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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.
00:00:00:00 - 00:00:25:21
Unknown
This is the Doc Nation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professionals 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 Doc Nation and not necessarily those of our Guests or referenced health centers.
00:00:26:17 - 00:00:35:08
Justin Nabity
John, great to have you on with us. And we'd love to have you share with everybody tuning in. How did you get involved with health care and what's your current role?
00:00:35:16 - 00:01:06:08
John August
Well. Thank you. It's always great to be with you. Thank you for inviting me again. So the way I got started in health care was after, going to university, graduate school. I got involved in organizing, not in health care, but, after about ten years of organizing in manufacturing and transportation. I, took a job with the health care Workers Union.
00:01:06:08 - 00:01:38:12
John August
1199 in Pennsylvania. And on my very first organizing campaign. Here's how I got involved in health care. I met a woman who I'll never forget. Two women, Teresa mello Farina and her roommate, Sharon McHale. They were in their early 40s, working in a for profit nursing home on top of a coal slag in Prattville, Pennsylvania, which is the old anthracite region of Pennsylvania.
00:01:38:14 - 00:01:55:20
John August
They worked in a for profit nursing home. They had called the union. I met them near their home in Ashland. So I met them and I said, so what's on your mind? Why? Why did you call the union? And here's what they said.
00:01:55:22 - 00:02:01:16
John August
We don't have enough wash clothes to take care of our patients.
00:02:01:18 - 00:02:26:19
John August
And we need to do something about that because, you know, we don't get paid a lot of money. You know, our benefits are not great, but we've both worked there for 20 years, and we love our job, but we can't continue to do our job unless we have more support from the management. So the long and the short of it is, is that,
00:02:26:21 - 00:02:50:07
John August
That was not the answer I was expecting. But since that time, which is now more than 40 years ago, that has been what got me involved in health care. Understanding that the people who provide health care in this country often have no voice about the most important things, which is how do they care for their patients?
00:02:50:09 - 00:02:54:13
John August
And that has been true every single day since then.
00:02:54:19 - 00:03:18:22
Dr. Anthony Giuffrida
And I think that's really important. I was going to mention what you mentioned at the end. There is their biggest concern. They may not have good benefits. They weren't getting paid much, but they didn't call you until they weren't able to take care of their patients. I think that's a lot of people need to realize, and health care is the reason physicians are getting frustrated is the patient care is very much starting to be eroded away.
00:03:18:24 - 00:03:40:19
Dr. Anthony Giuffrida
And, we can see we see what's going on right, we’re the canary in the tunnel. We see where this could take us in the next 5 to 10 years. If there isn't a change. And it's not a good place. And that's why we're reaching out to people like you, John, for help. People that understand how to bring a group of people together that don't have a voice, give them a voice, and hopefully change things for the better.
00:03:40:21 - 00:03:53:13
Dr. Anthony Giuffrida
And in this case, it's not even for the better of the employee, which is the physician. It's for the better of the patient who is actually the customer. So, that's really how health care is. Those are the people that go into health care. They care about the patient.
00:03:53:15 - 00:04:18:08
Reid Lancaster
If you remember back to the podcast with, Doctor John Nicol, and that was his main thing, there was a number of things that he had an issue with himself that were affecting him and his bottom line. Right. But not his voice didn't become louder until his inability to provide care, to the physician in the way that he thought was the best administration was the deterrent.
00:04:18:10 - 00:04:38:13
Justin Nabity
Yeah. Once you start talking about the patient and the patient not getting what they need and him feeling responsible, personally responsible for not being able to deliver what the patient needs, the patient's suffering now as a result of that, that's really where it struck a chord. So John tell us about current role. How are you engaging with health care today.
00:04:38:16 - 00:04:42:11
Justin Nabity
How has that changed. It looks similar to when you got started?
00:04:42:13 - 00:05:10:09
John August
Well I would say very little has changed. In fact, I think things have changed for the much worse. So I spent, many decades in the labor movement. My last, and probably most, impactful, on me personally was when I led the labor management partnership with Kaiser Permanente for almost a decade.
00:05:10:11 - 00:05:48:18
John August
And I've been at Cornell University now for I'm starting my 12th year this week. And my work at Cornell, is exclusively on health care. And I work with, members of the, the, management of health care, the labor side of health care, government policy, research, writing, consultation, facilitation. And through that work, I'm exposed, every day to the, on the ground, from, I would say, the front line to the C-suite, of the health care industry.
00:05:48:20 - 00:06:22:13
John August
Hearing from people who are looking for support on how to have a better relationship between frontline people and executives in the workplace to deal with the crises that are largely generated from external forces of, financing, insurance regulation, competition technology. And, as all of you know, all of those things have become overwhelming with almost no cohesive response.
00:06:22:14 - 00:07:16:04
John August
It's as though every physician, every nurse, every organization has to start from scratch every year to try to figure out how to survive in that environment, which creates a tremendous amount of unnecessary conflict. So, I try to bring of you that instead of having conflict between labor and management or executives and frontline, let's focus on working together in an environment, that we should try to control together as opposed to separately and, and so and I'll just finish by saying this last year and a half, no surprise to you is that the majority of interests that I get from people who call us at Cornell are from physicians, overwhelmingly.
00:07:16:06 - 00:07:20:20
Justin Nabity
Interests in terms of getting help because they see something's wrong in the workplace.
00:07:20:22 - 00:07:40:01
John August
Yes. As my department chair says, well John, you know we work on a world here at Cornell ILR where a lot of people call us for help, but they don't really know what they need. And I think that that's probably true. I think you know physicians who call you and they have a lot in their mind.
00:07:40:01 - 00:07:44:17
John August
They have a lot of pressure and they know they need something. They don't know exactly what.
00:07:44:18 - 00:07:46:19
Reid Lancaster
That's right. I say it all the time.
00:07:46:21 - 00:07:51:18
John August
Yeah, I say that that is not a, hindrance. That's an opportunity.
00:07:51:22 - 00:07:52:09
Reid Lancaster
That's right.
00:07:52:12 - 00:08:11:17
John August
We shouldn't look at it as a hindrance because the opportunity exists for us to do things that are innovative, new. And frankly, we shouldn't do old things anymore. The old things have obviously collapsed in terms of their effectiveness. And well I there's, there's a lot more on that.
00:08:11:17 - 00:08:30:10
Justin Nabity
But when you were talking about the conflicts so you're encountering conflict, that's obviously the issue. There's a disconnect between managers and the frontline workers. What do you see is a pathway, steps that can be taken to see improvement for the benefit of patients.
00:08:30:14 - 00:08:50:14
John August
Well, you know, that's a that's a tough hill to climb because, we all experience conflict in our lives right within our families, within our communities, within our workplaces. Conflict is is, I don't want to say it's normal, but it's everywhere.
00:08:50:16 - 00:08:56:18
Justin Nabity
And it is, it just call. It is. It's normal. We should expect it's going to exist. And so what do we do with it?
00:08:56:20 - 00:09:29:10
John August
That's right. And and, I look at conflict as an opportunity. Because if you just remain in conflict, which is easy to do, right? People just take their positions and they come out fighting. And at the end of it, people tend to be more beaten up and not, you know, in a, solution mode. So, I try very hard to work with parties on identifying mutual interests, which, is not not hard to do.
00:09:29:12 - 00:09:54:01
John August
People at the frontline and executives often have mutual interests. And, so, that's what I try to promote in my work and in the institute I work at, at Cornell, which is to help people understand that by continuing to have conflict, the the deep seated, causes of the conflict are never going to get resolved.
00:09:54:03 - 00:10:23:10
John August
So, what does that look like? What it looks like is, for example, using the example, which is, which is pretty common, which is to have parties participate in a facilitated, dialog, to identify problems we can actually solve together. They might not be global in nature, but if you can get people to work, on smaller projects that have impact.
00:10:23:14 - 00:10:54:00
John August
They learn that they, they can work on larger things as well. And ultimately, what that's going to be, I think, is, executives and frontline doctors working together to influence, those external factors like intervention of insurance, other regulations and so on. Not that they're going to be able to change the world overnight, but I can't think of a more powerful group than physicians and their management counterparts working together, to solve these issues.
00:10:54:02 - 00:11:18:07
Dr. Anthony Giuffrida
So, so one thing I've always been interested in with unions is the power to strike. Right? And, and how well it works and how well it can actually cause more conflict sometimes. Do you think there is a place where you ever see physicians getting or healthcare workers in general getting fed up enough to have a strike? I actually just read it.
00:11:18:07 - 00:11:32:05
Dr. Anthony Giuffrida
And and, you know, we're recently, the residency is there's been some strikes in the residencies, against their, their organizations. Do you ever see a collaboration of physicians striking? And what would that mean?
00:11:32:07 - 00:12:05:19
John August
Well, we do see it rarely. You're right. There's a strike going on at the, University of Buffalo right now. Medical school. And there's a potential strike at the Children's Hospital in Philadelphia among residents they haven't struck yet. I would say, though, that strikes among physicians are extremely rare. And they should be rare. I think that, while, you know, if somewhat controversial, I suppose, but the right to strike, you know, is a part of all modern societies.
00:12:05:19 - 00:12:39:19
John August
You know, you take away people's right to strike. Then they have no power. But I think the key is to, do everything possible to avoid it by coming up with solutions. And I think, most importantly, having the doctor speak as a really strong, collective voice about what they want to see changed. I happen to believe that physicians may be the most powerful group of employees in society to be able to make change in health care.
00:12:39:21 - 00:13:09:05
John August
I think they know that, too. I think what they're not used to is moving from the consciousness of being an individual practitioner to a collective voice. And I understand that. You've been trained to be individual scientists and healers, and you go to bed at night after healing people every day, and you feel great. The problem is, is that that's becoming, unfortunately, more and more difficult to do.
00:13:09:07 - 00:13:32:18
Dr. Anthony Giuffrida
Yeah. And I think maybe the physician thinks they have that power singularly, but but most people do not. Most physicians I know do not think the opportunity to come together is even a remote possibility right now. And that's why they are where they are. I mean, you take CMS cuts every year. We take less and less from insurance every year, and there is no pushback.
00:13:32:20 - 00:13:50:11
Dr. Anthony Giuffrida
So I actually think that's where the biggest gap is between an actual resolution to what's going on in health care. It's physicians just need to understand that, hey, it's not going to take that much. You have the power. I don't think a lot of physicians realize they have the power. That's what I think a lack is.
00:13:50:13 - 00:14:19:24
John August
And, you know, before we get too close to the end, I, I just wrote an article recently about something that I think is important for physicians to think about. I don't claim to be an expert, but I know something about, physician compensation. And from my reading about the root causes and not the root causes, but the underlying themes, if you will, of how physician compensation is constructed in the country today.
00:14:20:01 - 00:14:53:22
John August
It's largely based on increasing productivity. I believe that productivity in health care is important as it is in any business. But, there's a whole nother school of thought and that is that an emphasis on quality improvement and changing the system so that quality improvement is actually the focus? Yeah. Productivity will then increase or as opposed to productivity increases does not result in improved call.
00:14:53:23 - 00:15:24:06
Dr. Anthony Giuffrida
No no. Productivity increases and revenue increases and mandates have been proven to decrease patient care, but also quality improvement measures. That which has been gone and have been put been put into place for last 15 years are not written by physicians. They're being written by the administration, and they're ridiculous. I think I get I one of my quality improvement measures is to ask every patient if they're currently smoking, if they stop smoking, to ask them about weight loss, all those kind of things.
00:15:24:08 - 00:15:48:12
Dr. Anthony Giuffrida
Every time they come in. I don't need to. That's a waste of time. And it doesn't help me take care of that patient better. Listen, the first time we see the patient, yes, we should gather all that data. But there's no. There needs to be more thought into what those quality measures actually are. And it needs to be done purely by physician, that roundtable or whoever puts it together of 12-15 physicians need to be pure physicians.
00:15:48:14 - 00:16:08:24
Dr. Anthony Giuffrida
And say, hey, this is how we're going to really rate what is good quality care. Because the other thing that happens with quality improvement measures is, let's say there's some of that's really sick, and the surgeon needs to do the surgery to save them, but there's a 50-50 chance that patient might die. If the surgeon does the surgery and the patient dies, that's a ding against them, even though they try.
00:16:09:01 - 00:16:13:20
Dr. Anthony Giuffrida
So what do they do? They don't even try because they don't want to have that measure against them.
00:16:13:22 - 00:16:52:24
John August
So one of the challenges I put out to all of us is this that, you know, there are quality measures, there are quality bonuses, there are quality incentives built into, some systems. I think it's time that, at least one it's just one of many focuses for doctors to build a collective voice is to really take control of the issue of how quality is delivered, how it's measured, and how incentives are actually meaningful as opposed to what they are now, which are largely either insufficient and or missing the mark.
00:16:53:01 - 00:17:20:01
John August
And, I think to me, if physicians came together around that, that's what I mean about how they can change health care. I think it means that their lives would become much more, compatible with what it means to be a physician, and it's directly related to their compensation. So they have they have a self-interest, you know, they have a broader social interest in the same thing.
00:17:20:03 - 00:17:41:20
Justin Nabity
Well, John, this theme that you're sharing with regard to voice, physician voice, the doctor's voice, it's it's something that I feel like you you made it sound like as if they know they had the power, but maybe it's they don't know how to harness the power. Anthony, your perspective is maybe they don't know that they have the power.
00:17:41:22 - 00:18:01:17
Justin Nabity
You know, there's a missing piece here. It seems like. And we need to spend more time with you in the future unpacking this more. Because how do doctors get their voice back? What can they do? Who can help them? What steps can they take to harness that voice? Their voice is there. We would agree with you. It should be the most powerful voice.
00:18:01:20 - 00:18:25:21
Justin Nabity
There should be no health care without doctors driving it. Because if they don't play in the game, there is no game. So what can they do if they don't know how to find their voice or to get their voice heard if they're by themself? It was only a few of them. Administration won’t listen to them. There are people like Doc Nation who and John, this, this team right here.
00:18:25:23 - 00:18:43:21
Justin Nabity
We can help you have your voice. You do not have to do this alone. It will take a collective. Doesn't have to be huge. It can be a small group. But there are things you can do. And I think that's kind of the missing piece here is we'll spend more time on this in the future. Doctors getting their voice back.
00:18:43:23 - 00:18:49:23
Justin Nabity
That's going to be a huge part of what we do this year, next year, in the days to come.
00:18:50:00 - 00:18:55:19
John August
I agree, I mean, it's not simple. And quite frankly, if it was simple and would have been done already.
00:18:55:21 - 00:19:19:01
Reid Lancaster
That's right. Yeah. And we wouldn't have Doc Nation. You know, I say often, the existence of this company is actually kind of sad that the existence of this company is to fight. And, you know, we're fighting on behalf of the most, as you put earlier, John, the most important group in society. You didn't say important.
00:19:19:01 - 00:19:35:04
Reid Lancaster
You said something else. But I'm going to tweak it a little bit. It's the most important group in society. So thank you for your time today, John. We appreciate you. You've been very, very supportive of us. You've brought knowledge that we didn't have, and expertise and relationships that we didn't have before you. And we're very grateful for you.
00:19:35:04 - 00:19:35:11
Dr. Anthony Giuffrida
Thank you, John.
00:19:35:11 - 00:19:39:09
John August
Great to be with you. And best of everything.
00:19:39:11 - 00:19:41:17
Justin Nabity
Thanks. Bye.
00:19:41:17 - 00:19:58:14
Unknown
This has been the Doc Nation podcast. If you like what you heard, be sure to subscribe, rate and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes.
00:19:58:20 - 00:20:10:09
Unknown
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