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A movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry's resources.
00:00:04:00 - 00:00:26:14
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professional to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers.
00:00:26:16 - 00:00:32:04
Reid Lancaster
First of all, Evan, thanks for being here. We appreciate you carving out some time in your day to to join us now.
00:00:32:05 - 00:00:33:13
Dr. Evan Pollack
My pleasure.
00:00:33:15 - 00:00:56:11
Reid Lancaster
Yeah, we might as well just start now. Can we just start now? Yeah. Just a very, very, casual conversation, a real conversation. As you see in politics, you know, just just real, straightforward conversations are very, very effective on both sides. This is this is a nonpartisan comment, but yeah. Yeah, that's that's the aim and that's the goal for this, this podcast.
00:00:56:11 - 00:01:16:08
Reid Lancaster
So thank you so much, Evan, for your time. DocNation exists to, do two things. Number one is we help doctors on an individual level, and that level is just like a professional athlete has an agent. We are an agency for doctors. So we invite people to, give us a call. Send us an email.
00:01:16:14 - 00:01:38:10
Reid Lancaster
If you have questions about what those services look like. But it is the full gamut and the full gamut. It's like, okay, but they can professionally. But it's it's everything. We'll help you buy a new car, will help you sell a home. We'll negotiate your contract. We'll review your contract. We'll help you find a new job. Matter of fact, we were speaking with someone late last night till almost 7:00.
00:01:38:12 - 00:01:57:11
Reid Lancaster
And she's looking, to, this individual individual's looking to move back to a different country because she's not getting, she's she's not being respected at all. And she comes to the meeting and she's like, she's just the nicest human in the world. I mean, I was fired up last night. It was difficult for me to go jump back in with my family.
00:01:57:11 - 00:02:16:02
Reid Lancaster
But I will say she, she's been working there for for eight years, and, they're making it very difficult for her to travel abroad to see her family and, Justin and I start licking our chops and we said, this is exactly why you have us. We're going to get you what you want. Whether it's, finding a new job for you.
00:02:16:03 - 00:02:32:12
Reid Lancaster
She didn't she didn't even consider that for some reason. But she was ready to put her two weeks, and she was asking us how, what's the best way to put your two weeks in? And, I'm just proud that we're able to to do so much more than help people put their two weeks in. So that was, that was a fulfilling conversation last night.
00:02:32:14 - 00:03:06:17
Reid Lancaster
And then the other aspect of DocNation is, we we exist to create a union. Healthcare is in shambles right now. And I'll just in my opinion, I'll say why I think it's in shambles. And we can get into that a little more later. But in my opinion, the star players have been relegated to the bench and the people who need the star players, the fans who pay to, to watch the, the world Series have lost all respect in the physician because of the multiple middlemen like the insurance companies.
00:03:06:19 - 00:03:17:02
Reid Lancaster
So, that was a little bit of a preamble. Without further ado. Evan, would you please, tell us who you are and what brings you here today?
00:03:17:04 - 00:03:22:01
Dr. Evan Pollack
Well, I appreciate your baseball analogy. First off, it.
00:03:22:01 - 00:03:24:18
Reid Lancaster
Just helps people understand it a little bit better.
00:03:24:20 - 00:03:47:10
Dr. Evan Pollack
All right, I understand that just fine. So I've done a variety of things in health care. I practiced internal medicine for 20 years. I represented hospitals on their Medicare appeals, as well as their commercial denials. I actually, contracted for a period of time with the department of Justice doing fraud, waste and abuse.
00:03:47:10 - 00:03:53:08
Dr. Evan Pollack
I actually, led the fraud, waste and abuse team for a period of time.
00:03:53:10 - 00:03:53:19
Justin Nabity
Wow
00:03:53:19 - 00:04:09:07
Dr. Evan Pollack
I’m very active with the, American College of Physicians. I sit on, actually, their subcommittee for, coding and policy, and I'm on the editorial board for ICD ten. So, I did a lot of stuff in.
00:04:09:09 - 00:04:13:00
Reid Lancaster
Sure have.
00:04:13:02 - 00:04:21:22
Justin Nabity
What triggered you to go from being in practice to then these other initiatives, these other aspects? What what led to that?
00:04:21:23 - 00:04:38:13
Dr. Evan Pollack
You know, that's a great question. And I really got to the point where I wasn't enjoying, being in practice anymore, and, and, you know, you practice because you love taking care of patients. And I wasn't enjoying it. I decided to transition out.
00:04:38:15 - 00:04:43:09
Justin Nabity
Was that, like, midway, or was it toward the tail end of, like, 20 years?
00:04:43:11 - 00:04:44:24
Dr. Evan Pollack
I practiced for 20 years.
00:04:45:01 - 00:05:10:09
Dr. Evan Pollack
And, you know, my personally, my, you know, because I, worked with a lot of physicians that transfer that I led, a lot of physician teams, you know, about 15, 20 years ago, I'm seeing that, physicians are getting tired of it. You know, just for the the reasons which you previously stated, and, are looking for something else to do.
00:05:10:11 - 00:05:22:14
Dr. Anthony Giuffrida
What would you say is the biggest difference from when you started practicing 20 years ago to when you, when you stopped practicing? In, in regards to patient care and how your interaction with the patients are.
00:05:22:16 - 00:05:50:13
Dr. Evan Pollack
So, you know, I, I actually started practicing when things were, were changing, quite a bit. Hadn't changed all the way. But, you know, certainly what you're seeing now is more physicians being employed. They're having their schedules, actually made for them. So, you know, you come in, you're expected to do, so much, you start to see X amount of patients, a lot this amount of time per patient.
00:05:50:13 - 00:06:13:14
Dr. Evan Pollack
And, you know, you know, as the technology and healthcare has, basically increased the, you know, now you got your priorities, reservations, you got, you know, more expensive testing that you're, you would like to be able to use, but you're limited to use. You definitely spending more time, you know, fighting, payers to get things done.
00:06:13:14 - 00:06:27:06
Dr. Evan Pollack
And, as you said, you know, patients, their only interaction is with the, physician, and they tend to take it out on the physician because that's the only person that they see.
00:06:27:08 - 00:06:37:16
Reid Lancaster
You know, because they're in the process, they're going through the process. It's a miserable process for them. And but they don't understand that their physician, who they're talking to is being handcuffed in so many different ways.
00:06:37:18 - 00:06:57:09
Dr. Anthony Giuffrida
Yeah, yeah. Also, I realized the physician doesn't really have all those answers either. I mean, the, the the goalpost shifts so much I can't keep up with what codes to use and what insurance is cover what I we wouldn't learn that in med school. We learned how to take care of patients and how to treat diseases. And unfortunately, I feel like we're getting pulled in 18 different directions.
00:06:57:09 - 00:06:59:21
Dr. Anthony Giuffrida
And I think that's leading to that burnout you're talking about.
00:06:59:23 - 00:07:11:02
Dr. Evan Pollack
Yeah, absolutely. And a lot of physicians are leaving practice either to do administrative type work or just get out of health care altogether.
00:07:11:04 - 00:07:21:00
Dr. Anthony Giuffrida
One of the one of the best lines, one of my partner said, is medicine's the hardest thing I ever worked at to get into you. And now it's the hardest thing I'm working at to get out of
00:07:21:02 - 00:07:21:09
Reid Lancaster
wow.
00:07:21:09 - 00:07:22:02
Dr. Evan Pollack
Yeah.
00:07:22:04 - 00:07:26:15
Dr. Anthony Giuffrida
Yeah. Which is sad to see because we want our best and brightest in medicine and stay there.
00:07:26:17 - 00:07:36:24
Dr. Evan Pollack
And that's that's an excellent point that you raised, because it was in the past that the best and the brightest did go into health care. And I'm not sure that that's the case anymore.
00:07:37:01 - 00:08:08:22
Justin Nabity
Well, the best and brightest see the writing on the wall. And they are smart and they're looking at things and they're making a judgment call on how to set himself up. They're not they're not, you know, ignorant to the situation of what's happening. You had quoted in a previous article about how 77% of physicians have gone from being in an environment that was autonomous to now being told what to do, told what to think.
00:08:08:22 - 00:08:28:18
Justin Nabity
I really we're in a situation where they want doctors to function like factory workers instead of thinkers. What do you think has led to, if you had to summarize, like pinpoint what the cause of that switch of 77% leaving, being in charge of their own life and charge of how they see patients, what's led to that?
00:08:28:20 - 00:09:02:17
Dr. Evan Pollack
So, you know, that's an excellent point. And it's a it's a complex issue. I don't think that physicians necessarily want to sell their practice and become employed. Although really, if you look at physicians coming out of training right now, some, most of them prefer to be employed, but to run a practice is incredibly expensive, particularly a primary care practice where you're, you know, you you're basically office based, the overhead is is tremendous.
00:09:02:17 - 00:09:49:21
Dr. Evan Pollack
You got computer systems, electronic records. And a lot of what I see is a lot of the practices that are being sold to, you know, whether or not it be, insurance company or a hospital or, you know, the private equity, it's not necessarily because that's what they want to do. It's because that's what they have to do, or they're going to have to close their doors and, I think the the big issue is whatever entity buys a practice is their major goal to keep the practice going and provide good health care or make a profit and if it's to make a profit, then that's where the physicians really suffer because they move
00:09:49:21 - 00:10:11:05
Dr. Evan Pollack
in, they get rid of personnel, they try to cut costs as much as they possibly can because they want to turn it over and sell it. Whereas, you know, I think there are instances where physicians are employed that, you know, you see, everyone's got their preference. But, you know, things like Kaiser, Mayo, Cleveland Clinic, these are employed physicians.
00:10:11:07 - 00:10:22:09
Dr. Evan Pollack
But those, those entities want to provide good health care. Their goal is to provide good health care. And there are some physicians that are pretty happy in that situation.
00:10:22:11 - 00:10:39:02
Dr. Anthony Giuffrida
Yeah, they're marketing their marketing as good health care. So that's what that's what matters for those companies. But but I agree, it's hard to see, you know, people still have to stay on for five years and you lose half your staff. And the reason for that is there's no extra money coming in from CMS. The cuts come every year.
00:10:39:04 - 00:10:49:06
Dr. Anthony Giuffrida
So you if you can't put money on the top end, you have to get rid of money on the bottom end to make a bigger profit. And then how to do that is to reduce overhead, which makes the doctor's life harder.
00:10:49:08 - 00:10:50:08
Dr. Evan Pollack
Yeah.
00:10:50:10 - 00:10:51:09
Dr. Anthony Giuffrida
That's unfortunate right?
00:10:51:11 - 00:10:55:09
Dr. Evan Pollack
I mean, Medicare just proposed another,
00:10:55:11 - 00:10:56:09
Dr. Anthony Giuffrida
Just got approved.
00:10:56:11 - 00:11:15:19
Dr. Evan Pollack
Just yeah, another cut to physician salary. Not only is it being cut, but it's not been increased, commensurate with the cost of living. So, you know, it only looks like a 2.5% cut. It's something like 20% when you factor in the cost of living.
00:11:15:21 - 00:11:18:17
Dr. Anthony Giuffrida
Yeah, it's hard to see. It really is hard to see.
00:11:18:19 - 00:11:42:07
Justin Nabity
Earlier this year, there was a letter issued, I think, with like 200 plus members of Congress that were talking about supporting no more cuts. It was bipartisan. And to read what you mentioned earlier about us existing for a union, us existing for advocacy, people get afraid of the word union, or they get afraid of striking, or they get afraid of these different terms.
00:11:42:07 - 00:12:07:15
Justin Nabity
They feel like it's most doctors aren't aggressive by nature. They're they're very much patient first and wanting to connect with people and help them. Very servant minded and this is we're in a situation where we can no longer have things go as they are, and there is support. There's lots of support in Capitol Hill, on Capitol Hill in DC to do this.
00:12:07:17 - 00:12:32:01
Justin Nabity
What would you say, Doctor Pollack would be some things that doctors can do to be proactive, to gain their voice back. You've done some things where you've given yourself even more freedom as you transition. But for those that are in practice today, what would you say? What would you encourage them to do? To have their voice be heard in their workplaces, within their associations, to bring people together?
00:12:32:01 - 00:12:47:14
Justin Nabity
So that way it's not like everyone is just going in their own direction, competing voices. We got to get on the same playbook and call some of the same plays to move forward, to be large enough to push back on these cuts.
00:12:47:16 - 00:13:17:14
Dr. Evan Pollack
Yeah, I know the it's a good point. I mean, physicians, I think in general generally don't want to get involved in big organizations and don't want to involve themselves in that type of advocacy. But, my recommendation and, personally, what I did is I did get involved. I got very involved with the AMA, and you could say what you want about the AMA, but they're, the largest lobbying group of physicians in the entire country.
00:13:17:16 - 00:13:39:17
Dr. Evan Pollack
And, you know, I always tell people you don't like what the AMA does, join them and change it, because that's your voice. You can't sit on the sideline and say, well, I don't like what they do. It's like, you know, our election, you don't like who's in office. You have to vote. And so you have to get in there, you know, then there's specialty societies.
00:13:39:18 - 00:14:03:02
Dr. Evan Pollack
I've always been a big fan and gotten very involved with the American College of Physicians, and their advocacy. I've gone to their leadership day in a number of times. But you need to get out there and get involved. You know, the AMA's I mean, they're what they'll tell you is, you know, you don't didn't even have to show up for me and give us your money and let us advocate for you.
00:14:03:08 - 00:14:05:11
Dr. Evan Pollack
And they do they do a lot of advocacy.
00:14:05:11 - 00:14:26:17
Dr. Anthony Giuffrida
I yeah. And I think, you know, the younger group of physicians coming out is really soured by the AMA. That's the the word in the street. It's going to be a it's a problem because either we need the AMA to because all they're seeing is, hey, the last ten years have not gone well for physicians. And the AMA has been in charge of the advocacy.
00:14:26:19 - 00:14:48:02
Dr. Anthony Giuffrida
You know, I'm hearing no one joining. I'm a part of the AMA. No one is joining the AMA coming out of residency and med school, which which is a problem. And the twofold solution is either the AMA has to recognize that and has to, you know, change. I think that you don't just say, hey, we're going to do the same thing and ask for more membership.
00:14:48:02 - 00:15:01:14
Dr. Anthony Giuffrida
I don't think that'll work. I think they have to come out and say, hey, we understand this is not gone well the last ten years and we're going to change, or someone else has to step up and come in and say, hey, we're going to advocate more, because I agree, there's not just I sit in the sidelines.
00:15:01:14 - 00:15:08:16
Dr. Anthony Giuffrida
We can't just keep doing the same thing. We can't. And that's been I think a lot of physicians kind of just are used to it.
00:15:08:16 - 00:15:11:18
Reid Lancaster
Now, the truth is that's why DocNation exists.
00:15:11:20 - 00:15:12:19
Dr. Anthony Giuffrida
Yeah.
00:15:12:21 - 00:15:30:00
Reid Lancaster
To, to to help support the AMA in any fashion or to become a similar governing body. Just like them. We want to support, we want to help. So maybe this is the bridge, Evan, for maybe a meeting at some point with, whoever we need to meet with at the end.
00:15:30:02 - 00:15:54:04
Dr. Evan Pollack
With the AMA, you know, to say like, hey, we're physicians, I want to get things done. You know, I'm just going to throw this out. But the membership of the AMA is pretty expensive for a physician. The AMA does not make its money off its membership fees. It makes it off the CPT, where it makes millions and millions of dollars,