursed based on the services they provide some province. Some specialties also have like an academic plan which is mostly salary based So basically incentive to be able to teach residents because there’s also a cost to that, right? Like, if you’re teaching residents, you’re not as efficient, you’re not as fast. So compared to the dogs that are in the community that would be able to see more patients in a shorter period of time. So there’s a lot of provinces and a lot of specialties have that option to go towards a more salaried approach. And some also have a hybrid where they get a salary but for example, if you all their night calls or weekend calls might be billable. And so there is some flexibility in terms of how it’s how it’s how physicians are paid, certainly in our in my situation in critical care, we are paid a fee for service. And then my I also do Pyatt of care which that is being paid a salary. And so I get both sides of the equation.
Interesting. What about the hospitals? How do they How do they give you? Or is it the money flows from the region to the hospital in the hospital is the one that pays the doctor. One thing
I guess that’s quite unique in Canada, like, I am not a hospital employee, you know, the hospital, hospital doesn’t pay me, jack, it’s I build the government and the government pays me based on services are provided based on this fee schedule. Okay. And then the hospital does the same thing. And so the hospital, so they will either get paid by like, the most updated one that I know is our hospital will be paid based on quality metrics on the ability to minimize, for example, part of the equation, not the whole equation be the volume of patients they see but also are you meeting your quality metrics, less, you know, surgical infections, less ventilators, associated pneumonias, and so that enhances their their budget as well. So, yeah, so basically physicians get paid by the government. directly, hospitals get paid by the government or region. And but certainly the docs are being paid by the hospital. Okay. Okay.
Is there anything right now that’s being debated in the government any any hot topics? Or is it something that they’re trying to stay away from? Because because it’s too much too
sensitive to touch all man, there’s a lot of like hot topics in general like, or no healthcare sorry,
healthcare related. Yeah, being
debated in the government. Ya know, there’s lots so there’s where to start. So we mentioned pharmacare. There’s the privatization that’s still being debated, like having some level of privatization. There’s medical assistance in dying, like, you know, having more clear legislation in terms of who’s eligible. What else is there, all the cannabis legalization like, Ah, you know, in terms of, you know, right now, you could legally purchase Cannabis, but how safe is it? Are we doing effective monitoring? Well, what what if you’re if you if you consume and you drive like what’s the level? That is okay and what’s not okay?
They recently maybe figuring that out before legalizing I gotta
tell you a bunch of it in the wind and seeing what happens.
I gotta tell you this. There’s been a bit of a shotgun approach with a couple of things, but one of them was the candidates who were eager to to get the my personal opinion they’re eager to get the revenue because it’s obviously heavily lucrative if adopted appropriately and then medical assistance and dying. I don’t know what drove that one. But we, I would say we weren’t 100% ready for that when it came out as well. But, um, but yeah, there is a bit of a, hey, we’ll figure this out as we go approach in some of these. Some of these tissues.
It was popular so the politicians decided to pass it and just figured they would kick the can down the road for figuring out all the nuance that really makes it or breaks it.
Yeah. That’s what it feels like. Interesting. Okay.
Just like America. Yeah. So tell us about your podcast solving healthcare. My main question for you is, have you solved healthcare yet? And if not, What’s taking so long?
I love it. I love that question. So, so Brett, what’s it stem from is like I mentioned earlier that we have a research group resource optimization network. And we’ve been pretty productive over the last few years. And our area of interest is how to make healthcare more sustainable. How do we save money? How do we improve care? And honestly, we were doing these what I would say pretty great studies and nothing was changing at all. And it was totally myself like what are we like, what are we doing? Like, what’s the purpose of this if nothing’s gonna change? So then, you know, podcasts and fuzziest. And so I was like, you know, maybe if we increase awareness, and maybe maybe this could start drumming up some noise. And so, we decided to develop solving healthcare. And, you know, we’re about at the time of recording about five months deep into it, and I gotta tell you, Bradley like I’ve, I’ve never outside of like moments in medicine, but a this is truly been a humbling experience because like, I do feel like we are solving healthcare and things are changing and things are improving. I’ll give some examples. Like we did an episode on overparenting and, and the lack of support for kids with anxiety, depression and other mental health disorders and Like, for example, in Canada, we’re talking about what’s covered what’s not, if you wanted to see a child psychologist for services, that’s about a $3,000 bill for a proper assessment, and a lot of people can’t afford that. And so we brought this issue up. And now one of the clinics in Ottawa is going to be providing free care for, for kids that can’t afford it, essentially. And so I
feel like that’s such a great investment. Right? Like you provide child childhood mental health services, and you’re gonna save yourself a ton, right decades down the road, but you’re gonna save yourself a ton down the road that and that seems like they could. It’s so it just intuitive. But you’re right, you got to find the money somewhere to do that. And someone’s got to have the political will to say, you know what, we’re going to take money away from this and put it towards that.
Exactly. And so by increasing the awareness, bringing it up and like I’m married to a psychologist, and I had no idea what some of some of these issues, you know, I didn’t Know About the $3,000 bill that these families got to sort out or, or maybe just not go to see a psychologist because of and that discussion with Adrian, it was Dr. Adrian Matheson. And talking about as you put, if you invest in this in these kids early, it could have such upstream positive impacts on their lives. And that you wouldn’t believe it, you know, avoid long term mental illness, avoid them being incarcerated, avoid them and having drug addictions. And and it just hits such a. I mean, you and I, we both have three boys. And like, it’s like if we can’t step up for a kids, but can we step off for you know what I’m saying? And so like, when, like, when I heard about this initiative of having free care for the kids, I was like, This is what it’s all about. This is why we’re doing this. This is a small step. This is a little thing, but this i’m a i’m one person. I have a team now helping out with the podcast, so shout out to the team. Love you guys. But this is me five months in and already having a footprint. And this is to me, this is how we’re solving. And this is just the beginning to Bradley like, we, because of this similar episode, we did one on marginalized patient populations, like people that are on the streets in the care that they need. You know, there’s one of our intensivists approached me saying, Can we not start funding some kind of program to get, you know, these kids that are vulnerable into some program to try and, you know, give them some hope. And so, like, nothing has materialized yet. But we’re having that discussion. We’re having that dialogue, and that’s how it starts, and it’s how it started.
I can’t happen without that dialogue.
And I believe in my loins, I believe, like, things are gonna get better.
Well, where can people find where can people find your podcasts? Yeah, so
solving healthcare. We’re on or everywhere. We’re, we’re on. We’re on Apple. We’re on Spotify, Stitcher, everywhere you find your podcasts cost box, wherever you are Google Play, you can follow us at Quantcast on Twitter, Facebook, Instagram, YouTube, and I really appreciate the listenership and those that are listening already.
And I think there’s also a link to it on your web page resource optimization network comm it’s a good place to find it too.
And can I say one more thing, Bretton Woods, I, I want to make sure that your listeners realize how beautiful of a thing what you’re doing is okay. We as clinicians, and and medical trainees, we don’t get some of these finer skills in medical school. It’s very mentorship dependent and if you don’t have that kind of access to good mentors and like, some of the stuff the content you’re creating, we people don’t get that exposure. So I think Just want to commend you for the value of the show. I’ve been a recent subscriber and the content that you’ve been throwing down. It’s been beautiful and i think it’s it’s a way that we can become stronger we could become more connected with our patients and their families. So like, Good on you, my friend.
I appreciate that. That really means a lot that really warms warms the cockles. Should buddy
should
so I really appreciate you taking the time to be on the show. You’re you got a lot of hats, the podcasts resource optimization network, palliative care, the ICU three boys. Yeah, you got a lot going on. So I really appreciate it and it’s been a lot of fun, a great conversation, and I appreciate the compliment there on the
absolutely means a lot. Thanks for reaching out boyfriend.
I take care.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians. Guide to doctoring comm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Economic Impact of When To End Shelter-in-Place for COVID-19 with Adam Block, PhD

Adam E. Block, PhD, is a recurring guest, having spoken previously about common misconceptions of the Affordable Care Act, and Medicare for All. Today we will be discussing the how erring on the side of an earlier end to shelter in place could have a worse impact on the economy than waiting longer. We also discuss what a return to work could possibly look like and when can we expect our elective patients to start coming back to the offices. In our industry and many others, it is important to be able to pivot and adapt to the new needs created by this virus. From a public health perspective, we also talk about when the risk of poverty as a social determinant of health starts to outweigh the risk of the coronavirus itself and what populations are at highest economic risk.

Dr. Block is currently an Assistant Professor of Public Health at the School of Health Sciences and Practice at New York Medical College. He is a health economist with deep experience in the hospital, health plan and government sectors. His research is focuses on how individuals make decisions in health care markets including patient choice of hospitals, physicians and insurance plans. 

Prior to joining New York Medical College in 2017, has worked for a major hospital system, a large Medicaid managed care plan, spent several years developing the legislation on the Affordable Care Act as an economist at the Congressional Joint Committee on Taxation and later as Division Director of Health Plan Policy in the Center for Consumer Information and Insurance Oversight at CMS. 

In July, 2018 Dr. Block founded Charm Economics, LLC a translational economics consulting group.  His consulting work focuses on managed care contracting and pricing optimization of new technology and data analytics.  Dr. Block received his PhD in Health Policy from Harvard and undergraduate degree in neuroscience from Amherst College.

@AdamBHealthEcon on Twitter

CharmEconomics.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

Economic Impact of When To End Shelter-in-Place for COVID-19 with Adam Block, PhD

Adam E. Block, PhD, is a recurring guest, having spoken previously about common misconceptions of the Affordable Care Act, and Medicare for All. Today we will be discussing the how erring on the side of an earlier end to shelter in place could have a worse impact on the economy than waiting longer. We also discuss what a return to work could possibly look like and when can we expect our elective patients to start coming back to the offices. In our industry and many others, it is important to be able to pivot and adapt to the new needs created by this virus. From a public health perspective, we also talk about when the risk of poverty as a social determinant of health starts to outweigh the risk of the coronavirus itself and what populations are at highest economic risk.

Dr. Block is currently an Assistant Professor of Public Health at the School of Health Sciences and Practice at New York Medical College. He is a health economist with deep experience in the hospital, health plan and government sectors. His research is focuses on how individuals make decisions in health care markets including patient choice of hospitals, physicians and insurance plans. 

Prior to joining New York Medical College in 2017, has worked for a major hospital system, a large Medicaid managed care plan, spent several years developing the legislation on the Affordable Care Act as an economist at the Congressional Joint Committee on Taxation and later as Division Director of Health Plan Policy in the Center for Consumer Information and Insurance Oversight at CMS. 

In July, 2018 Dr. Block founded Charm Economics, LLC a translational economics consulting group.  His consulting work focuses on managed care contracting and pricing optimization of new technology and data analytics.  Dr. Block received his PhD in Health Policy from Harvard and undergraduate degree in neuroscience from Amherst College.

@AdamBHealthEcon on Twitter

CharmEconomics.com

Please be sure to leave a five-star review, a nice comment and SHARE!!!

This and all episodes can be found at PhysiciansGuidetoDoctoring.com

Do No Harm, a film by Robyn Symon on Physician Suicide

Robyn Symon is a two-time Emmy Award-winner, and an accomplished writer,

producer/director, and editor. She is the producer and director of the documentary film, Do No Harm, about the healthcare system that drives us to take our lives.

We discuss how prevalent physician suicide is and how the real numbers and demographics are so difficult to track. We talk about the difference between paying lip service to change and what changes may actually help. We also talk about how the current coronavirus epidemic will make more apparent how overtaxed and overburdened many physicians really are. There will be an upcoming virtual screening on April 19 (see below).

 

Ms. Symon began as a television news reporter in Texas, then joined PBS in Miami where she hosted and produced documentaries, public affairs programs and the TV series Florida! (6 seasons; Travel Channel). She wrote and produced the docu-series “Voices of Vision,” which focused on the work of non-profit organizations worldwide. She has produced hundreds of hours of TV series for major cable networks including Discovery, CNBC, HGTV and currently produces a series on the Reelz Channel.

DoNoHarmFilm.com

Virtual Screening

WHEN: Sunday, April 19th at 8 PM EST/7 PM CT/5 PM PST

WHERE: FOR TICKETS: ZOOM WEBINAR LINK https://zoom.us/webinar/register/8715849795868/WN_x–X68dnR_i6_kTXvCyVFA

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Robert diamond is a two time Emmy Award winner and an accomplished Writer, producer, director and editor. She’s the producer and director of the documentary film do no harm about the healthcare system that drives us physicians to take our lives. We discuss how prevalent physician suicide is, and how the real numbers and demographics are so difficult to track. We talk about the differences between paying lip service to change and what changes may actually help. We also talk about how the current Coronavirus epidemic will make more apparent how overtaxed and overburdened many physicians already were. There’ll be an upcoming virtual screening of her film on April 19, and see her website do no harm film calm for details. Miss Simon began as a television news reporter in Texas then joined PBS in Miami, or she hosted and produced documentaries public affairs programs in the TV series, Florida. She wrote and produced the docu series voices of vision, which focused on the work of nonprofit organizations worldwide. She has produced hundreds of hours of TV for major cable networks including discovery, CNBC, HDTV and currently produces series on the real channel.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Robin Simon, thanks so much for being on the podcast.
It’s my pleasure to be here. Thanks, Fred.
So let’s start with the hard numbers. how frequent is it that a physician dies by suicide?
The numbers that are used by suicide experts is about 300 to 400 a year but it’s really underestimates because many of these suicides are listed as accidental and planned as extra as accidental overdoses or car accidents. And so the families of the physicians and the hospitals, and you know, the medical community are not eager to say this was a suicide. So we don’t really know it could be three or four times that we just we don’t know. But that’s what the experts are saying three to 400. And, and they say that mid career physicians have the highest rate and women attempt more than men but male physicians are more successful if you use that word. Yeah, at suicide, but mid career. We see when there are a lot of factors that come into play. It could be, you know, a malpractice food that threatens your financial security, your inability to pay off alone, ruins your reputation, your job to be at risk, and you have a family. And it just, you know, leads physicians to make what they feel is a logical choice, a logical solution to the problem.
Yeah, that actually doesn’t surprise me that it doesn’t surprise me that it’s an underestimate because, as physicians, right, we also recognize that if you die by suicide, your family can’t collect your life insurance. And so if you are going to do it, you do it in such a way that it does not appear to be a suicide so that they are able to collect I can see that being a very calculating thing for you know, a physician just the way that’s that’s the way we think we’re very pragmatic. Yes. So where does that put us compared to other professions?
Well, you know, near the top is not the top when I was working on the Film Editing, which was about a year and a half ago, because we’ve been on the film tour for about a year and a half positions had the highest rate of suicide among all professionals, and almost twice the rate of the general population. So it fluctuates, you know, from year to year. And because we don’t really know the true numbers because of the stigma of suicide and mental health in general. We don’t really know but let’s just say it’s
towards the top if not at the top. That’s interesting. Yeah, I do. I do not when I was a medical student, when I was applying to medical school. I do not remember that being on the brochure I you know, they put those shredding. They put those short white coats on us and say welcome to the club, and something that they neglect to tell us is that That, you know, here’s this short white coat. Every patient you see from now on could be something a diagnosis that you could miss and get wrong that ruins your life and could be something that haunts you for the rest of your life and affect them for the rest of their life. And by the way, we have one of the highest if not the highest suicide rate of all professions. Here’s your white coat. Right? Yeah, I do not remember that being something now. Gustin medical school. That being said, it has been a while, since I since I graduated. So you know, I know this. The schools have evolved. And they’re including more,
they’re still around. They’re still not saying that. No, that’s still not part of the tech talk. Yeah. for new students. Yeah. Because another big issue is statistics. You know, we’ve been trying to find out statistics on the rates of depression and anxiety among medical students. You We know that when they go into medical school, they’re normal or above normal. And when it comes to mental health, and within a year, they have a 25% increase in severe depression and anxiety. So, medical schools don’t want to do these anonymous surveys, because if they have to show their statistics and other schools don’t, would it leave them at a competitive disadvantage? So in the film, there are parents who, you know, were blindsided by what happened to their perfect son. And when he died by suicide, they turned their grief into action, and worked to try to get legislation passed that would force medical schools in Missouri to reveal their Or surveys for depression and anxiety. And at first, all the medical schools killed the legislation. And then they tried again. And finally, you can see in the film after much effort with the help of a very brave state representative who also have position, they finally were able to get it passed. But no, it’s the transparency is not, not the top of the list for medical schools and hospitals. Quite frankly,
that’s interesting that you say you said that they start that we that physicians or rather medical students start out with with mental health that is either consistent with the national average, let’s call it or even better than the national average. But I would think that dying by suicide would be there’d be a higher incidence among high achievers So how do you I don’t know how to juxtapose those two ideas. Right?
Right, you would think so, but their emotional state and they are perfectionist, yes, there, there may be some emotional aspect of, you know, them being perfectionist, OCD, or whatever. But this isn’t a generality. This is a survey of them being above normal. So that’s what we know. But there are ways to mitigate those rates. And it’s St. Louis University in the film, they did a pilot program, and we’re able to reduce pression and anxiety by like 20%. So it was down to 4%. And it wasn’t that difficult to do. It didn’t cost that much. But the most important thing is these young med students, this is the foundation for their career positions. So the whole premise of the film is that, you know, if you don’t have a doctor who’s mentally invested Physically functioning? Well, you can’t provide good quality care. So this is something that affects, you know, all of us. What was
it that St. Louis University did? What were the changes?
Uh, it was a combination of small things. So, for example, they went to pass fail, which, you know, step one,
and I would say that’s a big deal. I don’t think that’s a small step.
That’s a big step. Now, they’re all doing it. But at that point, there were only like 20 schools that did it. They provided they got rid of classes that were too difficult. And they gave their students time off. They extended holidays like thanksgiving for the students to go home. And they and they provided them an opportunity to do charitable work in the community. So they felt fulfilled. Not just you know, with their heads in the book. And they also did, you know, a small resiliency program. But it was the combination of these things. And of course, you know, anonymous counseling, a combination of all these things that really work. So you have a lot of hospitals now that are doing what I call bandaid approaches to improving wellness among physicians going online and do this model. So in the AMA website,
you know, the the irony of having to do medical having to do additional model modules additional work. Yeah, it’s incredible.
More, it’s incredible. And so when there’s
a lot of it’s mindless clicking Yeah,
mine was and what does it do if you don’t complete it? It makes you feel worse. Well, Wow, I can’t even do these modules, you know, for resiliency and burnout. So that’s not the solution. The solution is looking at systemic changes. That should be made to allow physicians to perform at their best, whether that means providing more support people, whether it means, you know, dealing with the EMR system that, you know, nobody seems to, like, time off, you know, dealing with a sleep deprivation, whether it’s dealing with the stigma of mental health, providing anonymous counseling, there’s so many systemic things that should be done, but not these meditation and yoga classes. And certainly, when you have bad outcomes with a patient, you know, they should be providing regular support, like support groups, every two weeks for physicians, and you could you should drop in and if you’ve had a bad outcome, lost a patient, you drop in, and it should just be part of the program. Not like, Oh, well next Wednesday at 230 The Chapel if you want to talk, we’ll have a psychologist there for you. That’s basically what’s happening in many programs. It’s like lip service to wellness programs. And it’s just not good enough. And that’s why we don’t see the change that we should be seeing because it’s very meager attempt to support physicians. So when when you can be establishment when you confront the establishment about this, right,
who is the establishment who’s
who’s in charge here?
Like who do we? Who do we even go to?
Well, really, you know, it’s a hospital system, you know, if you work at a hospital, but there there are a lot of groups involved. So for example, the medical board the medical licensing board, the questions in many states, not in New York, they changed it, but in in many states, the questions that they asked on that licensing board exam to get relicense or license in the first place. about mental health needs to change. They asked you just filled out that form. It’s still there. There was a question that was asked, Do you remember?
i? Honestly, I don’t remember. I don’t remember exactly how it was phrased. But I definitely had to check some box about make you feel uncomfortable. No, but just given that I have this podcast, I am more aware of that question than I otherwise would have been. You know, like I, as someone, you know, I don’t have any diagnosed mental health issues. So in the past, I would have just checked that off. But, you know, this this, one of the benefits of hosting this podcast is it’s made me a little more attuned to issues like this. And so yeah, when I had to fill it out at it, I understood why people would not come from forward with their mental health issues because now they’re having to check this box and you know what checking that box means Yeah, right. There’s gonna be a whole lot more that comes down the road that’s gonna make it harder for your license renewed. If you if you check yes on that box so I just you know, I just I don’t remember specifically how it was phrased but I’m definitely more to that
needs to change because this positions you don’t have the right and should be encouraged to seek mental health counseling there there on the front lines and we see that now more than ever people are finally starting to see how important positions are you know, there’s so much anger and anger towards positions you know, between the patient and condition relationship has deteriorated so much, but,
and everyone right now who’s on the front lines dealing with the Coronavirus, right the the ICU doctors, the hospitalists, the palliative care physicians, the ER doctors, the anesthesiologist, the pulmonary physicians that all of these doctors that are like neck deep in Coronavirus right now are should, should all have easy access to counseling because of what they’re going to leave they’re getting there really
is these these now we’re getting the respect that they have deserved all along. But I really fear that when this who’s done or when this was passed that day, those on the front lines are not going to have access to mental health counseling. I mean, this is like a war. And they will be suffering from PTSD. Many of them already have PTSD from losing patients. But you know, But I fear that it’s just going to be business as usual. And no mind is going to be paid to what they’ve gone through emotionally. And it’s going to be a big problem. And I just fear, you know, look suicide is, you know, what the end result gets a lot of attention. But there are just a lot of people, a lot of physicians suffering deeply with depression and anxiety. And there’s a lot as you know, self medicating. And, you know, I come from a family of physicians, but as a patient, you know, I want my doctor to feel great, and be at the top of his or her game. So we need as a as a society to wake up and understand that physicians are human and that they deserve emotional support because they’re human, just like firefighters and police officers. They’re on the front lines. They they have they have a sense of camaraderie that physicians don’t have. It’s not encouraged for them to get together. They fight fires together. We treat patients fire sensing. Exactly. So yeah, I have a big fear about what’s going to happen after this is over. So, yeah, we’re going to talk about it. Never that never a discussion that we’re going to have after the virtual screening on April 19. I know that a
virtual screening right now. Well, it’ll be in the show notes. But let’s plug the virtual screen.
Well, here’s how this happened. Because we were planning a we’ve been on a film tour for almost two years since September 2018. And we’ve had about 170 screenings at hospitals, medical schools, medical countries. foods like ASAP, and APA and many, many others. So we had a host spring, you know, live events at hospitals and conferences. And of course, with COVID-19, everything was just cancelled. But I people really wanted to see this film. So I said, you know, let’s have a virtual screening with a panel discussion. And so the film is heavy, like it’s about suicide and burnout. And it’s like, why do we need, you know, to talk about this, we’re already you know, barely surviving here. But the panel discussion is really going to focus on how this pandemic has impacted not only the healthcare worker, not only the physician but their family to what they’re going through emotionally, and what needs to happen. So we’re advocating for let’s not forget when this is over We need pork for physicians. It shouldn’t be business as usual. So that’s what I hope the focus of the panel discussion will be. First of all, what trends we’re seeing with Dr. Pamela Wible, who you know, is the physician advocate. She runs a hotline for physicians and medical students, a doctor called Puri, who does like Chi trust at UCLA. And he’s also a writer on the Chicago Med series. And parents who are featured in the film who lost their son Kevin to suicide. So we’re going to talk about what kind of numbers and calls the Pamela’s getting on her hotline. And, Paul, for us, it’s like high interest. We’ll talk about the impact on physicians families, and how they can cope best I mean, there’s a lot going on with separation of families because the physicians don’t want to infect their family. So you’ve seen the stories they’re sweeping into And in basements or not even at home where they’re sending their families away. So they’re coming home to empty homes. It’s just, you know, it’s a very scary time. So we need to, you know, deal with the fallout afterwards.
Yeah. And I think it’s, it’s important for the physicians that are going through it to realize that I’m sure as they’re going through it, recognizing that, that they’re, they’re not the only ones that are feeling this way. Right. They’re not the only ones that are having these thoughts. You know, we are we’re a community and we’re a tribe, as physicians,
that’s, that’s really the message of the film, you know, you are not alone. You’re not weak, because you’re feeling depressed or anxious or afraid. Even you know, before this crisis. You’re not alone. You’re You’re not a weak link, as the professional would like you to think because you know, there’s cutthroat competition starting in medical school, so the the message of the film is you our community, and we have to support each other. And it’s not you. It’s the system. And we need to change that
when you show this movie to physician audiences, what tends to surprise us because I think we understand, right? That we’re under a lot of pressure, right? We have to see a ton of patients, we have to chart correctly. Every patient could be a landmine of a possible, you know, an error that you can make sure you do everything perfectly, and yet they still come back and sue you, and then you’re staying late to finish your charts, financial pressures to pay back your loans. You know, you get home and then your family needs you and you feel like you’ve given everything at the office. Right? I feel like physicians, we we understand this. I’m not saying that I mean don’t misconstrue what I’m saying like as as that like validating the act, but like just the the crushing pressure that we’re under, I think you’d be, you’d be it would be hard to find a physician that wouldn’t understand that, that feeling of being under this crushing pressure, at least at some point in the career, maybe just in residency, maybe afterwards. But what do you find surprises physician surprises, the physician audiences when you show this to them? What, what really surprises us?
Well, first of all, you know, physicians are born overachievers. And then of course, you’re told, you know, now you need to build resilience. So which is kind of crazy. But I’ll tell you when when physicians see the film, because majority of the audience is made up of the blue ocean, they’re shocked at how repressed they are. about the experiences they had in medical school and residency, because they’re just, you know, trying to keep keep on that treadmill, and you don’t want to look back because you’re going to fall. So when they see with film and they see the hazing, the pimping, the bullying the, you know, sleep deprivation, in residency that we follow, they afterwards they say, wow, I had repressed so much of what happened to me. And I think being able to recognize that, even though it’s difficult is healing it’s part of the healing process because repression is not good. So it’s, it’s really good for them and it’s good for them to share their weaknesses and their fears. with each other, they normally would never do that. And I’m really surprised at how many people share their suicidal ideations, their attempt stories, their, you know, even mistakes that they’ve made their frustrations with administrators. I mean, they’ve been very vocal. So the dialogue that we see is really incredible. After the event,
it’s almost like the movie is a key that unlocks something that then just pours forth from us. Right. It’s almost like permission to start talking about the things that we weren’t, didn’t feel like we were able to talk about before.
That’s exactly what it feels like. And my uncle was a colorectal surgeon in New Jersey for 30 years, and I say was because we lost them a couple years ago, but I showed him 20 minutes of the film when I was working on it, and he said, this is going to open up Pandora’s box, because physicians are just not used to talking to each other about their struggles. It’s just not done. You know, in fact, like people would describe to me, you know, they would avoid each other in the hallways, other than like a little nod because, you know, you don’t want to ask how someone’s doing because, you know, they don’t want to show their weakness. And then you don’t want to get involved because then you might wind up holding their pager if they need help. So down the line, so there’s such little discussion about what’s really going on. So you have these relationships, but they’re very superficial. And what the film has done is really got people talking on a much deeper level and some administrators are supportive of this because they understand that to improve morale to improve wellness, you need dialogue. And you need support. So you can’t just have the film and say, okay, you have a film and you know, you got to air your feelings. Now let’s get that to work. You really need to take this and move the ball forward. What can we really do? How can we be proactive to make changes that will see real results in morale? And after the event I talked about, you know, because I’ve traveled to a lot of events. I talk about solutions that I’ve learned along the way at different hospital systems and I share them with other physicians and maybe it could work at your hospital or your medical school. So it’s been interesting to see that sharing going on. Could we do that? can we implement this? And so it’s, it’s the way I used when I do documentary films. It’s for change. And I hope that change is happening. But I just hope that it’s embraced more by the powers that the administrators at hospitals, medical societies have been very supportive. But the AMA is not supportive of the film, The acgme. Well, they don’t come off looking at well in the film, not supportive. So, you know, it’s too bad. We can all work together, but we’ll push forward for what really counts, which is systemic change to improve the wellness of physicians, and also quality of care patients. Is this an issue in other countries? Is this or is this a product of American culture where you’re worth really hinges on your status whether status is defined as academic excellence or financial Success is that is this? Is this a purely American phenomenon? Or is this happening in other countries? That’s what’s fascinating in the film, we have a section on what’s happening internationally. And what we found out is that this is truly a pandemic, because what we realized is that it doesn’t matter. Whether you have a managed care system, the pay system doesn’t matter if it’s socialized medicine. What it really comes down to is sleep deprivation and the stigma of mental health, the inability of physicians to get mental health, the stigma that they face, in their communities, for needing counseling. So if you have those two elements, the stigma of being depressed and needing help or just wanting mental health treatment or just appearing weak Feeling the stigma and sleep deprivation? together? You have this problem. And we hear from people all over the world. huge problem in Asia. We hear from Australia, big problem. South Africa, now in India, but it’s hidden, except in India in the film. You see, they read the suicide notes on the evening news. So they talk about it, but it’s a huge problem. So
still a problem even though it’s out in the open.
Yeah, exactly. Because the stigma still exist. And the sleep deprivation still exists. So especially for residents, you know, in the film, Dr. Charles Sizemore from Harvard, he and Dr. Chris Landrigan both from Brigham and Women’s and Harvard who run the sleep Center at Harvard, and they you know, they sent to me and I put it in the film like speak about it. You’re a resident, I knew Resident you’re an intern, you just got out of medical school, you’ve just had all this training. And now you’re about to see patients on your own. You know, you have clinicals, your third and fourth year of medical school, but I’m talking about really caring for patients on your own as an intern, and that they’re really you’re set up to fail, because you’re forced to work 28 hour shifts, when it’s been proven that after 16 hours, you’re not really learning your brain because you are human, doesn’t have the capacity after 16 hours. And they’ve done many studies in the lab about sleep deprivation and medical errors. So you’re a resident and you’re now forced to work these slave shifts. You get into your car, get into a car accident, sent out by the hospital, go home for come back in a few hours and then you live with a fear of hurting someone or worse killing a patient in the beginning of your career, so you’re set up to sale right from the beginning, that might hurt or kill someone. I mean this what kind of profession is this?
So well, that really begs the question, what is a resident? Right? What is an intern? Are they a student? Are they an apprentice? Are they an indentured servant? Like what? What are the what is their role? Is their role just to learn? Are we trying to optimize their learning? Or are they there to work? Like, you know, like a physician extender. Why? And I think if we really to sit down and define, we’d have to define it first before we could decide what they are. Right? And then you could decide whether those work hours are because they’re, you know, clearly they’re unreasonable. But are we going to be Are we going to accept it? Are we going to accept it They’re an apprentice. They’re not a student anymore. They’re an apprentice. So I think we need to define that. I mean, personally, I think the whole the system needs to be built from the ground up. Because Yeah, we know so much more about effective learning and effective teaching than we did. And this this system, the system has evolved. And just like we covered in episodes on the podcast about evolution with Nathan lense, who’s an evolutionary biologist, you know, evolution creates just a cobbles things together one thing on top of another, so something that used to be an arm now becomes a wing, because that was the limb that happened to be there was it? You know, if you built it from the ground up? Would you have that arm turned into a wing? Probably not. You probably have a separate set of wings and arms, but that’s not how it works. And that’s how the medical system has evolved, right? It’s just cobbled together over time. It hasn’t been built from the ground up and if we could build it from the ground up, then I think we we’d win Have an effective system because of how much research is out there. So if we’re really scientists, then we really do need to take what is what data is out there about the most effective learning and then institute that.
You’re talking about a one, nobody’s really asking me, no one asked you. And you’re talking about a century old system that no one wants to bother changing. And what you say is, that’s in medical school, and even in hospitals. Dr. ciphered said to me, Imagine that you’re using medicine has changed so much just even in the last 10 to 20 years. But yet, we’re using the same model that we did years ago, decades ago. It doesn’t work. So you can’t use the same system you have to resolve. But the system has not evolved in medical training, and it hasn’t evolved for practicing physicians. It’s a big problem because evolution could cost money and it could take time. And it seems that the people in charge, the administrators don’t want to spend the time and the money to evolve with what’s happening in our society and the demands on health care. So, for example,
because you’re going to take a financial hit, right, you’re gonna see fewer pay, it’s gonna end up with either residents who are attendings, or both see your patients, and that’s going to be a financial hit. Ultimately, it may lead to fewer medical errors and fewer lawsuits, but that front end investment that you got to make and that’s a that’s a tough thing to do. We got away from something that I want to come back to because I’m just really curious about what the answer is. You know, you mentioned that women attempt suicide more often, men die by suicide, because those their attempts are more right for lack of a better word successful but aside from the male female split, what are the other demographics is this is this more common in minorities, this is more common in people from a higher or a lower socioeconomic status. Is this, like who is this affecting the most? I’m
curious. Statistics are so cooler. Because until recently, I think since 2014, when in New York, I don’t know if you remember these two young doctors within a week of each other, jumped from the roofs of their hospitals. And it really woke everybody up once again, because I guess we went to sleep for a while to to the problem of suicide and burnout. And you know, there was renewed interest, because remember these tough topics on mental health and about suicide and depression, nobody would go. So it wasn’t just, you know, the leaders of the conferences of these big organizations. Physicians themselves, didn’t want to talk about this because they were You know, brought up just to say, this is not a problem for me because I’m supposed to be perfect. This statistics are very shaky for me. There there isn’t. There aren’t statistically say, you know, minorities are more effective. It’s it’s not. It’s not a minority thing. It’s not a socio economic crisis. You don’t really know and I don’t really because we don’t know because so many suicides are really coded as accidents. We don’t really have a good grasp. We’ve been using this 300 to 400 number for so long. Because we don’t really know I do know that Dr. Pamela Waibel when I started working on the film and she showed me this book, she said she had a die of suicide diary, and she was compiling for herself because there were no real statistics. suicides male female Now hot method of suicide. And when I shot that scene with her that you see in the film, she had about 200 names. Now she’s got over 1600 names in this diary, because I shot that scene with her in 2015, let’s say. So that’s what she’s added to her diary in just that space of time. And those are just the ones that she knows about. Those aren’t the ones that are coded as accidents, she can verify those. So we don’t really know, Brad, it’s just so that’s part of the frustration. That is not a real interest to find the numbers. The real numbers. Yeah,
yeah. I mean, you know, that was gonna make the segue into the current pandemic, same issue, the numbers, how many cases are out there? We don’t you know, we’re not tracking it. We’re not we’re not our testing is Limited, that the numbers that they’re putting out there are, you know, pale in comparison to the, to the real numbers. And it’s hard to code, you know, who actually dies as a consequence of COVID-19 versus, you know, some secondary cause. And then, you know, those statistics are just are just challenging. So, in the face of this pandemic, let’s say you, you were in the process of creating your documentary. Hmm, right. You had done it a couple years later. So that this was occurring in the midst of you creating your documentary.
What would you have done differently? In the wake of the current pandemic, what would you have either included or tracked or covered? If you had included this, what we’re going through right now in your documentary, first of all, Brett, I think it would have been easier because when I started working on excel in 2014, no One wanted to talk about it. It was so challenging to get physicians and medical students, or part of the establishment to talk about this topic, it was still very much hidden. And, you know, people just have this vision that physicians had this cushy life. And you know, they were playing golf, it just, there wasn’t a lot of motivation to talk about it. So I think now if it had happened now, there would be a lot more interest to talk about the pressures, and a lot more acknowledgments, a lot more transparency, because we see it, we see them getting suited up and getting sick and losing their allies to help patients. So of course, this would be a fascinating example of how important positions are. But when I started working on the film, position, suicide and Look, you know, suicide is a problem in society in general, why should we care about physician suicide? And I, you know, was trying to draw the link Look, if if physicians are taking their lives, what kind of care do you think you’re going to get? as a patient? Think about it, think about it. So now it’s, it’s easier to see how important positions are now, you know, men don’t realize these are ER and ICU, you know, these are hospitals that are really on the front lines, physicians like you that have private practices that are hurting and other ways you know, financially. You know, no one’s having elective surgery and people are reluctant to go out of their house forget about, let alone go to an empty appointment to get their deviated septum
earwax clean. Yeah.
physicians in private practice are hurting in other ways, but it just would have man made it easier to get along. empathy for positions that what I experienced back in 2014 1516 of all it took me four years in between shooting for a year and a half, two years and then editing for another 18 months. So in in that space of time, you know, there was just starting to see, you know, more dialogue and more programs, but there was still a lot of resistance to talk about this. So it would have been actually easier.
Yeah, I can see that right now. They’re just so overburdened and overtaxed and if they were already even a bit burned out beforehand you know, they they have no guard left. So you ask them a question and they will be more than happy to go into great detail about what is what challenges they’re facing or and have been facing.
I’m holding posted a cold COVID-19 we can still use this film as a means To get the community together and have a dialogue about what has happened, you know, how can we use this spotlight this national spotlight, this global spotlight on physicians and all healthcare workers to demand change to improve wellness and safety. So
tell us one more time about the virtual screening for do no harm.
The screening is on April 19, which is a Sunday evening. It’s 8pm on the east coast. 7pm Central and 5pm on the east coast. The easiest way to register is if they go to the do no harm film website, and on the homepage, there’s a button right there to click to learn more about the panel and the event. And then you can register
and that’s do no harm film calm, correct. Okay. Robin Simon, thank you so much for creating this Extremely important documentary and for taking this time to do the podcast.
Thank you, Brad. It was a pleasure. Thanks for having me.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
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