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Branch Out
Branch Out
#84: No Frills Quality Healthcare w/ Dr. Gilbert Simon [Sapling Edition]
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In this new series, both old and new interviews will appear in bite-sized chunks! In under 20 minutes, you can get a great story and expert insight into the medical world. Join us for these Sapling episodes every other Tuesday!
Begging for more? Check out the full version on our website! https://sycamoredocs.com/podcast/83-no-frills-quality-healthcare-w-dr-gilbert-simon
Dr. Gilbert Simon has been a practicing physician for over 50 years. Through the establishment of clinics serving low-income families, Dr. Simon learned how to operate a successful practice on a shoe-string budget. He joined Branch Out to share his ideas on how the healthcare system can change its practices to reach more people and eliminate wasteful spending. Tune in to hear this lively conversation regarding overtesting, overtreating, and overcharging, as he and Larson encourage physicians to remember their original oaths and callings.
Hello and welcome to Branch Out with Sycamore. This is Larson Hicks. I'm the CEO of Sycamore Independent Physicians, and I'm joined today by Dr. Gilbert Simon. Um, Dr. Simon is a primary care physician for more than 40 years, um, had his own uh award-winning uh network of clinics that served low-income patients. Um, and he is on mission now um to to talk about the American healthcare system and uh and and chart a new path and and stimulate conversation and and uh action towards something different. And uh for that I I applaud him. I'm so thankful to have you here on the show today. Thanks for joining us.
SPEAKER_00Okay, thank you. That's exactly why I'm here to to uh promote my ideas and stimulate conversation and discussion and argument.
SPEAKER_01Fantastic. Well, just just as a way of before we dive into your um background and and everything, I'd like to just real quick frame this up. Uh and even for you, Dr. Simon, just to give you some some of a um some background on this podcast. Uh Sycamore um is a uh a group that's committed to physician autonomy. We're we're trying to uh trying to help unplug doctors from the matrix, uh, one one doctor at a time is kind of how we think about it. Um we are essentially uh locum tenons, although we felt like uh the locum tenons problem in that industry is lack of transparency and and high cost. And so we built this this flat rate um transparent pricing uh locums business that's really built for physicians who want to go independent. And um, and we view it as a partnership uh rather than kind of your traditional middleman who's trying to maximize their profit off of each doctor. Um and so it's been a really we we've been in business since uh really since 2016. Um I've been at the helm as CEO since 2018. And we started this podcast because there's a lot of physicians who who um A, I think need to need to be encouraged, you know, to to think outside the box, to consider their role in this healthcare system and and their um and and how they're voting with their feet, so to speak, with with uh where they're practicing and how they're practicing and and and the the opportunity that they have perhaps to um to make an impact um by by uh by regaining kind of their own independence and autonomy as physicians, I think um we think that a world where more physicians have more autonomy in healthcare, that it's gonna be a better uh a better healthcare system. Um and so we're uh we did this podcast, we call it branch out. Obviously, our name is Sycamore, um, but we call it Branch Out because we're trying to inspire physicians to think about um doing something different with their careers. Maybe uh we've we've had folks who um have become kind of financially uh more diversified uh by uh doing things like real estate or doing things like starting businesses, bio, you know, biotech businesses or or device businesses or um any any range of things. We had a we had someone on who uh started a daycare. Um and uh and so anyway, we're we're uh we're always looking for folks that uh would help us on this mission and help us to inspire physicians to uh to to be willing to think about branching out. And so um so anyway, that's just kind of uh just kind of setting the stage for uh for why we've why we do this podcast and why we're excited to have you on.
SPEAKER_00Okay, thank you. Shall I turn up my branch again?
SPEAKER_01Yes, absolutely. Please, and and maybe if you're up for it, I mean I'd love to kind of go all the way back, if you don't mind. I mean, I'd love to go back to why did you get into medicine the first place? When did you know you were gonna be a physician?
SPEAKER_00Uh from the time I was born, I think I knew a big physician. It was uh I'm a congenital physician. The uh uh my family always referred to me as uh as Gilbert the doctor. And uh uh I went back to my elementary school yearbook and and where it says, What are you gonna want to be? Physician. It was always physician. Uh I never deviated once, which made it somewhat easy. Well, I'm a I'm really a one-trick pony. I've only learned to be a physician. That's all I can do. I'm nothing more than a physician.
SPEAKER_01So so do you view it? I mean, I this is one of those questions I've I think is always interesting to hear physicians talk about. Do you do you do you view it as a calling as much as you view it as an occupation?
SPEAKER_00It's a calling entirely. Yeah. Uh it's not an occupation. Doctors from of my generation never wanted to retire or give it up. Uh you retire from jobs, but not from callings. You you stop your calling when you can no longer do it. Uh and but it was it would always been a calling. The relationship between doctors and patients was always a separate, special relationship, like like none other. And uh uh it it has been a calling. I love my my career, I love my profession.
SPEAKER_01That's awesome. Well, I I think um you know the I think the answers I get to that question are more varied than I'd expect, but I but I think there are more out there like you than than uh than than the other. I think most physicians get into this because they they feel called to it, and um and and and it is a I I do believe it is a calling. Um so so you you knew from a young age, and then how did you what how did you choose um to go the route that you went?
SPEAKER_00Uh I chose pediatrics as as my specialty uh because it gave me the chance to to uh engage both male and female, young and old, uh, and as a special bonus, it gave me the chance to deal with the whole family. Uh because when a child is sick, the whole family is gonna sick. And and uh uh when the mother brings the child into the office, I had to deal with the child's illness and the mother's anxiety and andor guilt. So it gave me the chance to really spread out all my what whatever talents I had to as wide an audience as I could possibly find. So that's why I chose pediatrics.
SPEAKER_01That's great. I I um you know, pediatrics is one of those uh, you know, you talk about a calling, I feel like uh uh of the specialties, pediatrics is definitely uh I think at the top of the list of of those uh specialties that that the people you meet in pediatrics really feel called to the work, are really doing it because it it's it's part of their DNA, it's part of their mission in life. Um what what is it about you know when you think about how to define the calling or the the mission of a physician, how how do you think about that? What is what is the calling? What is the mission?
SPEAKER_00Uh the mission is to involve yourself uh in the lives and in the health and well-being of children as they fit into their families. Uh it's it's not just the child, it's the it's the entire family, um, with the child being the focal point. Uh and the calling is the uh uh to be given given being the receipt of the honor of their of their respect and their trust. And then the calling is not to betray that honor. Not to betray it. Be truthful to it.
SPEAKER_01Wow, if if uh if more physicians had that as their mission statement, um I I think we'd be in a in a different um situation than we are now. I think um somehow um powers that be uh in in healthcare have have turned what what I think is a calling, uh, into a job. And uh and I think a lot of physicians feel like um they're just supposed to do what they're told, you know, and um and and have kind of lost that sense of ownership uh in healthcare. And I think um I think uh unfortunately I think a lot of physicians have kind of ceded a lot of ground um to to the government and to um to um corporations and and uh and of course those those entities are gonna do what those entities do. Um and s and it's not they're not people who are called to you know the CEO of the hospital system is not uh didn't take the Hippocratic oath, right? Um No.
SPEAKER_00No. Most likely it took some other oath, some uh accounting oath or some other kind of oath. Not a Hippocratic oath.
SPEAKER_01Well he's got a f he or she has a fiduciary obligation to their shareholders. So they they do have this kind of moral um imperative to produce a return on investment.
SPEAKER_00Right. And that's exactly what Morton Strickley, the uh the the boy, the boy who took uh his DRPRIN drug from $18 to uh $700, he said the same thing. I have a moral imperative to make the most money I can for my for my stockholders.
SPEAKER_01Yeah.
SPEAKER_00And that has been the uh the issue.
SPEAKER_01Kind of jumping a little bit further into uh into some of this the kind of meat of the conversation. Um I as I was I haven't had a chance yet to read your book uh completely, but it uh it looks it's it looks tremendous. It's called uh ripped off. Uh the subtitles Overtested, overtreated, and overcharged, the health the American Healthcare Mess. Um and and this this section here um stood out to me, and I'd love to hear you talk a little further about it. Um and this this I think is um the this is a good segue from what you were just talking about. So I'll I'm just gonna read a little section. It says I saw primary care doctors foregoing their learned skills and functioning more as referral agents. I'll skip down a little further. Specialists had become procedurists. Some of the procedures were life-saving, but others were to be of no value at the time they were being done. Were known to be of no value at the time they were done. Despite the best evidence, they persisted in doing their lucrative procedures. Get rich quick scammers took advantage of our defenseless honor system. Purveyors of medical supplies hawked their devices and equipment with the promise that they would be, quote, free. Doctors bought testing equipment because they added revenue, not value. I'll stop there, you go on, but I'll stop there. Um that's pretty uh it's a pretty grim, uh a pretty grim view, you know, of uh of medicine.
SPEAKER_00Grim but true, unfortunately. I didn't want to hold back anything. I wanted people to get angry uh and and say, well, if that's the case, what are we doing? Why are we just standing around doing nothing about this?
SPEAKER_01Yeah. Can you I I I've heard some pretty crazy stories, but but I'd love to hear, you know, just you know, the the the get rich quick scammers, you know, I I feel like I go to conferences and everyone in the exhibit hall are you know, every every vendor in the exhibit hall is some new company that's figured out a way to bill for it in a creative way for a new code that Medicare's put out, or it's or it's some you know, medical device um group that that um you know that that's offering you know some some uh some new new new product or test that's that's you know incredibly expensive, but you know, again, the the the view as they're as they're marketing it to these doctors is well you don't have to pay for it. It's and it's you know it's it's essentially free, insurance covers it. Um so what have you seen? And I'm sure in in your years of practice, you've seen a lot of these these kinds of folks um hovering around the the healthcare industry.
SPEAKER_00Well, they they didn't often come to my my direction because they didn't they knew that my my my patients were low income and poor, and we we couldn't afford frills. Uh we we were just the meat and potatoes. Uh but but my colleagues were were uh fully engaged in this. I had uh people who bought into uh into CAT scan machines and and uh were part owners and would uh refer their headaches to the to their CAT scan machine operator. Uh made a ton of money doing that. Uh there are there are ways of getting rich. If if that's the if that's the objective, uh my objective was to uh get butt get by and get the patients healthy.
SPEAKER_01Yeah, I um I I had the um misfortune about a year ago or two years ago at this point of taking my daughter uh to the ER because she had um she'd had fevers, you know, for that that had lasted for several days, and so we finally said let's take her in. And and you know what it ended up being was a fairly common, I'm sure you're familiar with the the you know uh bladder, you know, reflux or urinary tract, you know, infections that that uh that um that it sounds you know from from talking to more doctors about it and looking into it, it sounds like a fairly common thing for little girls and something that that that frequently will resolve itself over time. Um and I'm and my hunch was that the physician knew that pretty much right out of the gates. Like like his suspicion was that that's what it was. Um but they didn't let us out of there until they had done uh IV uh antibiotics, which I appreciate, but uh they had done uh sent off some blood for testing, they had done uh ultrasound, I think we did an MRI. Uh um I'm trying to think of all the different things that were done, all the different poking and prodding and and I certainly remember the bill uh when I got home. Um and you know, every time, and and I feel like I'm one of these informed consumers, and every time the doctor said, Well, I think we need to do this, my my question would be, do you do you really think it's necessary? And the response was always, Well, we just gotta be safe. We just we'd rather be safe. Um and what I've uh uh we work our our our company works primarily with emergency physicians, and so I hear these stories from emergency physicians all the time, and this is why ER doctors are quitting in droves right now and are just completely burned out with healthcare is that that ER doctor that I saw, if he hadn't run all those tests uh and ordered all those things, um, and and when his manager came in the next day and saw that somebody with the this chief complaint, you know, uh didn't have all those tests run, uh there would be a a difficult conversation um about not ordering the right tests and and not maximizing the revenue on that patient. Um and so it does seem like certainly the healthcare systems um and and the the kind of administration of these uh hospitals have really are really oriented towards maximizing revenue uh per patient. Um and uh and that's uh that's not necessarily through keeping their patients healthy, um you know, getting doc you know patients home as quickly as possible, et cetera. It's it's really it's really uh about what how many times can we swipe that insurance card.
SPEAKER_00Well, uh unfortunately the emergence room is really the the uh ground zero for this happening. Uh uh patients go there uh they're usually because they're t they're very scared of of the illness. Uh the emergence room doctor uh typically has never seen the patient ever before, knows nothing about the patient except what they what's what they're being told, which usually is not not very much. Uh and the ER doctor tends to think that he's got to do do it all because once the child leaves or patient leaves the emergency room, they're going into a black hole, and nothing more will be done. And that that kind of mindset is creates tremendous cost.
SPEAKER_01Yeah. Well, there's a fear of litigation too, right?
SPEAKER_00That's that's what's that's commonly said. I'm not sure how true that is, uh, because even in areas where where litigation rates are very low, the same overutilization occurs. So it's the fear of being wrong. It's the fear, it's the fear, fear that somebody will criticize you for not doing that test. It's the third fear we had when we were in training, we would walk around the hospital floors and there'd be some attending physician asking you questions. Did you do this? Did you think of this? Did you think of this? And that that stays with you the rest of your life. And I think that I think that these ER doctors are just afraid of being criticized.
SPEAKER_01Mm-hmm. Mm-hmm.
SPEAKER_00And that's you know, I I had one page that's mentioned in my book. Uh I I personally took care of a child with uh an intestinal virus with vomiting and diarrhea. And the mother wanted more. She wanted more more than just that. And I told that story, that's all there is. You got children's virus. That's all there is, and there is no treatment. Just give your child some fluids, it'll go away. She ran to the emergency room, and and and while she was there, the child had uh uh an MRI of the abdomen, and one of the pelvis, uh, had was given IV antibiotics, every test known to man, and then left with a diagnosis of intestinal virus. So there was no need for any of that.
SPEAKER_01I I applaud you for the work you're doing uh and and would encourage you to keep keep it up, and uh and and I appreciate your willingness to make time here to come on our show.
SPEAKER_00Thank you, Larson, and I appreciate your willingness to give me the opportunity to be heard and to hear my voice.
SPEAKER_01Absolutely. Well, if if people want to learn more about you and about the work you're doing, obviously the book ripped off. Um can can folks find that on Amazon or where would you where would you direct people?
SPEAKER_00Uh Amazon's the best place. I have a website uh but that's also listed in Amazon, but it it's it's uh no no frillshealthcare dot com. Um but but uh Amazon is a sales page. Yeah, thank you very much, Larce. This was a pleasure.