My very first experience with medical commentary came from the research lab I worked in all of undergrad. We did pharmacology research with vascular tissues of rats and that’s where I learned about setting up an experiment, collecting data, analyzing numbers, and publishing articles.
In my 3rd year I helped with the writing of the abstracts and performed some of the stats work in order to come up with our publications. That’s when I first learned how easy it is to manipulate data – not necessarily intentionally. It’s just human nature to see certain facts when they aren’t there.
In medical school and residency I was barraged with scientific papers. I recall when Actos was such a big deal and the senior residents and attendings would orgasm over which Actos facts were most accurate.
All the while, patients really had no change in their health outcome – the same poorly controlled diabetics remained poorly controlled diabetics before and after the reign of Actos.
Commentary on Medicine
The scientific, data-driven side of medicine died down pretty quickly for me. Sure, the research articles were fascinating but most people didn’t understand them. The number crunching was incomprehensible. And regardless of the what new hot topic was published, the practice of medicine and patient outcomes rarely changed.
I really got into UpToDate because it wasn’t just facts gathered from research articles but actual experts in their fields sharing their practice styles. Of course this isn’t perfect, obviously it’s biased, but at least someone was taking a stance by saying “this is how we do it”.
By 2009 I came across KevinMD and thought, wow, here is someone who is putting it all out there. Openly commenting on how medicine is and the bullshit we deal with.
It wasn’t until very recently when I realized that genre of websites take a wide, safe turn around the real facts. It’s likely because they want to preserve their financial incentives and no individual physician wants to become the enemy of medicine.
The Real Facts
I had just finished residency and I was desperate to know the facts about my career. As a family medicine doctor I wanted to know what obstacles I was going to encounter. I already knew that research articles weren’t going to make my patients healthier but I needed to know what would.
I never realized that being a male physician was going to be such an obstacle.
I didn’t realize what a big deal finances were going to be.
I understood burnout but not in terms of a late 30’s professional. When you’re in your 20’s nothing seems impossible.
Figuring out taxes and student loans – I thought someone would have explained that to me. It’s as part of family medicine as wearing a stethoscope – even if I hardly ever use it.
Most definitely this Kevin dude was going to blog about it! For sure some MD would talk about it on those opine pieces in the back of the NEJM or JAMA! No such luck.
Transparency in Medicine
When I became a chief resident in my 4th year at UCLA I started seeing all the things that were going on behind closed doors.
Some faculty members had gotten themselves into legal trouble and had to be taken off of rotations without anyone finding out why. Secrecy was critical.
We had residents with DUI’s and addiction issues who were dealing with the medical board. I only knew very little but just enough to have to change their rotation schedules. .
So my chief residency year offered me just a little more transparency in medicine – hidden transparency, but better than what I was used to.
Most importantly, I was convinced that surely in medicine, unlike all these other fucked up professions, there would be honest conversations and genuine transparency. Somebody had to care.
Large Medical Group Medicine
As I’m writing this post I am reminded of the words of Dr. Sur who warned me not to work for Kaiser. That they were the devil in medicine and all that’s wrong with medicine.
Not only was I convinced she was wrong but I also thought I proved her wrong when I made my $430k in 2014. Shit! What did she know?!
Over the years I dealt with a lot of bullshit at Kaiser Permanente and it was mostly stuff that I could handle fine on my own. I don’t think KP was a bad organization but they had a very different take on how medicine should be practiced and they weren’t afraid to fuck over their doctors to preserve that.
I wasn’t allowed to work for other medical groups, meaning, KP had a monopoly on my medical license. I wasn’t allowed to write public opinion pieces because it would reflect poorly on KP. And I wasn’t allowed to volunteer anywhere unless I notified HR.
The Hidden Transparency
You know what’s terrible? Oppression. You know what’s worse than oppression? Disguised oppression.
In a country like Iran women are oppressed and so are religious minorities. But it’s a fact of life. The government is not trying to be subtle about it, they aren’t hiding it. It’s as fucking transparent as it gets. Women wear head scarves and have limited political and economic rights – there is no confusing the matter.
I assumed the AMA or the medical board or my malpractice insurance, someone, anyone, would be on my side as a medical professional. Someone would have my back if shit hit the fan.
But there was no support except from a lawyer at $300/hour. I had no idea how the medical board investigation process was going to go. There was zero transparency and the information was purchased by the lawyers. A completely one-sided situation where the physician was intentionally kept in the dark.
So how did my lawyer know so much about the medical boards and what they would accept and what they wouldn’t? Well, as he told me, 2x a year these larger health care law groups meet with a group of medical board representatives, usually from California and New York, and they basically come to an agreement of how shit should be run.
Are you fucking kidding me?! So these fucks decide our fate and don’t share anything with us. We have to pay the lawyers to find some of that information out.
If a system is fair then there is no reason to keep its details hidden from its constituents. If you intentionally are designing it with a knowledge slant then you’re doing so in order to push your own agenda.
I spent nearly $5,000 to attend my weekend remediation course in San Diego. Here, I was told how to not expose my genitalia to patients and not send dick-pics to my female coworkers – invaluable information.
But how did these fucks know all this information? Well, they shared that with us as well.
This PACE organization meets with the medical board once every year and petitions how they will structure the course and what information they want from the medical boards, in return. This is how most lawyers and medical boards choose them as their go-to remediation course.
They find out everything. And frankly, I was taken aback that they were sharing that so openly – a mix of pride and showmanship.
And it wasn’t like this was a selfless move on their part. These guys were getting paid fat dollars to put on these courses for those of us who had gotten into trouble with the medical board.
And did they write blogs or lecture to their fellow physicians to warn them of this shit? No! Of course not. That kind of transparency would kill their earning potential. They rely on the hidden transparency of our profession to make money off of us.
I am not affiliated with any group and I don’t make any money from the information I provide on this blog – there are no hidden agendas on this blog. And yet, I’m not allowed to talk about the medical board investigation that I went through.
I am not allowed to talk about the information my lawyer provided me.
I am not allowed to share the details of my telemedicine work on this blog.
The medical board and the large medical groups, the lawyers, and these peripheral organizations have a monopoly on the information and are protecting it by bullet & gun.
I’m not exaggerating. The medical board investigator who was foaming at the mouth on the phone told me in plain English that I could face criminal charges if I didn’t do as he said. This included jail time .
Words like ‘criminal’, ‘perjury’, ‘theft’, and ‘license revocation‘ is what you hear when you’re sitting around waiting for others to decide your fate.
Not assessed by your colleagues. Not those with whom you served in the trenches. But those who get to make money and have job from deciding your fate.
But let’s assume that Dr. Mo is just bitter. He did something wrong and he got busted and now he wants to be pitied as a pariah. That’s what’s I thought about every doctor who got in trouble with higher powers – if what they did wasn’t a big deal then they would have been exonerated.
So why isn’t my case on display on the medical board’s website? Why not on the ABMS? Why is it that the only thing on there is my medical license suspension notice and a story that the medical board investigator came up with?
Blogging About Medicine
I have whittled down my blog posts about the medical board, about my employers, and about the IRS down to the most palatable and legally permissible facts possible.
I’ve re-written them when I have gotten threatened by various groups and I have taken some things down. There is enough in there to paint a decent picture but you still don’t get to see the nipples – my lawyer insistent on that.
Transparency in Medicine
We need more bloggers in medicine. We need more voices telling their stories. But who is willing to lose their medical license for it? Only a select few can afford this.
Even though it’s not perfect, other physicians can read about these cases, heed these warning and use the facts to protect themselves against these powerful groups.
I am not even talking about the lawsuits which get settled out of court, the facts of which nobody but the lawyers and doctor know about. These are amazing learning cases which never see the daylight.
1. If you deal with something that other medical professionals can learn from then write about it. Do it anonymously. Nobody can prove that a particular website is yours if you take the proper steps to protect your identity.
2. Get adequate insurance. Get disability insurance and know how to file for it when you need to. Don’t be a helpless victim. We may not have a lot of power and few people feel sorry for a doctor in this society but we got brains.
3. None of your colleagues will stand up for you. Nobody wants to risk going up against their own medical group or smear their names with the medical board. It’s too easy to become indentured to the debt and lifestyle of medicine.
4. Get your own malpractice insurance or get it in writing that your malpractice insurance will cover you in case of a medical board investigation or whatever unforeseen cases you can conjure up. Mine didn’t. They said that it wasn’t in their best interest to cover me and so I was stuck footing the bill.
5. Don’t rely on practicing clinical medicine as your only source of income. I will be serving my 30-day license suspension this month but I will have multiple sources of income coming in.
6. Earn your income because you are bringing value as an individual to your patients; don’t be a cog in the corporate wheel. Don’t be another worker on the assembly line. No matter how much your employer will sing your praises, they will replace you like a broken pint-glass at a pub.
7. Work towards financial independence and towards early retirement. You don’t need to stop working once you’re there. You just want to get to a place where you can tell everyone to fuck off if you need to. And I hope you’ll never be placed in such a situation.
8. Get rid of your debt. All your debt. No debt is good debt unless it’s making you money. Without debt you can downsize. When you downsize you are less vulnerable. You’ll make your decisions from a more secure position and thus you’ll make better decisions.
9. Don’t believe everything you read and don’t assume that what’s not talked about isn’t real. Take preemptive steps if you need to. Spend $5k and take the PACE course. Sit down with a therapist who counsels doctors on substance abuse after they get in trouble with the medical board. This will help you protect yourself and your income; it’s the antidote to the hidden transparency in medicine.
10. Understand that it’s not just the patient who poses a threat to you. It’s also your female coworkers (if you’re a guy). It’s your medical director, your nurse manager, your ex-girlfriend, your ex-husband, your business partner, and even your business competition. If you work in a hostile environment then anticipate what they could do and protect yourself.
7 replies on “Hidden Transparency in Medicine”
This is all very sad.
Please write a blog post about protecting your identity while blogging!
It’s unnecessary, that’s what I have concluded. I had lunch with a 60 year old therapist who gets 95% of the medical board referrals for medical professionals who are busted for substance abuse – whether DUI’s, alcohol, opioids, marijuana, or benzo’s. And he was telling me that only in the past 10 years had the medical board basically turned on these MD’s and PA’s. He’s been doing it for a long time and he feels bad for every one of these clinicians because he sees what hell they go through.
To boot, he added that if the doctors just knew what he knew then they could avoid all this headache in the first place. So why not share what he knows? Well… because 95% of his customers come from his local medical board.
I feel terrible that you went through all this stress with KP and the California medical board. You did nothing wrong. And your situation could happen to other innocent docs. I agree with you that all docs need to strive for financial independence ASAP. I still keep working as a doctor, but I am finically free to walk away from a bad work environment and that is a priceless power. I hope many docs will take your advice and eliminate debt and build their financial holdings. You have a great attitude and great resilience and I think your powerful financial position has helped you stay strong through all this stress.
As always, thank you for your supportive words.
I learned a good deal and I’ve connected with a bunch of other doctors who have shared their own shitty medical board ordeal with me. I’m glad they are finding me through this blog.
I wish it wasn’t this way and I’m sure it’s only this punitive for a select few of us in this profession but it’s life-altering. It’s just another risk like malpractice risk or life insurance or auto collision insurance – except that we cannot protect against it through mainstream methods. So the only way, as you said, is to get to a financially free situation so that you can walk away when you need to.
I’ll add that there it’s a terrible feeling to be in a room full of adults, most of who are ex cops or ex military guys, used to intimidating people, and then walking out with your tail between your legs, apologizing for shit you have no need to apologize for. You have to live with that and it makes you lose a little self-confidence.
“I wasn’t allowed to work for other medical groups, meaning, KP had a monopoly on my medical license. I wasn’t allowed to write public opinion pieces because it would reflect poorly on KP. And I wasn’t allowed to volunteer anywhere unless I notified HR”
I’m not sure what you expected. You were working for a corporation. In nearly every industry, when you work for an employer, you relinquish your ability to do the above mentioned activities.
When you’re young and inexperienced then you don’t develop a whole lot of opinions, nor do you think them to be consequential. A you get wiser then you realize that society progresses not because of secrecy but because of open discussions. Nothing wrong with running a large corporation like a communist society and when you get really large, you have no choice but to. That’s why the small and nimble tend to survive longer.
The medical professional doesn’t have to let themselves be monopolized by their large medical corporation. The majority of the posts I have written focus on how to break away from full-time jobs, from large medical groups, and to get to a place where you don’t have to fear a medical board retaliation.
everything is a series of trade offs. I’m sure the benefits offered by Kaiser (and other large employers) make them attractive options. My wife practiced 14 years in a small 3 provider office. At least twice a year she would miss a paycheck because they had to pay the staff of 17 first, pay the rent, pay the utilities in the office, and CMS was holding reimbursements due to no budget having been passed. Once, she missed a check because a truck struck a utility outside her office, and they lost power for 3 days.
Those things don’t happen now that is part of a large multispecialty group (no, not Kaiser). She now deals with a bit more bureaucracy, but she gets to focus more on medicine, and less on HR bullshit. For her, it works out great. YYMV