• Rebekah Bernard

Investigative journalist exposes the dangers of 'MD Lites'

We are joined on the podcast by Eric Starkman, an investigative journalist who works to shed light on dangerous corporate practices in healthcare. Mr. Starkman is relentless in exposing the work of bad actors in the medical-industrial complex and discusses how the replacement of physicians by nonphysician practitioners is contributing to the decline of the U.S. healthcare system.

"Nurse practitioners and physician assistants aren’t real doctors. They can’t, don’t, and never will provide comparable medical care. They’re MD Lites – Less training. Less knowledge. Less skills." - Eric Starkman,

Read Eric Starkman's article about the book 'Patients at Risk' here.

Listen to the podcast here.


Rebekah Bernard MD:0:07

Welcome to 'Patients at Risk,' a discussion of the dangers that patients face when physicians are replaced with nonphysician practitioners. I'm your host, Dr. Rebekah Bernard, and I'm joined by my co-host and the co-author of our book, 'Patients at risk, the rise of the nurse practitioner and physician assistant in healthcare,' Dr. Niran Al-Agba.

Niran Al-Agba MD:0:25

Good evening.

Rebekah Bernard MD:0:26

We are so excited today to be joined by Eric Starkman. He's an investigative journalist, and he works to shed light on dangerous corporate healthcare practices. Mr. Starkman is relentless in exposing the work of bad actors in the medical-industrial complex. And it's such an honor to have you here with us today.

Eric Starkman:0:45

It's an honor to be here. The book was a great motivation.

Rebekah Bernard MD:0:48

Thank you so much for writing about the book, we really appreciate it. And I wonder if we can just start out by having you tell our listeners about yourself and your background and how you became interested in corporate healthcare issues?

Eric Starkman:1:01

Well, my background originally was journalism. When I graduated from journalism school, I worked the major newspapers in the US and Canada, I realized that it wasn't a business that I wanted to get old in. I transitioned to public relations, originally working for a couple of big companies. I was never comfortable in doing PR either, so I ended up starting my own, and I ran my own PR firm for 25 years. And for a lot of reasons, I just had to get out of public relations. My plan was to - well, I actually did write a TV pilot. I haven't sold it yet. But that was my plan - to transition to write programs based on my experiences. As it happened, the pandemic happened.

I got a call one day from a friend in Michigan, and we were just talking and he mentioned in passing his daughter was a nurse and she worked at Beaumont Hospital and Beaumont wasn't paying their nurses very much extra to work during the pandemic and Henry Ford was paying over $20. My friend owns Deadline Detroit, you know, it's a feisty online publication. He's a great guy and I thought yeah, that's an interesting story. You know, Beaumont caters to a much more affluent clientele. It's a bigger hospital. Now, they had a lot of World Class surgeons. And I just thought was an interesting story that the poor hospital was paying its nurses more. So that's what I set out to do. It was supposed to be a story and take me an hour. When I started to do the story, Beaumont ended up closing one of the hospitals that was designated to be a pandemic hospital to treat COVID patients. I couldn't believe at the height of a pandemic, a hospital was closing one of its COVID hospitals. The reporter who broke it, she did a really good job and said they closed the hospital and the PR guy tried to spin it. 'We didn't close it, it's paused.'

Now one thing I can educate your leaders on, you can tell a lot about a company when they start talking PR speak. You want to say it's a pause, like, it's still closed, you know, it's gonna reopen? It's semantics and just something didn't seem right. And I wrote one story and then people started approaching me because nobody had ever written about Beaumont critically. It's a big, powerful hospital - the biggest hospital system in Michigan by some metrics and biggest employer in southeastern Michigan - one of the biggest, not the biggest - but nobody had ever written about them critically. They had been under really bad oppressive management. People just came and approached me. As this happened, Beaumont decided to outsource its anesthesia to a very controversial company and that blew up the whole hospital.

I was really touched by the dedication of the staff there. I mean, these are people that are committed to their communities. Most people who work at Beaumont are like real Michiganders, you know, they grew up there or they moved there because they want to be in Michigan. And this CEO, he's from Atlanta, he still owns his home in Atlanta, he has bought a vacation home in North Carolina, it's very clear where he's gonna go. I just kept digging, and the more I dug, it got bigger and bigger.

I always thought when I lived in New York City, that Wall Street was the most corrupt industry. And then I moved to San Francisco and I thought Silicon Valley might be the most corrupt. And then I stumbled on healthcare, and it's like, oh my God. And one of the reasons healthcare is like corruption on steroids is because you've got Wall Street influence and you've got private equity influence which, as you know wants to do away with all you. They think that somebody can go online and study medicine and in a couple hours, okay, you can diagnose.

So it's eye-opening. It was eye-opening to me and I think it's a poor reflection on American society, this could even happen. I grew up in Canada. So I have a different view on health care to begin with. I never saw medical bills until I moved to the United States. And it's changed since I lived in Canada, but I had access to great health care. Even in smaller towns, you could get great health care in Canada when I was growing up. I just think it's wrong. And I think to these MBAs that are running hospitals and using metrics, it's just wrong. I read your book, and you connected something with me in my mind that I hadn't appreciated before. That getting rid of doctors is one of the strategies - that we don't need somebody with 15,000 hours of training, we can get somebody with a lot less trained to do the job. So that's how I got into it. It just keeps getting bigger and bigger. And I find it quite disturbing, actually.

Niran Al-Agba MD:5:55

So since following Beaumont, to its temporary pause or whatever they want to call it, how much pushback have you had from larger media or even the hospitals themselves?

Eric Starkman:6:05

This is an example also, why local medias fail, because the local media stayed away from the story. Now, the cynical part of me is like Beaumont, it's an advertiser, but I don't know that that's it. I think it's newspapers today, the people who work at them, they're not tied to their community. You know, when I worked at the Toronto Star, we knew Toronto, and they had a rule. You know, I was talking earlier about the importance of experience, you know, I was pretty cocky myself when I was younger. And Toronto Star, I used to have a rule that's, 'what's it mean to Metro?' And Metro was Metropolitan Toronto - that's what we called it. You could have the biggest story in the world. And I'll give you an example. It might be apocryphal, but people told it all the time. That there was once a big plane crash in India, it was international news. 300 people killed on India jetliner, but that wasn't good enough for the star. They had to send a reporter out to the Indian community, and they found somebody who had a cousin on the plane. And the headline in the Toronto Star was 'Cousin of Metro woman amongst the 323 killed jetliner.' And in those days, I thought that was very provincial. But that's why they were the dominant paper in Toronto. They outsold the other two papers combined.

Local papers that - young people today, they want to talk about race, they want to write about gender issues, and people in their local communities what they want to know like, here in Los Angeles, we got a problem with coyotes. Now you're not gonna win a Pulitzer Prize writing about the proliferation of coyotes, well, you possibly can if you're really good reporter you can turn any story into a big story. But no, that's why the LA Times is losing $50 million a year - they've got a bigger agenda. So the local papers with the exception of the business paper, and they did an okay job, they didn't hit them too hard. But it was respectable. You know, Crain's Detroit business is actually one of the better local business dailies. But the other papers, they still haven't reported that a colonoscopy patient died undergoing a routine colonoscopy. That's the problem. That's why health care is deteriorating so badly. It's all a reflection of how poor the media is.

Rebekah Bernard MD:8:22

You know, Eric, I'm so glad that you said that, because I have to tell you that we've worked really hard to try to get some media attention on our book, on these stories. We have lots of other stories, and it's very difficult to find journalists that are willing to take it on. And so I think that's why we're just so thankful for what you're doing. And I just want to talk a little bit more about your Beaumont story, because I think our listeners need to know how tenacious you were with this. Not only did you report on this story, but you actually wrote 39 articles over a series of about a year and those columns questioned and raised the issue, brought attention to the forefront, to the point where you got legislators on board with opposing this merger that wouldn't have been very good for the community. And of course, you've got a lot of criticism. So some of the things that the CEO Fox of Beaumont said that you were a 'mudslinging machine only interested in the next bucket of mud' and 'a psycho blogger.' And I only bring that up because Niran and I get a lot of those kinds of comments too. And we're just so proud of anybody that speaks the truth and stands up even though you get this kind of retaliation. Of course, it's because you're speaking the truth and they don't want that to be spoken.

Eric Starkman:9:41

I'd like to address the problem you're experiencing - it is that

the media today has become a lagging indicator. The problems unfolding - what's happening in healthcare - a few years from now there's gonna be a lot of people dying, and someone's going to wake up and do this story like, 'oh my God, do you know what they did?' But that's after the fact. And I think good journalism is like warning people that this is happening before it happens. Rather than say, 'let me give you a 10,000-word feature about how healthcare ended up the way it did.'

It just doesn't do any good. What I find so frightening is that I've learned that hospitals aren't really regulated. And I'm sure you guys are familiar with the GPO issue, the group purchasing organizations that reared its ugly head with Beaumont because the GPO had gotten them - if you saw that story - had gotten them a rebate. They use certain Stryker products, medical device products, they would get a rebate if they used them 75% of the time. Fortunately, at Beaumont, the orthopods were ranked 11th best in the country. They're kind of feisty in their own right, and they refused. But that it even happened? And that it probably happens at other hospitals where you know, surgeons don't have the courage to push back.

I've learned that doctors have become employees. And they function as employees. They are afraid to speak up. And rightfully so.

I just saw - I think it was an internist, but it might have been a cardiologist - that is suing in Indiana, that in the Indiana health care company there is such a monopoly that they can only refer patients within the monopoly. And you start making waves, you know, you get blackballed, and you're out of business. And that's just wrong, any kind of concentration of power, especially, you know, you're talking a lot of money in healthcare. So a lot of money that's not being regulated and watched and money, these hospitals get bigger, you know, bigger is not better. And it's there's study after study showing that when hospitals merge, quality, patient care goes down, and costs go up. The only benefit to a hospital merger is to the CEO, and to the investment bankers, they can sell the deal, but there's no other benefit to anybody else.

Niran Al-Agba MD:12:08

And so I what I hear you saying, which is what I wanted to comment on is essentially the way I look at hospitals is they're buying and selling. So they're even buying and selling human beings to a certain extent, you know, or services to those human beings. So like you said, if they pick Stryker products that there was this kickback or benefit, and then they own the physician, so to speak, as well. And they own their voice they take - they strip them of like every ability or power that they have and kind of tell them what to do. And so I've kind of come to the conclusion because this has gone on in my hometown as well. It's been taken over by a monopoly that the answer is really putting the power in the hands o the people to a certain extent and educating them. But you're the investigative journalist. So I guess my question to you would be, how do we change this or help people be more aware of what's going on?

Eric Starkman:12:56

I think your book is a great first start. There's a real problem in America in that the country's been dumbed down. I saw a story - it was in Kansas, Oberlin, Kansas. I don't know if you guys saw - that was the KKR company that provides emergency room physicians and some physician sued them for not staffing properly and won like $25 million. And the reporter just wrote the story straight. Here's a doctor that won $25 million for understaffing the hospital emergency room. And it's like, Are you kidding me? Well, if they were understaffed, what about the emergencies that came in? Somebody comes in a car accident, there's only one doctor. And the reporter didn't think to follow up or why are they outsourcing the emergency doctors? And you know, it's the quality of journalism in this country has really gone down, particularly on the local level.

The other problem is that people just have become inert to wrongdoing. Just every day they read about another dishonest company, another dishonest CEO and the people that - and our government's very weak. And Michigan is a warning sign about how low it can go. Michigan's leadership - and to think that Governor Whitmer almost was named vice president. And the reason she was named almost named vice president is Joe Biden saw her on TV and thought 'she's really good on TV. ' You know, she allowed Beaumont to do nothing. Dana Nestle, the Attorney General allowed it to go down. Beaumont owns a hospital that's got a very high Medicare patient indigents that happen to be Debbie Dingles and Rasheeda Taleib's district, but they got bigger fish to fry. And it's like really a tragedy.

A community is defined by its hospitals and its schools - that reflects the values of a community in southeastern Michigan. They let a guy from Atlanta come in to destroy - Beaumont in its day - I mean, when you talk about like the Cleveland Clinic, or MD Anderson, you wouldn't put Beaumont in that category, but they actually had some surgeons that could have gone to those hospitals if they wanted to. The anesthesia at Beaumont was always first-rate. In fact, one of the former heads of the American Society of Anaesthesia worked at Beaumont, it had really rigorous standards. Now, if you live in southeastern Michigan you don't have to go to Ann Arbor, you know, University of Michigan hospital's a pretty long haul. Then you have Cleveland Clinic, which is only three hours away, but you didn't have to go there, you could get quality top like quality care at Beaumont.

Rebekah Bernard MD:15:40

I think you're speaking to the point that is so true that these community hospitals are now being taken over by these huge conglomerates that really don't have that much interest in the community or the patients or the physicians or the nurses. They are interested in making money for themselves and for shareholders in many cases. And I have to tell you, that your point of that, it's really hard for people to stand up to this injustice. It resonates so much with me and when I read the article that you wrote, which was 'Why I'm passionate about covering the destruction of Beaumont health,' you wrote,

'being a team player in corporate America signifies a willingness to toe the company line and ignore wrongdoing and hypocrisy. I prefer to die standing than to live on my knees.'

And I gotta tell you, that just gave me goosebumps because there's not a lot of people that have that - I mean, they may have the integrity, but they aren't able to have that kind of conviction and stand up for what's right. Why are you so brave? What how can we learn from you, those of us that are listening to stand up for

Eric Starkman:16:46

One is that I'm not in the healthcare industry, what's right? so there's not much - they can't blackball me because I don't want to work in healthcare, so they can't harm me that way. I've always been kind of an iconoclast. My parents are very ethical people. I just grew up thinking that's the way the world is. My dad, I can tell you great stories about my dad, who was a senior partner in an accounting firm, he was also religious, but he didn't have a religious side and the business side. He believed that ethics, the ethics you heard in the synagogue had to be lived in your everyday life. There wasn't like, well, I can do this in business. And then I go and tell the world how religious or pious I am. So it came from that. I've always been a little fearless. And that's why I went to journalism, you know, it was just natural for me.

Rebekah Bernard MD:17:39

I just love that so much. And I think we need more fearless people like you who are willing to speak out. You know, Niran and I are able to speak out even though we're in healthcare because we own ourselves, we own our own practices. And so really the worst people can do is, you know, write things about us on the internet and send us mean emails, which they do. But it's okay, because we aren't able to really be fired, because you know, we just work for ourselves. And I think that's a really important message for physicians and nurses and health care professionals that are listening out there, that when you're owned by a corporation, unfortunately, that may mean that you can't speak out. So either decide that that's going to be okay - although I guess there are whistleblowers that, like you pointed out, that are suing organizations. But unfortunately, I also hear stories of people suing and not winning, or getting blackballed and things like that. So it is the reality. But it's all the more reason why it's good for people not to if they can avoid joining these huge conglomerates and either join small practices or own themselves.

Eric Starkman:18:41

One thing I'll share with you as an observation is that there is a very definite trend right now for nurses to unionize. And I've actually been following this. Every case I've looked at every incident, patient safety is their number one concern. About staffing levels. And they have become almost like the conscience of the healthcare industry, because they see it every day, see the cost-cutting, they know they're stretched too thin. They know they're going to make mistakes. I think you talked about that in your book if I remember correctly. In Beaumont, in Michigan, they got no support. And none of the locals, not one politician, lent support and interestingly enough, Beaumont's flagship hospital is in Royal Oak, which is in 11th district. And Andy Levin was, you know, down in Alabama trying to work to help older organize the Amazon workers but offered no support for the health care workers in his own community. But that's not true of all communities. In Portland, the city I mean, I was really impressed the Maine government put out a statement the Democratic leaders, like, it was unequivocal. Like, we don't like what's happening, we stand with the nurses. Few people have stood by. There's a big strike going on now in Worcester, Mass. A couple of politicians have lent support but Elizabeth Warren, you'd expect would be out there. Now she said some letter saying, hopefully, the hospital will go back to the negotiating table where I thought I was pretty lame.

Niran Al-Agba MD:20:22

I will tell you, the politicians are useless. We have been at this for a number of years. And on almost every podcast, I end up saying sort of I've given up on the politicians, I've given up on the government, I've given up on the hospitals, I've given up to certain extent on a lot of the doctors to because I think the employed ones just have to follow along. So it's the people. That's it. That's my last resort, and not my last but my best resort. We have to tell people how to protect themselves. I think that's the thing, you know, which is why we're grateful to you, because you're helping us do that, because regular people read your read your blog, read your information. But that's it. I mean, I just don't think the Elizabeth Warrens understand the problem. I don't think they care about the problem. And I think their pockets are padded by those hospitals. And those hospitals say they're doing good. And that's it. But tell me I'm wrong.

Eric Starkman:21:11

The reason I'm laughing is like, I recently posted something about the American Hospital Association, I said that really should be renamed. I know I put some thought into it, so I can't remember exactly what I said, but the 'organization for increasing the compensation of hospital CEOs.' I mean, that's - and they're so deceptive too. Somebody sent me from the Michigan Hospital Association. They got a solicitation to support. People innocently think, hey, if I support the Michigan Hospital Association, I'm doing good by hospitals, then like the former chairman of the Michigan Hospital Association was the CEO of Beaumont. That's like, and you hit it hit the nail on the head. You know, the American Hospital Association is a major contributor to lobbyists in Washington and politicians and they're major. That's why politicians like yeah, yeah. You would expect that Elizabeth Warren or Bernie Sanders or somebody out there would have taken up this cause, but they don't, you know, and they talk about taxing the rich. Well, why don't we address like how the rich got rich? Right? instead of like taxing them after the fact? Why don't we talk about how they got the money in the first place. And that's what's wrong.

Rebekah Bernard MD:22:30

And you know, regarding the political parties, when it comes to the issue that we've talked a lot about, which is the replacement of physicians, really both parties, neither party is addressing that. And to be honest with you, there really are no books or really no real good literature out there as a healthcare health policy critique, addressing this issue. You can read an American sickness, you can read - I mean, we scoured all the current literature critiquing the American healthcare system, and not a word spoken about the growth of non physician practitioners. Which is why we really appreciate you shedding light on the issue by sharing our book. And I really liked a few things that you wrote in the article, which you called 'The Rise of the MD Lite,' which I really liked. He also said, he had a great idea from his PR background, which is that doctors should maybe create our own little logo that says, you know, there's a real doctor under here.

Niran Al-Agba MD:23:25

Or underneath logo, that's fantastic

Rebekah Bernard MD:23:28

We might have to hire you for our PR, Eric.

Eric Starkman:23:31

I'm quite passionate. And where I'm disappointed,

I don't know the politics of the American Medical Association, but your book should be in the waiting room of every doctor, every family practice guy and woman in the country, it should be like right there, I wish and it should be on the AMA's website.

This is example, when you hire PR people do your brand. And so the physician assistants, they want to now call - they hired a PR firm, and they called it a branding firm, it was actually a PR firm. And they probably paid like as much as like $500,000 for this to come up with the name Physician Associate. And frankly, I don't think there's that much of a difference, you know, associate okay, but obviously, it's not a physician. The response that the AMA gave to that was so lame. I would've given a response that said something to the effect that our tolerance with physician assistants and nurse practitioners kind of fashioning themselves as doctors has worn thin. They want to provide the quality of care that doctors provide then let them go to medical school, something like that. And they would have dropped it because the one thing that they didn't anticipate, and maybe correctly so that the AMA or the physicians might come back with a vengeance like this might wake up the industry. Like, do we really want to test it? And I thought the AMA response was very lame. And I think doctors are making a mistake, you know, particularly anesthesiologists. Like why anybody would go into anesthesiology, do they? And, and I've got a fondness for anesthesiologists. By the way, I've gotten to know them, a lot of people - I think he mentioned you had Dr....

Rebekah Bernard MD:25:25

Sibert. Yeah, Karen. She's amazing.

Eric Starkman:25:29

She's like, she's not afraid to speak up. And you know that the great thing about anesthesiologists is that they basically were so good that they put themselves at risk, you know, yeah.

Rebekah Bernard MD:25:43

She says that they're a victim of their own success.

Eric Starkman:25:46

In safety, right, because it used to be anesthesiology was, you know, was riskier than the actual surgery. And they got the safety record down in years. Nobody thinks the anesthesiologist is where the risk is. But you guys touched on and, you know, use the same analogy that I was using. So great minds think alike. You know, the airplane analogy, you know, you get on a plane today, you know, that all of us could probably learn to fly a plane within six months, you know, just to basically get it up and get it down. It's all you're basically just reading the instruments. But when those instruments go faulty, you got to know how to bring down the plane the old-fashioned way. The miracle with the US Air Flight, you know, on the East river was that that guy was a veteran military pilot, he knew how to fly planes under extreme circumstances. Now, pilots, today don't come out of the military anymore. The commercial pilots, it's the same with anesthesiology. It's like when something goes wrong. You need Captain Sully to...

Rebekah Bernard MD:26:52

Yeah, we totally agree with that.

And I think what makes it so difficult is that people don't realize they see all these studies saying that nonphysicians are just as good as physicians. But what many people don't realize and I think many physicians because we didn't really know this until we did research, was that every single well-done study, and really any study that has shown purported to show equivalency has always been done when these individuals are practicing under physician supervision. So that's them flying the plane with Captain Sully right next to them. You don't know how they would do without Captain Sully next to them, we would only assume they probably wouldn't do as well, just because they don't have that same experience.

Eric Starkman:27:31

In fact, you know, you brought something up, that's really critical when they he was brought up at a hearing, questioning, I think it was the decision to land in the water is compared to try to make it to the airport. In using those calculations. It was based on a decision he had already made. I can't do justice. But like in their investigation, they used his expertise that they had, because he used it. And then when they realized that they didn't have that knowledge, it would have been a very different outcome. So yeah, we're on the same page.

You know, I think relying on media, you know, the media is a lagging indicator, I think you have to, you know, the great thing about today is that you can create your own content, and you can market your own content. I think you got to do it on a community-by-community level. And I think you got to find people like yourselves, individual communities to develop a training program. So people say, you know, going out to church meetings and just say like, this is what's happening to our hospital. And I think nurses are a great ally. I've seen a lot of guys, especially at Beaumont particularly the nurse anesthetists. They are tough. I think they eat nails for breakfast. And they speak out, you know, they sounded the alarm about the outsourcing firm. I just give them so much credit. You know, they played the outsourcing firm CEO, they played him pretty well. He was threatening them if they didn't sign up right away, he was just gonna hire other people. So they went and signed and on the first day of their contract, they went and filed for a union organization, as you guys know always like that's one thing hospitals don't want is a union

Rebekah Bernard MD:29:20

I think that's a whole other conversation that I would love to have. And unfortunately, we're out of our time, I'd love to talk more with you. I so so appreciate everything that you've done. And we thank you for promoting our book and for all your work in exposing corporate healthcare problems.

And I'm going to encourage of course everyone that's listening to learn more, please get our book. t's called 'Patients at risk: the rise of the nurse practtioner and physician assistant in healthcare.' It's avaivable at Amazon and Barnes and Noble. We'd love for you to join our group Physicians for patinnt protection. Of course please like and listen to our podcast and our YouTube channel. It's called Patients at risk Thanks so much and we'll see you on the next podcast.

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