"Moving Towards The Light" Cover Art by Dr. Jack Akop Seksenyan by Physician Outlook Magazine

ISSUE 9 | VOLUME 1

OCTOBER/NOVEMBER 2020 2020 IS THE YEAR OF CLEAR VISION FOR PHYSICIANS AND PATIENTS ALIKE

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PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS

Cover Art By Physician Artist Akop Jack Seksenyan, MD. PhD Covid_Child

PHOTO CREDIT: HANNAH JESTER, RN

F R O M T H E P U B LIS H ER

Pandemic Pregnancy

Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

s we get ready to publish the 9th issue of Physician Outlook I can’t help but ruminate about the similarities between the last 9 months of this pandemic and an unexpected, unplanned, perhaps even unwanted pregnancy. For our family, the “estimated date of conception” was early-mid March of 2020. Forgetting science, I carelessly and recklessly threw caution to the wind as a parent and physician and gave my blessing for our daughter to travel abroad with friends on her spring break. Like unprotected, wanton sex, travel during an early pandemic had unintended but predictable consequences. She came home with wonderful memories and tales of fun but was also 2 | O C TO B E R/ N OVE MBER 2020

one of the first in our state and on the east coast of the United States to be definitively diagnosed with COVID-19. It was a lesson learned, and one which we will not soon forget. As I approach 36 weeks post her diagnosis and recovery, I am more than ready to push past this stage of the pandemic and into the next phase of life. But what kind of life will exist when this pandemic is finally “over?” How do we define “over?” Just like a pregnancy, its end is just the beginning. Will this COVID-created imprisonment last another 2 years, as depicted on this month’s Physician Outlook cover? The artist, Dr. Akop Jack Seksenyan, depicts a curious caduceus-wielding toddler following a larger-than-life

coronavirus as it “goes towards the light.” The boy is alone, but wellgroomed, wearing shoes and dressed in clean pants and a jacket. The scene is eerie and lonely, however. I can’t help but wonder where his parents are, who were the most likely creators of the large red chalkboard coronavirus on the brick wall. Have they succumbed to COVID-19, sacrificing their lives for the next little progeny who is armed with the future of medicine as his only weapon? All of humanity unknowingly became impregnated with a virus that firmly implanted itself into our matrices, changing our lives forever in 2020. As days turned into weeks, and weeks into months, we now wonder how many years it will take for life to

feel “normal” again. Globally humans have individually experienced the first ¾ of 2020 differently, but collectively we can look back at the last 9 months and know that our future looks very different. Some of us have experienced relatively uncomplicated pandemics, and have accepted all of the attendant changes in stride. Much like the gravid woman accepts that her body will inevitably change, the great majority of us have adopted mask-wearing, social distancing, home-schooling, and telecommuting as temporary but necessary intrusions into our lives. It may not be “normal” but we accept and trust that humans are resilient and that eventually, this pandemic has to come to an end. Others of us throughout the world have experienced very complicated, high-risk pandemics with frequent hospitalizations, loss of life, debilitating residual COVID-related fatigue, and organ failure. Many remain paralyzed with inactivity and swaddled in fear of the unknown. So much has been politicized during the coronavirus pandemic that I am looking forward to fast-forwarding past the upcoming November U.S. election. Regardless of the outcome of the election there will be some peace in finally knowing what to expect politically for the next 4 years, when so much about the virus has left us in limbo. This pandemic has produced the kind of anxiety families experience when an obstetrician diagnoses a developing fetus with a chromosomal anomaly. If November 4th, 2020 brings full effacement and dilation that ultimately culminates in a “delivery” and an eventual end to the pandemic, I for one, will breathe a sigh of relief - not unlike the one that a laboring mother lets out when that crying baby--”normal” or “not” is finally laid on her bosom. 1 Dr. Marlene Wüst-Smith Publisher

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Table Of Contents FROM T HE PU B LI SHER

Pandemic Pregnancy By Marlene Wust-Smith, MD/p.2 VI PP SPOT LI G HT

The Social Dilemma: What Is The Problem? By Jean Robey, MD/p.6 B A B B LI N G S

The Sekhmet Writing Project 6|12: The Influencer By Megan Babb, DO/p.10 ADVOC AC Y I N AC T I ON

HPEC-Physician FAQ By Mehnaz Hyder, MD/p.12 Insidious Buzzwords Contributing To The Decimation Of Physician-Led Healthcare By Estine Wells, patient advocate/p.18 Chronicling Our Times Through Art By Lily Kak/p.20 OFFI C E SPAC E

Trust Toolbox - Take Back Your Time With Mobile-Ready Patient Paperwork By Nathan Eckel/p.26 T I ME FOR YOU

Teen Turned Trainer By Nicholas Fuentes/p.28 IN TELLI G EN C E ON T HE MOVE

Tiger Lilies By Ayushi Chugh/p.31 T HE LA ST WORD

10 Years Of ACA Obamacare By Craig Wax, DO/p.32

Front Cover: Physician Artist Akop Jack Seksenyan, MD. PhD Covid_Child WWW.PHYSICIANO U T LOOK . C OM | 5

V IP P S P OT LIG H T

The Social Dilemma WHAT IS THE PROBLEM?

Wri t t en by J ea n Ro bey, M . D.

he Social Dilemma, released in January of 2020, is a do c u ment a r y a i me d at addressing the pitfalls of social media as a medium that has entered a coexistence, if not a leading role, within society. In the documentary, various noteworthy and instrumental people in the digital world involved in developing and marketing social media discussed their concerns over the operating premise of social media engagements. Inherent in the design of those platforms is manipulation - a crafted bias and control of information that obscures and limits truth. It is certainly worth watching for many 6 | O C TO B E R/ N OVE MBER 2020

intriguing deductions about society’s growing derailment and the part social media plays, but the number one intriguing questions was, “What exactly IS the problem?” When asked point blank, to define the exact problem the modern human race faces, one after another featured commentator paused, unable to answer this question plainly. They felt the answer was too complex; however, the root problem in a society crafted by social media is simply, “Each human is convinced he or she knows what is best.” This arrogance born of what appears to be access to unbiased informa-

tion and the perceived discernment to digest it all alone is the problem. An expert is born every 15 seconds. In the end there is division, untold polarization, and obscuring of truth as a byproduct of a flawed unilateral processing system. How could the pandemic help rectify the social dilemma? The undercurrents during the pandemic fed dominoes that set in motion so many things as riptides sending society reeling literally every day of these long months. What of spring break, the end of school, summer adventures and relaxation worry-free, fall and the

dependency on distractions, waste, want, and future. We turn to the few beside us during the initial uncertainty and the ongoing global crisis and truer colors are seen. By rekindling our basic self awareness and exercising the courage to look inward, we position ourselves to move forward better than ever. That universal pause button has slayed the society we were becoming against our better judgement and fundamental constructs. How can we be together while being safely apart, and what will we recall of the last months of this epic year? Truth In the Social Dilemma there is a powerful statement expressing the notion that our minds are unevolved for millions of years yet the technology to both feed and trick our minds is rapidly evolving at a pace that will soon sabotage our ability to have or even maintain human progress.

exciting resumption of school, and holidays to come? What of the elderly - so marginalized, of the youth - so eager to taste life, and everyone in between? Each family has a unique cluster of considerations and we are all working to numbing exhaustion to find that middle ground that is Truth. The pandemic has created an unprecedented opportunity for exposing the toxic social media climate we identify in. By its required social distancing, selective socialization, social accountability, and measures for sheer survival, the pandemic can reconcile the growing layers of facades and straw men principles and prompt the reinstitution of

fundamental truths. At the beginning of the pandemic, a global fury was on to secure ourselves to wait for clarity on how SARS-COV 2 would impact society. This extreme and global lock down created a universal pause button. Although technology aided humanity to stay connected, productive and entertained in a global shut in, society soon admitted how human contact was essential and a missed elixir. While we face the inescapably arduous task of developing what vaccines and mitigatable treatments we can, we are invited to take inventory of our self identify, self worth, affiliations, priorities, joys, needs, purpose, unhappiness,

What are the basic truths? Basic tenets include health and well being, human presence, basic supplies including food and water, social contracts that provide safety and regards for all sexes, creeds, and ages, safe livelihoods that produce meaningful products and safe engagements, and finally, entertainment when safe and once all other things are afforded first. These basic needs are the bare bones of the human experience and by stripping down and reinstituting first the most important, then the remainder, and seeing the urgency of the lesser needs boil over, we begin to see the failings of society to create a fundamental substance in the social structure. How do we exercise truth in these days to come? We can ask for technology to serve the user better rather than allow it to use humanity to basically cannibalize itself. We can literally redesign the days and demands to reprioritize the time we spend and the circumstances in which WWW.PHYSICIANO U T LOOK . C OM | 7

“Everything from the little house was in the wagon except the beds and tables and chairs. They did not need to take these, because Pa could always make new ones.”

PHOTO C REDIT BY IN GRA M IMAGES

-Laura Ingalls Wilder, Little House on the Prairie

we do so. We can slow down the pace of engagement and map out the best value for engagements. We can choose social venues that create safe spaces that regard all within society respectfully. We can allocate for children, and children with special needs, their dues. We can carve out a place for elderly to be served and be engaged. We can understand the gaps in our social structure where marginalized members fall out and how we have used certain platforms like schools to find those in need and fill those gaps but will use other means and other designs to fill gaps. We can foresee the ramifications of a society that is running from distraction to distraction to fill fundamental holes in relationships, and to avoid self reflection of worth and purpose. We can then ask society to make fundamentally more fulfilled, more substantiated citizens who can withstand a pandemic having been fortified in earnest joy. The year has burned away like a wildfire overtaking our spirits and days. We are heavily fatigued and utterly confused as to how 2020 was profitable. But what if 2020 gave us the hardest look into our “social di8 | O C TO B E R/ N OVE MBER 2020

lemma?” What if 2020 told us how we would rally or react or persevere and prioritize if a THREAT came to our world? What if we listened and dared to redesign every engagement and every holiday until we rose above the manipulation and polarization to find ourselves eating pumpkin pie in April, traveling without leaving our homes, eating healthier at home cooking for ourselves, having more meaningful relationships, missing our parents while they are alive, being creative to say, “I love you, I’m thinking of you,” using Christmas lights whenever, practicing kindness to those isolated or less fortunate, understanding how we are the same more than different, protecting each other from all elements of weather and cruelty, and declaring ourselves only capable of part of truth but united powerfully identifying with the many truths of a human experience? What if we found the TRUTH about human connection that is threatening to be buried under the delusions of our rapid progress in a technologically driven world? What if we found the real virus and the real cure to what is killing humanity?

Then we would grow gardens, make shadow puppets, learn to slow dance, go for drives, be outdoors, go on long walks, eat slower, talk longer, find delight in little tasks that we do repetitively, cultivate a meditative core, read more classics, cultivate more talents born from boredom, have more pets, take on more long term projects that can improve our homes and our comforts, delay gratification while fortifying what is gratifying about life, and see the pandemic of 2020 as the best opportunity for a reset. All tallied there can be something gratifying about 2020. It is cheap and simple and forever yielding. It is not “normalcy” as it is cultivated under social media but normalcy as it has always been true for humanity. WE are that something about 2020. WE are what remains when you strip away the fabric to find the humans still yearning for each other and fighting by patiently waiting for safe passage to reconvene, with less to take for granted. WE exist in a time of plenty and of possibilities to be helpful and caring and reach out in what means we can by the very social media that grew to nearly extinguish humanity’s best attributes of consciousness. WE are grateful for a time of deep and collective reflection and the insight to see this year as a gift. 2020 has been a time of extreme potential masked as extreme taxation of nothing but a shallow façade. As the year closes, take this opportunity to recreate the best of our world and our existence. You will find 2020 was the best year of our re awakening in a stoicism that has propelled many to an enlightened happiness. We are once again salt of the Earth, spilled and, thus, sanctified. “Everything from the little house was in the wagon except the beds and tables and chairs. They did not need to take these, because Pa could always make new ones.” Laura Ingalls Wilder, Little House on the Prairie 1

B A B B LIN G S

Si x | T w e lv e: T h e

The Sekhmet Writing Project 6/12 THE EMPOWERING ONES Wri t t en by D r. M ega n B a bb

hen my first daughter was born, I was near the end of my intern year of residency. My pregnancy was flawless without complications and I worked up until her due date. I was lucky. Fast forward two weeks after her birth and everything changed. She was born on a Monday. After a brief stay in the NICU, we were both discharged four days later. This is where my journey starts. Here I go… The first day home I remember looking fondly at this little human being. I couldn’t help but feel an intense overwhelm thinking how perfect she was. She had the temperament most parents wished their babies had. She 1 0 | O C TO B E R/ N OVEMBE R 2 020

fed; she slept; she occasionally cried. Though I found myself looking at her in awe, I couldn’t help but notice that with each passing day, things began to change in me. I began to feel a force pulling me from her. Though we were never physically separated, it felt as though I was miles away from her because every day the force pulling on me became stronger. After a short period of time, what remained was an empty shell resembling me. This went on for weeks. I tried to fight through it. “I am fine,” I would tell myself. I pretended to smile. Being a mother was supposed to be such a joyous occasion but the more I pretended, the more numb I became. Getting up to address her very few needs became a chore. Until one day, the numbness

turned to paralysis and I felt frozen in time. My husband would care for her every need both day and night while I slept. No matter how much I wanted to feel normal again, it occurred to me that it would never happen without the help of my physicians. I was numb. Undoing that would take courage and an acceptance of what I was suffering from. Although outward conversations about postpartum depression and postpartum anxiety were just starting to happen in society, it was still highly stigmatized. And despite the fact that millions of Americans live with a mental health condition, it is still an area of medicine that lacks transparency. However, with more women entering the field of psychiatry, this was beginning to change.

Dr. Jessi Gold

h e E m p o w e ri n g O n e s

Dr. Jessi Gold, Psychiatrist The social constructs of medicine have historically discouraged physicians from voicing outward opinions in large forums like social media. In addition to this, it has also been slow to speak outwardly on the stigma of mental illness. However, for Dr. Gold, this is where she shines. Dr. Gold is unlike any other psychiatrist that I have met. Her unapologetic ability to speak about mental illness and her use of social media as one of her platforms is courageous. “I love to hear about people’s stories,” she told me. “We live in a country that has severed the relationship between mental and physical health. I wanted to help change this. I realized that social media became a good place to discuss it

because I saw the need and demand for it in spaces like Twitter so I changed it.” Her authenticity is what makes her commentary that much more real. As a contributor to Forbes and Newsweek, she is starting to create a name for herself. “My goal is to provide a better community for others. Since social media allows me to connect to individuals across the country, it allows me to extend the community I help.” When I asked her about how she works to empower women she said, “Women need to not be afraid of being told no. Many opportunities that have come to me have come because of others that have not gone in my favor. Challenging the status quo is the only way to change it. If I want to help change the perception of mental health

in America, it requires me to put myself out there knowing that not everyone will agree with what I have to say. Part of my ability to do this is wrapped in all things therapy. There is no wrong time to talk to someone. In fact, to do this is to reinvest in ourselves which strengthens self-compassion.” Had I had Dr. Gold when I suffered from postpartum depression and postpartum anxiety, I am convinced my struggle would have been less. It would take another four to six weeks after seeking help for me to start feeling better. I am convinced however that the continued perseverance of female physicians like Dr. Gold is making the stigma of mental health disorders less and more of a normalcy that many individuals suffer from. It is my hope that other psychiatrists follow the lead of Dr. Gold by creating a safe place to speak about mental health. Perhaps if so, the fractured relationship between mental and physical health can be mended. 1 To learn more about Dr. Jessi Gold and to see her works please visit her website at drjessigold. com. Dr. Megan Babb is THE ORIGINAL SEKHMET of our time. To read more of Dr. Megan Babb’s written works, you can find them by following her on Twitter and Instagram by clicking on the following links: Twitter: @MeganBabb1522 Instagram: Mbabb1522 Vocal.Media: https://vocal.media/authors/ dr-megan-babb WWW.PHYSICIANOU T LOOK . C OM | 11

ADVO C AC Y IN AC TIO N

HPEC-Humanitarian Physician Empowerment Community PHYSICIAN FAQ Wri t t en by Me hna z H y der, M D

Q: “Why do physicians need a physician centric and physician controlled technology?” A: At the crux of the crisis in medicine are middlemen who have inserted themselves between the doctor-patient relationship in order to profit from the pain and suffering of patients. The middlemen in healthcare are able to dictate terms and compel doctors and patients to comply with protocols that serve their interests and bottom line. This has led to widespread physician disempowerment, lack of autonomy, adverse consequences for physician reputation, and many other issues. The main prize middlemen are after is the physician’s 1 2 | O C TO B E R/ N OVEMBE R 2 020

professional identity, which correlates to their right to render services and bill for those services. When middlemen usurp your professional identity, they control the narrative, and collect the revenue. If physicians take control of their professional identity, they will be able to shift the power dynamic back to doctors and patients, where the power belongs. Thankfully, technology has advanced to a level where the true identity of an individual can be digitally stored, verified, secured and exclusively owned by the user. This technology is called self-sovereign identity (SSI). Once physicians take possession and ownership of what makes up their identity they will

be able to bypass predatory third parties at every level. The physician’s professional digital identity includes all of the documents required for hospital credentialing including state medical licenses, and unique identifiers like PTAN, NPI, and DEA number. These are the professional assets that give physicians the privilege to make life and death decisions on behalf of their patients. With an increasing number of physicians being employed, it has also made it more and more difficult for the physician community to connect with one another. Once all physicians have their own self sovereign identity it will create a decentralized network of physicians

PHOTO CREDIT BY INGRAM IMAGES

When middlemen usurp your professional identity, they control the narrative, and collect the revenue

that is not controlled by their employer, health systems or insurance companies. It will allow physicians to find each other based on specialty, location, type of practice and interests all self directed by the individual user, and free from 3rd party oversight or influence. This will make it easy for physicians to form interest groups and share information with their community. The only thing that makes this possible is SSI technology. By using their identity to cut out the middleman, physicians will also be able to capture dollars lost to third parties and extend more cost savings to patients. Physicians, we need to get off the menu, and help our patients do the

same by building a new table. SSI gives us the tools to do that. Q: “Why should we trust HPEC? How is it any different than the AMA, professional associations or specialty medical boards?” A: Our current world is centralized, meaning there is a group of select people who hold power over others. As physicians this vertically integrated, top down way of doing things is demonstrated and amplified by increasing employment. There are now large vertically integrated health systems that dominate entire geographic areas, trapping both physicians and patients.

Sutter Health is one example, and they have been hit with a second major lawsuit, this one amounting to over $3.7 billion lawsuit for their anti competitive and predatory behaviors. There are currently two major EHR companies that hold more than 50% of the contracts for electronic health information storage. Even our specialty boards have colluded to gain market share by compelling health systems and insurance companies to require physicians to purchase MOC®: their proprietary product, or be out of a job or out of network. When MOC® was initially proposed by specialty boards, many doctors referred to it as “extortion,” however because doctors did not have any way to powerfully organize around their opposition they were ignored. It is clear that doctors are kept in information silos and decisions are made for them by a select few who collude with politicians to keep physicians and patients trapped in the current system. Decentralized systems are participatory, there is no central authority catering to a special interest agenda. Members of a decentralized system have an uncensored and digitally incorruptible platform to establish their position in an inclusive and self directed way. In the future, this powerful technology can allow doctors to form decentralized versions of their specialty boards and professional organizations and now doctors can ensure that organizations meant to represent them actually do so. Q: “We already have the FSMB and CAQH, we don’t need another credentialing database. How is HPEC different?” A: The Federation of State Medical Boards is a private entity that incentivises doctors to pay in order to store WWW.PHYSICIANOU T LOOK . C OM | 13

PHOTO CREDIT BY IN GRA M IMAGES

and maintain their credentials. Physicians have no control over what that organization does with their credentials. Currently the FSMB is proposing a Universal Medical License, which at first glance sounds great, but if you dig deeper you see potential flaws that could be detrimental to the patient-physician community. Not only will the FSMB now have control over what was originally a state lead issue, but there are no disincentives from tying the license to costly and time consuming administrative burdens, for example MOC®. This will further restrict the physicians right to work, and will likely further decrease access to care. HPEC technology puts the individual physician in complete control, by providing the tools to store their credentials and be the primary source of truth regarding credential verification. HPEC will give you a private secure wallet to store your protected information so ONLY you and NOT even the founder of the company can see. Once you control your own credentials in your own wallet, nefarious parties can’t vote on your behalf or mine your data for their own predatory gain. Also your 1 4 | O C TO B E R/ N OVEMBE R 2 020

credentials have to be obtained by you only ONCE. After adding them to your wallet, any party that wants to look at your credential, such as a hospital you are onboarding with, would have to get your permission to see your credential. Having possession of your portable credentials also gives you leverage with an employer. If you felt mistreated at a job, it would be much easier and quicker to quit, and rapidly re-credential elsewhere. Q: “We need a union. Why would HPEC be better than a union?” A: Unions typically require uniform consensus from the employees they represent. The union may not be able to represent workers who have private practices. What physicians really want is to be able to organize and make a large impact. When you get your unique digital identifier from HPEC that only you control and execute, you can start a bid for an important issue and all the physicians who agree with you can digitally endorse this bid and digitally record the collective answers in a sealed, incorruptible ledger. If we had this ability during the California 2020 AB890 senate hearings for independent nurse

practitioner scope of practice law, every doctor with an active California medical license could have registered their endorsement against this measure and the total number of No votes, potentially 142k of them, could have been sent to the media as well as the California legislature. We could also have had our patients register on the blockchain and use their unique identifier to endorse a NO vote as a patient. For specialty specific issues, there will be ways to reflect the endorsement from one specific specialty and the participation of all other specialties is not required. This ability to digitally represent uncensored and incorruptible physician opinions prevents other people, who don’t have our best interest in mind, from speaking on our behalf without our consent. We, the doctors, need to be speaking for our own selves! With this technology, there will be less confusion about what doctors really think. Q: “How will HPEC deal with insurance providers?” A: Right now physicians have to apply to be part of an insurance network. Once inside the network, they become

trapped with little negotiating power and have to accept whatever terms the insurance company decides to set. The insurance companies know that doctors have no way to contest reimbursements and can’t organize and negotiate on a large scale. That’s why they can suddenly change their terms in a dreaded “Dear Provider” letter with far reaching consequences for patients without the consent of doctors and patients. The insurance companies often do not keep their networks updated, and this leads to patients being left with surprise bills because their treatment was not covered. If physicians control their data on HPEC, they can reflect their network participation in real time. The physician community can easily find other physicians in the common insurance networks that will enable them to organize and collectively negotiate with the insurance companies. Right now the healthcare insurance industry operates by keeping all the doctors trapped inside narrow insurance networks that they control 100%. When we, the physicians, keep our own data and make our network on HPEC, it’s the insurance companies that will be asking us for permission to be in our network. See how that flips the script? Now the doctors will have leverage to make the insurance companies compete for the most favorable terms on any issue that affects doctors and patients. For the first time, doctors will be able to organize and walk away en masse from an insurance provider with unfavorable terms. Q:”How would patients benefit from HPEC?” A: Patients are a vulnerable population and they expect their doctors to advocate on their behalf and make the best clinical decisions for them. The way healthcare works currently, the hospitals and insurance companies have too much influence over the physicians decision making power. Because of the HITECH act, all medical systems were

mandated to use an Electronic Health Record system. The implementation of EHR was first sold to doctors citing doctor’s bad handwriting. The true intent was to consolidate billions of dollars worth of data that is used by third parties for their own gain, completely unbeknownst to the patient. Thanks to HIPAA, which is a data PORTABILITY act NOT a PRIVACY act, at any given time there may be dozens of people reading a patient’s chart, knowing their personal problems, denying treatments and selling their data to third parties. This data is de-identified, but extrapolated to look at like patients in order to make sweeping changes in entire patient populations without their knowledge or consent. For example, elderly patients with urinary incontinence may have their data sold to a catheter supplies company who will send their advertisements to patients who have similar profiles. On the HPEC platform, the patients will also be given a digitally secure private wallet with their credentials (payment details, insurance information, Medicare card, and personal/portable medical records). Nobody will be able to view the contents of this wallet except for the user and whoever else they explicitly authorize by generating another digitally unique code. With an encrypted click of a button, the patient can send their medical record directly to their doctor’s tablet without the prying eyes of middlemen waiting to take their cut. Patients will be able to own and store their medical record data and only release their data to parties they trust and willingly interact with on their own terms. This is a gift that the physician community can give to their patients through the HPEC platform. Q:”What does data have to do with physician autonomy?” A: Our autonomy is being stripped, because middlemen are watching our every move, and recording our every click. We as physicians have to stop

sharing data with nefarious third parties. The third parties have no interest in altruism and this has been demonstrated to us over and over again. Third parties become emboldened because we never put up any resistance. Many of us are afraid of speaking up in our institutions and these institutions know very well that our options are limited. Because of the legal mandate ordering use of EHRs, the HITECH act, data miners are able to copy the clinical decision making and practice behaviors of physicians in order to generate their own algorithms. The most obvious utility of these algorithms is to generate flow charts so that nurse practitioners can practice medicine independently. At this moment there are powerful parties backing companies that are creating artificial intelligence bots with the intent of eliminating the doctor completely and utilizing a lesser skilled individual to follow the orders of the algorithm. That person will not have the clinical experience of a physician to recognize that some recommendations may be wrong or dangerous. There is no doubt that these algorithms and bots will be designed to prioritize profit. The recommendations from the machine will be the most profitable course of clinical interventions for the hospital system that purchases them. The HPEC platform provides a decentralized solution that gives digital wallets to MD/DO physicians so that their practice behaviors and data are secure and not being used to create profit algorithms for insurance companies. If there is an ethical use of artificial intelligence, it should be solely physicians and patients discussing and authorizing its use, not potentially predatory third parties. Physician and patient data are very powerful. In the modern technology world, it is our duty as physicians to protect our patients’ medical data from malicious intent. 1 See Dr. Megan Frost Babb’s article https://www.physicianoutlook.com/articles/hippocratic-oath-20. WWW.PHYSICIANOU T LOOK . C OM | 15

YOU CAN HAVE THE PRACTICE YOU DESIRE No one teaches you this in medical school. You learn everything you need to know to care for patients but practically nothing about running a practice.

Nearly 50% of physicians are owners, partners, or associates in private practice. That means there are a whole lot of doctors out there running practices who learn as they go.

But just like you use exams, tests, and images to discover what’s ailing a patient, you need to learn the tools that will help you discover what’s ailing your business.

Why are costs always creeping up? How can you increase the quality of the time you spend with patients? Why are patient satisfaction surveys coming ack so low? Are you intimidated when you are faced with the financial decisions of your practice? Do you understand how to utilize productivity reports? How do you feel when you are handed the financial reports of your practice?

When you work to discover what’s really causing your operational challenges, you’ll resolve them for good. These books will provide you the valuable knowledge you need to develop a thriving practice. DAVID J NORRIS, MD,MBA

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Insidious Buzzwords CONTRIBUTING TO THE DECIMATION OF PHYSICIAN-LED HEALTHCARE Wri t t en by E s ti n e We l l s , pa t i ent a dv o ca t e

atient care is no longer the focus of behemoth hospital conglomerates and insurance companies. It is about profitability. Managed Care, Gatekeeper, participating vs. non participating, HMO’s, PPO’s, POS, Capitation, Provider, in network vs. out of network, mid-levels, EMRs, and Minute Clinics are just a few of the deleterious terms wreaking havoc on quality healthcare. The implementation of Managed Care was the harbinger of attempts to distance the doctor-patient relation1 8 | O C TO B E R/ N OVEMBE R 2 020

ship. Ascribing the title of gatekeeper to primary care physicians with financial incentives, represented a conflict. Making physicians in charge of approving specialist referrals sparked an immediate alienation of that vital connection. In addition, in network, out of network, participating, and non participating added confusion and untenable options. It was sad to see physicians having to tell patients to choose a specialist from a participating network list. No longer could physicians refer to a specialist they trusted and respected, unless that spe-

cialist was on their preferred provider list. Physicians are not interchangeable. Clearly, managed care companies signed up specialists with whom they negotiated the best rates. It was not based on quality, expertise, or performance. Listing physicians, NPs, PAs, and other advanced practice practitioners under the category of providers marginalizes physicians. Non-physician practice managers assume too much control over practices. They determine the need for a patient to be fit in for an appointment, with no regard for the urgency.

PHOTO CREDI T BY INGRAM IMAGES

Listing physicians, NPs, PAs, and other advanced practice practitioners under the category of “providers” marginalizes physicians.

Capitation was another debacle devaluing physicians. Primary care premiums were kept by insurance carriers, if the patient didn’t sign up with a primary upon enrollment. Only when a patient showed up for a visit or needed a referral was it ascertained that the office had not received the capitation for that patient. Requiring several calls to the health carrier to resolve the issue took up time and man hours. Each carrier was contracted with a different lab, so offices who drew lab required staff to ensure the correct lab was selected for each carrier.

Graduating from medical school, completing residencies, and fellowships, being on call day and night to, now, having to perform burdensome administrative duties as well, takes time away from patients, sabotaging the patient-doctor relationship further. Restrictions and regulations distract and convolute the noble practice of medicine. EMRs, providers, team, protocols, formularies, model, urgent care, Minute clinics, hinder the physician’s ability to spend as much quality time treating patients. Non physician

administrators add another layer of impractical, coercive, threatening, and divisive tactics aimed at controlling and restricting the best quality care. Again, it is about the bottom line with little regard for the expertise of physicians. Team is a key buzzword used to imply that a team approach is better than the one on one physician approach. Continuity of care is so important. It has become more difficult to see the same physician when calling for an appointment. Receptionists offer other physicians and Nurse Practitioners as options available. It is unacceptable. However, while certain teams provide valuable and comprehensive care, ALS teams, etc., others dilute care and delay information being properly transmitted to the physician. By the time the mid-levels relay the information, it is misconstrued, delaying and obstructing care. Protocols, drug formularies, and precertifications only exacerbate the dissonance between physicians and healthcare institutions. More and more duties are placed on physicians who, now, must get approval for certain prescription drugs, and tests, while being expected to know all protocols. Salaries are no longer commensurate with training, degrees, and expertise. A barrage of insurmountable overhead for physicians has led to many selling their practices to hospitals, becoming employees of the institutions only to face performance quotas and the threat of sanctions and dismissal if those quotas and other criteria are not met, further leveraging the hospital’s position. I hope this article resonates with those reading it. Physicians need to take back control of healthcare, before it is a fait accompli. Our lives depend on it! 1 WWW.PHYSICIANOU T LOOK . C OM | 19

ADVO C AC Y IN AC TIO N

Chronicling Our Times THROUGH ART

Wri t t en by Li l y Ka k

ne hundred years. In 1920, the women’s suffrage movement culminated in a historic, hardwon right for political equality for women. In 2020, we commemorate the one-hundredth anniversary ratification of the Constitution’s 19th Amendment granting women the right to vote. Today, we take this right for granted – it is as natural as the sun that rises in the east and sets in the west. One century. In 1918, the Spanish Influenza pandemic swept across the earth, killing over 20 million people. People were ordered to wear masks. Businesses, theaters, schools were closed. There was no cure, there was no vac2 0 | O C TO B E R/ N OVEMBE R 2 020

cine. That was then. A century later in 2019 and 2020, a microscopic monster raised its ugly head, strangling the earth in its suffocating embrace, swiftly sweeping across the world and killing a million people in less than a year. Like a tsunami, it has raised its monstrous head over us and just when we thought that it had crested, we are informed of a second wave that will engulf us. And that is now. History repeats itself. Throughout the globe, the pandemic has touched us all in profound ways and our response to tackle it is intertwined inextricably with our cultural and political beliefs, our history of disparity, our health system, and our

national and local leadership. Living in Washington DC as an immigrant and as an international public health specialist, I reach into my network of childhood friends and family in India and the network of clinicians and public health experts in the US and around the world. As we share our experiences and exchange notes, I am struck by the universality of our experiences across the globe. We have developed a new lexicon and new habits in shared experiences - lock-downs, new mandate to work from home, fear of being infected, fear of gasping for breath while dying, relying on the phone and the internet

C REDIT A RTIST LILY KA K - WE TH E WOM E N

for social interaction, social distancing, WhatsApp, video meetings and parties, home schooling, face-masks, hand sanitizers, soap and water, contact tracing, scientific evidence, myths and misinformation, freedom to wear masks, freedom not to wear masks, hope for vaccines, anti-vaccine, ventilators, oxygen, macho male national leadership (US, Brazil, Russia), empathetic and resilient female national leadership (New Zealand, Germany, and Taiwan)…. It did not take very long for the world to see that the US, long admired for its strength, was down on its knees with the highest death toll. COVID19 has laid bare the inequities, the broken pub-

lic health system, and the lack of national leadership that seems hell-bent on dividing the country in every possible way. Deeply touched by the universality of our collective global experience and the historic significance of this experience in the time of COVID, I vowed to chronicle the events through art as they unfolded in our lives. I began to paint one pandemic painting every month, striving to transform a dark theme into an uplifting one. And thus began my personal journey as the art chronicler of our times. I drew on many sources of inspiration - the national news, my friends, my family, my colleagues, and my profession in global health.

As the world became aware of the selfless and tireless sacrifice made by health providers, people expressed their gratitude in many ways – across the globe, grateful citizens sang in tribute to them, clapped their hands in thunderous applause, lit up monuments, scrawled “thank you” on neighborhood fences and pavements, honked their cars as they drove by hospitals, artists painted them with capes and personal protective equipment, and poets waxed poetic. Sadly, many families mourned their sacrifice. Many of these health providers are unsung heroes – women of color – serving as physicians, nurses, physician aides, and janitors. They have saved countless lives, held lonely hands with compassion, cleaned and sanitized intensive care units, and went home exhausted and fearful for their own children. As I thought about them, I came to hear about the project “Women of Color on the Frontlines” which focuses on female health workers of color who are underrepresented in the narrative of the nation’s response to COVID19. The project had put out a call to physicians of color to send their photographs and to artists to paint their portraits. I was so deeply moved by the poignant photographs of physicians in their personal protective equipment, I knew that I couldn’t limit myself to just one portrait. I knew that my painting had to be a tribute to as many physicians as I could squeeze into one sheet of art paper, that it needed to reflect patriotism and strength, and that it would celebrate diversity. In the end, I squeezed in 15 images in a single painting and called it “Women of Color, Healing America.” In one corner is the American flag unfurling a shower of stars and stripes on Caduceus, the symbol of medicine, which keeps the coronavirus at bay. Fifteen physicians from Asia, Africa, and Latin American countries in 15 shades of brown, celebrating strength in diversity, risking their lives every day as they went to work in their PPEs to save American lives. Unsung, exhausted, compassionate heroes of our time. WWW.PHYSICIANOU T LOOK . C OM | 21

C REDIT A RTIST LILY KA K - WOMEN OF COLOR_H E A LIN G A M E RIC A

With great zeal and a self-imposed mission for 2020, I hunkered down and began to chronicle our lives during the pandemic through art. With equal zeal, I dived into my profession of global public health. And with a great sense of urgency, even before the World Health Organization and the US Center for Disease Control recommended universal face-covering, I began to sew 500 facemasks and surgical caps to give away. I wiped the dust off my trusty old sewing machine, pulled out stacks of beautiful African fabric that had piled up in my closet from my numerous travels to Africa and that seemed to have been waiting for a pandemic to be put to good use. I delighted my friends, colleagues, and health providers with these face-masks but, in truth, the pure joy of giving when death seemed so imminent in the early months of the pandemic was immeasurable. 2 2 | O C TO B E R/ N OVEMBE R 2 020

It wasn’t very long before the colorful and exotic cotton face-masks prompted a colleague to inspire a new painting, “We the Women” to commemorate the 100th anniversary of women’s suffrage, their right to vote as bright and hopeful as the rays of light shining from the torch held high by another famous woman, Lady Liberty. At the center of the painting is my war machine – the sewing machine. Receding into the background is the outline of New York City, the epicenter of the pandemic at the time I created this painting. The universality of the global experience inspired “One World: Alone Together” - people wearing their national flags for face-masks, hand-washing, plummeting stock-market trends, the national news, a new mandate for the workforce to stay home, and health pro-

viders going to work and asking people to stay home. Overcoming all this is a little girl – representing joy and hope in a rainbow dress and a rainbow mask in her hand and no longer covering her mouth. My daughter, who is a physician, served as my muse in “Heroes Work Here” and in the “Women of Color Healing America” in which I express my gratitude to the many heroes of our time – the physicians, nurses, police officers, teachers, and postal, fedex and grocery workers. We are excited to learn that she is pregnant and expecting her baby in December; we are acutely aware and fearful that she, like countless other physicians and nurses, puts herself at risk every day as she does her job of healing her patients. We hope that she will stay safe during her pregnancy and have a healthy baby – a beautiful new beginning. In the midst of the pandemic, George Floyd died fighting for breath, reinvigorating the nation’s movement against racism and inspiring me to chronicle “Black Lives Matter” as part of the pandemic experience. A parade of people carrying a banner – bright and hopeful - across an urban landscape, faceless but for their legs of many colors and escorted by a sympathetic person in uniform. As the Black Lives Matter movement galvanizes the US and the pandemic rages on, I am struck by a core theme that runs through both the racial pandemic and the coronavirus pandemic: the inability to breathe freely and voting as a powerful means of bringing about change. “Taking the knee” has emerged as a powerful sign of anguish and a peaceful protest against racism, reminiscent of Gandhian non-violence. A patient struggling to breathe in a hospital bed. Every breath counts; every vote counts. A woman voting and, right above her, a rainbow sky expressing hope. “Your Breath Counts: Vote for Change!” 1 www.lilykakart.com

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O F F IC E S PAC E

Trust Tools

TAKE BACK YOUR TIME WITH MOBILE-READY PATIENT PAPERWORK Wri t t en by Na th a n E c k e l , p hy si c i a n spo u se

hat would you do to increase patient compliance - without extra phone interruptions to your staff or your own schedule? I know how important it is to protect your limited time. Because as a kid in the 70s, my father did a remarkable job of protecting and prioritizing time for me and my 4 siblings - in addition to his daily rounds, dictations, charts, and office hours. This photo is of his desk circa 1983. Fortunately for him, we didn’t have COVID back then. In today’s health landscape many solo physicians are finding that it’s not enough to go about business as usual. They are realizing that they need to think ahead of the rest. And that kind of creative thinking takes time and energy. The good news is that in the last 6 months we’ve seen something that 2 6 | O C TO B E R/ N OVEMBE R 2 020

never happened before. We’ve seen medical norms change in response to COVID-19. Much of this change is very good. Because patients are not only flexible about telehealth and technology, many are embracing it because of the convenience and time it saves them. Fortunately, solutions could actually be much simpler than you realize. In prior articles I talked about how to protect your staff ’s time simply by anticipating your top 3 most frequently asked questions, pre-recording them, and “prescribing” them to your patients so you can give them the short version and actually give them a way to partner with you on their own time. In this case, by learning from you in a format that doesn’t monopolize your time. This month we’re moving beyond verbal conversation to written communication.

Let’s talk patient educational materials - how are yours doing? Are you happy with them? Are your patients happy? Would your staff agree? Or are they spending too much time explaining simple things to patients after their visit? From a customer service viewpoint it’s great to have your staff available to help, but from a reimbursement perspective it might not be so great. So especially if you’re a solo physician, what could you do to optimize your patient paperwork - especially post visit materials? Here is what Dr. F. recently found out… He had been referred to me because not only were his patient materials analog (photocopied), they were taking too much time to explain to patients. His

materials needed to be reinvented to not only save time for patients, but to become available to the patient - anywhere, anytime, without any phone calls. Here are a few things my team did for him: 1. We digitized his materials 2. We simplified the patient checklist 3. We summarized the checklist into DOs and DONTs 4. We recorded a short sit-down walk through video 5. We made it mobile-ready by adding SMS/Text-by-number access 6. We added hyperlinks to the explainer video 7. We made it enjoyable by printing in color and adding a few well-picked emoji instead of bullets There’s no reason you couldn’t do any or all of these things for your patients too.

This is just one of several tools in the “Trust Toolbox” that strengthen your ability to serve your patients. And as you involve your patient, you change the dynamic of your relationship. The effect of this is to help your patients choose a healthier lifestyle and partner with you in walking that out. Whether you are a family doctor, a pediatrician, a surgeon or an interventional cardiologist you can have an impact. You can help patients proactively choose healthy actions that elevate their lifestyles - and save time. Perhaps your creativity got sparked just by reading this anecdote. What did I miss? I’d love to add your favorite patient materials for next time. 1

Unlock The Future Of Healthcare RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS. VISIT HPEC.IO TODAY!

For an early look at how to implement this, reach out at nathan@patientpaperwork.com. WWW.PHYSICIANOU T LOOK . C OM | 27

TIM E F O R YO U

Teen Turned Trainer

QUARANTINE-INSPIRED QUEST FOR SELFIMPROVEMENT

Wri t t en by N i c ho l a s F u ent es

hen quarantine first began I was ecstatic because of how much time I had to myself. At first, I took it easy and did nothing more than watch movies and play video games, however, it quickly turned repetitive as days turned into weeks. One month into quarantine I was forced to ask myself, “Am I doing things that will help me be the best version of myself?” It put the future into perspective and I realized I could be using my time more productively. I decided I wanted to be more active and start an exercise regimen. I looked into different workout programs but I didn’t know what to focus on. I had some knowledge about bodybuilding but I did not have enough knowledge on subjects like a proper diet and optimal rest times. I researched different bodybuilders and athletes to see what routine and diet would best suit 2 8 | O C TO B E R/ N OVEMBE R 2 020

me. It wasn’t until I learned that everybody’s journey is different and that it is impossible to replicate somebody’s physical profile that I realized I needed to take a customized approach. I began researching different body types to see which one I was. I learned I was an ectomorph, naturally thin. That told me I needed to consume more calories than the average person because of how fast my metabolism works. I didn’t know how much weight I wanted to gain but I knew I wanted to be healthy and build muscle. Based on different variables, my goal was to gain 50 pounds. I would go from 130 pounds and 18 percent body fat to 180 pounds and 13 percent body fat. I chose to gain 50 pounds because of my height and I wanted visible and vascular muscles. I decided to measure my body fat because it would help me track how much pure muscle mass I would gain.

I found a 5 day routine that was solely focused on the use of dumbbells. This was beneficial as lifting dumbbells is less likely to cause injuries than barbells. I arrived at the ideal diet by utilizing a macro calculator based on my physical attributes. It indicated that I should consume 3660 calories and 132 grams of protein a day. If I followed this diet I would gain at least two pounds a week. I officially started working out on June 24th. My first week was very exhausting and my body was extremely sore but I persevered and stayed on task. To ensure I was eating the proper amount of calories I downloaded an app, called mydiet. It indicated that I needed to eat more calories. I added a shake that had 50 grams of protein and 1250 calories as well as 5 grams of creatine monohydrate. Creatine monohydrate is a healthy supplement

that improves muscle strength, muscle growth, and exercise performance. Incorporating these two supplements made me feel less fatigued after each workout. Finally, I wanted to add cardio in order to balance my weight training. I decided to bike 3 miles a day on my off days. As time progressed my workouts felt less like a chore and more like a hobby. I felt great and had more energy. I gained my first 10 pounds of muscle and no body fat in less than a month. I noticed a slight change in my physique. Eventually, I added a core workout to my regular sessions to strengthen my core. My weak core was prohibiting me from deadlifting and squatting more weight. My workouts remained consistent except I gradually increased the weight used for each individual exercise. One month later I gained 10 pounds and 1 percent body fat. This time I noticed a lot more definition in my arms, chest and legs. I’m currently 168 pounds with 19 percent body fat as of September 8th and still working toward my goal. This journey has helped me become a better version of myself. Personal fitness was always important to me but it seemed I never had enough time. Having my daily activities come to a screeching halt gave me the opportunity to reflect and prioritize. Oddly enough I did have the time, I just needed to focus on how I allocated that time. I hope that my story will inspire others to become active - the hardest step is just getting started. 1

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Dr. Alley-Hay is an international women's empowerment coach, author, speaker, educator, and longtime feminist committed to helping women master their inner power and vision. She is bringing feminism and humanism to medicine, seeking to change the culture of medicine. Her experience includes 25 years in clinical medicine as an Ob/Gyn and over 10 years of life coaching.

What is feminism in medicine? "Women and allies as a collective, committed to feminist principles and working for the highest good, for all people, in a healthcare system that works for everyone." When you work individually or in a group etting, you will: Identify your life and career purpose and discover what fulfillment and satisfaction look like to you Remove obstacles, limiting belief, past trauma, selfsabotaging behaviours, and energy blocks from your life and leadership Develop your communication skills for freedom and ease in having your ideal life realized Open new paradigms and develop a path of action that takes you to your calling Empower yourself to reach your highest self!

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IN TELLI G EN C E ON T HE MOVE

Tiger Lilies Poe m b y D r. A y us hi C hug h, M. D, Ne urolog is t, Phoe nix, A Z .

W hat’s in a name,they ask, For We are not celebrit y Roses.. The Name says it A ll, oh Tiger Lilies For You glow brighter,stand ta ller,than a much celebrated Rose.. Gentle, Humble, No rude thorny surprises Exude f ierce Strength Yet k now when to bend boughs, Bow, yet never Brea k in the Storm Tiger Lilies..Thunder Lilies, Born,Bloom with ever y Roar of Thunder True to your Name, Strength in Humilit y, They blush,don’t fuss over us, We don’t like being under Spotlights Indeed, for You are Spotlights incarnate,

CREDIT PHYSICIAN ARTI ST DR MAR IA CAPPAR EL LI

Beacons of Hope that hea l the Soul, Leading and lighting, the way Nature intended, That’s in a name, oh Tiger lilies!! The Name does say it A ll, after a ll!! 1

WWW.PHYSICIANOU T LOOK . C OM | 31

T H E LA S T WO RD

10 Years Of ACA Obamacare WHAT HAVE WE DONE?

Wri t t en by C ra i g M . Wa x D O

PACA, the misnamed “Patient protection and affordable care act,” was jammed through the Senate in the wee hours of Christmas Eve 2009. Vice President Joe Biden, serving as Senate chair, announced the vote. After three more months of political maneuvering and bypassing of rules, the House and Senate passed the final version in March 2010. In order to pull a fast one on gullible voters and Americans, his advisor Jonathan Gruber admitted, President Obama famously claimed, more than two dozen times, “You can keep your insurance. You can keep your doctor. Each family will save $2500 per year,” he promised. ACA was signed and marked as the crowning achievement of President Obama‘s legacy, but what were the actual results over the last 10 years? One failure after another. 3 2 | O C TO B E R/ N OVEMBE R 2 020

Perhaps the most prominent failure: “PolitiFact has named ‘If you like your health care plan, you can keep it,’the Lie of the Year for 2013. Readers in a separate online poll overwhelmingly agreed with the choice…” ‘Why did readers agree? Because more than 4 million received cancellation letters from their insurance plan.” So, what about control of healthcare? President Obama and those of his party, again and again, reassured the public that this wasn’t a Healthcare take over. But, to the contrary, Obamacare ACA redefined health insurance as a high-deductible plan with an astronomically high premium. In a rational world, high-deductibles are supposed to lower premiums. Obamacare cost taxpayers and our children trillions of dollars to save us millions. Just one facet of ACA, subsidies on individual coverage cost $341 billion dol-

lars from 2014 to 2016 and increased coverage by only 1.7 million people. That is $200,000 per person, reports Linda Gorman. It has funneled money to government cronies like insurance companies, hospital health systems, and other deep pocketed special interests. The result? Patients are now further divorced not only from their physicians, but now from their money and savings. What’s more? Through a government-invented definition of insurance and “healthcare marketplace,“ even the website was a $678 million dollar “SNAFU” that didn’t work on opening day. It was outsourced to a Canadian company, run by the first lady Michelle Obama’s college roommate, Tori Townes. Those repairs apparently didn’t work so the now infamous Andy Slavit from the C-suite of United Healthcare was brought in to “fix” it.

PHOTO CREDIT INGRAM IMAGES

That was only the beginning of the cost spiral. Currently, our office healthcare insurance is a high deductible plan with an HSA, that has doubled in cost over the last decade and has gone up by 24% in the last year alone, from $1200 per month to $1500. So, what about keeping your plan and diversity of healthcare insurance choices? In the state of New Jersey, the Blue Cross Blue Shield affiliate offered 144 different plans for employers and individuals to choose prior to ACA passage in 2009. In 2010, the insurance offerings dwindled down to a dozen plans from this major insurer. Because the government ACA “marketplace,” and community rating (guaranteed issue, the famed pre-existing condition clause) eliminated the state risk pools, the individual policy market was destroyed and insurance choice was dec-

imated. Even in major markets, there were only 1 to 3 different insurance plans on the ACA Obamacare exchange, hardly a market and hardly a choice remained. What about the “co-op” plans that were predicted to be popular choices and created in lieu of a public option? All but three have closed up shop. The big insurance companies made sure the rules were written so co-ops would fail. So, did ACA simplify healthcare and its financing? The 2,800 page ACA bill called for the creation of dozens and dozens of boards and commissions. This included the dreaded, and omnipresent, IPAB, the independent payment advisory board. What would IPAB do? Take away payment “for critical health care that may be needed to save your life,” explains former general counsel for the American Civil Rights Union Peter Ferrara. More simply put it was a rationing board, composed of unelected bureaucrats, that would decide what care would be available to patients and what care would not. Its decisions would be made “independent of Congress, independent of the president, independent of the judiciary, and independent of the will of the people,” warns the CATO Institute. Thankfully President Trump signed the repeal of IPAB in February 2018. Good riddance. So, what about keeping your physician? ACA Obamacare pushed insurers to implement “narrow networks.” This eliminated many physicians, hospitals, and many other care opportunities as choices for patients. Many patients could not keep their trusted physician either. Narrow networks are traditionally found in plans offered to Medicaid enrollees and are now a feature of ACA plans, that guess what, are often run by the same companies that run Medicaid. So, what did it accomplish? ACA Obamacare did manage to kick millions of employed, self employed, and unemployed citizens off their health insurance only to force them to buy bloated cost, junk plans on the Gov-

If you think the ACA is bad just wait until you see the single-payer disaster.

ernment exchange. In this way, it also forced millions on to Medicaid government dependence, forcing states taxpayers to pick up the tab ad infinitum. The bottom line is that citizens were kicked off their insurance, forced to pick another plan, and pay exorbitant rates to subsidize others. In other words a government sanctioned bait and switch. We can thank President Trump again for seeing that some of the penalties, like the Individual mandate tax, have been sent to the scrap heap of failed health care financing policy. Overall, the only phrase that sums up ACA Obamacare is #EpicFail. It is so dismal that even the Democrats who passed it, without knowing what was in it, are now calling for single payer government health care, euphemistically called Medicare for all. Or was that the plan all along? If you think ACA is bad just wait until you see the single payer disaster. It is time for patients, their physicians, employers and all of society to stop the vicious cycle of government control, rise and allow an organic, free-market to grow naturally. This is the path to abundance, serving the needs of all involved parties, and fostering the unique choices of individual patients, instead of filling the pockets of government cronies. 1 References: Lie of the Year: ‘If you like your insurance plan, you can keep it’, published December 12, 2013, www.politifact.com. Obama’s “Keep your plan” promise labeled “Lie of the year,” published December 13, 2018, www.cbsnews.com. Obama is gone, but his fiscal waste is still befouling American health care, published April 3, 2018, www.thehill.com. Michelle Obama’s Princeton classmate is executive at company that built Obamacare website, published October 25, 2013, www.thedailycaller.com. The Independent Payment Advisory Board: PPACA’s Anti‐Constitutional and Authoritarian Super‐Legislature, published June 14, 2012, www.cato.org. WWW.PHYSICIANOU T LOOK . C OM | 33

Al-Agba and Bernard tell a frightening story that insiders know all too well. As mega corporations push for efficiency and tout consumer focused retail services, American healthcare is being dumbed down to the point of no return. It’s a story that many media outlets are missing and one that puts you and your family’s health at real risk. JOHN IRVINE, DEDUCTIBLE MEDIA

Laced with actual patient cases, the book’s data and patterns of large corporations replacing physicians with non-physician practitioners, despite the vast difference in training is enlightening and astounding. The authors’ extensively researched book methodically lays out the problems of our changing medical care landscape and solutions to ensure quality care. MARILYN M. SINGLETON, MD, JD

A must read for patients attempting to navigate today's healthcare marketplace. BRIAN WILHELMI MD, JD, FASA

This book is a warning of what is to come if we ignore training and education. Share this book or tell others to buy it. We cannot wait to act on this.” DOUGLAS FARRAGO MD AUTHENTICMEDICINE.COM

This book exposes one of the best kept secrets in our current healthcare jungle created through the corporatization of medicine. Filled with relevant examples and anecdotes to help the reader understand the issues being addressed, this book captivated and held my interest from beginning to end. AINEL SEWELL MD

Inspiring, inciteful, and eye-opening! An in-depth and thought-provoking examination of important decisions affecting modern healthcare in America. This work should be mandatory reading for all administrators and policymakers influencing the US healthcare industry. KEVIN LASAGNA, LTC, US ARMY

A masterful job of bringing to light a rapidly growing issue of what should be great concern to all of us: the proliferation of non-physician practitioners that work predominantly inside algorithms rather than applying years of training, clinical knowledge, and experience. Instead of a patient-first mentality, we are increasingly met with the sad statement of Profits Over Patients, echoed by hospitals and health insurance companies. JOHN M. CHAMBERLAIN, MHA, LFACHE, BOARD CHAIRMAN, CITIZEN HEALTH

HIRING TWO PHYSICIANS! PMR/Sports Med/Pain/Neurology/Rheumatology/OMM/NMM

P.R.I.S.M. Spine and Joint is a thriving multidisciplinary practice specializing in complex musculoskeletal and neuromuscular care with a particular focus on hypermobility. We work closely and are co-located with a Neurosurgical Practice specializing in Ehlers-Danlos Syndrome/Chiari/Spine instability/Tethered Cord. Located in Silver Spring, MD just 0.5 miles from Washington, D.C., our area offers impressive schools, culture, and national parks as well as the Chesapeake Bay. The public school system is renowned, offering French/Spanish/Chinese Immersion programs and tech magnet programs starting in elementary school. Our practice currently has a six month wait for new patient appointments, and continues to grow each week! Contact: Adam@prismsj.com Position Summary Practice in an environment which combines NMM/OMT, Sports Medicine, PMR, and Neurology to care for complex patients with spine and joint instability and injury as well as athletes and weekend warriors. Many of our patients have Ehlers-Danlos Syndromes, and within a few months you will be an expert in heritable connective tissue disorders and the accompanying variety of injuries, autonomic nervous system dysfunction, and care needs of these patients. Lots of research opportunities/collaborations in place. Average of 36 clinical hours per week, minimal home call. 3 weeks PTO in year one, 4 weeks thereafter. Competitive salary, performance incentives, and benefits package including Health/Dental/Vision/Disability Insurances. Minimum Qualifications •MD/DO, BC/BE. Eligible for state licensure. •Life-long learner with commitment to patient care

Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Alejandra Suarez Assisting Editor: JR Hill VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Marketing/Social Media Intern: Allison Eason Contributing Authors: Megan Babb, DO; Ayushi Chugh, MD; Nathan Eckel; Nicholas Fuentes; Mehnaz Hyder, MD; Lily Kak; Jean Robey, MD; Craig Wax, DO; Cover Art: Akop Jack Seksenyan, M.D., PhD, Neurologist, Physician-Scientist (front & back); Other Art: Maria Capparelli, MD; Lily Kak; Jade Robey, age 15 Sandra Day O’Connor High School, Phoenix, Arizona Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark” WWW.PHYSICIANOU T LOOK . C OM | 35