7: The rising toll of private equity in health care

11: Standing up for kids: When one physician's voice changes everything

What if the most important thing you do as a physician happens outside the exam room? Free N. Hess, D.O., a board-certified pediatrician and pediatric emergency physician, reached this epiphany early in her career when she realized that many of the children she was treating didn't need to be there at all. "Moving from an inner-city hospital to a rural area opened my eyes to how many injuries and illnesses could be prevented by more community resources and better education," Hess said. That insight didn't just change how she practiced. It changed her sense of responsibility. "I wanted to do more than educate one-on-one in the emergency room. I wanted a larger platform." Hess took action, starting the website Pedi-Mom, launching a podcast, and branching into social media. Now a national expert on child safety, Hess speaks at medical conferences, regularly consults with families, schools, and manufacturing companies, and was even interviewed for the BBC documentary "Childhood 2.0." And her work is making a difference. Read more at MedicalEconomics.com [http://MedicalEconomics.com] [http://medicaleconomics.com/]. Music Credits Medical Education by Art Media - stock.adobe.com [http://stock.adobe.com/] Editor's note: Episode timestamps and transcript produced using AI tools. 0:17 — Dr. Free Hess introduces herself and her background in pediatric emergency medicine 1:18 — From the Bronx to rural Florida: How the move changed her perspective on preventable injuries 4:33 — Frustration with one-on-one education in the ER and the decision to build a larger platform 4:49 — Launching Pedi-Mom, the podcast, and expanding to social media including TikTok 6:09 — Safe sleep: Explaining the difference between bed sharing and room sharing, and why "co-sleeping" is a problematic term 8:18 — Why safe sleep generates so much backlash, and working with parent advocates who have lost children 11:15 — Expanding into speaking, documentaries, and consulting on child safety and online predators 12:03 — Why physicians need to be on social media and how to get started 13:25 — Practical advice for overcoming the fear of criticism and imperfection online 16:16 — Discussion of a viral post on teenage pregnancy and the broader threat of child sexual exploitation 20:11 — How advocacy opens doors: BBC's "Childhood 2.0" documentary and collaborating with outside influencers 21:22 — The scope of child sexual abuse and how social media and AI have expanded predators' reach 23:15 — Explaining sextortion: How it works, why teen boys are the primary target, and the link to suicide 25:01 — Advice for parents and physicians on protecting kids online 25:44 — The sextortion story that changed everything: A mother's message and a Department of Homeland Security arrest 28:18 — Saving parent thank-you messages as motivation, and the impact of getting just one physician online 30:19 — Advice for physicians on reaching out to peers when things go wrong on social media 33:22 — Closing thoughts on why the benefits outweigh the risks of speaking out

10: Physicians fight for malpractice reform — and win

New Mexico has faced its share of health care challenges in recent years, but perhaps none has been more urgent than the loss of physicians, many of whom cite the state’s extreme malpractice climate as a major reason for leaving.  “Between 2017 and 2024, between 200 and 300 physicians left the state as a net negative,” says Aaron Snyder, M.D. [https://www.linkedin.com/in/aaron-snyder-a8a76846/], a board-certified emergency physician practicing in Albuquerque. “It’s the only state in the country that actually had a net loss during that period.” Snyder, who has been fighting for malpractice reform since arriving in New Mexico in 2021, believes the medical-legal risk of practicing there bears much of the blame. Indeed, surgical oncologist Amani AJ Jambhekar, M.D. [https://gravatar.com/full0a5d2182e63?utm_source=email_signature], says she left the state for mainly that reason. “It wasn’t that I was personally worried I would be sued,” Jambhekar says. “It was the downstream impact of the malpractice environment on the ability to recruit collaborating plastic surgeons and provide the care our patients need.” In the two years that she practiced in the state, Jambhekar says that she didn’t see a single plastic surgeon move into her community. Jambhekar advocated for malpractice reform by writing op-eds, sharing information on social media and visiting legislators before ultimately deciding to leave the state. “As a surgeon who treats patients with breast cancer, I had patients driving more than 250 miles to get comprehensive reconstructive care. The environment was very, very challenging because of these limitations.” Read more at MedicalEconomics.com [http://MedicalEconomics.com] [http://medicaleconomics.com/]. Music Credits Medical Education by Art Media - stock.adobe.com [http://stock.adobe.com/] Editor's note: Episode timestamps and transcript produced using AI tools. 0:16 — Introduction: Aaron Snyder, M.D., on New Mexico's net physician loss from 2017 to 2024 0:37 — Amani AJ Jambhekar, M.D., on the plastic surgery access crisis and why breast cancer patients were driving 250 miles for reconstructive care 3:15 — History of New Mexico's Medical Malpractice Act and the structure of the Patient Compensation Fund 5:00 — The 2021 legislative overhaul: raised caps, uncapped punitive damages, and lumping independent practices in with hospital systems 7:52 — Personal financial exposure under New Mexico's limited asset protections 8:03 — Punitive damages attached to 92% of malpractice cases and the forced-settlement dynamic 9:42 — A $412 million nuclear verdict in a urology case accelerates the physician exodus 10:00 — A husband-and-wife primary care team closes after two decades and relocates to Missouri; insurers exit the state 15:00 — Emergency physicians absorbing primary care volume; a jaundiced patient's story prompts real-time legislator outreach in the ER 16:27 — QR codes for constituent contact, rallying major health systems, and the emergence of HB 99 18:26 — What HB 99 actually does: caps on punitive damages, raised evidentiary standard, and post-discovery sequencing 20:00 — Jambhekar on leaving New Mexico, feeling relieved, and the state as a cautionary tale for Virginia 22:54 — Jambhekar on missing her New Mexico patients; the outsider trial bar's structural grip on an unpaid legislature 25:00 — Resident retention rates, incentive gaps, and what it would take for Jambhekar to return; Snyder on how advocacy became an antidote to physician burnout 30:00 — Closing from host Rebekah Bernard, M.D. 30:40 — End

9: When facts become ‘arrogance’: Physicians push back against political theater

Physicians don’t show up to legislative hearings expecting applause. In fact, most arrive knowing the vote may already be decided. They come anyway — on their own time, at their own expense, often canceling clinics or trading call shifts — because patient safety is worth two or three minutes at a microphone. What they don’t expect is to be personally attacked for telling the truth. Yet that is exactly what happened during a recent Florida legislative hearing on a bill that would allow psychiatric mental health nurse practitioners to practice independently, without oversight by a psychiatrist. After calm, evidence-based testimony from multiple physicians outlining differences in training, patient safety risks and noncompliance with existing law, the bill sponsor closed not by rebutting the data — but by attacking the physicians themselves. They were described as “arrogant,” “obnoxious” and “greedy.” The sponsor claimed doctors were profiting off nurse practitioners, earning thousands of dollars per month per clinician, joking that physicians could use the money to “buy a plane and go to The Bahamas.” It was not a debate over policy. It was political theater — and physicians were cast as villains for refusing to play along. Read more at MedicalEconomics.com [http://MedicalEconomics.com] [http://medicaleconomics.com/]. Music Credits Medical Education by Art Media - stock.adobe.com [http://stock.adobe.com/] Editor's note: Episode timestamps and transcript produced using AI tools. 0:00 – Florida legislator’s closing remarks attacking physician testimony 0:24 – Episode introduction: Physicians speak out against unsupervised psychiatric nurse practitioner legislation 1:38 – Dr. Vicki Norton’s committee testimony on training differences and patient safety 4:23 – Interview with Dr. Norton: Reaction to lawmaker’s comments 7:22 – Introduction of Dr. Ankush Bansal 7:57 – Dr. Bansal’s testimony on physician education, ethics, and access to care 9:58 – Dr. Bansal reacts to sponsor’s personal attacks 13:32 – Introduction of Dr. Mays DeBose (South Carolina advocacy effort) 13:57 – Dr. DeBose on physician image, humility, and legislative communication 15:11 – South Carolina “turf war” characterization 15:43 – Dr. DeBose describes committee hearing experience 16:02 – Dr. Phil Schaefer testifies on lack of data 16:18 – Legislator comments about AI replacing radiologists 16:42 – Dr. Schaefer responds to AI comment 18:27 – Florida bill sponsor closing remarks (“It’s going to be cool”) 19:06 – Dr. Schaefer on legislators’ understanding of medicine 19:46 – Call to physician advocacy 20:34 – Dr. Norton on overcoming personal attacks and getting involved 22:48 – Dr. Bansal’s advice for physicians interested in advocacy 23:43 – Dr. Schaefer on why physicians struggle to engage politically 24:33 – Dr. DeBose on supporting organized medicine 26:05 – Dr. DeBose on collective voice and combating learned helplessness 28:20 – Final encouragement to join local and state medical societies 29:02 – Closing remarks from host Dr. Rebecca Bernard

8: Avoiding the ‘P-word’: Why these physicians are taking the ‘no provider pledge’

“Please stand, raise your right hand, and repeat after me: I pledge not to use the word provider when referring to physicians and further, to encourage my colleagues to do so. You may be seated.” So began rheumatologist Dr. Robert McLean’s [https://www.northeastmedicalgroup.org/physicians/robert-mclean] inaugural address as 2019 President of the American College of Physicians — and with it, his mission to eliminate the “P-word,” provider, as a term for physicians. “People stood, smiled, I got some claps, and several came up afterward to thank me,” McLean recalls. “It kind of became my moniker. For the rest of the year, at every committee meeting, I would start with the ‘No Provider Pledge. If somebody slipped up and used the word provider, they had to throw a dollar in the kitty.’” Six years later, McLean is still widely recognized among recent ACP physician leaders as the standard-bearer against the term. “At a recent AMA meeting, when the word ‘provider’ slipped into speeches by CMS Director Dr. Oz and AMA CEO Dr. Whyte, people sitting nearby would turn around and look at me and shake their heads,” he said. McLean notes that the AMA [https://policysearch.ama-assn.org/policyfinder/detail/inadequate%20to%20describe%20the%20extensive%20education?uri=%2FAMADoc%2FHOD.xml-0-3588.xml] and other major physician organizations have longstanding policy opposing use of the term. While some may argue that fighting a word isn’t worth the effort, McLean and others believe replacing physician with provider represents far more than semantics. It reflects a deeper erosion of professional identity, clarity, and trust in American medicine. Read more at MedicalEconomics.com [http://MedicalEconomics.com]. Music Credits Medical Education by Art Media - stock.adobe.com [http://stock.adobe.com/] Editor's note: Episode timestamps and transcript produced using AI tools. Introduction to the "Provider" Problem (00:00:13) Overview of the episode’s focus on the term "provider" and its impact on physicians’ roles and identity. The "No Provider Pledge" and Its Reception (00:00:36) Dr. McLean introduces the "No Provider Pledge" and describes physicians’ reactions to it. Origins and Spread of the Term "Provider" (00:02:34) Historical background of the term, its use by insurance companies, and its effect on healthcare roles. Confusion in Clinical Titles and Patient Perception (00:04:06) How patients are confused by titles, and the implications for care and professional identity. Declining Standards in Nurse Practitioner Education (00:06:18) Concerns about the quality and rigor of nurse practitioner training and its consequences. Legislative Changes and Nurse Practitioner Autonomy (00:07:36) Dr. McLean’s advocacy experience and the evolution of laws allowing nurse practitioners more independence. Differences in Training: Physicians vs. Non-Physicians (00:10:10) Discussion of the rigorous, standardized training for physicians compared to other practitioners. Personal Sacrifice and Physician Burnout (00:13:07) Dr. Alaba shares the personal costs of becoming a physician and the emotional impact of being called "provider." Corporate Medicine and Physician Demoralization (00:15:14) How corporate healthcare, loss of autonomy, and generic titles contribute to physician burnout and suicide. Propaganda and the Visual Blurring of Roles (00:17:12) Analysis of social media posts that visually equate physicians and non-physicians, reinforcing the "provider" label. Physician Reactions to Lack of Recognition (00:18:22) Doctors’ emotional responses to being grouped with non-physicians and the importance of proper recognition. Strategies to Reclaim Physician Identity (00:19:33) Dr. McLean discusses ways to push back against the "provider" term and reclaim professional identity. Relational vs. Transactional Care (00:21:22) Emphasis on the unique physician-patient relationship and the dangers of commoditizing healthcare. Market Forces and Commoditization of Medicine (00:22:32) Discussion of how insurance and private equity treat healthcare as a commodity, harming the profession. Comparison to Legal Profession and Final Thoughts (00:23:25) Comparison to law, concluding with a call for physicians to reclaim their identity and resist being called "providers."

7: The rising toll of private equity in health care

A newly published study in the Annals of Internal Medicine [https://www.acpjournals.org/doi/10.7326/ANNALS-24-03471] has added more fuel to the growing alarm over private equity’s expanding role in American health care. Researchers found that hospitals acquired by private equity (PE) companies experience a decrease in staffing and salaries, as well as an increase in emergency department patient deaths and patient transfers to other hospitals. This isn’t the first time such concerns have surfaced. Previous studies [https://jamanetwork.com/journals/jama/fullarticle/2813379] have shown that patients treated in private equity–owned hospitals suffer more hospital-related adverse events including bloodstream and surgical site infections and falls. A 2023 systematic review [https://www.bmj.com/content/382/bmj-2023-075244] went further, concluding that private equity ownership was consistently associated with increases in costs for patients and payers with mixed to harmful impacts on quality, noting an association with reduced nurse staffing levels and a shift towards lower nursing skill mix. Researchers concluded: “No consistently beneficial impacts of PE ownership were identified.” To explore how these findings play out in the trenches, Physicians Taking Back Medicine spoke with two doctors — anesthesiologist Marco Fernandez, M.D. and emergency physician Robert McNamara, M.D. — both of whom have witnessed firsthand the consequences of private equity in health care and are now leading efforts to reverse its influence. Music Credits Medical Education by Art Media - stock.adobe.com [http://stock.adobe.com/] Editor's note: Episode timestamps and transcript produced using AI tools. 0:00 – Intro Announcer tees up new study showing ED mortality rises after private equity hospital acquisitions.  1:22 – Guest Intro: Dr. Marco Fernandez Anesthesiologist; president, Midwest Anesthesia Partners and Association for Independent Medicine.  1:41 – Hospital Contracts Replaced by PE Firms Fernandez explains two contracts lost to TeamHealth and NorthStar, no RFP, community backlash, OR shutdowns.  4:32 – Dr. Robert McNamara’s Background Long-time critic of private equity’s role in emergency medicine; sets context from a 2021 interview.  5:00 – How Private Equity Operates Investment return expectations, cost-cutting, staffing model changes, profit over patient care.  6:34 – Study Data: Mortality, Staffing Reductions ED death rates, declines in FTEs, salary cuts in ED/ICU after PE acquisition.  7:21 – Personal Impact on Fernandez & His Family Private equity staffing squeezes, inadequate nursing support, and his mother’s suffering.  10:32 – Wider Trend: Mortality in PE-Owned Facilities Research also finds higher death rates in PE-owned nursing homes and hospice.  10:52 – “Penny Wise, Pound Foolish” Fernandez on leadership short-termism, physician exodus, higher long-term costs, persistent understaffing.  11:57 – Working With Legislators & AGs Corporate practice of medicine laws, tightening loopholes, educating state leaders.  13:03 – What Corporate Practice of Medicine Means McNamara explains non-physician control, enforcement failures, and harmful workarounds.  14:23 – Grassroots & Organized Medicine Joint advocacy efforts, silos among specialties, need for education and alignment.  15:47 – Reimbursement Reality for Anesthesiology The “30% problem”: Medicare valuation error in the ’90s, lower unit pay, subsidy dependence.  17:26 – How the Miscalculation Happened Time not accounted for in reimbursement; only anesthesia affected.  18:01 – Subsidies, Locums, Unsustainable Economics Why most anesthesia groups now require hospital subsidies; Fernandez’s pivot to independent contracting model.  19:39 – Private Equity Pitch: “Efficiency” and Subsidy Cuts Bait-and-switch promises to administrators; consolidation and extraction incentives.  21:29 – Golden Parachutes & Senior Partners Deals driven by outgoing partners, quotas, short visit times, erosion of practice control.  22:28 – Strategies to Fight Back Litigation, protecting physician groups from corporate replacement, expanding advocacy.  23:33 – Going Beyond AMA & Specialty Societies Coalition-building with large independent orthopedic groups; focusing on state-level strategy.  25:40 – Physician-Led Advocacy & Taking Action Host discussion on organized medicine vs. grassroots disruption and multi-front tactics.  26:41 – Advocacy as Antidote to Burnout Meaning, connection, and purpose through engagement.  27:46 – Changing Mindset & “Showing Up” Networking, persistence, attending meetings, building momentum.  29:08 – Closing Reflections & Call to Action Partnership, unity, and showing up as vehicles to reclaim medicine.  29:11 – Outro Host sign-off and thank you.