Associate Professor #DABOM @Yalemed #Obesity #SoMe Editor @soard_journal / bariatric surgery Tweets are my views and not my employer @yalesurgery
Joined October 2013
- Tweets 103,947
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Jun 12
The Doctors
We are the most powerful entity in US Healthcare
but…
Our division is our Achille’s Heel
Together we cannot be stopped
Divided, medicine continues to fail
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Neil Floch MD retweeted
Over the last thirty years, the average American worker became 78 percent more productive.
Yet in healthcare, hospital labor productivity grew by an astonishingly dismal 1.5 percent over the same period.
Despite the IT revolution and leaps in medical technology, the modern hospital is barely more efficient than it was in the age of paper charts.
The usual excuse is Baumol’s cost disease, the idea that medicine is a high-touch service industry, and you simply cannot automate that human connection.
But this is a half-truth that protects a broken system from scrutiny. Tools like the MRI radically compressed diagnostic uncertainty. The missing productivity wasn't lost to the unavoidable realities of human care. It was swallowed whole by the electronic health record and an endless parade of mandatory clicks.
We invented tools that should have made physicians more productive, then wrapped them in billing rules until they became a tax on clinical judgment. In the rest of the economy, software reduces friction because it is disciplined by customers. In healthcare, software creates new work and compliance pathways because it is disciplined by regulators and payers.
The chart was transformed from a clinical record into a billing document that just happens to contain some medical information.
American hospitals do not have flat productivity because healing is immune to improvement. They have it because our regulatory structure rewards administrative sophistication at the expense of actual efficiency. Read my latest essay in the reply below.
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Unfortunately our health system has eliminated capitalism for most doctors. When industry, health insurance, and health systems function by the rules of capitalism but US government laws are created to limit rights of physicians, the entire system violates the 4th and 5th amendment rights of physicians. Without an even “playing field” doctors cannot promote a better system.
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The reason anyone gets insanely rich is almost always because of the stock market. It certainly how @elonmusk did.
And the reason they get rich from the stock market, is because 150m Americans decided they wanted to own shares of stocks directly, or through their retirement plans, or through other approaches as a way of building their net worth and trying to create a better life for themselves.
One Hundred Fifty Million Americans. About 60% of adults.
Effectively believing that @elonmusk and many billionaires could make them wealthier and help them achieve a better life.
If you want @elonmusk , and most billionaires to no longer be that rich, convince those 150m to sell their stocks, funds, ETFs whatever.
Of course you would wipe out the net-worth of most of those people, and everyone else’s savings, as the markets crashed and brought down the economy and created the worst depression we have ever seen.
Alternatively
There are ways to improve healthcare access and eventually make it available to all.
To start -
If you want @elonmusk and all billionaires to improve healthcare for everyone , ask them to stop doing business with the enormous healthcare conglomerates and to work directly with transparently priced care providers.
It’s the behemoth HC conglomerates that make HC so bad for so many. (Check my timeline for more detail)
Removing them would push the cost of healthcare down for everyone. Their corporate decisions impact our healthcare cost and availability.
Of course if they do that, not only would our HC costs go down , and the quality of care for their employees and the entire country go up
But
They would see their corporate cash flow increase dramatically and we would have more millionaires, billionaires and maybe even another trillionaire when that cash flow moved from the big health care conglomerates to their bottom line, so would the net worth of the 150 million American adults that own public stocks
Capitalism is better than socialism because 150m Americans can influence exactly what happens in this country.
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Are you a physician?
Are you a member of the @AmerMedicalAssn?
17%
Yes
83%
No
6 votes • 6 days
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Jun 12
If the @AmerMedicalAssn does not represent US doctors then who represents us? Is there another organization? What are other organizations that have some representation? Why don’t we create another organization that accurately represents US physicians!
Let’s go! Comments?
Jun 11
It is absolutely wrong to refer to the AMA as America’s physicians. There are hardly any active practicing physicians who belong to the AMA. They say they have 350,00 members because they consider all 300,000 students and residents as members of the AMA.
I can tell you from having a worked there that they don’t even tell their own employees how many actual members they have it’s embarrassingly small. I also know because I used to manage the CME portfolio that they provide very few CME credits for their members – another indicator of how small their membership is. When I was there they would issue about 20 to 30,000 CME credits per year which almost all came from JAMA. Less than 10% of their CME came from AMA activities. This is in contrast hundreds of thousands or millions of credits given by other by other organizations that actually do have very large memberships
When I first went to work there I was shown a poll that showed 70% of physicians have a unfavorable view of the AMA.
2/3 of their income comes from their ownership of CPT and HHS mandates that CPT be used for billing. Without CPT there would be no AMA.
I had an awful experience working there as some of you might know.
The physician community should absolutely not let the AMA present themselves as representing American medicine
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Jun 12
The Doctors
We are the most powerful entity in US Healthcare
but…
Our division is our Achille’s Heel
Together we cannot be stopped
Divided, medicine continues to fail
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925
Neil Floch MD retweeted
Jun 12
I’m throwing @SoMeDocs’ bat into the ring, though we don’t represent docs, nor claim to represent docs, in quite the same way as the AMA claims to. The no movement’s mission is simple: autonomy. And we do this through PR, publicity, and heavy facilitation of networking and discussions behind the scenes. If you’re a healthcare professional and have not yet joined, I highly recommend. Esp since it’s free if you’re in the US. Could not be better.
Doctors thus far (though we’ve opened up directories for nurses, pharmacists, dietitians, therapists, scholars, and others): doctorsonsocialmedia.com/doc…
Jun 12
If the @AmerMedicalAssn does not represent US doctors then who represents us? Is there another organization? What are other organizations that have some representation? Why don’t we create another organization that accurately represents US physicians!
Let’s go! Comments?
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Jun 12
The organizations with the most members that may more accurately represent US physicians (by membership only)
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Neil Floch MD retweeted
Jun 11
Honored as member of writing cmte for 2026 AHA/ACC/ADA/ASN CKM Guideline! rigorous marshaling of evidence & expertise-provides unified approach to treatment-elegant staging system with treatment, coordination & assessment recs - never a better time to treat obesity and its consequences - Obesity, Diabetes, MASH, CVD, CKD don’t occur in isolation- let’s treat them all
jacc.org/doi/10.1016/j.jacc.…
@ASMBS @WorldObesity @ObesitySociety @AmDiabetesAssn @American_Heart @EliLillyandCo @novonordisk @boehringerus @Amgen @JNJNews @Medtronic @teleflex @ObesityAction @ACCinTouch @OMAsocial @pfizer
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Neil Floch MD retweeted
Jun 6
I get paid more (or more RVU credit now) for seeing 3 acute trauma patients in the ER than I get for operating and doing a laparoscopic or robotic cholecystectomy
This is objectively false.
If I come in at 2am and do a craniectomy for traumatic brain injury, I would get paid more if I didn't bill for the surgery and just billed for the postoperative care instead.
CMS has consistently reduced payment to surgeons relative to "thinking" specialties. And this is not an argument that "thinking" specialties deserve less money than "cutting" specialties.
It's an argument that CMS central planning has unintended consequences.
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Neil Floch MD retweeted
30 Oct 2025
I like most all physicians in private practice in Connecticut lost my practice as insurance companies stopped paying us reasonable rates for seeing patients and performing surgery. The government supported the vertically integrated insurance companies, doctors went into debt, sold to private equity, joined large groups, or joined hospital systems. Patient service suffered, patients lost their long time doctors, quality sank, patients lost faith in the system, and doctors burned out. The cost of medicine soared as the ACA gave insurers excessive power and the for profit insurers had to answer to Wall Street. More profit equalled less patients treatment for a higher cost.
29 Oct 2025
When 3 vertically integrated insurance companies control 90 pct of every insurance and provider market , what happens then ?
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Neil Floch MD retweeted
Jun 10
Without being dramatic: avoidance of this publication by firing the government staff members involved and replacing the advice with “just consume less” supressed the evidence that any level of alcohol is unhealthy.
Manipulation of evidence to intentionally harm the health of the public and protect the economic viability of industry is a betrayal by our government to its people and a failure of the capitalism that we respect.
Jun 9
The suppressed report that concluded there is no protective or safe level of alcohol consumption, now published. It was commissioned by US Congress
Report jsad.com/doi/10.15288/jsad.2…
Editorial jsad.com/doi/epdf/10.15288/j…
"Despite the study’s adherence to its mandate, its findings were sidelined.”
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Jun 11
The ultimate professional:
1. He exhibits professionalism
2. He uses his fame to support the needy
3. He elevates his team by sacrificing money from a potentially larger contract
4. He takes responsibility when the going is toughest
5. He focuses on the critical moment and does not let emotions interfere
6. He appreciates what he has
7. He uses his power to elevate others and the team
8. He avoids the limelight
9. He is an example for all leaders in any capacity where good teamwork is needed to achieve success
10. With poor examples of leadership in our society, our children need to watch this man at work
11. Basketball is just a sport but the examples of how to behave in the manner that man displays are invaluable to all
Jun 11
Jalen Brunson post Game 4: "Before we start…
My thoughts & prayers are with a friend of mine I got to meet last week. Jonathan from North Carolina. From Make a Wish Foundation
They asked me to make a video. But something told me to Facetime…
I got the pleasure to do so…Quick call but well worth it.
My thoughts and prayers are with him and his family…
May God rest his soul"
(Reporter asks question)
Jalen (can't answer): "Sorry…"
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Neil Floch MD retweeted
We’ve know for yrs after bariatric surgery, patients lose>30% TBWL, but overall function IMPROVES. Some lean mass loss is ok. Still, exercise is important! @PBRCNews #adaSciSessions @ADA_DiabetesPro @ASMBS @IfsoSecretariat @ObesitySociety @ObesityAction @rvcohen @FRubinoMD
How concerned should we be about muscle loss during GLP-1 treatment?
Pennington Biomedical's Dr. Eric Ravussin recently joined Dr. Samuel Klein at the 86th American Diabetes Association Scientific Sessions to debate whether lean mass loss during treatment is an expected adaptation or an underrecognized concern.
Watch the discussion and hear both perspectives on one of the most important questions in obesity research today.
youtube.com/watch?v=8HEPSyB0…
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Neil Floch MD retweeted
Jun 11
A warm invitation to the
Seventh @IBCOxford World Congress
September 15-17, 2026
ibcclub.org
@IBCClub1 @NeilFlochMD @BariatricNews @ZaherToumi @mohakbariatrics @MPGN46 @SWexner @Dr_NaifAlEnazi @OMGhanemMD @BalibreaJose @SighPichamol @DrChowbey @Ali_Aminian_MD
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Jun 11
#EMR physician notes she be concise and to the point. They should be easy to read and give new information while concisely reviewing the history.
Jun 9
The #EMR insurance game works like this… doctors are encouraged to write long detailed notes to justify their billing levels.
Billing and medico-legal systems both assume that: “if it’s not documented, it did not happen”
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Neil Floch MD retweeted
Jun 9
The #EMR insurance game works like this… doctors are encouraged to write long detailed notes to justify their billing levels.
Billing and medico-legal systems both assume that: “if it’s not documented, it did not happen”
US regulations are responsible for medical records being full of pure slop. American doctors write notes that are, on average, 4 times longer than peers in other nations.
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Jun 10
My favorite video today. Brilliant!
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Jun 10
It’s a dangerous road to take non-FDA medications-self prescribed…..
Jun 10
The biggest problem with peptides right now:
Searches went from 1.3M/month in 2024 to 8M/month in 2026.
Meanwhile the analysis of 6,285 samples from 203 vendors found 41.6% failed basic purity or dose standards.
Demand is vertical, but evidence is flat.
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Neil Floch MD retweeted
Jun 10
🚨💫🤩 A special invitation from Dr. @JaimePonceMD, IFSO President Elect!
Join us at the XXIX IFSO World Congress in Toronto 🌍🩺
📅 September 1-4, 2026
HURRY UP 📢LAST DAY to take advantage of the Early Bird rate!
👉ifso2026.org
See you in Toronto! 🇨🇦✨
@IFSO_NAC
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Neil Floch MD retweeted
Jun 7
The core of the discussion about physicians today is less about money and more about the loss of autonomy. Laws have shifted the balance of control of medicine toward insurers, administrators, and government, and completely away from doctors. Physician “Burn Out” occurs from a loss of control and all the new demands that must be met while lacking the ability to protest or change. The doctor no longer has control or leverage and that is first frustrating and ultimately infuriating.
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