The Paradocs Podcast with Eric Larson

Dr. Eric Larson of the Paradocs podcast joins me to discuss what we think RFK Jr. wants to do if confirmed as head of the Health and Human Services division, what he might get done, and some priorities he ought to do to make America healthy again. q Video - https://youtube.com/live/wt69j-XebVg This episode is brought to you by Trijent's new Universal Mech-loader - https://trijent.com/spangle Trijent, a pioneering small business, proudly introduces the Universal Mech-loader. This advanced speedloader is designed for a variety of ammunition types including 9mm, .40 S&W, .45 Auto, .223/5.56mm, and 7.62mm. It significantly reduces loading time, minimizes hand fatigue, and enhances your shooting practice. With its adjustable mechanism, the Universal Mech-loader fits multiple magazine types, ensuring a universal fit for your firearms. Transform your time at the range with efficiency and ease. Do you have comments or questions about this episode? Visit it on ChrisSpangle.com and leave one! --- Join our Patreon now for commercial-free shows, bonus content, and our complete archives - https://www.patreon.com/wearelibertarians --- Join our Facebook Group to meet other listeners. - https://www.facebook.com/groups/walnutssociety --- Visit Chris-Spangle.com to see my other podcasts and projects or to add me on social. www.Chris-Spangle.com --- Looking to start a podcast? Download my podcast Podcasting and Platforms now, and check out my recommendations for buying the right equipment. Chris Spangle and Leaders and Legends, LLC edited and produced this podcast. If you want to start a podcast or take yours to the next level, please get in touch with us at LeadersAndLegends.net. Learn more about your ad choices. Visit megaphone.fm/adchoices

Are you a decision maker at your business? If you're a CEO, CFO, the head of HR, or perhaps the owner of a small, medium or large business then you owe it to yourself to check out this fairly simple solution to save over 50% on your health care spend. Health insurance is usually one of the biggest overhead expenses after salaries for any company and it affects the bottom line of nearly every business. Imagine what your company could do if it paid out less than 50% in its health care spend - while also maintaining a similar if not improved plan for employees. Before you scoff and say that there is no way you can provide your employees high quality care at less than half the cost, just remember that only about 25% of every dollar spent in health care actually goes to caring for patients. There's plenty of room to cut. Why Health Insurance Is So Expensive?The reasons for expensive insurance is obviously a complicated question. However, it's simplest to think of it in just a few ways - especially when we look for ways to bypass the rotten system to save real money for our business. The insurance companies make money by paying out a lot in claims. This seems illogical at first glance but makes a lot of sense once you realize that the insurance companies are only allowed to use 15-20% of the total they pay out in claims towards profit and overhead. Therefore, the more in claims payouts, the higher amount they can profit. Pharmacy benefit managers (PBMs) hang onto the rebates. Instead of passing on the volume discounts (or rebates) onto the employers and employees they keep that percentage of charges. Just like the insurance companies, the more that is paid out in charges the greater revenue they get to keep leading to ever increasing pharmaceutical prices. Insurance brokers primarily make their money through commissions from the insurance companies. This incentive leads them to find only solutions for your company that involve large insurers. The only way you can actually save money is to bypass the traditional means of creating a health plan which most brokers are not aligned to do. Building a Better Health Plan?What becomes readily obvious as far as solutions go is that you must create your own self-funded health plan and find transparent PBMs and rational contracting to pay for services. Very few companies are prepared to do this which is why you need to find insurance brokers and third party administrators who can set it up for you. There are plenty around, you just need to seek them out. I've had two on in the past whom I reference in the show. Of course, they are hardly an exhaustive list of players in the field but they would be a good start for anyone investigating these solutions for their business: Katy Talento of All Better Health and David Contorno of Epowered Benefits.   show notesEpisode 176: Today's show Episode 111: Katy Talento tells us how she saves businesses money. Episode 150: David Contorno explains his business model. Episode 043: How PBMs jack up drug prices. All Better Health: Katy Talento's business where she helps others create their own health care plans. E Powered Benefits: David Contorno's business helping others create health care solutions. We Are Libertarians: The Paradocs is a proud partner and member of this outstanding podcast network. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Learn more about your ad choices. Visit megaphone.fm/adchoices

COVID has reshaped the world and China holds a unique position in the world's approach to combatting pandemics and in the fact that it was first described in the city of Wuhan. We may never know exactly where or how COVID originated in China but we can be certain that the unprecedented strategy to 'lockdown' was one that originated in China. The Lockdown Before when the COVID pandemic was just a regional epidemic in China, the CCP embarked upon a zero-COVID policy where they took extreme measures of shutting down their economy. As an authoritarian government they were able to use extreme measures to prevent the movement of people. This was accomplished by sealing citizens in buildings and delivering essential goods (sometimes) with very harsh penalties if people tried to escape. How is the Lockdown Going? Jennifer Zeng is familiar with the CCP as one who has escaped a political prison to the United States where she now reports on the Chinese government. And that government's zero COVID policies seem to be taking their toll on their citizens as they are well into the third year of rolling severe restrictions. Protests are occurring all over the country and unlike the Tiananmen Square in Beijing in 1989 they aren't isolated in just one city. The CCP is faced with troubling questions as to whether it can really trust the military? Would easing the restrictions embolden people and lead to increased calls for freedoms? Learn more about your ad choices. Visit megaphone.fm/adchoices

History is a funny thing. Often, we think we know what happened either as we experience it personally or have trusted sources that give us an account. However, it depends on who is relaying the information, and the prior biases and perspectives. The goal of a good historian is to gather information from multiple sources and figure out what happened and why it played out the way it did. In today's episode we focus on why the US ended up with a third party payer system left to the insurance companies to dictate payment and generally how physicians can practice medicine. It Begins with InsuranceDr. Christy Chapin has focused her research on the history of health care which includes insurance and finance. She believes that you must understand how we got to where we are today with insurance (private and public) dictating how medicine is practiced through payment mechanisms. It's easy to look at Medicare and Medicaid and assume that there was always a large influence on health care's practice through insurance reimbursement - but that's not the case. In fact, most doctors assume it was the decade or two before the creation of Medicare in 1965 that insurance really came to be a big player in health care. Actually it Begins with the AMAThe standard story is that wage controls coming out of WW II left employers with limited ways of attracting top talent since they couldn't adjust employee incomes easily so they resorted to offering benefits like health insurance to entice the ones they wanted. Although that story is a handy explanation, it isn't really borne out by the evidence either in uptake in the frequency of health insurance being offered to employees or its use more broadly in the marketplace. In fact, the creation of health insurance product came from the AMA as they looked to thread the needle and avoid corporate interests taking over medicine (worked out great, huh?) and a federal nationalization. Unfortunately, the AMA, by squashing all other physician led ways of organizing the delivery of health care, removed all other alternatives to their preferred method - insurance. Initially, the insurance companies agreed to not limit any claims, pay in full whatever charged by the physician, and pay wherever the charges originated (ie, the physician's own lab, etc.). This led to cost over runs and then the endless government fixes including governmental insurance (Medicare/Medicaid) and the resulting changing of the landscape of medicine. Learn more about your ad choices. Visit megaphone.fm/adchoices

It's been a while since I've done an episode and it's mainly because I've had a COVID rant percolating for some time. So I just had to let it out now that the president (accidentally?) mentioned that the pandemic of COVID-19 is over. In this episode, I cover mandates, vaccines, public health policy and much more. A frank discussion with you about where we are and where we need to go as a country with this irritating virus and resulting policies. This is an expansion on my speech from episode 156 and a broader discussion with Dr. David Graham in episode 143. Learn more about your ad choices. Visit megaphone.fm/adchoices

In survey after survey, the number one satisfier for physicians - by a long way - is their relationship with patients. Anything you can do to improve or deepen that relationship makes the work better and decreases the incidence of burnout. Obviously, barriers put in the way that detract from creating a deeper relationship with patients makes the job of medicine less desirable. One way a lot of doctors have gone is to practice using a direct care model which removes many of the obstacles in place within modern medicine from forming that all important bond with their patients. Getting Help to Start a DPC PracticeUnfortunately, doctors don't usually receive training in how to run a business and set up a practice like this. Even if they have heard about direct primary care (DPC) there are a lot of things to overcome to start up. First, they need to understand how the model works and what space, supplies, and equipment they need to begin. Second, they need to find ways of bringing patients in the door which requires marketing and sales. Finally, there is a lot they need to learn as far as running the practice since most of their training probably came in an academic setting or at the very least, an insurance based model for providing care. That's where today's guest, Chris Habig of Freedom Healthworks, comes in. He and his brother started the business initially to help their parents (who are primary care physicians) rekindle their love of medicine. What they've built is a company that helps doctors at every stage of the process setup, start, and run a DPC practice. Doctors can use as little or as much of their services as they feel they need but essentially Chris and his team take away a lot of the unknowns and help navigating medicine in this space. Learn more about your ad choices. Visit megaphone.fm/adchoices

Occasionally, you come across an interview or subject that blows you away with incredible claims that are both out in the open - and yet invisible. Today's guest is an author and expert witness for some of the biggest pharmaceutical cases of this century, Dr. John Abramson. He reveals the rot that centers not only in the pharmaceutical industry but also the institutions that are constructed to serve as its guardrails - the medical journals, federal agencies, and guideline committees. In some What Would Physicians Say if They Knew Medical Journals Had No Access to Data for Peer Review?The most stunning aspect of the whole conversation centered around how the most prestigious medical journals conducted peer review without all of the clinical data. This means if anything was misrepresented or omitted there is no check on the truth of the claims from the study. Essentially, the journal and its reviewers are relying on the good faith submission of all important details from the study designers who are usually paid employees or have research paid for by the pharmaceutical manufacturers.  The most famous landmark case was with Pfizer withholding adverse event data (or misclassifying them to avoid statistical significance) on cardiovascular events (heart attacks and strokes) with their medication, Vioxx. Only when Pfizer was sued in a huge class action lawsuit did the actual clinical data get revealed showing that they had seen a signal for adverse events but intentionally did not disclose it (or the raw data) to the medical journal reviewers. Worse yet, once the error was presented, the medical journals spent very little time discussing the error. According to Dr. Abramson, this is in large part because up to 40% or more of medical journal revenue comes from study reprints. This financial incentive to find positive results and publish makes for a twisted system that incentivizes the promotion of new medications and devices when they may not be safe or very useful. Learn more about your ad choices. Visit megaphone.fm/adchoices

What is one common difference between the hiring process of most professionals with advanced degrees and those in sports and talent industries? The use of talent agents. People dedicated to finding their clients jobs, negotiating the terms, and essentially doing all of the analytical work to determine market value for the "talent."  What if the Talent were Physicians?Raised by a physician mother, my guest today is Ethan Nkana, who didn't enter the world of medicine as a doctor but instead got his JD and MBA to enter the world of hospital administration. Ethan cut his teeth negotiating physician contracts, running operations, and more for hospitals. But he decided to get out and start a business working on the other side of the table with physicians in the negotiation process. His model is simple in that he uses the same as talent agents for musicians, artists, and athletes except his clients are doctors.  Ethan brings his knowledge at the Rocky Mountain Physician Agency of what hospitals want, where their pain points are, and what they worry about to help doctors maximize their compensation or work situation. Fortunately for Ethan, there are plenty of physicians now employed and looking for more. Learn more about your ad choices. Visit megaphone.fm/adchoices

I confess that I hold a lot of biases when it comes to various surgical specialties. One such bias is that orthopedic surgeons - especially trauma - are not deep thinkers. My guest today completely turns that prejudice on its head as we discuss the role of nutrition and vitality in disease and recovery rates. Setting the Hammer DownObviously, an orthopedic trauma surgery focuses their care on treating patients with fractures sustained in injuries. However, Dr. Miller now looks beyond the obvious mechanical or lab-based problems that patients present with. He uses some principles of functional medicine to seek the answers to what might afflict his patients. For instance, perhaps the pain in their joint isn't from arthritis but from a dietary problem. Learn more about your ad choices. Visit megaphone.fm/adchoices

In 1973, the US Supreme Court ruled on the Roe v. Wade case and concluded that Americans have a constitutional right to an abortion up to viability of the fetus. That has been the law of the land... until now (or at least very soon). Roe v. Wade OverturnedA few weeks ago, a draft majority decision by the Court was leaked which showed that there was a majority of justices on the Supreme Court who were going to rule in favor of the state of Mississippi in their challenge to the Roe decision from nearly 50 years ago. Effectively, overturning the Roe decision would revert back the power to regulate abortions from the federal to the state level. Many states have been anticipating or preparing for the eventuality of this decision and have created 'trigger laws' which go into effect if and when Roe is reversed. Most of those states make abortion more restricted or outright illegal. However, some states have liberalized abortion making it legal right up until birth. Challenges for the StatesElizabeth Nolan Brown, Senior Editor at Reason magazine, lays out a few of the problems with this ruling coming back to the states. Primarily, although the states can regulate what happens in their borders, it is very difficult for them to restrict what people do in other states. For instance, can states really stop women from crossing the state line and getting an abortion? Can they prevent mail order morning after pills? Learn more about your ad choices. Visit megaphone.fm/adchoices

What would you do if you were fired by your employer over something you had said on social media? Would you be able to survive or would you have to scramble to find work? That scenario is exactly what was faced by today's guest, general surgeon Dr. Buck Parker. And his solution was a surprising one. Seeds of an EntrepreneurIt doesn't appear that Dr. Parker never set out to find ways to be financially secure outside of medicine. His path through medical school and his general surgery residency seemed fairly traditional. However, there were signs that he had an entrepreneurial streak about him as he began a very small online business selling gym equipment. Following that, he landed a role on a reality TV series which led to another starring role on a second show. Aside from practicing clinically as an acute care and trauma surgeon, Dr. Parker leveraged his appearances on TV and built up a following on social media through Instagram and YouTube. And that's where the trouble began. Losing Your JobDr. Parker's termination within his hospital system in 2020 happened a lot like the old joke in bankruptcy. "How do you go bankrupt? Gradually and then suddenly." Parker's CMO had been very upset with his YouTube channel and social media presence for some time and when Parker published a video stating that the highest risks for COVID are those who are obese, elderly, and with medical co-morbidities, it was the final straw. Perhaps it was because the video went viral and the light it shone on an institution that didn't want any attention paid to it. No matter the reason, it was the end of the line for Dr. Parker's Salt Lake City surgical career. Overcoming Job Loss as a MinerPerhaps by happenstance, Dr. Parker had researched and eventually took the plunge to mine bitcoin. Fortunately for him, the price of bitcoin exploded from a few thousand a coin to tens of thousands from the time he started to the time he had been let go. It more than supplemented his income lost as a surgeon and gave him the financial freedom to be able to walk away and not worry about scrambling to get another job. It's now been almost 18 months since being let go and the CMO has been replaced and the hospital has been busy. So busy they actually asked him to return but he declined. For right now, Dr. Parker doesn't see himself going back to medicine but time will tell. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Jay Bhattacharya returns today to further our discussion on the dysfunction within the scientific community around COVID-19. Specifically, we discuss what exactly happened to Dr. Bhattacharya after he co-authored the Great Barrington Declaration where he and two other prominent academicians laid out a case for a more focused protection plan for the elderly than the widely adopted general lockdowns and mandates at the time. Dr. Bhattacharya was not surprised to face opposition to their plan - but the way it formed and by whom did.  A Government Bureaucratic Cabal?After the publishing of the GBD, the attack against Dr. Bhattacharya and his co-authors was blistering, numerous, and seemingly coordinated. Those on the outside, and even Dr. Bhattacharya himself, believed that the scorn from media, government, and academia was due to a general disagreement with their position - not a coordinated attack. It turns out that FOIA documents of emails from Drs. Fauci (head of NIAID) and Collins (head of NIH) prove that they worked in tandem to discredit the GBD through their contacts within the scientific, media, and government communities. Learn more about your ad choices. Visit megaphone.fm/adchoices

The US health care system is fraught with all sorts of problems. Many of these have to do with consolidation in the market and scores of rent-seekers (those using legislation and regulation to maintain their market share. Those issues can probably be best resolved with fundamental changes within the halls of government. However, some of these problems can be addressed with new technology which offers solutions not even dreamed possible a few years ago. And the driver of much of this innovation rests on block chain technology. Block Chains to the Rescue? The basics of block chains have been discussed on this show where we explained the basic concept of what it is and how it works (here and here). We also looked at some helpful business applications such as decentralized finance and how that could unlock capital and make for opportunities for small medical practices. However, the real allure of block chain is whether it can solve some of the bigger problems in health care and bring about real structural change to the problems that plague doctors and patients alike: information sharing, supply chains, and payment processing. Patient Information Sharing and Storage Big Data is big money and there is no more valuable data set than patient health information. Companies pay millions of dollars for this data to develop health processes and businesses to manipulate the data to change patient behavior, physician behavior, and new businesses. However, the biggest problem is that the patient has no ownership of their information meaning that they cannot decide if the data is used or be compensated if it is. The possibilities of the block chain allow for patients to control their information and dictate those to companies - not the other way around. Additionally, patients owning and securing their own data would allow for more accurate and safer transfer of their personal medical information when traveling between medical systems, EHRs, or even health providers within the same system. In essence, a patient could only transfer the information they want and deem important to a particular provider and no more. A quick example would be to just provide personal demographic information to an imaging center and not all their health history. Learn more about your ad choices. Visit megaphone.fm/adchoices

There's no shortage of an alphabet soup of government agencies but the same exists within the nebulous public-private sphere of medical education and credentialing. These non-profit organizations were created to ensure a baseline within medical education institutions across the entire country for medical students, foreign medical graduates and residencies. However old and established these institutions are, they are still staffed by people who make decisions and are charged with maintaining the organizations financial stability. But, since they don't have any real competition, they can make financial decisions that are not always the best for the long term viability of the organization which can lead to problems in the future. Sometimes those futures become the present and people paying for their services, ie, medical students, residents, and foreign medical graduates take the brunt of their poor fiduciary planning. The real financial risk to many of these organizations is similar to what threatens governments at the local, state, and federal level: pensions. The Sorry State of NBME's Pension ProgramCharles Kroll is a forensic accountant which means he is adept at parsing financial reports and determining where money is flowing and where the inherent financial risks are to organizations. With the help of analyst Elizabeth Tremblay, they have analyzed the financial data from the National Board of Medical Examiners (NBME) - which conducts the testing for medical students - and have found troubling signs. Foremost is that the NBME has a retirement fund that is worth almost $300 million which is twice the value of the organization. On top of this, the retirement fund is still underfunded which means it is at some risk for default with an organization that clearly could not meet those extra payments since it is dwarfed by the size of the retirement fund. Of course, the great risk is to medical students which would probably be on the hook to make up for the financial offset if the retirement fund becomes grossly underfunded. The only real source of revenue for the NBME is its examination fees. And for medical students, they are forced to pay whatever fee the NBME comes up with since there is no competition and alternative testing organization in the United States. The financial mismanagement of this and other organizations will fall hardest on those with no choice and the least ability to pay. Defined Benefits are the ProblemRetirement benefits are usually of two main types, defined benefits and define contributions. It effectively shifts the risk either on the employer or the employee. In the private sector, defined benefits (guaranteed payouts over the length of your retirement) haven't really existed for 35 to 40 years. Nowadays, private companies and most non-profit organizations offer 401Ks which are specified contributions but do not guarantee your future payouts - they are whatever they returns are. What is so unusual is that all of these medical education boards use defined benefits as their retirement structure which puts their organizations and, by definition, their clients at risk for covering the gap of underfunding their benefits. According to Kroll, unless the organizations kill their defined benefits plans they will be at increasing risk for insolvency or at a minimum, jacking up fees to students. Learn more about your ad choices. Visit megaphone.fm/adchoices

It's easy to become despondent about controlling spending or eliminating waste through reform on government expenditures. We've all seen the headlines about the $1 million hammer or toilet seat and governments losing track of money. Also, with all the people who have been elected on the platform of 'transforming' government or making it efficient, there has been almost nothing but the exact opposite happen. It's why the joke about death and taxes not only funny but very true. To make matters worse, imagine government getting involved in the purchase of a product that is incredibly expensive and wasteful - US health care. This is a recipe for budget overruns, poor health outcomes, and a bottomless pit of spending. The opportunities for wasteful spending is so great and the lobbyists to keep the gravy train of spending so powerful that tackling it at the state level seems hopeless. Yet that is exactly what Christin Deacon did. Reforming New Jersey's Health and Benefits Plan Maybe it's because Christin Deacon didn't know any better but she looked at the amount of money being spent on New Jersey's health and benefits and actually thought she could find some meaningful savings for taxpayers. To her credit, she asked the questions that no one had asked and pursued solutions that no one had seriously tried before. Through her persistence, Deacon helped save New Jersey citizens over $500 million per year for years. Those billions of dollars have been used to fill other gaps in the state budget and most importantly, haven't been thrown away on poor contracts or inflated pricing. Learn more about your ad choices. Visit megaphone.fm/adchoices

Expanding Choice for Physician Board Certification (NBPAS) with Dr. Paul Mathew A rite of passage for doctors is completing a residency in a specialty. Sometimes, they complete multiple specialty trainings but ultimately sit at the end of their years of training for board certification. At one time, once a physician got board certified, they were considered a specialist for life and no further testing or training was necessary. That all changed in the 1990s as the governing board for all the specialties, the American Board of Medical Specialties (ABMS) began to require that new trainees only receive time limited certification. This meant they would have to undergo new testing or requirements in order to maintain their board certification. Initially, this expiration was every ten years and usually just involved an exam. Physicians grumbled about retesting within their discipline which required time, money, and travel usually. Eventually, over the years, the testing and continuing education modules grew and expanded requiring more and more time and expense. Now, a physician who is triple board certified, like a hematologist-oncologist, would have to do testing every 2-3 years with almost continuous rounds of studying parts of medicine that he/she no longer practices. This can cost the doctor upwards of $40,000 every ten years! Why NBPAS is NeededAs the onerous and expensive requirements for ABMS recertification continued to pile up, doctors from prestigious medical institutions from around the country decided that it was time for another choice for board recertification. The concern was not in the initial training and certification process but simply in the verification of continued mastery in the doctor's field of practice. Therefore, they set out to create a board certification that recognized prior training but focused continued medical education that the physician felt best helped them in their day to day practice. This allowed the new all volunteer board to decrease the annual certification price to only 30% of the ABMS price while also drastically eliminating all of the mind-numbing busywork that doctors say contributes nothing to their practice but grows their burnout. Doctors were upset over the perceived exploitation and lack of response to their concerns over the recertification process so another choice through the NBPAS is a welcome addition. NBPAS is Now Accepted by URAC and NCQAOne of the main limitations in the acceptance of NBPAS by hospital credentialing committees is the fact that private insurance carriers couldn't get credentialed by their credentialing bodies if they didn't use ABMS credentialed physicians only. Hospitals were very hesitant to allow medical staff who were not qualified to get paid by insurance carriers as they feel that this puts their patients at risk for surprise bills. Fortunately, NBPAS has now obtained acceptance by NCQA and URAC which are the main credentialing services for insurance carriers. This paves the way for physicians to have a choice between the ABMS certification or NBPAS and still get paid. Learn more about your ad choices. Visit megaphone.fm/adchoices

The COVID pandemic has created a lot of interesting surprising and challenging political dynamics in countries all over the world. In the United States, we have a clear divide between those who declare themselves Democrats and Republicans in whether they support mandates and vaccine passports. The treatment of children remains a subject of a tremendous amount of strife. However, our neighbors to the North in Canada are having the same political tension growing as exhibited by the Freedom Convoy. What is the Fredom Convoy?The Freedom Convoy began January 22nd as a decentralized protest movement in Canada led by truck drivers entering the nation's capitol, Ottawa. According to my guest today, Warren Speyers, the convoy is seeking to end the vaccine mandates for traveling and generally moving into businesses. Speyers says the truckers are not looking to fight vaccination, rather, just the mandates and edicts which they feel are restricting their freedoms and businesses. The convoy consists of not just truckers but also many other Canadians who share those same goals and values. Speyers says that there are all sorts of trucks, tractors, and even personal vehicles which line the streets around Canada's Parliament. From Speyers' description, the convoy has been met with lots of support from citizens in Ottawa. The protests have been largely festive celebrations with people packing saunas, hot tubs, and even their hockey skates along with their families. The truckers have been showered with food, meals, valentines, money, hot showers, and offers of diesel gas from well wishers. The Canadian Government's ResponseAlthough the protests have been peaceful, the Canadian government has sought to end the movement without pulling its restrictions and mandates. On the day we recorded, February 14th, Prime Minister Trudeau and the federal government invoked the Emergencies Act which is essentially grants the federal government extraordinary powers to prevent massive violence, threats to Canadian sovereignty or a threat to public safety and health. In practice, the government has threatened to freeze and seize the financial accounts of anyone who financially supports or participates in the protest since most of those involved are owner-operators and not actually parts of large corporations. Learn more about your ad choices. Visit megaphone.fm/adchoices

If there is one thing that seems obvious throughout the pandemic, public discourse on just about everything seems to have broken our brains. We are incapable of having discussions without vitriol and there appears to be a real desire to not simply win arguments but destroy our ideological enemies. This leads to all sorts of strange behavior like fracturing previously solid personal relationships between family members, friends, colleagues, and, in today's example, patients and their doctors. Going After Her Medical LicenseIt began with a surprising email in her gmail account in the fall of 2021 for Dr. Meg Edison. A man identified himself as an investigator for the Michigan State Medical Board and was following up on a patient complaint for 'misinformation.' After a google search to feel comfortable that the individual was an actual state employee investigator, Dr. Edison gave him a call to find out what the nature of the complaint was against her. It turns out that one of her long standing patients had lodged a complaint with the state board of medicine claiming that she was pushing misinformation at their child's last visit. The claim consisted of the 3 allegations: That cloth masks were not a very effective barrier for protection from infection by COVID and they would do better to wear a higher quality mask, That it was unlikely that the FDA would approve a pediatric vaccine, and That even 70% of the deer in Michigan have been infected with COVID as shown by serology testing. As one can see, all those statements are correct and were true by government authorities even back in the fall of 2021. Fortunately, the story has a happy ending and the Board of Medicine found the complaint to lack merit and was summarily dismissed without any action taken against Dr. Edison. How Organized Medicine Can Protect DoctorsOrganized medicine can be an extremely challenging and aggravating landscape for physicians to navigate sometimes. However, when it comes to standing up for doctors, there aren't many organizations that will do it. And when it comes to taking on the licensing boards, state regulatory bodies, or hospitals the only groups that have doctors' backs are the professional groups. Dr. Edison made the point that it is important to find your niche in organized medicine and run with it to help foster relationships with other physicians and learn more about the state of medicine and different ways to practice.   Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Graham is the most frequent guest on the Paradocs Podcast and has appeared 5 previous times to discuss COVID (they can be found here, here, here, here, and here). Today, we talk a lot of COVID but also what it takes to retire amidst a pandemic. Do you need extra financial security during these times? What strategies work best? But mostly, we discuss Graham's optimistic feeling on where we are with the pandemic. The Pandemic is EndingDr. Graham's very optimistic that we are in the final stages of the pandemic. Both from a scientific, social, and political aspect. Scientifically, we are closely approaching the point where nearly everyone in America has been infected or acquired immunity to COVID from vaccination., This will significantly reduce the chances of mortality and move future infections to less severe. Socially and politically we are definitely seeing a shift away from shaming and hysterical calls for zero-COVID towards a more rational approach of accepting the virus' endemicity and learning to live with its presence without extreme mitigation measures. There also seems to be a real reckoning that most of what we did to prevent transmission was largely ineffective even within the ruling class. This is an important point that makes it less likely that these measures will be broadly pushed in the future. Of course, there are still further calls to now push vaccine passports and mandates but the utility of them is crumbling as we see that vaccination is hardly effective at preventing the spread of the virus. Pushes to continue mask mandates except to N95s are present in some communities (especially schools) has occurred but are being met with even more hostility from the lay public. One Way Masking is Now PossibleAs for N95s, it is clear that they are fairly protective for individuals and all other masks have limited utility. This means that if you are an individual who wants extra protection from others, you can simply don the N95 yourself. This also means, that others can operate in their lives in a pretty normal capacity without worrying about others. Since vaccinations and boosters are widely available, anyone can get the protection they want without having to worry about others and what their 'status' is. This is a huge leap forward and Graham argues is the way forward with schools and businesses as it allows those who want extra protection to protect themselves and those who choose not to to live a fairly normal life. It is probably the only politically feasible path forward for our schools and everyday life. Paxlovid is a Game ChangerFinally, Dr. Graham spoke a little in that he is more optimistic because Paxlovid, the novel protease inhibitor, is now approved and has had amazing therapeutic results for those at risk of serious complications with COVID. It also may serve as a platform or basis for future therapeutics in other respiratory viruses. Yet another reason to be optimistic on the future of the pandemic. You can listen to my latest discussion with Dr. Monica Gandhi to get her explanation of Paxlovid in episode 154.   Learn more about your ad choices. Visit megaphone.fm/adchoices

(The following is a speech I would give if I were allowed to replace the current head of the Presidential task force on COVID-19, Dr. Anthony Fauci. We have had a huge loss of trust in our public health institutions and a change must be made. This is the speech someone needs to make as they replace the current regime which has had a run through two presidential administrations.) My fellow Americans, it is a great honor to receive this appointment to head the US task force on COVID-19. I want you to realize that I approach this position with great humility recognizing that I can never have enough knowledge and must rely on others to gather the most complete picture on this virus. The fact that this is a new pathogen means that our knowledge is ever-evolving and we must be nimble in our course of action.  It has been a long and dark 22 months that we have been dealing with this pandemic. SARS-CoV-2, the virus that causes COVID-19, has killed hundreds of thousands of Americans and millions world wide. Make no mistake, this virus can be deadly. Unfortunately, throughout the pandemic’s response, the American people’s trust in public health, modern medicine, and government authorities has eroded significantly. Large swaths of our population no longer trust voices whom they deemed trustworthy just two years ago. This is mostly the fault of those in charge of public health and I seek to reestablish that trust. Of course, regaining lost trust is not easy. It requires those who were in authority to accept their missteps. It requires a whole profession to admit it was wrong..... Learn more about your ad choices. Visit megaphone.fm/adchoices

Whether you are in medicine or not, you are affected by the board certification and board recertification process. The certification and recertification process is not only expensive but also stressful contributing to burnout with physicians. After completing a specialty residency training, candidates for board certification have to jump through a number of tests to become board certified. These include a written exam and then possibly other components like oral exam, case review or something else. That something else is the subject for today's show - the Objective Structural Clinical Examination (OSCE). What is the OSCE? The OSCE is a new addition to the board certification process by the American Board of Anesthesiology whereby the trainees are subjected to various tests with 'standardized actors' to see how they can perform various personal skills like informed consent, canceling cases with surgeons, etc. This type of extremely subjective exam (despite the title) is ripe for interpretation that puts residents at the whim of cultural, personal, and acting disadvantages. The further question would be does this actually add anything to the skills of the physician? What do Residents (And Program Directors) Think of OSCE? The study conducted by Dr. Goudra looked at what residents thought of the value of OSCE was not good. In fact, 90% felt that it was a useless component that provided no benefit to determining whether someone was a good physician or better clinician. A previous study conducted by the ABA actually found that a majority of program directors also thought the exam was not worthwhile - yet it was implemented and still exists. This is about as good an example of the specialty boards' complete lack of accountability and focus on revenue. We've talked about all their problems with recertification here, here, and here. Learn more about your ad choices. Visit megaphone.fm/adchoices

Throughout the pandemic that has raged over the past two years, the press and public have leaned heavily on experts on navigating our way through uncertainty. The most prominent member of this class of public health experts is Dr. Anthony Fauci who is essentially the face of the pandemic response and sets policy used by most state, county, and local public health officials. Unfortunately, through a number of missteps and poor communication techniques, the trust in Dr. Fauci and public health in general have suffered tremendously this year. How Mistrust Develops Dr. Pomerantz points out that the loss of trust in public authorities is multifactorial and influenced by things like over reassuring the public, panicking and overreacting, flubbing the rationale for lockdowns, abandoning the flatten the curve plan, and insisting that public health be in charge of many aspects of the pandemic response. All of these points were areas where the public health authorities made mistakes leading to a continued erosion of trust in their abilities, motivations, and perception of expertise. Can We Rebuild Lost Trust in Public Institutions? Losing trust in public health, or the health system in general, is not one that should be viewed lightly. It can have profound long lasting effects. This is exhibited by the research from Dr. Sara Lowes (from episode 120) where she found distrust towards modern medicine generations after unconsented medical experimentation in parts of previous colonial France (Congo). What is amazing is the passing down of distrust towards medical authorities for years despite obvious advances in medicine and ethics. Unfortunately, for trust to be rebuilt there must be a tremendous effort put in by public health authorities. This begins with a big mea culpa for all their mistakes in messaging and getting things wrong (like mask flip flops, vaccines stopping transmission, etc.) and also the endless shaming and 'othering' of those who run contrary to their edicts. The most critical aspect of all of this is to bring back the part of the public that has been pushed out of the group by showing empathy. Unless that is done - and soon - we risk delegitimizing public health for generations. Learn more about your ad choices. Visit megaphone.fm/adchoices

DonorSee is a New Innovative Way to Run a Charity with Gret Glyer When Gret Glyer decided to search for meaning in his life after a short stint in corporate America by flying on a whim to Malawi, he never expected that in less than ten years he would create and run a multi-million dollar global charity. In his search for a fulfilling life, Gret found much more - an innovative way to raise money for those in need. Using Video to Fundraise Soon after arriving in Malawi - one of the poorest countries on Earth - Gret recognized the tremendous material needs for so many and he sought to find ways to help. He began by blogging and asking for help but found that it didn't resonate the way he had hoped. So on a whim, he figured he would harness the power of video and document those in need and then follow up after people had provided the financial support. He was struck by how capturing the need and success in video brought people the personal connection they rarely got with traditional charitable organizations was so powerful. Later, he harnessed the powerful draw of video to launch an incredibly ambitious project to build a self-sustaining all girls high school - in 12 weeks. Building a School Prior to crowdfunding for the school, all of the projects Gret had done were small in their scope. He had never embarked upon a project this ambitious He would need to raise a little over $100,000 in just twelve weeks in order for the school to open in time for school that year. Perhaps the most critical steps of this project were that there was overwhelming support for the creation of the school within the village and he had a local partner who had a plan. Her plan was not just to build a school but how to fund it, staff it, and educate girls in a self-sustaining manner throughout the years. So he then embarked on a fund raising plan to document by video weekly laying out the vision and then the construction of the school as they raised the money. Through this concept Gret pulled all the donors along the way to show exactly where their money went and the progress it made. Amazingly, his efforts raised the necessary capital to complete the school and it opened that fall in 2016. To this day, the Sunshine Academy is doing great graduating girls in a country where girls almost never receive secondary education. DonorSee is Born With this proof of concept, Gret launched DonorSee a few weeks later where people anywhere in the world can donate directly to a project and then receive a video update afterwards where they are usually personally thanked by the receiver of the funds. Projects range from buying a goat, paying for simple medical expenses, building homes, and paying for education. You can either pick out individual projects or donate monthly to random projects. No matter how you choose to contribute, you receive video feedback of the impact of your donations. Relief Vs. Development An important aspect to charity is being mindful of the impact that the donations have. We must be careful to separate relief from development. Sometimes, an individual just needs relief like after a natural disaster or medical emergency. But we must be careful to not provide services and goods that result in preventing the local economy from developing properly. That is why it is so important to have people on the ground with local knowledge to vet projects and makes sure the relief allows for human flourishing and not dependence. To that end, Gret and his partners in Malawi started a very ambitious project to build a self sustaining STEM school to train the next generation of scientists, doctors, and technicians to help move Malawi into the 21st century and serve as a bright example for other African countries. Learn more about your ad choices. Visit megaphone.fm/adchoices

Vaccine mandates, mask mandates, boosters, and variants have been a constant source of debate and controversy with the pandemic. My guest today is Dr. Monica Gandhi, an expert in immunology and infectious disease who runs the HIV clinic at UCSF. She has been a fairly prominent voice in support of the mask and vaccine mandates in her home state of California and city of San Francisco. She returns from her visit in June where we discussed the delta variant for SARS-CoV-2 in which she guessed that it wouldn't evade the vaccine or prior infection (spoiler alert: she was right). Do Vaccine Mandates Make Sense? Dr. Gandhi is the first to point out how she has been very supportive of mandating vaccines in the general population and specifically for health care workers. She has written extensively in many local and national outlets about the case for vaccines to reduce transmission of SARS-CoV-2 and hospitalizations. However, she has begun to rethink her support for these draconian measures because of a number of reasons: It can cause a problem with mental health in those who are restricted from interacting normally with society. It erodes the public trust in public health officials and well established measures. Even when vaccinated and boosted, those individuals can still become infected and infect others limiting its value as a way to stop transmission in its tracks. The political payback for politicians who support these measures may be significant at the ballot box. Are there Good Therapeutics Coming Out? One of the more exciting developments out of the pandemic is the emergence of designer drugs for this coronavirus. The newest therapeutic drugs are protease inhibitors which can be developed with a specific virus in mind. These drugs work by blocking the ability of the virus to successfully hijack your cell's ribosomes to create more viruses. Molnupiravir has been approved by the FDA but hasn't been shown to be all that effective because it was not designed with this specific virus. However, the new drug Paxlovid has show extremely high efficacy approaching levels seen with the vaccine around 90%. The advantage of these drugs is obviously that as soon as you show signs of symptoms it can arrest the extent of the infection and prevent hospitalizations and worse outcomes. Is Omicron Worth Worrying About? Finally, the question of whether the new SARS-CoV-2 variant, Omicron, is one that should concern us was posed to Dr. Gandhi. Much like the Delta variant, she is very confident that those who have gotten an adequate immune response from vaccination or prior native infection should be well protected from serious harm. Additionally, reports out of South Africa and elsewhere have seemed to show that this variant causes a much more benign infection. She believes it is possible that this variant - if it is truly more infectious but benign - might be the world's ticket out of this awful pandemic. Learn more about your ad choices. Visit megaphone.fm/adchoices

What happens when you take Go Fund Me and put it into an ecosystem of likeminded folks who want to build a community to care for each other's health care expenses? You get Crowd Health which draws upon some of the concepts of crowd funding for one time health care expenses within its community. By taking people from all over the country and putting them into a community where there are expectations of caring for others, Crowd Health offers a solution to paying for health care expenses without breaking the bank. Is Crowd Health Insurance? If you've been paying attention to the US health care space for the last, well, forever, then you know that it is expensive and keeps getting more so. People stay at jobs they don't like just to keep their health care coverage which is often not very good anyway. However, for those who are self employed or with a very small business, it seems their only option is to go out onto the open ACA exchange and grab a lousy and expensive plan that hardly covers anything. Crowd Health offers an alternative to paying for health insurance. Although it definitely isn't insurance since you are asked to pay into your own bank account each month to be prepared to pay others' health expenses. There is also no guarantee that your expenses will be paid as you often have with a traditional insurance policy. However, oftentimes even with traditional insurance you don't get everything covered and have to cover up to the deductible and everything over until you hit your out of pocket maximum. And that's before considering the inflated prices paid by insurance companies. Is Crowd Health a Health Sharing Ministry? The answer to this question is more complicated. In short, yes and no. We discussed sharing ministries in my previous ventures with Samaritans and an episode with Liberty Health Share. Basically, in a sharing ministry you send your monthly 'premium' to someone in the community. If you have a health expense, you submit a claim after you pay the bill and people will then mail you checks to cover the expense. The down side of this process is that the delay to getting paid can be fairly long (months) meaning you will have to have the funds to cover the bill that might be fairly large. And people don't often have that much money sitting around in the bank. How Does Crowd Health Work? CEO Andy Schoonover describes the fairly simple mechanics of Crowd Health. You take a group of like minded people who want an alternative to the traditional way of paying for health care. Then you have them commit to contribute a small amount to run the overhead of the community which helps pay for the technology and people tasked with negotiating with local hospitals, etc. and assisting patients with their navigation through the health care space. Community members pay the first $500 of a health care event and then request the community fund the remaining amount. Each community member then has the option of helping out or not. Each member carries a social credit score determined by how often they 'help', ask for help, or shop around for less expensive health care options. Learn more about your ad choices. Visit megaphone.fm/adchoices

The COVID Drawdown Today we are going to discuss the COVID drawdown. Essentially, this is what must inevitably happen for us to return to lives of normalcy where we have typical interactions with others at family gatherings, sporting events, concerts, and business meetings. Unless we are prepared to radically change the way we live our lives and choose isolation (which probably has far greater physical and mental health detriments) then we have to consider how the drawdown occurs and what conditions ned to be present for it to happen. What HaS TO HAPPEN FOR THE DRAWDOWN TO OCCUR? We've talked to numerous experts who all have various opinions on how the pandemic will play out and what strategies will be needed to get to the 'other side' of the pandemic. You can find the initial conversation with Dr. Graham, immunology with Dr. Gandhi, and science ethics with Dr. Bhattacharya on the episode list at the end of this writeup. The following is a short list of what conditions need to be present to return to normal: Broad acceptance of the fact that the virus, SARS-CoV-2 which causes COVID-19, will become endemic. Recognition that the endemic virus cannot become eradicated and will absolutely infect everyone - probably multiple times. Understand that vaccination including booster shots will not significantly stop transmission of the virus but only provide protection from serious illness. Sterilizing immunity (protection from infection) for SARS-CoV-2 will be temporary whether one has had vaccination or prior natural infection. Accept that no measures to stop transmission outside of severely draconian restrictions on movement and social interaction have middling effects on the spread of the virus. We will have to be comfortable with no longer 'looking' for the virus with every respiratory illness and only test those whom we feel are at high risk or can use novel therapeutics. Public health officials, politicians, and policy makers have to accept that there is very little that can be done to 'contain' the virus. What the Drawdown Will Look Like The drawdown will look different depending on what part of life you are looking. Schools:  Most schools will continue their current policies through the end of this school year. Next year, most school systems will have returned to pre-pandemic policies of no temperature checks, mask wearing, etc. Only the most heavily unionized schools or urban will mandate extreme measures like vaccinations. This will become even harder to enforce as the majority of the country has returned to normal and we see a striking similarity of outcomes between the two ways of schooling. Universities: Already there are differing policies in place between schools and the lack of differences with outcomes will move nearly all universities to eliminate all restrictions next school year. Mask Mandates: These will disappear completely by next year in almost the entire country. The political cost for maintaining these measures will be increasingly steep and politicians will declare victory over the virus and insist that their earlier measures did their job to save lives but are no longer needed. Vaccine Mandates: Despite attempting to impose these mandates through federal fiat on transportation and for air travel - these will disappear as more and more states reject their use. Hospitals: Health care facilities will still likely be burdened with extraordinary personal protection measures like masking at all times throughout all of next year. The federal government controls this regulation and unless there is extraordinary political pressure these will continue. Perhaps the loss of workers in health care will encourage the removal of this rule but that will take longer than this year.   Learn more about your ad choices. Visit megaphone.fm/adchoices

When you run a business, one person you usually meet and hire is a health insurance broker. In theory, these brokers work with the employers to secure the best deals for health insurance to meet the company's health care objectives. However, in practice, the brokers serve as a sales force for the insurance companies who lavish them with bonuses, trips, and gifts. The seedy underbelly of the health insurance broker industry is that they are really not working to save money or get deals for their clients - the checks are written by the insurance carriers and that's who they answer to. Who do the brokers work for? You or the Carriers? I spoke to Katy Talento in episode 111 who runs a business where she unbundles health insurance for employers and helps them run an efficient and less expensive health care plan. One of the problems she saw is that insurance carriers bundle all these services and then charge a very large administrative fee to run the plan. Also, their plans rarely save you money as they build in enough profit to cover the agents who sell those plans - the brokers. That's the world that David Contorno is trying to combat with his company at ePowered Benefits. The business was founded with the intent of looking at real ways of not just unbundling but finding high quality and inexpensive ways to receive care. As Contorno said, "The only way to pay less for health care is to pay less for health care." Health Plans Are Gimmicks Through his 18 years of experience in the health insurance broker field, David points out that most of the various plans sold by insurance carriers are really just gimmicks that don't really change the cost of care. Whether it is an HMO, PPO, of some hybrid FFS plan - it ultimately just ends up being the same in failing to control costs. The reason is that the care comes from the same hospitals and with the same contracts no matter how they make the employers and employees pay with copays, deductibles, and coinsurance. Even HSAs (health savings accounts) which are held up as a way to control costs by putting the patient in charge, rarely bring about the cost control as advertised. This is primarily because even using an HSA and picking where you get your care still is within the framework of hospitals, insurance contracts, and provider networks which all have massively marked up prices. Only by leaving the insurance network entirely can one see real savings. Why Don't the Brokers Work for You? Simply put, the work that health insurance brokers do is to carry water for the insurance carriers. The carriers are the ones who pay their bonuses, provide them with expensive trips to Tahiti, and give them sales targets for selling their plans. The checks aren't written by employers but by the insurance carriers. So naturally, the brokers respond first and foremost to what the carriers want. This doesn't make them bad people but understandably their incentives are not aligned with those you'd hope. The reason most brokers don't even know they're working for the wrong people is best summarized by the quote from Upton Sinclair, "It is difficult to get a man to understand something when his salary depends on him not understanding it." David Contorno is the CEO and founder of ePowered Benefits. David spent 18 years as a traditional broker in health insurance but felt that it could be done in a better way. Learn more about your ad choices. Visit megaphone.fm/adchoices

Not only has the COVID pandemic politicized our country - it has led to a lot of misinformation and a shutdown of communication. For instance, is there really asymptomatic spread of COVID? Or just pre-symptomatic and symptomatic spread? That might seem like splitting hairs but it can have a profound effect on policy for quarantining and testing. We've talked about this before on the show as well as general discussions on COVID policy which can be found here, here, and here. 12 Myths and 12 Facts About COVID-19 If there is one certainty during this confusing pandemic it is that there are plenty of myths circulating in the media and popular culture about COVID. In fact, many of the things we think we know are wrong. Public officials get them wrong. Doctors and nurses get them wrong. The CDC and FDA get them wrong. Unfortunately, once we discover the truth, often the word doesn't get out there widely enough to change behavior, regulations, or rituals. Dan Halperin points these out in his book on 12 common myths and 12 uncommon facts about COVID-19. One great example of this is the transmission of SARS-CoV-2 on surfaces. We have almost no instances of the virus transmitting in this manner and it travels almost exclusively through aerosol means. However, despite this, businesses, individuals, and regulatory agencies still act as if 'deep cleaning' and intense adherence to eliminating surface contamination will help prevent viral transmission. This is patently false but it's been over a year since we have known this and yet we are still wasting our time practicing this type of hygiene. Another example of a myth believed by many is the transfer of viral particles from asymptomatic individuals to uninfected people. There are almost no documented cases of this type of infection yet we treat asymptomatic infection almost as a common vector. It is important to note that there is pre-symptomatic spread but people who never develop any symptoms just aren't infectious. It is also true that you never know if you're about to become symptomatic but we could certainly change the way we approach close contacts if the infected person never develops any symptoms. Is the Current Environment of Scientific Debate Akin to McCarthyism? Not only has Dan Halperin written on the epidemiology of COVID but he has also weighed in on his concerns with the academic and public nature of scientific debate. He notes how one of the creators of the mRNA technology expressed some "strange views" which many did not agree with. But instead of rebutting the researcher's concerns, he was virtually eliminated from history. His contribution to the development of mRNA technology was removed from Wikipedia and he has been eliminated from all common public forums. Dr. Halperin says it feels a little like McCarthyism which happened in the 1950's over concern that the Soviet Union and communists were infiltrating American government and society. At the time, most Americans were in favor of the practice of 'blackballing' people because of the perceived threat of nuclear annihilation from our Cold War adversary. Only through the lens of time can we now look back and find the practice objectionable and he suspects the same will be the case with our current lack of public acceptance of differing opinions on COVID. Daniel Halperin is an epidemiologist and full professor at the University of North Carolina School of Public Health and the author of the book: Facing COVID without Panic: 12 common myths and 12 lesser known facts about the pandemic. Learn more about your ad choices. Visit megaphone.fm/adchoices

There are a lot of urgent care clinics all over the country. But few of them, to my knowledge, also operate as regular primary care clinics. But that is exactly what is happening today in the Houston, Texas area with the emergence of Next Level Medical. If you think about it, it makes perfect sense to leverage all the facilities needed for a primary care clinic - exam rooms, physicians, etc. and use it to deliver regular and sometimes non-urgent care. We've discussed free standing ERs before that lower the cost of care with transparency so this seems like the next logical step with urgent care. We have also discussed pediatric urgent care clinics but those never had the component of doubling as primary care. What is Urgent Care? Probably the most puzzling questions you can ask even someone who works in health care is: What is the difference between urgent care and emergency care? The answer is that it depends which is why you really need a better triage system that people (patients) can access before then head across town to either the ER or UC clinic. It's this triage that is probably the most important way to keep ER visit costs low and less frequent. This is one of the services offered by Next Level Medical to their members. Why Urgent Care Membership? At first, it seems strange that one would establish any sort of membership status with an urgent care clinic. But Next Level has made it work by basically selling it as a one stop primary care clinic. Or a primary care clinic on steroids that comes equipped with supplies for taking care of fractures, lacerations, laboratory studies, and imaging. And if you have the same staff working a regular schedule you can get physician continuity for patients making well care a very achievable goal. Employers like the flexibility as it provides the primary care for their employees with convenience since there are clinics all over town. Additionally, the clinics can care for their employees who might get injured either at home or work. This added benefit means a whole lot less in expensive ER care and probably healthier employees since their primary care is taken care of without all the copays and hidden costs that keep lots of hourly employees from staying on top of their chronic conditions. Doctors Like the Schedule Doctors looking to become employed usually have to make a lot of concessions. First in their autonomy and second in the lack of control over their schedule. The amount of work they take home or 'unpaid' time can be large at times making a forty hour a week job quickly turn into 50 or 60. This is where Next Level can offer doctors the opportunity to truly do shift work, have a regular patient panel, but not take home their work and let the sophisticated call center triage their patients overnight. Dr. Juliet Breeze is the founder and CEO of Next Level Medical which offers membership based urgent care services in the Houston, TX area. show notes Episode 146: Today's show Next Level Medical: Dr. Breeze's urgent care clinic company. [email protected] - Dr. Breeze's email if you want to contact her. LinkedIn: Dr. Breeze's profile Episode 035: Free standing and fully transparent ERs is Oklahoma Episode 069: Pediatric urgent care clinics to eliminate a lot of the burden from the ERs. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Learn more about your ad choices. Visit megaphone.fm/adchoices

A lot has happened since we last met with Dr. Keith Smith from the Surgery Center of Oklahoma back in 2018. Back then, we talked about how he brought the radical notion of full price transparency to the surgery space in 2009 all without taking any government payers. We also spoke about how the system was rigged to enrich the hospital systems, insurance carriers, and PBMs (what's new right?). So what's happened since then and how has the center done with the pandemic? Is the Surgery Center of Oklahoma Thriving or Just Surviving? Not surprisingly, Dr. Smith says that the center is doing just fine and has increased its market share from other states. Additionally, the international community from Canada is now being allowed to come back into the US for their surgeries which are more backed up than ever. His surgery center is a great alternative for an increasingly backlogged health system that is strained under the COVID crush of patients. Can Other Surgery Centers Dabble in Direct Contracting? One interesting aspect to Dr. Smith and his crusade for more transparency and market forces within medicine is the development of using clearinghouses for arranging surgery. The clearinghouse is used as a quick means for posting prices anonymously and then linking the agreeable surgery center and potential payers who are either patients or employers.. This is a great way to ease into direct contracting for a lot of surgery centers that are still dealing with commercial and government contracts. What is the Future for the Free Market Medical Association? Dr. Smith says the FMMA has grown significantly over the past few years as more and more facilitators, physicians, surgical centers, and administrators gather to learn how to harness the market to increase their book of business. Now that the pandemic has caused a lot of disruption in the market people are really starting to look for fresh solutions to survive and the FMMA feels like it has just what they need. Anyone can sign up and their next conference in in April 2022. Dr. Keith Smith is the co-founder of the Surgery Center of Oklahoma which has 100% price transparency which opened its doors in 1997. He also founded the Free Market Medical Association which works to promote the free market in all health care transactions. show notes Episode 145: Today's show Surgery Center of Oklahoma: Dr. Smith's 100% price transparent surgery center in Oklahoma City, OK. Free Market Medical Alliance: The organization that Dr. Smith helped co-found to encourage using the free market in more US health care transactions. @SurgeryCenterOK: Twitter for the Surgery Center of Oklahoma LinkedIn for Keith Smith, MD Atlas Billing Company: The company that helps link employers with surgery centers without posting all their prices openly to allow some direct contracting. Episode 012: Dr. Keith Smith on a fully transparent pricing system for surgery. Deputy: Today's sponsor who helps you with your employee scheduling and so much more. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Learn more about your ad choices. Visit megaphone.fm/adchoices

A big struggle for doctors is when they watch what goes on in the state and national legislatures and realize that there is very little knowledge of what they do, how they practice, and what they did to get where they are. There are no better examples of this failure to understand the nature of what physicians do than the debate over the Affordable Care Act (Obamacare) in 2013.That episode was what put the fire in the belly of today's author, Dr. Matt Moeller, to write his article that went viral and later led to a book. Professional Stresses There are quite a few stresses that cause lots of problems for practicing doctors Inconsistent schedules making a home life difficult to plan Multitasking by expecting doctors to do multiple things at once No downtime to get away from work where patient concerns (following up lab results, etc.) never stop even on vacation or after hours Rules and regulations The Difference Between Income and Wealth Doctors usually command a big income but don't accumulate wealth until much later in life. This puts them at a disadvantage as income is taxed much more heavily than wealth. It also makes it much harder for doctors to catch up financially to others who began working in their 20s and compounded their wealth and were not as saddled with student debt. How Do You Discourage Doctors? Keep technology complicated and makes doing their job harder. Insecurity among medical staff with their pay and jobs in perpetual jeopardy Turning them from decision makers into decision implementers (algorithm medicine) Escalating productivity expectations Increased responsibilities with decreased autonomy leading to learned helplessness Placing more barriers between physicians and their patients Solutions to What Ails Health Care Simplify costs and reimbursement and increase transparency Reform tort laws Increase the role patients have in their own health through expanding HSAs Prevent chronic illnesses Reign in the numbers and salary of administrators Dr. Matthew Moeller is a gastroenterologist in Grand Rapids, MI and the author of What It's Like to Become a Doctor that addresses the journey through medicine training. The second half of the book spends time addressing the problems in medicine and some potential solutions. show notes Episode 142: Today's show   Dear Lawmakers: This is what it's like to be a doctor today: Dr. Moeller's seminal piece that become viral and was reposted in mainstream media in 2013. Dr. Moeller's KevinMD Page Live Free Now Podcast: Hosted by John Bush Dr. Moeller on LinkedIn: LinkedIn link for Dr. Moeller. Locum Story: Today's sponsor who will help you find locum tenens opportunities. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Learn more about your ad choices. Visit megaphone.fm/adchoices

Ask any primary care physician and they will tell you the toughest thing about helping their patients change lifestyle is that they don't have enough time or contact with the patient. Especially when it comes to weight loss control, primary care docs are stretched so thin on time that they struggle to have the impact they'd like on their patient's healthy habits or lack thereof.  Weight Loss Begins with Awareness It's no surprise that a successful weight loss program begins with awareness that you have a problem with weight and your lifestyle. Dr. Egan, says that to be successful one must stay focused on a number of things. All of these are a priority with her management style at her new practice:  Relationship with food. One must pay attention to why they are eating and to recognize healthy and unhealthy options. This is all with an awareness of how we are often left with no perfect options because we don't have the right ingredients, time, or abilities. Movement. This goes beyond just saying someone needs to exercise. The movement program must be created with the specific patient in mind and their input. Medications. Sometimes once the other parts are optimized, it is best to look at medications to supplement the rest of the weight loss program. A well designed drug regimen including hormonal treatments can be the difference between success and failure. How to Pull Off Weight in Primary Care Dr. Egan is teaming with Dr. Bitner (from episode 115)  and using an entirely new model of care to help women lose weight. Instead of trying to develop a multidisciplinary clinic through an insurance based model, they have decided to go with a membership model where they limit the number patients to allow for more time and contact with the physicians. It's similar to direct primary care but probably more accurately described as direct contracting. I suspect it will be a much more successful model for getting patients the results they want than through the traditional insurance model. Dr. Egan is an internist who is board certified in weight management and will be starting at True Women's Health in August, 2021. show notes Episode 138: Today's show True Women's Health: Dr. Egan's new practice where she will work with Dr. Bitner. True Women's Health on LinkedIn Dr. Celia Egan on LinkedIn True Women's Health on Facebook @truewomenhealth on Twitter Physician Advocacy Institute: This is organization who conducted the survey and is committed to keeping a vibrant marketplace for physicians by helping advocate for them and providing resources to aid in their practices. @PhysAdvocacy: Twitter for the Physicians Advocacy Institute. Episode 115: Dr. Bitner on leaving corporate medicine to practice OB/GYN in an innovative model. Episode 102: Dr. Fung on the advantages of intermittent fasting. Episode 107: Dr. Fung on cancer and how excessive weight puts you at increased risk for cancer. Care Cloud: Today's sponsor and a sister show on the Doctor Podcast Network hosted by Care Cloud that will give you a free assessment of your practice business. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Learn more about your ad choices. Visit megaphone.fm/adchoices

Being an expert has a lot to do with muffins. Or rather, when I was eating a fresh muffin the other day for breakfast it certainly got me thinking about experts. You see, I eat my muffins differently than the rest of my family. They break off the top of the muffin and butter the top and then the bottom. I felt like it would be better to cut my muffin down the middle so I could eat a muffin top with every bite (since the tops are the best). Well, this brought teasing from my kids and wife. The other day, my daughter got a broken muffin so she had to eat it 'my way' by buttering it down the middle. She admitted after eating it that I was right and my way was better. We both considered ourselves experts in what we liked to eat. Who Is an Expert? The definition of what an expert is is fairly well defined but the exact qualifications is not. Being an expert is probably more a matter of degrees of knowledge and mastery than any absolute number. I am certainly more an expert in all things medical than most people, but when compared to other physicians that would sometimes not be the case.   Is the Expert Really an Expert in What We Are Discussing? The biggest problem with the use of the term expert over the last year and a half of the pandemic is that we proclaim people experts when they can't possibly be experts. No one has lived through a unique respiratory viral coronavirus pandemic such as we are having. Yet, many proclaim that they know the best treatments, mitigation measures, and modeling predictions. Certainly, some have a better foundational knowledge than others but since this is brand new there is no way anyone can be an expert in this particular disease/phenomenon. Stay Humble Ultimately, if you are in this space where you might not really be an exact expert in what is being discussed, you need to acknowledge it and accept some humility that you can't know. Also, you have to be open the possibility that you may, in fact, be completely wrong. Even experts in their own specialized field are occasionally wrong and must recognize that and be even more cautious when giving 'expert opinion' on topics in which they can't know as much. Self reflection on who an expert is and whether they might be wrong is critical. show notes Episode 137: Today's show Doctorpodcastnetwork.com/advicemedia: Advice media helps you fix your online social media engagement issues. Click now to get a free $60 amazon gift card just with a complimentary consultation. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.     Learn more about your ad choices. Visit megaphone.fm/adchoices

There has been no shortage of casualties in the last year and half with the COVID pandemic. Schools have been closed, businesses shuttered, and families torn apart with different levels of concern for the virus. But one surprising victim has been science itself. The practice of scientific inquiry, discussion, and debate disappeared. Instead of science - which we can loosely define hypotheses that are then tested and either proven or disproven - is longer present when it comes to COVID. Learn more about your ad choices. Visit megaphone.fm/adchoices

If you want to get a doctor's blood pressure up or make her sweat, just tell her that you have a great electronic health record (EHR) to use. EHRs are the bane of a physician's life because they don't work well with your work flow, create extra work and inefficiencies, and cost a ton of money. That's why I spoke to Dr. Richard Sztramko of Hamilton, ON who is co-founder of Arya health technology company that has designed a new EHR. Learn more about your ad choices. Visit megaphone.fm/adchoices

"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals and funeral homes. Are the variants that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi, the answer is a simple no. Learn more about your ad choices. Visit megaphone.fm/adchoices

This year, the Colorado legislature introduced a bill to radically change the way health care would be delivered in the state. HB 21-2132 was introduced this year with the hope of creating a public option health insurance for everyone in Colorado. Of course, their expectation is that they will lower health care expenses by over 10% with this plan. If this doesn't happen, the hammer comes down on everyone providing care and they lose their license to practice. Learn more about your ad choices. Visit megaphone.fm/adchoices

In many ways, Dr. Fauci's failure to properly handle the pandemic response with COVID was inevitable. Men like him - according to my guest Peter Suderman of Reason.com - believe in the general infallibility of the bureaucratic process. They think that by following a mechanical paperwork process that they will come to the best, safest, and correct conclusions. These public health bureaucrats also hold a paternalistic view of the average citizen and that those citizens need their protection.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Perfection. We all strive for it. Some more than others, but we all look to be better versions of who we are. In medicine, we tend to be high achievers so we want to 'conquer' parenthood. Being perfect isn't any more possible in parenting than it is in medicine. Human relationships are messy and raising children up to be the best versions of themselves has no handbook. The push and pull of you trying to get your kids to be who you think they should be is often at odds with who they think they should be. Learn more about your ad choices. Visit megaphone.fm/adchoices

The most important question we have to ask ourselves is who should get the vaccine? The question comes down to who should get the vaccine, or rather, who shouldn't get vaccinated? This is where Dr. Noorchashm argues that anyone who has had COVID-19 and cleared the disease should not get vaccinated. A near immunological certainty is that once you have cleared a viral infection, you have immunity that is at least if not more robust than immunity you can acquire from a vaccine. Learn more about your ad choices. Visit megaphone.fm/adchoices

We're talking about COVID and our American Independence Day from SARS-CoV-2 on June 1, 2021. The first thing I need you to do is look down and if you're wearing a red shirt, take it off. Not just one sleeve, take it all the way off. Likewise, if you're wearing a blue shirt, I need you to do the same thing. There are no red teams or blue teams here. We're just Americans. It's time to open up. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today's episode strikes right to the heart of the reason I started this podcast - the injustice of maintenance of certification. If you're a doctor, you know all about the unfairness of this system which requires more money, paperwork, money, testing, money, time away from patients and families, and money. It contributes to physician burnout. For patients, it is why your doctor might retire early, look stressed out, or be unavailable when you need him or her most. Learn more about your ad choices. Visit megaphone.fm/adchoices

Health care, according to today's guest Dr. Eric Bricker, is filled with euphemisms. One you hear a lot is value based care. The claim is that we need to restructure insurance plans to reward health systems that provide care focused on outcomes instead of activity. Conceptually, it makes a lot of sense that you would reward the people providing superior outcomes with better pay. Unfortunately, this scheme has been tried before and failed. It's unlikely the outcome will be any different this time around. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, we depart from our pandemic of SARS-CoV-2 to discuss what was easily the number one killer of colonial Americans in the Revolutionary War - infectious disease. It is estimated that battle casualties totaled 5-6,000 while disease (infections like small pox and the like) killed between 40-50,000. The toll paid by the civilian population was even worse as loose estimates put the death toll at 100,000 from infection.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Advocates for vaccine passports are multiplying by the day. But rest assured, this a bad idea. Not only will they be impractical, they will be useless in a few short months before the passports could really be developed and adopted. In the show, I will lay out the case for passports and then explain why they are bad idea from a practical and civil liberty perspective. Learn more about your ad choices. Visit megaphone.fm/adchoices

My guest today is Dr. Vatsal Thakkar who developed an app to take away the pain for patients and health care professionals trying to file out of network insurance claims. Lots of care is provided outside of insurance contracts which requires people unfamiliar filling out insurance paperwork to do so. Thakkar created Reimbursify which does all the filing automatically and eliminating a huge pain point for these practices and their patients. Learn more about your ad choices. Visit megaphone.fm/adchoices

There is so much evidence right now that shows that the virus spreads and bursts into regional epidemics independent of local measures to contain it. This doesn't mean that masks do not work for individuals to prevent infection or protect others. However, it is pretty clear that laws don't affect much in the spread of the virus. Comparing states to one another shows that there is little difference in the extent of outbreaks based on their policies - but more dependent on where the state is located. Learn more about your ad choices. Visit megaphone.fm/adchoices

Trust is essential in medicine. Not only between a doctor and patient but between a community and the health care system. A unique difference between the United States and Africa is the relative recency of colonial powers controlling the country. Our colonial past is distant dating back to the 1700s. For Africa, it's as recent as the late 20th century. But how does history of recent colonialism affect current attitudes towards medicine? Learn more about your ad choices. Visit megaphone.fm/adchoices

Today is a departure from a direct discussion of the medicine or the US medical system. We delve into food. Food, is medicine in a way since it has physiological effects on how our bodies function. Finally, what's the deal with eggplants? If the food is locally sourced it has many inherent advantages like improved 'ripeness' at harvesting, decreased transit time and chance to spoil, and it supports a local food network. Learn more about your ad choices. Visit megaphone.fm/adchoices

One thing few outside of medicine realize are the unique challenges doctors face in their personal relationships. Marriage can especially difficult due to the unique responsibilities and expectations placed on doctors with work. Unusual hours, call, and administrative work that can find its way into the home is stress that can strain any relationship if the couple isn't careful. Learn more about your ad choices. Visit megaphone.fm/adchoices