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  • Writer's pictureRebekah Bernard

Physicians in politics: MD-JD discusses why doctors must get involved

More than ever, healthcare and politics are intertwined. Decisions made by politicians and have a major impact on not only healthcare policy, but on the day-to-day practice of medicine by physicians. Today we are excited to be talking about healthcare politics with Dr. Kermit Jones, a California internal medicine physician, attorney, and military veteran who is working to bring his medical expertise into the political arena.

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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 1:17

Good evening.

Rebekah Bernard MD 1:35

More than ever, healthcare and politics are closely intertwined. decisions made by politicians have a major impact not only on healthcare policy but on the day-to-day practice of medicine by physicians. Today, we are excited to be talking about healthcare politics with Dr. Kermit Jones. He's a California internal medicine physician and an attorney and he's working to bring his medical expertise into the political arena. Dr. Jones, welcome to the show.

Kermit Jones MD JD 2:01

Rebekah, thank you so much for having me. I appreciate the time to talk.

Rebekah Bernard MD 2:05

Kermit, can you start by telling us about your background and how you came to be involved in law and politics as well as medicine?

Kermit Jones MD JD 2:12

Sure, I'd love to. So my background is, I grew up on a small farm in South Haven, Michigan. One of the biggest, I think, early experiences I had in healthcare was my mom was a home health nurse. And she helped me understand the importance of compassion and relationships in medicine. And we on our farm had 50 head of cattle. And I got to see anatomy very early on, in terms of, you know how big a cow heart actually is. And that was one of the most fun things I could say in terms of bringing that to my biology class. But I'd say in terms of medicine, I had an opportunity to shadow our family practice doctor when I was in high school, and he was on his way to retirement at the time. And I never forgot, he told me said, 'Kermit, medicine is going to look different over your career than it did in my career, it's not going to be enough to just have a medical degree, you're going to have to either get a business degree or some administrative degree or a law degree, something that gives you an opportunity to translate your experience in medicine into something else for people to understand.' So it was with that conversation that I decided when I was going to medical school, that I was going to do some type of combined degree program. And I figured I could take a business class here and there, but nothing was going to teach me the law by going to law school. And so it was through that process that I did the MD JD program at Duke starting in 1998. And ending in 2005. And during that that program, I got an introduction to a lot of the issues that I think a lot of physicians are taught in medical school in terms of risk and negligence, intellectual property issues, different types of contract issues. So very phenomenal experience.

Rebekah Bernard MD 3:56

That is such an interesting background, I wish that I had known about those types of combined programs. And there are so many doctors that are interested in law school and the law to tell us a little bit more about what that experience was like I think a lot of our listeners will be really fascinated. I hear so many doctors say I'm thinking about going to law school.

Kermit Jones MD JD 4:15

Yeah, definitely, I would say of no other experience that I had. It helped me frame medicine in a way in which I can understand the importance of individual rights. You know, in terms of patient autonomy, informed consent, making sure that patients understand what we're doing to them, because if they don't understand that they don't consent, then it is assault and battery. But then also making sure on the other side of that the rights of physicians, you know, and making sure that we understand legally, what we are able to bring to the table. And then in terms of what we should advocate for in terms of our ability to actually do our jobs. I'd say in addition to a lot of that background information I got an understanding the importance of advocacy. Understanding how to frame arguments based upon evidence and logic and reasoning was probably the most fulfilling thing that I got out of the law school experience. And then I think much broadly, I had opportunities to work on HIV and AIDS Policy at the World Health Organization got to work on intellectual property issues, I had the opportunity to work at a law firm doing FDA regulatory work, which was very important because that helped me understand that process when I had to advocate for specific medicines for my mom to go on. Fast forward when she was diagnosed with lung cancer about 25 years later,

Niran Al-Agba MD 5:36

I think people forget how much the professions are linked. And certainly, as a pediatrician, you know, every day I'm facing questions, I've got all these 13 and 14-year-old teenagers who want to get COVID shots. And it's so interesting when I have one parent or the other who says absolutely not, I'm not allowing it. And it's, of course, and I know this probably varies by state. But as a pediatrician, this has come up for years, you know, where we've had to talk about the mature minor doctrine and do what the child can consent to. And it's been amazing to me how few we have a lot of practices in Washington that refused to give any shots to a child that's under 18. If a parent doesn't approve it, and I'm over here, saying, hey, it's one parent, we need one parent, you know, to approve it, we also if it's a mature minor doctrine, and we feel that we have discussed it with the patient, we've known the patient their entire lives, they really understand what they're facing and the risks, benefits, and alternatives, then we can discuss that in our chart, you know, this child meets mature minor doctrine standards, I'm going to go ahead and immunize them. And, again, it's always been able to hold up, I definitely have seen parents get angry with me. But the bottom line is, I think it's so so important for patient autonomy that we have this understanding of the law, as it applies to whatever specialty obviously mine's pediatrics.

Rebekah Bernard MD 6:50

Let me ask you about that mature minor doctrine. Is that something that statewide or is that that federal policy?

Niran Al-Agba MD 6:57

For us, it's my understanding is it's statewide. Again, I only know Washington state law, I know that whenever these things come up, I do always contact my malpractice insurance company. But I originally had this problem, the child of her lost her mother, and there was no father. So she was taken in by a kind of unrelated Guardian when she was 14 years old. She's now in her 30s. And I'm taking care of her kids and another generation, but immunizing her at that time, you know, at 14 was like, Oh, my gosh, what do I do? And that's when I first learned about how do you immunize an unaccompanied minor because this comes up from time to time. And I remember thinking, you know, I wish I'd gone to law school because there are so many times these small issues come up. But it's allowed me to sort of fight for patients, which of course, is you know, so important.

Kermit Jones MD JD 7:42

I couldn't agree more. And it does vary from state to state because the laws of the states are going to vary based upon whatever state you're in, and the Supreme Court precedent in that state, and the case law. But I would say that this goes to your point to the capacity, and whether the, you know, minor, whether emancipated minor or not, has the capacity to make those types of decisions. And thankfully, the law is broad enough that it's outside of, you know, much broader than medicine, in which we've determined whether they felt as if people would have or miners that have the capacity to contract for specific things, to make specific decisions. And this falls into medicine. And it's very important. And even to your point, we've had situations where, unfortunately, doctors would not know whether a patient had the capacity to make a decision or not. And were making, you know, very serious life or death decisions based upon that, because they didn't understand the law of the state. So I'm glad that something that sounds like the two of you have been, you know, self-educated.

Rebekah Bernard MD 8:41

I mean, it's something that comes up all the time. I mean, even just today - The reason I was asking that question, today, I received a message from a patient saying that your child wants to get the vaccine one, the COVID-19 vaccine specifically, I think, a 15-year-old. One parent says yes, the other parent says no. And then here's the dilemma. Now what? So I guess this is where it comes in really handy to have our attorney colleagues or if you're MD JD, you're obviously that's even better. But there are nuances that happen all the time. So it sounds like not only Is that helpful, as practicing as a physician but also a lot of attorneys are laying into the political arena. And that's something, Dr. Jones, that you are looking at right now. And in fact, I'd like to just share a little bit of the email that you sent us, which said, 'like Dr. Al-Agba recently said, healthcare has been hanging by a thread for some time. I think the book 'patients at risk' emphasized to me that physicians have no one fighting for us and our ability to care for patients at the congressional level for decades. I also learned that butting heads with policy wonks when I was on the healthcare team on a recent presidential campaign.' So tell us all about your journey into politics and what your ideas are.

Kermit Jones MD JD 9:57

Definitely, thank you for that opportunity. Rebekah. So, as I said, before, going back to the MD JD program, I thought, by doing that program and doing some things with law firms, I would have a very deep knowledge of what I need to do on a policy level to try to advocate for doctors and for patients and for members in the healthcare system. I was surprised when I worked on a couple of different presidential campaigns and had these discussions with the people that, you know, advise candidates that, you know, may have master's degrees in administration or, you know, can read statistical studies, but have not seen any patients in clinic and or in the hospital. And why that's important is that these are policies that determine how we see our patients, it determines the risk associated with it, how we reimburse it in their determinations of the incentive. And so because of that, if, you know, determines how much time we can spend with the patients, the RVUs, you know, how that's calculated. And because of that, that actually determines the leaps and bounds so to speak of what we can do and how we can establish these trust relationships to influence behavior. And I was surprised because at the end of the day, the It seems as if the voice that was least listened to, or the one that had the least amount of clout was the physician was, you know, tons of other people, you know, if he had spent 15 years in government and did this, that and the other, still never saw any patients who were listened to more, you know, if he were, you know, from a nurses union, or something like that, you were listened to more. But when it came down to the positions, a lot of the physicians were seeing as, okay, you're the assembly line worker, you do this, you do that. And we will circumscribe what you do and move forward. And I was surprised by the gap.

Rebekah Bernard MD 11:49

Yeah, you know, there really is a gap. And I think about things like the Robert Wood Johnson Foundation, they have these nurse executive fellowship programs. And what they do is they actually send nurses to Washington, DC, and they learn how to craft health care policy, they get involved in different committees, they get to meet legislators, legislative aides, basically, they get introduced to this world of politics, and they really start to get embroiled in it. And really, we don't have anything like that for physicians. So I think that may be a little bit of some of the reasons for that gap. And, you know, I also think that maybe it's part of the reason why nonphysician practitioners, especially nurse practitioners have gained some of the rights and privileges that they have now, and maybe even why they have a louder voice in health care policy than even physicians.

Kermit Jones MD JD 12:35

Well, I mean, just kind of your point. So I was looking at some statistics a little bit earlier, earlier. And, you know, over the past 40 years, since 1975, the number of hospital administrators has increased 3200%, the number of primary care doctors has increased 150% - a 21 times increase. And there was a study that came out with Commonwealth - Mirror, Mirror - that looked at and compare the US healthcare system with 11 other countries around the world, I think it was actually 10. And it shows that we were pretty much last, and everything except the amount that we pay and process measures. So it seems as if we're very good at measuring things, there are 400 quality measures that Medicare requires of hospitals. But when it looks at when you look at our life expectancy, it had the biggest hit that it had, since world war two last year, when you look at our primary care numbers and how we compare to other countries, we're dead last. So whatever we're doing is absolutely wrong. So you know, this, this argument of, you know, not increasing the number of primary care doctors circumscribing the amount of time that we see with our patients, you know, letting these other, you know, members of the team, you know, granted, I mean, mid-levels are members of the team, that the mid-levels that are members of the team that in some instances have either 1/5 or is up to 1/12, of the training that we've had kind of, you know, determine and dictate how things are done, is, is problematic. And so that's why I argue that unless we have more physicians at the table, whether it's through some of these fellowship programs that you mentioned, or like me running for Congress, we're going to continue to erode the ability for physicians to establish those trust relationships with patients. Right now. I'll have tons of patients that come in and say, you know, Well, look, I looked this up on Dr. Google. And this is why you know, I think, you know, you should give me ivermectin as opposed to, you know, try to suggest me getting vaccinated. I no matter what you say to them, yes, to me lower the pH of endosomes. but so does hydrogen peroxide, and you're not gonna drink a bunch of that, right. So, you know, unless we have these relationships in which we establish trust unless we are reimbursed in a way in which you know, our value is recognized, then we're going to continue to have worse outcomes. higher costs and health care.

Niran Al-Agba MD 15:02

So I love that you brought up the dropping life expectancy because I've actually looked at it over the past few years and written quite extensively about how we had a drop in life expectancy for three years in a row. And then we had a year before COVID, where it kind of held or even increased a little bit. And then, of course, you know, 2020, obliterated everything. And so what's interesting as well, one is due to COVID, we still were trending downward in life expectancy and Right, absolutely came to the same conclusion that you did that we just don't have enough primary care doctors. And, you know, I'll take Montana, for example, because that's where I've done most of my work trying to, you know, be on the admissions committee at the University of Washington and expand the tape or expand the ability to keep the students home in Montana where they're accepted, and then get them to go out into primary care. So there are incentives to do this. Right. And I guess what I wanted to ask is, do you have thoughts about how to increase primary care physicians in primary care specialties because that's where we have a problem. That's what we're doing wrong, among many other things. But that's something that feels really tangible, that we can set goals and we can improve upon.

Kermit Jones MD JD 16:05

Yes, I do have policies that I do want to implement. If I had the privilege of getting into Congress to represent California's 4th congressional district, I do want to say that I have to say that I was brought to your group by other colleagues of mine that I'm writing a paper with Dr. Maya Kawaji, and Dr. Hector Guzman, both of which were, I think, at least been familiar with the advocacy that your organization has done. And I mentioned them because we're actually writing a paper on this right now. So when you look at the trends in terms of primary care, we have trended towards many doctors moving into more employment-based care practices, you know, either, you know, with large HMOs, or hospitals. And because of that, you know, they kind of come under the fold of hospital administrators, which in some instances isn't necessarily a bad thing, if those hospital administration, administrators are actually also practicing, but in many instances, they're not. And so one of the things that we advocate for is, you have to be able to make it so that there is competition, which tends to work in every system, for those particular primary care doctors, you do that by giving them the economic resources that they need to stay independent. You know, we learned during COVID, that when the federal government wants to we can put $6 trillion into the economy, right, and keep going. The same thing should be advocated with respect to primary care doctors. One of the policies I want to put in place is if you are a primary care doctor that wants to hang your shingle out in an area, that's not a lot of primary care doctors or rule, the federal government should be able to say to you that we'll give you a $250,000 forgivable loan, to set up a practice, if you stay there for five years, it's completely forgiven. And they'll also provide insurance for you to do that. If you're a group of two, you know, it would be $600,000, a group of three the million dollars. So doing this in a way in which you provide the economic means for physicians to stay independent, and do things in the community that they would not otherwise be able to do. Otherwise, they make the decision of becoming employees, once they become employees, they are turned into cogs, pretty much and they no longer have the independence of their practice. So that's point 1. Point 2, as both of you I'm sure are very aware, there are programs out there that help residents that come out of residency, go into public health service forgivable loan programs, a lot of those are designed that you have to work in a public hospital, or some public setting. I think that is short-sighted on there are many instances and areas whether it's rural or urban, where there may not be a public hospital there, there may only be private options, we should have people give loan forgiveness, whether you go into an area where they're not primary care doctors, whether it's public or private, you still get loan forgiven. Because at the end of the day, what we're trying to do is increase the number of primary care doctors out there, we should shorten the pipeline, make it so that if people want to go into primary care, there are more monies out there for them to be able to do that. And there are some places that we've proven with respect to the UK, where people don't necessarily need to be an undergrad for four years. The main undergrad for two years and go straight to medical school, if they go on a primary care path with increased the reimbursements for primary care doctors. You know it for primary care doctors to compete with specialists. And this is why 70% of people finish residency and going to specialty one because they make so much money. And then too because they don't need to see as many patients, you have to increase the amount of money that you're going to pay primary care doctors,

Rebekah Bernard MD 19:37

And also Kermit, get rid of some of the unnecessary burdens on the primary care physician because that's one of the reasons I've opted out of Medicare at this point is I could not comply with meaningful use as a small practice. It costs money and I cannot implement an electronic health record that is required to capture you know, reasonable reimbursement. So that's one of the things that really has to be changed everything you said I'm 100% on board with that. And also, we really got to cut some of those barriers that make it make it to where nobody wants to do primary care anymore.

Kermit Jones MD JD 20:11

Well, I think you hit the nail on the head, I'm sorry to interrupt, I just want to know what one other thing I just want to throw out here. So I don't forget, with those 400 quality measures, in some instances, several hundred quality measures on the outpatient setting, one of the primary things I would do is challenged CMS to actually drop quality measures that have not correlated with improved outcomes. There have been studies by people like Andrew, I think Ryan at the University of Michigan demonstrated that some of the quality measures we have out there do not correlate with outcomes. And you require people to meet these quality measures, you know, if for every two hours that a physician spends trying to fill out a lot of these measures, that in some instances is five to 10 less patients, so they get to see that day, and you create a supply-demand mismatch. And I'll stop with that. Sorry, I've been talking too much.

Niran Al-Agba MD 21:02

I was actually going to essentially say what you were talking about, because, of course, I am opted out of Medicare as well, for obvious reasons, none of my patients qualify for Medicare, thankfully. And I would say that you know, I'm still on paper. And what's so interesting is when you talk about this forgivable loan, you know, I've been spending with COVID, I'm in Washington State, obviously, and I have young children, we are not flying on airplanes. And we are not traveling other than to go to the San Juan Islands, which is a small area group of five main islands in a number of surrounding islands. And there's not a single pediatrician on the islands. Actually, I've now and, and I've been vacationing there and just talking to the community and it keeps coming up over and over that they need a pediatrician. And what's it's easy for me, right, I have all the insurance contracts, I have paper charts, I can easily go up there. I've talked a lot about spending three days a month if they're doing basic preventative care. And the big logjam right now is essentially number one, finding a place to put the clinic or put a clinic or rent space or whatever and make that investment to hang the shingle. And it really wouldn't be hard, I'm already up and running, right. But something like you're talking about would be perfect for someone like me, I can be open in a month or less with a grant for a loan. And you know, again, the PPP loan, I know for many small businesses, including my own kept my employees working, it was easily forgiven, because I followed the rules, and it really helped bolster independent practices to stay open. So I think that that's kind of a fantastic idea and plan. And I think these are the kinds of innovative solutions we need.

Kermit Jones MD JD

Now, what we saw during COVID, with the 1134 waivers was that you know, to make it so that you could you know, do virtual medicine anywhere in the country was the sky didn't fall, right? I mean, so we had a lot of things where they said, hey, look, if you do X, Y, and Z, it's going to compromise patient data, and HIPAA and these other types of things. But in a crisis, all of a sudden, all those regulations went away. Right? So we are regulation heavy, you know, and in the instance where we are trying to figure out how do we get more patients seen, have better relationships, and save money, we need to look at what's out there and start trimming the fat away from things so that people can actually do the jobs they're trained to do?

Rebekah Bernard MD 23:15

You know, I think that this is the main reason why we have that - what was it 3,000% jump in health care administrators? - because it coincides with all of the requirements and obligations that healthcare centers must comply with. So they hire all these different people. And we create more and more members of the team. And to me, that just basically spreads around the responsibility so that really, ultimately nobody's really in charge, you just sort of pass the buck from person to person, which, you know, I say that the trouble with team-based care is that you're only as good as your weakest link. And when you have a huge team of all these different people, one person doesn't pull their weight, and patients get harmed. So that's an unintended consequence of all of this. So I'm doing direct primary care. So I've cut out all of that sort of thing. I'd love to see a way that doctors can work with the system be able to take Medicare, be able to take insurance, but not be administrated to death over it. I think that's really a good solution. And you know, you mentioned statistics, one of the things that we uncovered in our book is that the United States ranks 24th of 28 similar nations as far as our number of physicians per capita, and yet ranked number one, as far as nurse practitioners and physician assistants. And I think it directly correlates to this increased burden. We've hired all these associates to try to help us be able to take care of patients. And the question is do didn't really need all of that, or could we have just simplified the system so that doctors could have the time with patients and not have to do all this?

Kermit Jones MD JD 24:51

Rebekah, I 100% agree. I mean, so I looked at some data before we got on it said on average across the country, the number of physicians Per 100,000 rate is from about maybe 119 in Mississippi and maybe 190, I'm not looking at the data in front of me, to over 300 per 100,000 in the Northeast. In my district, California scores, it's actually closer to zero per 100,000 in Alpine to about 80 per 100,000 in Eldorado, which is significantly less than the average or even outside of that, that median for a state itself. But where that goes to his exact point of what you said, you know, when you look at the basic economics, you know, which I took enough economics classes to understand this, is, in order to hang out your shingle, you have to have all of these people that can process the claims, you have to have all the people that can run the management department, and you boil all that overhead down, and the per-unit cost, it costs too much for that physician to go out into some, you know, small area, you know, in the islands off of, you know, Washington to set up your shingle. And that's directly correlated with all of these different requirements. You know, and just to be completely fair, you know, I'm not saying that the people that are making a lot of these rules aren't well-intentioned, you know, I'm saying that it is hard to be in Baltimore, where CMS and Medicare, you know, is and dictate the terms of how someone's going to see someone in Washington State, or how they're going to see him in California, it's just not going to work. Because there's not enough understanding of the nuance of what's going on in those situations for that to occur. I'll give you one more good example. I was talking to a previous president of the AMA, and we're talking about some of these different, you know, average requirements that are sometimes placed on reimbursement for particular types of patients. And, you know, this person was talking about how based upon the type of patient, you know, you may have a situation where let's say, a patient may have, you know, stage three or stage four type of cancer that, you know, has distant, that's the one type versus another. And so based upon those differences, the one patient will be excessively more expensive to treat than the other. And if by the luck of the draw, you just have more of those patients, it's going to be a whole lot harder for you to get the reimbursement that you need, based upon the averages that come out of Baltimore, DC.

Niran Al-Agba MD 27:20

Now, I do want to talk about one of my goals, when I came out of residency was to be a White House fellow. So I applied and was not accepted, of course, and you know, that's is what it is. But I've always been fascinated to talk to someone who's done it and what it was like, and so could you tell us about that experience? And what you took away from it, and what you've benefited? Having done it, etc? Tell me all about it, because I didn't get to do it.

Kermit Jones MD JD 27:44

Well, I feel very lucky to have done I'll be honest with you. And I was shocked, you know, when I got chosen. You know, I'll tell you, my wife, when we found out that I got accepted, she said, 'I'll be honest with you, I didn't think you were going to get this.' So I wasn't sure, you know, I was like, you know, did they make some mistake or something like that? Yeah, I would say it was probably one of the most broadening experiences I ever had. And that's even including being in the military and deploying to the Middle East. And it was because, you know, the three components of the program, there's the fellowship, where you come in with 11-19 people after the whole process of the interviews, there is an educational component where you get to listen to these leaders that have grappled with some very serious decisions, you know, like, Secretary of State Colin Powell, or getting an opportunity to talk to the President. And then also, you know, there's a component of, let's say, your educational or like the opportunity of the placement itself, so you know, what you're doing in that particular year. So what I was doing during that particular year is I was working in the immediate Office of Secretary Sebelius, which was a phenomenal experience and a very great leader to have cabinet secretary. And I got to work on military medical issues, trying to figure out how people that were leaving the military that were working as corpsmen and medics could preserve some of their GI Bill didn't have to get retraining and things they were trained to do there to get certifications, but also working on innovation issues, trying to look at one of the new institutions at the National Institutes of Health, and seeing what metrics you know, can be used to determine how well we're doing. I would say, what the biggest thing I got out of that program was an understanding that it is very challenging to run a government - run a country as powerful and as big as ours is, without realizing that there are going to be some mistakes that are made on the people that come to the conclusion that they do and try to do the best that they can, you know, need our help need our political process to make it work. And the program itself that was designed by Lyndon Johnson was designed to take you know, lucky people like me, put them into government. Let them see what the federal government can do and then they take that experience back to their communities and continue to learn from that. And that's what I wanted to do. So after having that experience, we settled in California, I saw what California is fourth Congressional District, which runs from taho, all the way down to the acidity needed in terms of access to primary care, the idea of health being much broader than just seeing your doctor, you know, it being whether you have access to, you know, breathable air and nutritious food, whether you have a community that supports you, all those types of things, and then helping to strengthen that relationship between communities and the federal government. So I'd say those were the biggest lessons I learned in the privilege of being a White House fellow.

Rebekah Bernard MD 30:39

That sounds so cool. And you have to forgive me because I don't know too much about the program. Is there one that is specifically for physicians? Or is it open to all different professionals? And how many people get picked? And how do you go about finding out about this for our listeners?

Kermit Jones MD JD 30:53

Sure, Rebekah, so I'll tell you one thing, it is not specific to physicians. And, you know, to kind of go back to what I was saying to there on the biggest lesson, I'd say I did learn was I'm not as smart as I thought I was, you know, because you get in there with these people. Some of them have, like, you know, run organizations that had like, 100,000 people, you know, some guy was like a sniper, you know, in the seals or something, right? And so you feel to yourself, when you come in, like, oh, wow, I'm kind of, you know, I'm a pretty, you know, talented guy, I did a law degree and a medical degree. And you see these other people and you read what they did, they're just like, Okay, I'm just gonna sit in the back and be quiet and listen to everybody else. But yeah, it is. It's a phenomenal, I think, leadership training experience. But what I will say to that, I think a lot of opportunities like that are ones that doctors should consider doing. Because unless we understand how to interact with these different components of government, and society, and really advocate for ourselves in our profession, then we're going to continue to get our profession eroded. One of my favorite quotes in politics is, 'if you're not at the table, you're on the menu.' And I'd say in terms of doctors, and our profession, and why we went into this, which was to take care of people to have that compassionate ability to change people's lives, has been eroded by a lot of people that are in this for the money that are in this for, well, you know, I couldn't become a doctor. So let me become something else. But I still want to be called a doctor, you know, these types of things. Or, you know, like I said, people that run for office, and aren't necessarily concerned with figuring out how to get the best care for a patient, they're more concerned with, how do I get the best sound bite on so I can get an office and people actually think that I care. I mean, that's not why I'm running, you know, I'm running because I've had multiple experiences in the healthcare system seen over 20,000 patients, and also saw that, you know, but for the fact that I was a doctor, my mom wouldn't have gotten the care that she needed, as a stage four lung cancer patient that never smoked. You know, and that is what taught me that unless we have more physicians at the table, we're gonna end up worse off.

Rebekah Bernard MD 33:03

There's so much more than I want to get into, but we're out of time. So I'd like to bring you back for part two. In the meantime, if you'd like to learn more about this topic, we encourage you to get our book. It's called patients at risk, the rise of the nurse practitioner and physician assistant in healthcare, it's And at Barnes and, we'd love for you to subscribe to our podcast and our YouTube channel. It's called patients at risk. And of course, if you're a physician and you'd like to be more involved in promoting physician-led care and truth and transparency among healthcare practitioners, we would love for you to join our group. It's called physicians for patient protection. Our website is physicians for patient Thanks so much for joining us.

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