When you are taken by ambulance to the nearest emergency department, you are completely vulnerable. This is not the time when you can research or negotiate prices. With the corporate takeover of hospitals, bills for emergency services have skyrocketed. Patients often receive enormous bills that can sometimes even bankrupt them. These corporate systems are also taking advantage of physicians, and in many cases, replacing them with non-physician practitioners.
We are joined by two experts on the subject – Dr Robert McNamara is an emergency room physician who has been publishing articles on this subject for 25 years. Dr Mitch Li is an emergency medicine physician with a practice based on the direct primary care movement and is raising awareness about the dangers of private equity and corporate healthcare.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Articles by Dr. McNamara:
Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future - https://www.jem-journal.com/article/S0736-4679(16)00007-X/fulltext
A Survey of Emergency Physicians Regarding Due Process, Financial Pressures, and the Ability to Advocate for Patients - https://www.jem-journal.com/article/S0736-4679(12)01725-8/fulltext
More reading:
The Rape of Emergency Medicine - Free download at https://www.aaemrsa.org/get-involved/the-rape-of-em
PhysiciansForPatientProtection.org
When you are taken by ambulance to the nearest emergency department, you are completely vulnerable. This is not the time when you can research or negotiate prices. With the corporate takeover of hospitals, bills for emergency services have skyrocketed. Patients often receive enormous bills that can sometimes even bankrupt them. These corporate systems are also taking advantage of physicians, and in many cases, replacing them with non-physician practitioners.
We are joined by two experts on the subject – Dr Robert McNamara is an emergency room physician who has been publishing articles on this subject for 25 years. Dr Mitch Li is an emergency medicine physician with a practice based on the direct primary care movement and is raising awareness about the dangers of private equity and corporate healthcare.
Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/
Articles by Dr. McNamara:
Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future - https://www.jem-journal.com/article/S0736-4679(16)00007-X/fulltext
A Survey of Emergency Physicians Regarding Due Process, Financial Pressures, and the Ability to Advocate for Patients - https://www.jem-journal.com/article/S0736-4679(12)01725-8/fulltext
More reading:
The Rape of Emergency Medicine - Free download at https://www.aaemrsa.org/get-involved/the-rape-of-em
PhysiciansForPatientProtection.org
Welcome to'patients at risk' a discussion of the dangers that patients face when physicians are replaced with non physician practitioners. I'm your host, Dr. Rebekah Bernard, and I'm joined by my co host and the co author of our book, patients at risk the rise of the nurse practitioner and physician assistant in healthcare. Dr. Niran Al-Agba.
Niran Al-Agba MD:Hi, good evening.
Rebekah Bernard MD:Today we're talking about the dangers that patients face due to the corporate takeover of health care. We are joined by two experts on the subject. Dr. Robert McNamara is an emergency physician who has been publishing articles on this subject for 25 years. Dr. Mitch Li is an emergency physician with a private practice modeled on the direct primary care movement. And he wants to raise awareness about the dangers of private equity and corporate health care, both of you, we welcome you very much to the show paid to be here. When you're taken by ambulance to the nearest emergency department, you are completely vulnerable. This is not the time that you can research or negotiate prices. And with the corporate takeover of hospitals, bills for emergency services have skyrocketed. Patients often receive enormous bills that can sometimes even bankrupt them. Mitch, I first learned about this issue from a Facebook post that you made where you really broke down a lot of the issues that are happening in corporate healthcare. Can you kind of summarize what's been going on?
Mitch Li MD:Yeah, it's a long discussion, I think we can start with the concept that the emergency medicine treatment and Labor Act, and it's effectively the the only universal health system that United States has, it is going to be the safety net. And it says that any patient who presents to the emergency department needs to be treated evaluated for an emergency treated appropriately, regardless of their ability to pay.
Rebekah Bernard MD:And I guess before that, like the hospital could turn away somebody if someone was coming in, in labor or had a real emergency, you know, you were kind of out of luck. So now the idea is that the emergency room has to take care of at least patients that are unstable, right?
Niran Al-Agba MD:Yeah, it was passed in 1986. It was part of this idea that people were dumping patients, they were saying, you know, we can't take you. And so this was the government's answer to the problem.
Mitch Li MD:Clearly, it was sort of needed. The emergency department and the US healthcare system is broken. So we have a lot of, you know, patchwork solutions. And so this was be referred to ACEP refers to that that's the American College of Emergency Physicians, rightly does refer to this as an unfunded mandate. It was a mandate that emergency physicians and hospitals have to take care of patients, regardless of their ability to pay, but it's not funded on a federal level. So the problem with that is it puts the patient into a very vulnerable situation where they can be treated regardless of their ability to pay. But that doesn't mean that they can't receive a bill and then be taken to collections and then be sent, you know, had their credit ruined, bankrupted or even sued.
Rebekah Bernard MD:You know what, I didn't even think about that. So the idea is that they have to treat patients but not that they have to do it for free. So in other words, they can still send bills to patients, and they can really seek collections against them. And a lot of Americans are going bankrupt because of medical bills.
Mitch Li MD:Yeah, so how we deal with that really varies upon institution, of course, and the emergency physicians might be employed by a hospital, or they might be employed by a small democratic group, or a large contract management group. And the individual physician usually has very little say over how their services are billed for, or how aggressive the billing company might be with the patient. And even if they did, we don't have any control over the facility fees that the hospital bills. So this really gets to basically the beginning of Emergency Medicine. And Rebekah, I'm sure we can discuss this more really, you know, the original Turf War of Emergency Physicians versus family medicine in the emergency department. And back in the early 90s. And really, in the 80s, the Rape of Emergency Medicine was published. And this was a book by the Phoenix, which was a pseudonym for Dr. James Keeney at the time, who detailed a lot of the corporate profiteering and sort of underbelly of Emergency Medicine. And that really prompted the formation of the American Academy emergency medicine because it was felt that these profiteering powers that started the original contract management groups were also embedded in the major specialty society, which is the American College of Emergency Physicians. The problem in my view is that while this was true, a lot of Emergency Physicians weren't really paying attention to it. And even though that's what would cause the foundation of the American Academy of Emergency Medicine, it really only took off as far as membership when the wedge issue of board certified emergency physicians only as opposed to FM physicians and others could be members. And I think that we kind of, it's very easy for doctors to turn against one another. And that was the easy wedge issue. And a lot of the corporate issues kind of took a backseat to that and so that snowballed 30 years later or so into a really difficult situation where the CMGs are bigger than ever With an even greater profit motive than ever,
Niran Al-Agba MD:I do want to just for people listening that maybe aren't familiar with how emergency medicine kind of came to be, I think it's a fair way to kind of go back. I know Rebekah and I've talked about this a couple of times, when my father started practice in 1969-70 timeframe, there were no emergency medicine physicians. So in our town, for example, there was one hospital, every physician had to work in the emergency room, no matter their specialty, no matter what their scope was. And the point was, then when your patients came to the emergency room, it was like an ownership kind of, then you know, Mitchell, if you are in the same town and I'm in the Bahamas, you would therefore take care of my patient, because I also was volunteering my time in emergency room covering your patients when you're on vacation. So to be fair, it didn't matter pediatrician, cardiologist, you know, whatever, surgeon, you did a shift in the ER, and I remember my dad talking about this growing up, he said, I'm not equipped, you know, a man comes in with a heart attack. I'm a pediatrician, I really need support. You know, I'll work two shifts, if someone else takes the adults and works, let's split it up or something. So it will say I think in the beginning, a lot of emergency, I'm not as familiar with the family practice, maybe there's more of a tour for I'm not aware of, but I will say at least in our town, there was a lot of Welcome to have a specialty so that there was coverage. But you're right. And maybe Dr. McNamara can speak to this a little more of how these corporations came to power at that time.
Rebekah Bernard MD:Yeah, I want to ask Dr. McNamara about that, because he's been writing about this since 1994. And Mitch calls him an 'encyclopedia of corporate medicine. 'He's the chair of Emergency Medicine at Temple University. He's the past American Academy of Emergency Medicine President tell us about when when you started in emergency medicine, when you started seeing these corporate takeover start happening and emergency medicine.
Robert McNamara MD:So I mean, if you look at the arc of Emergency Medicine, it started with great intentions, a moral imperative to deliver care to the poor, the uninsured, the people that were arriving in emergency departments. And it just really it there's a whole history of this that you can read up on. But essentially, you know, as stuff started to get concentrated in the hospital, better equipment, the decline of the home visit, the ED became a one area for care. And in the mid 50s, you had these all these surgeons to come back from Korea and say, 'Look, we did better care for injured patients in Korea than we're doing in the United States.' So that was another part of the drive actually, a lot of academic emergency medicine started by surgeons, o then, you know, you created this, and then well look, it's really getting busy. There's history - articles that you can look at where the volume started to shoot up and became recognized that we need somebody who specialized in emergency medicine sort of the sad thing is, is that the way the specialty took off, there was a lot of social justice type things, EMTALA, pregnant women who were poor being told to go to the county hospital. And it was almost when you look at it, and I researched the history pretty pretty well. I started my residency in 1982. And I kind of wish I had started a decade earlier to be able to kind of stop things before they got out of hand. But there were two pathways. One, you had the docs at the big hospitals, the academicians that were really focused on creating specialty to serve the needs of the patients, again, that the poor the uninsured. And then along the other side, you had the entrepreneurs who were realizing, hey, we can make a lot of money off emergency medicine by hiring our colleagues, unprofessionally, you know, to make money for us when we're not even there seeing the patient. So while we were busy creating an academic base, you know, getting NIH funding, becoming academic departments, we were censoring each other for taking pens from pharmaceutical companies. And then on this whole other track, there was this creation of an industry to exploit your colleagues to make money off of them. And then that's morphed over time, they grew bigger, and then they sold delay interest. The first one was EM care to a company called Lay law, and then that later roll to private equity. And now we have a situation where private equity is dominant, many, many emergency departments you walk into and private equity owns it. And the danger to the patients is they determine who sees you private equity says, What's the business decision here? Is your going to be a board certified doctor, or is it going to be you know, a non physician practitioner? How can I get away with the cheapest model, because the number one costs to delivering that kind of care is the cost of the practitioner. That's what I tell residents got to understand one thing what they pay the doctor is the number one expense for these companies. And we've seen abuses resulting from that where you know, the patients aren't really getting to what we thought was important, the board certified doctor,
Rebekah Bernard MD:let's stop and just break down a few definitions because not everybody listening really knows what all of these things mean the first thing when you say private equity, what do you mean by that?
Robert McNamara MD:So these are in companies where the investors put money in they have a you know, a group of managers that look for opportunities where you know, in a five to seven year period, the investors can get back 20% - 15 to 20% return on investment. In the meantime those running the private equity firms are making money for themselves getting healthy salaries. So private equities basically where rich people generally put their money to try to make more money. And it's all over. I mean, it's it's not just emergency medicine is fighting it. I mean, Taylor Swift fighting it. My daughter's a big Taylor Swift Fan. And the trouble is they come into an industry. And they create practices to make money that can have negative effects, they can shut down hospitals. And we saw that in Philly here with Hahnemann, there was some private equity backing there, they do what they can to profit, right. Their goal is to profit when you know, the goal for healthcare is to take care of the patient.
Rebekah Bernard MD:So I think that this is the problem. I don't think patients understand I think if you go to a hospital, you're being cared for by maybe an altruistic group of people that is there to take care of their health. And what I think a lot of people don't understand is now medicine has become a business or a commodity. And as a patient, you're there for healthcare, but you're actually there to make money for this system. And this system is often owned by businesses. And there's stocks that are traded, right, and things like that. So the question becomes, is there another interest besides just patient's health, when there's a lot of money at play, then that might change the way patients are being treated? And so I think that's the first thing that patients need to understand. Now, Mitch, can you explain this CMG idea? So a lot of people are talking about CMGs, which stands for contract management group, right?
Mitch Li MD:Sure. Yeah, that's an interesting one, because you can actually talk about definition is for probably an hour, we use CMG and really what we're referring to when CMG it's really a colloquial term, and there's a few examples that are clearly CMGs. And then the definition gets murky from there, there are CMGs that have private equity ownership, and then there are CMGs. That don't. So it's not a prerequisite to be a CMG, but it kind of makes everything bad about a CMG infinitely worse, to further address what Dr. McNamara said about private equity, I think it deserves this a little bit more exploration, which is that private equity is is kind of a special form of ownership, we have to look at the definitions of profit and profiteering a little bit. So Rebekah, you and I both have private practices. So technically, in order for us to have a salary or to pay ourselves something, we have to have a profit, right. So there's something reasonable, there's a reasonable amount, even if you're an employee of the NHS, you know, government owned system, those doctors need to take on some kind of money in order to live. So there's profit, and then there's profiteering. And the contract management group model was is one in which somebody is disproportionately profiting off the top. And that could be an individual physician that owns the group, a group of investors, it could be the public market, or in the extreme, it could be a private equity ownership. So when it's an individual physician, you could have essentially what you could call like a benevolent dictator, right, that that turn I think I learned from Bob, a long time ago, which is well, that is you know, that one doctor wants to be altruistic and they're charging a fair amount for their work as an entrepreneur, the doctors that are working for that Doc might be paid fairly. And that Doc may not be taking advantage of patients. But it goes downhill from there, when you have a very large pyramid structure where somebody is profiting disproportionately and somebody gets greedy. So as that group grows, and they're most incentivized to grow, as opposed to a group of altruistic doctors that's not thinking about this, the more steep the pyramid structure, the more incentivized they are to grow. And we reach this catch-22 where the most profiteering groups are the most likely to grow throughout the country. And so at this point in time, I would say I think the estimate is around these 50% of emergency departments are staffed by these contract management groups that we that I'm referring to, in the colloquial sense, the ones that are profiteering the ones that are sending patients to collections without a network surprise bills and profiting disproportionately over the physician.
Niran Al-Agba MD:So obviously, I guess, you don't know that I own a private practice. It's 50 years old, actually. And we're on fourth, third and fourth generation patients. So I will tell you that in the old days, especially with like Henry Ford, for example, he set the income at no more than 10 times what his lowest employee made. And then he made sure that we bumped up the employee's income so they could afford a Model T for example. And that's how the Ford company kind of made their mark and I've always really held to that like I've never made more than 10 times what my lowest employee makes even though I'm you know, they're on the holidays, I'm writing my own paychecks, I have my employees. So to me, that's always been what's profit, right? So that's, that's kind of what I think you're defining and I like to define it in terms which is I think it makes sense to as the CEO of my business or Rebekah's or yours to not make more than 10 times what the lowest employee makes. So I think profiteering above that is where we're getting into millions of dollars. And I guess my question then for you is my understanding of the ER Doc's was they got their own management groups because they weren't getting paid well enough. They were not getting sort of autonomy, and the hospital wasn't necessarily reimbursing them properly. So my understanding was that a lot of them started their own groups and then contracted with the hospitals. Do we own any responsibility for this? Or is this totally just the hospitals and private equity?
Robert McNamara MD:So the problem was started by physicians, right? It was the physicians that saw the profit motive those that got in and saw the the chance to take advantage of others. I can tell you the original constitution and bylaws of ASAP wrote in 1968 specifically said in there that you will not take the fees of a colleague that you're you know, you will earn your income from your own services to patients. It also has a line in there that you won't allow practice of medicine by a non physician. So again, against both corporate control and also against non physician providers, practitioners being independent, it started out right and the doctors started it - the eight docs - that formed and wrote the bylaws were independent practice, they were people that came out of family practices and decided to get together the cover an ED, but then you know, you've got the entrepreneurial spirits that come in and saw the opportunity, hey, at this, actually, if you read the rape of Emergency Medicine, you see how it happened, like somebody was moonlighting at a hospital and said, 'Look, you can get your colleagues to work, I'll give you 10 bucks an hour for every hour you cover with them.' And they just they just saw the profit motive one of them quit their residency just to go into ED staffing, and it grew and grew. And then they actually said, 'Let's rise to power.' And they changed the bylaws of the ACEP. So they wouldn't, there wouldn't be anything, any barrier, the academicians you should have watched in the shop, we're too busy trying to create journals and research and that stuff. And the moral force of the academics was not brought to bear on the American College of Emergency Physicians. And essentially, they created a system where they shut off debate, I can actually show you a letter to the editor, where they said, 'We are not going to discuss this stuff in the journals,' they shut off the press to suppress debate. And then you know, the book was published the rape of Emergency Medicine brought a new generation myself and others say'wait a second, this is going on.' And once you've lifted the lid, you can see that was pretty clear. There were abuses going on when we let our residents go out into the world. So I got involved, that was a program director. And I said this is wrong. I mean, this world is not right, or the being taken advantage of.
Rebekah Bernard MD:Yeah, you've been speaking out about this for about 25 years. And I read one of your articles that you wrote in 1994. And you wrote that the problem had already been developing that large publicly traded corporations had begun to acquire hospitals, and that Wall Street type contract management groups now control and employ a large number of physicians staffing emergency departments. And then you go on to say that things like government mandated electronic records managers and administrators, they use that as a tool to monitor physicians to check on their productivity, how many tests they're ordering, if they're admitting patients, and there are certain, like, thresholds that they want doctors to get. And doctors have begun to be influenced or coerced, or threatened that if they don't comply, or they don't charge X amount of dollars, that they can actually be fired or lose their contract
Robert McNamara MD:that's been shown. Right. So I mean, it's the listeners, you know, they can go search on a 60 minute show called the cost of admission by Steve Croft. It was done in 2013. And their HMA hospitals for profit chain, colluded with Envision EM care to basically force doctors to admit a quota, If you were over 65, you came in, they expected a 50% admission rate, otherwise, you would be threatening your job or fire. So this is an example of the bean counters trying to press you to be more profitable. And we see the same thing with the nonphysician practitioners. 'don't interfere, don't try to supervise, you've got to supervise them, but don't interfere, let them operate independently.' We hear these stories all the time as the American Academy of Emergency Medicine. So it's the profit motive. And that gets into what in other topic is the corporate practice of medicine. In most states, there exists laws to say businesses can employ physicians, there's the same thing exists for lawyers, you don't want the business interest between the patient and the doctor. You don't want the business interest between the lawyer and the client. Yet in medicine, these have not been enforced. They have scams to get around them. And it's sorely needed. I mean, this is something that I've been advocating for for a long time. I think we're starting to wake up to this with what's going down. And with private equity being more aggressive. The pandemic brought it out doctors that are risking their lives getting pay cuts in the middle of the pandemic, people start to say wait, why? Why is that Wall Street company determining staffing levels here? So it's an opportunity for anyone listening for the public for doctors themselves to step back and say why do we have private equity involved in medicine?
Niran Al-Agba MD:Well in what do we do about it? Some of us don't aren't involved with private equity. I mean, I'm still on paper for gosh sakes. I practice the same way my dad did 50 years ago. So I mean, I've managed to survive and feed my children and my family. So I guess my question to you is, though, once they have you in your clutches, like what is what's the solution to reverse the trend?
Robert McNamara MD:Well, it's to try to get all physician organizations to use the existing prohibitions out there that take back medicine. I mean, that's why Mitch and I are part of the 'Take EM Back' and a lot of the big states in the home state of Envision EM care, Texas, there is very strong prohibitions on corporations practicing medicine, they use doctors, as paper owners, to create sham professional associations. This was all discussed in a pro publica article, I don't know if you saw that, or the doctor who's the owner has no idea the finances, all profits are swept so getting organized medicine to deal with the Attorney General's Office. This is the illegal corporate practice of medicine filing suit. Okay, now, the American Academy has filed suit four times against corporate groups, we need to do it more. We won three of those four cases in the fourth one, we just didn't get standing. Fee splitting. That's another rule. Okay. So technically, you know, you're paying a part of your feet for the right to see patients in the emergency department, again, in every state that's prohibited got to bring that to light. You were aware of some Federal False Claims actions, when some of this kind of stuff, it's got to collectively come from organized medicine. You know, the aim is the smaller of the groups, I think we've successfully proven that you can do something of course we file to four times we've been defending doctors left and right get fired. We've been writing the hospital administrators you know, don't replace the physician don't group with a corporation, this would be a problem advocating trying to take him back and other specialties are just as bad as we are now. I think we started and then they morphed that into radiology, anesthesia, private equities in the urology, Gi, it's just becoming rampant because they say, Hey, we made a lot of money on emergency medicine, like dermatology, those guys make a lot of money, we can really retain a profit there.
Rebekah Bernard MD:Now, you mentioned AAEM. And you also mentioned ACEP. So basically, if I'm not mistaken, there are two emergency medicine organizations. And the big one, as you mentioned, is ACEP right. And AAEM is the newer, smaller, but really fighting for the little guy kind of group it sound like.
Robert McNamara MD:The ACEP was formed in 1968. AAEM was formed in 1993.
Rebekah Bernard MD:So one of the biggest challenges that you guys are facing is here, you are speaking out about this, however, ACEP, which is the large group with probably the most power. They are maybe having a little bit of a conflict of interest here. And Dr. McNamara you actually wrote about this back in 1994. You did this like point counterpoint article, which was so interesting, where you pointed out back then that ACEP board of directors had a conflict of interest that they had ties to the contract Medical Group, and you really were critical. And what was so interesting was that Dr. Hellstrom, who I guess is one of those people in that group. He wrote a rebuttal to you and he accused you of quote, innuendo and exaggeration. And he said that you it's quote, attempted to paint a picture of group influence and greed that simply does not exist. This was back in 1994. So fast forward to today. Obviously, you were right, because we are seeing a lot of these leaders really with really questionable conflict of interest. And Mitch, you've actually been writing and talking about this a lot. In fact, you posted a video from what's his name, Dr. Kevin Klauer. Tell us about that video and why you thought it was important for people to see it.
Mitch Li MD:Thanks. And that was a little bit of a powderkeg incident. That's kind of how I would describe that event. And if I can, before I get to that, I just wanted to address a little 30,000 foot view on what you had just asked Dr. McNamara about which is how do we do this within was who was at fault originally? How do we get out from under the grasp of all this? And I think one angle that a lot of physicians are familiar with is that in the the BUCAH plans - Blue Cross, united, Cigna, Aetna, Humana, they become profiteering. And they have neither Dr. McNamara or I would refute that. But what's happened is we've gotten this sort of Faustian bargain that a lot of the leader in that we should align ourselves with another financial giant, which is private equity in order to fight. And right now, you just mentioned it. We have two organizations in emergency medicine. That's pretty rare. I don't think that's the case for any other specialties in the AMA, which you might consider the joint specialty group that represents a very small portion. I don't have updated figures, last I saw was 15% are represented by the AMA, because largely physicians have lost confidence and still has influence in DC because there's really no other group that has so we're reaching that point where physicians don't have a unified voice with society. We've lost the trust of patients. probably for good reason, because we've sold out to business interests everywhere. And so the individual altruism is kind of a physician has lost upon the public. So the problem I see is that we need to unify against private equity and non transparent exploitative as that effect both patients and physicians dinner not just our specialty but workhorse within medicine. And only then can we actually albums in American healthcare only then can we take on you know, profiteering insurance companies. So that right now with emergency medicine sort of being the the epicenter, the pioneer of this CMG exploitative model, it needs to start here to unify the groups and the individual physicians against private equity. And that's going to happen with or without.
Rebekah Bernard MD:Well, what you're saying is really important. You're saying that doctors need to band together. So I think what was so interesting about this Kevin Klauer video, was this was a video that was about five years ago and Kevin Klauer was he was one of the presidents of the of ACEP I believe, he was a leader in ACEP. And he also was a big part of CMG are sold out to private equity. But what he wouldn't let you explain that, but what he was saying in this video was doctors need to just put their heads down and take care of patients, 'you guys, if you do your job, everything's gonna be just fine.' And so I think a lot of people were really angry when they saw that because they're said, this is the downfall of medicine, doctors are so busy just doing that taking care of patients and then expecting that these corporations are going to take care of us or do the right thing. And of course, they don't. Is that right, Mitch? Am I getting that Right? why people were so upset about that video?
Mitch Li MD:Yeah, you know, I didn't know Kevin klauer at all, I didn't know who he was. I know he has a history, just like a lot of the forefathers my specialty. I'm sort of learning as we go and put this in context, when you know what, as a young physician, when I go to the ER, we all get a little confused, or when a older patient says, 'Oh, that's cute. What are you going to do when you grow up?' And we're like,'I'm an emergency doctor. This is this is what I do.' Because we know that history, there is what Dr. Al-Agba had described, which is your primary, your regular doctor goes in and meets you in the ER, and we get confused when they say, 'Can you get my cardiologist in here to meet me?' And they're like, 'no, they don't do that.' So there's a history of em that I'm sort of learning. Right. And in part of that was discovering this video with Kevin Klauer. And I think it relates back to the concept of physician burnout versus moral injury. We're reframing it now. Right. Dr. Windy Dean from the moral injury foundation or Healthcare Foundation has kind of reframed that, and burnout is very much a victim blaming learned helplessness type term, and that's what this video at least emoting It was basically saying, in so many ways, do yoga, and you'll be fine. It was basically saying it was it kind of an inspirational video very well shot. And if I were a young physician watching it, I probably be inspired by it.
Rebekah Bernard MD:It was actually for Doctors; Day too, which I think is funny. I have a little more information about Kevin Klauer. This was five years ago that he made this video and someone said this is before the C suite made millions off of the sale to private equity firm Blackstone Group. So he was part of teamhealth I guess he was the chief medical officer of teamhealth. It was acquired by Blackstone for $11 billion. That's with a B. So a lot of people were saying,'Yeah, you tell us to put our heads down. And meanwhile, you're making billions of dollars off of our back.' And you know, people got really upset about that, because like you mentioned there is moral injury. We have physicians taking their lives, and we have physicians getting out of the practice of medicine. And these kinds of people are really taking advantage. And I think Dr. McNamara your point that the original bylaws said that we shouldn't take money from our colleagues, I think that it really comes right back to that.
Robert McNamara MD:Well if you put- if you put the perspective of Emergency Medicine, on top of what you just said. So the emergency doctors were there. 24/7 We're there on the holidays, we work night shifts, it's extremely stressful. We see young children die, you know where I work. I see 16 year old kid shot and killed dealing with the mom. It's just you know, it just tears your soul. But now you have created within the specialty of feeling of exploitation. So first off, the doctors have no idea what's being billed and paid in their name. So they're in the dark, lack of transparency breeds distrust. They see the displays of wealth that are out there with these companies. They host giant receptions. We hear leaders who are doing quite well. You know, you know, one leader of one of these large groups got a tower, the Ohio State football stadium named after him and you feel like, here I am doing a difficult job and I'm being exploited. That's really like the core reason I'm involved being in an academician training residency. Because I don't think you can do a difficult job if you feel somebody's being taken advantage and then you take it to the patient level. If your doctor feels exploited, burned out, they're not going to deliver the best care. They're not in the right frame of mind. It affects the doctor. It affects patient care, and then the patients on the other end are getting these excessive bills. Doctors have no idea what the charge Master is. And then they get pursued. So it's a just doesn't make any sense that you can't have private equity in emergency medicine.
Rebekah Bernard MD:We have so much more to talk about, but we're out of time for this session. We will come back on our next session and we'll hear a lot more about this. In the meantime, if you'd like to learn more about this issue, we encourage you to get our book it's called patients at risk the rise of nurse practitioner and physician assistant in healthcare, we would love for you to subscribe to our podcast and our YouTube channel. And if you're a physician, please join us physicians for patient protection.org Thanks so much and we'll see you very soon on the next podcast.