I DON’T WORK FOR NOTHING. Echoing on a post by Heath Veuleman: My dad owned a small independent pharmacy in New Jersey. When I was about 11 years old, I was helping him process prescriptions for the PAAD program. Back then, everything was done on onion-skin forms that had to be filled out perfectly and mailed to the state. One day I made a mistake on a form for a prescription that reimbursed his pharmacy about $4.00. He looked at me and said, “I don’t work for nothing.” I never forgot that. I am now 64 years old, and every time I sit across the table from commercial insurance companies in brutal contract negotiations over the past 30 years, I still hear my father’s voice. Physicians should not be ashamed to make a good living. Not after a decade or more of training, not after massive educational debt, not after sacrificing our 20s and 30s, and not after carrying the responsibility of human lives for decades. I did not finish my schooling until I was 36 years old. Meanwhile, insurance company CEOs make tens of millions of dollars per year while independent physicians fight over reimbursement for cognitive medical care. My father taught me something very young: your work has value, your skill has value, and your time has value. That lesson applies to physicians, pharmacists, teachers, mechanics, electricians, small business owners, and every person who works hard to build a life and support a family. It is also one of the reasons I have spent my entire career defending independent private practice. I believe physicians are most effective, most accountable to their patients, and most able to reach their full potential when they remain autonomous and independent. And if we do not recognize the value of our own work, nobody else will. @HeathVeuleman @DrDiGiorgio @DutchRojas @NeilFlochMD #doctorlife #meded #solopractice #medtwitter #privatepractice

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

My job is to make sure your surgery center never gets built. Eleven years, and I have never lost. The kid had it all lined up. Board-certified, two partners, a lease on a space where he could do the same procedures my client does across town. He showed up to the hearing with a slide deck and patient testimonials. Adorable. I did not bring a deck. I brought one sentence. “This facility is not necessary.” That is the whole game. In this town, you cannot pour a foundation until a board agrees the community “needs” the place. The people who get to argue that you are not needed are the incumbents who would lose the business. My client gets a seat at the table where his own competition is approved or killed. I have sat in that chair for eleven years. I have never once said yes. The kid drained himself dry to file. The application alone is the moat: thick, slow, and expensive enough to stop most physicians before they ever reach a vote. He cleared it anyway, which I respected, right up until I buried him in it. We said “duplication of services.” We said “protecting the safety net.” Language that tested well in 1974 and continues to test well today. The board tabled him for review. Review became a year. The year became a withdrawn lease, and three physicians quietly returned to working for the health system. You want to know what we were actually protecting? A physician down the street doing the same procedure for less. Medicare pays us more. Which means commercial pays more. I don’t share. That is the threat. Everything else on the record, the duplication, the waste, the safety net, we wrote for the transcript. Patients kept paying more. My client called it a win. I bought a boat last spring. I named her Certificate of Need.

I’m pro Shutze. Better representation of vascular surgeons who work outside academic surgery. Which is most of the vascular surgeons in the USA.

Cost of everything is outpacing physician compensation growth in most cases. So, you all need to be very cautious about: - how your major purchases (home/car) reflect your priorities - how dependent you are (to relieve stress) on your existing day to day spending habits

An open letter to every physician still waiting for the system to fix itself. It will not. The people who built it are paid to maintain it. The regulators who oversee it are former executives of the entities they regulate. The legislators could change it receive campaign contributions from the people you are waiting on. Your patience is their strategy. You have one career. Use it.

It’s an absolute game changer to not be on call all of the time. You don’t realize just how much it improves your life until you aren’t constantly waiting for a shoe to drop.

Healthcare is the only sector where the government picks the winners, sets the rates, blocks the entrants, and then hires economists to explain why the prices are high.

I think what you're trying to say is that putting doctors out of business drove prices up.

Please be patient for a few minutes as the thousands of Strait of Hormuz Twitter experts are making the shift over to the Voting Rights Act. They will be with you momentarily....

Hospitals do not set Medicare prices. CMS does. If Chairman @RepJasonSmith wants to end the scam, the levers are already on his desk: •Site-neutral payment. •Repeal Section 6001. •Let physician-owned hospitals compete. •Reform the RUC. •Audit 340B contract pharmacy growth. •Enforce real price transparency. Chairman since 2023. Lecturing CEOs is theater. The architecture is the policy. @JoeSquawk @SullyCNBC @WaysandMeansGOP

Should physicians own hospitals ? Listen to neurosurgeon Elad Levy on massive efficiency gains when a neurosurgeon is running things vs. some admin.

Preserve independent practice by raising reimbursement and providing stability within a competitive noose that hospitals and systems can exert and leverage due to their artificial high facility fee

Large hospital systems are profiting off Medicare rules that pay them more for the same service than independent practices. That means a senior in my district can pay MORE for an X-ray at a hospital than at a local doctor’s office -- and the hospital makes MORE too. Today I asked hospital system CEOs a simple question: should we equalize payments to lower costs and expand access? They said no. Americans deserve affordable care, not a system that rewards higher prices.

Doctors think political donations are unseemly. Hospitals think political donations are insurance premiums. Insurance is a tax-deductible cost of doing business. Unseemly is what you call something you have already decided not to do. open.substack.com/pub/dutchr…

Gene Braunwald died at 96. In a normal world, this would be front page of the NYT and WSJ. The father of modern cardiology. Fled the Holocaust as a boy Went on to save millions of lives The most important clinician-scholar of the last 50 years. We should all know his name

740,000 Medicare discharges. 17.5% lower prices. 46.7% lower cash prices. The argument against physician-owned hospitals is already dead. Get your comments into @CMSGov …

To all physicians- the comment period is now. Don’t let this sit or the hospital lobby will keep their stranglehold and the prohibition against physician run hospitals will continue

Every major payer in America has filed a position on whether physicians can own hospitals. The physicians themselves have not. That’s how Section 6001 has survived fifteen years. Now is your opportunity… buff.ly/ESDn2Ue

I had to explain to a medical director on a peer to peer that a complete occlusion was actually more than a 70% stenosis. I had to call Medicaid for a CT scan approval. As soon as I typed in the claim number, the automated voice gave me the approval number. Why did I need to call? I am pretty sure there are people on X who are employed as peer to peer docs at the insurance companies. I’d love to hear what their perspective is.