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  • Writer's pictureRebekah Bernard

The High Risk of Healthcare Part 2: GPOs

In part 2 of this discussion with Dr. Marion Mass, a pediatrician and the co-founder of Practicing Physicians of America , we learn about the impact of group purchasing organizations (GPOs) on the high cost of healthcare. In 1987, the federal legislature granted GPOs safe harbor from anti-kickback statutes, allowing them to reap millions of dollars. Dr Mass also explains how these GPOs have created artificial shortages in essential medical supplies, leading to patient and clinician harm.

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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 non physician 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 0:27

In our last episode with Dr. Marion Mass, we discussed the high cost of American health care, focusing on the role of pharmacy benefit managers. And today's episode Dr. Mass is going to shed light on another hidden aspect of healthcare costs - group purchasing organizations. Dr. Mass welcome back.

Marion Mass MD 1:40

I'm delighted to be here. And you guys are some of my very favorite advocates.

Rebekah Bernard MD 1:44

Well, thank you, we feel the same way about you. Can you start us out by just explaining what group purchasing organizations are? And of course, the acronym for that are a GPO. So usually when you hear about that, you'll hear it in that term. So what are GPOs?

Marion Mass MD 1:58

Okay, sure. So in the 1920s, we were starting to see a lot of patients, you know, it's actually post the 1918 flu pandemic, we were starting to see the rise of hospitals at the time. And so smaller hospitals couldn't get a, you know, a fair shake on having to purchase a lot of the things that they had to purchase. And so they were purchasing organizations that formed it, you know, think about it, like a Costco for hospitals. And then, you know, time went on. And if you think about medicine, and the changes that happened in the 50s 60s 70s 80s, and we had a lot of changes, and we had a lot of, you know, great moves forward, you know, cardiothoracic surgery, you know, people invented the CABG at some point, you know, so that we had need for lots of things inside of a hospital, you know, IV tubing. My gosh, you know, if you talk to like really old timey pediatricians, they'll tell you that they used to give IV fluids sub q underneath the skin, until we invented IV fluids, IV tubing, oxygen tubing, pacemakers, you know, the things that we needed to help patients know put in new valves, you know, Valve replacements, all of these things are things that are purchased by a hospital, they're part of your supplies. And so initially, group purchasing organizations were formed just to be kind of like a Costco for smaller hospitals that didn't have enough buying power. That was their original intention. And, you know, you would think that if they work that way, everything would be going great.

Rebekah Bernard MD 3:29

Yeah, I mean, it sounds like a reasonable plan. But then something happened in 1987, there was a change to federal law for the Medicare and Medicaid programs. And all of a sudden, it became legal for these middle man wholesalers to be able to start taking kickbacks, or money from some of these wholesalers, I guess, in order to provide their product to the hospital. And then that sort of changed everything. And that's where this pay to play started to come in. Can you explain first of all, do you know about that law? How did that come about? And why?

Marion Mass MD 4:03

I don't know how it came about. I mean, if I made my guesses and knowing what I know about DC and policy, I would guess that you know, hospitals came along and they said, hey, look, you know, we've been paying our membership to these GPOs just like you and I pay a Costco membership. Initially, like my guess would be that hospitals probably said, you know, we can't keep paying this this membership or hospitals and we have too many other bills to pay. So instead, let's make it so that the suppliers are, you know, paying the GPOs but of course we all know that's a kickback. If you think about what a kickback is, it's like if you're getting a special business arrangement to have your product put out there then you know the person who's putting the product out there is taking the money, right that doesn't work out great. Like I always use the example of like iced tea like if you go into your local convenience store and there was only one iced tea because the iced tea maker, you know, whether it was for Snapple or Honest Tea or whatever if they could, if they could purchase the right to be the only one and the convenience store, they'd be making out like bandits. That's why it's a bad idea. But in '87, stuffed within the medicare/ medicaid Patient Protection Act, like is a little statute that no one was really noticing they allowed these group purchasing organizations to have the right to receive legalized kickbacks. And I guess the first thing I'll say is, is that I think it's always a bad idea when you're stuffing something into another piece of legislation. We always say how the sausage is made in DC, if things get hidden, people aren't really noticing. It's always a bad idea.

Rebekah Bernard MD 5:37

And you know, I don't think that any of us, most of us, we weren't aware of this issue. And I think what really brought it to light for many of us was the covid 19 pandemic, and the shortage of PPE or personal protective equipment. Because it turned out that a lot of the reason for the shortages in many hospitals, where doctors and nurses were being forced to reuse N 95 masks, or they were told they couldn't bring their own from home was because the hospital was only able to get that equipment from their GPO and they were under a contract not to be able to get it elsewhere. Is that right, Marian?

Marion Mass MD 6:14

Sure. And you know, the contracts don't see the light of day. So we're sort of taking some guesses out there. But there was a wonderful article, and I was honored to be quoted and it was in Vanity Fair, it was written by a reporter named Diane Falzon. And I think she's a really brave reporter. Let's Let's tag her all over this when we put this out there. But you know what, what she had dug up was that there was a hospital in California. And their GPO contract said they could only use a mask from supplier x. And so that even when they got donations, they weren't allowed to take those donations. And the same hospital says shocking, the same hospital was asking its employees to sign waivers saying in the middle of a pandemic, if you get sick by COVID, you will not hold our hospital responsible. Well, someone in our hospitals, someone in that C suite, you know, these suits that we talked about, right? If they were making the decision that we're not going to allow anything but mask maker X to supply masks. So you you're taking every nurse, every respiratory therapist, every physician, every person who's like seeing a patient and potentially taking the COVID cough in the face, and you're preventing them from getting masks. That's disgusting.

Niran Al-Agba MD 7:30

Well, and before people say, Well, maybe that hospital thought those masks were the best on the market. And they only wanted the best for their employees. I would like to add that most of us during this time, you know, community members were dropping off dentists, retired dentists were going and getting stuff for us. And people were even bringing in like the masks used when you're like painting your house. And so a lot of these, whether it was a K 95 , N 95, whatever it was, it really didn't matter at that point, we would have, we would have taken honestly, anything. And I think it was pretty much whatever was dropped off by community members or donated was just I mean, maybe not 100% is safe if you're intubating a patient, but literally, for those of us just on the front line in primary care and urgent cares, any kind of mask or barrier would have been helpful. And like, you know, it's so much easier. What we did is people dropped off so much to me, personally are in the clinic. And we were able to get a system going where we distributed to other independent physicians in my community. So we made sure people had gloves and extra because everything gowns, gloves, masks, you know, face shields. And you know, so many engineers on those printers, those 3d printers, were printing out shields and then you could just say I need 10 shields, they dropped them off. So I want to be clear, like, it is disgusting. It's super disgusting. Because it wasn't that the hospital was sort of saying, well, we love this supplier, and we trust the supplier. And that's why - it was simply a 'pay to play' or a kickback scenario where this was money exchanging hands, money being more important than people.

Rebekah Bernard MD 8:58

And it really is unconscionable. And I want to just talk about Marion's article that she wrote, because she wrote a lot about this for Practicing Physicians of America on the website. And we're gonna get into that in just a few minutes. But one of the things that she posted that was so interesting and just incredible. It was a story that I had read about a year ago, where doctors were concerned about not having the proper equipment. So they were emailing and complaining about it. And there was a hospital administrator, Laura Forese, and she actually used to be a practicing physician. She was an orthopedic surgeon, who became the Executive Vice President and CEO for New York Presbyterian. And so she actually complained about these doctors and nurses and said that it was dispiriting, quote, unquote, to have to hear this this protest. And I really appreciated you bringing that to light Marian, because this is the kind of attitude that we experience. Either you're threatened that you're going to be fired, or you're told you know, you are not being a team player you're being you're causing the CEOs to feel dispirited? How could you?

Marion Mass MD 10:03

It's really astounding. You know, like, I remember reading that and thinking to myself, you poor dear, there you are in the comfort of your C suite, a say I in the comfort of my duck bathrobe right now. But still, you know, like, I mean, she was saying this at work. And I think to myself, if you're a leader, like, you know, the kind of leader that we all want, is someone who's there on the ground, and who knows what we're dealing with. And it was even worse for me, because I think that there's, Oh, goodness, like a sort of a special sort of hell, if you've already been a scrub, and then you pick up the suit and you put on the suit. And you're, you're kind of bashing on the scrubs. And I'm not just talking about this, this physician who bashed on just just other physicians, but every nurse that might have been complaining every respiratory therapist that might have been complaining and in sending the emails into her C suite, well, I'm really sorry, sweetie, that you're getting all these emails, you know, it's a tough life, everyone else was getting the COVID cough in the face. And meanwhile, you have doctors like Dr. Al-Agba, who was just telling me, you know, we're telling all of us that she was helping to distribute protection to her community. She was doing the job that the GPOs were supposed to be doing in the first place,

Niran Al-Agba MD 11:16

And I want to be clear the community gave them to me, and then I was distributing them to the other health care workers. But it's so important. We don't just talk about doctors, right? We had nurses, we talk about, you know, I talked about janitorial staff. I mean, they were really at the same level of rescue, they're cleaning up these rooms of people who were sick, had COVID, may have been intubated, there's particles floating around the air. So I kept sort of, you know, making this big list whenever I was talking about it. It's like nurses and techs. And, and you know, it's really interesting, you mentioned leadership, and I don't always have the greatest stories to tell. But what I find fascinating is, you know, you're talking about someone who was a doctor, right was a practicing doctor gave that up to supposedly go in and manage hospital. And I think a lot of these doctors who are switching to this kind of administrator role have initially really good intentions, and then they just, it's just not something that they really do a good job of. And to be honest with you probably until very recently, I was the one I always told my staff, I was taking the hit no matter what you know, so I was I had them in protective equipment, but I often would have my staff stand 10 feet away from the car when we go outside, right, because I didn't want them getting sick, I'd pre signed a prescription, I would then tell them exactly what to write, I'd look at it before they hand it to the patient that way. If I was dirty, quote, unquote, with COVID, I wasn't touching my staff. I wasn't touching anyone else. And I'd come into different areas, disrobe. And we finally had a medical assistant who, despite being vaccinated, got infected, actually, through her husband's so a completely separate way. And now she does a lot more of the testing in the same way I did just because we look at it like how can we keep our other staff the safest. And I think that is what these Doc's who turn administrators forget, is how do we keep the staff and this is every staff member safe, so they can serve the public,

Rebekah Bernard MD 12:59

I think that anyone that goes into healthcare administration, that's a physician or a clinician, they should at least continue doing that, at least a small part of their job, because I think it's very easy to lose touch with what it's like in the trenches. So I really feel like - I know that they're probably very busy but I think part of their job really should be to connect with the people on the front line, which clearly, they're losing connection. I want to go back to Dr. Mass's bravery, because she writes and she speaks out and she's amazing. And so in fact, she wrote an op ed and she had a response to her op ed about GPOs from Todd Ebert, a pharmacist and the President and CEO of the healthcare supply chain Association. And what's so interesting is, of course, they defend themselves, they claim that they save hospitals and the system $45 billion annually, that GPOs are voluntary, their critical partners, okay, they say all that. But before they say that, they have to try to slam Dr. Mass and make her out like she's a bad person, they say to her, which is what this is the MO, right, for all of these people. And they said, she has aligned herself with the anti GPO efforts of conspiracy theorists and fringe groups, such as the American Association of physicians and surgeons and physicians against drug shortages, which is really interesting that physicians against drug shortages, they're like a there's a very powerful lobbyist that fights against them that just like tries to find physicians that have even talked to them and write bad things about us on the internet. So I really want to applaud you, Dr. Mass for standing up to this kind of bullying than you did write a response on your website. Can you talk a little bit about what you said? You mentioned that really they're trying to defend very bad practices,

Marion Mass MD 14:47

The healthcare supply chain Association of America, it's pretty much the lobby group for the GPOs. So he gets paid to write those things. I don't get paid to write my things. And that's okay. I I'm perfectly happy not getting paid, however, is the Association for a powerful lobby group. I mean, I think someone should ask themselves like before he opens his yap in the newspaper, like, how much is he getting paid to open his yap. And that was the third time he had called me a conspiracy theorist in the press. I had written something in the PennLive, the Harrisburg newspaper, about GPOs, and PBMs. And I had written something in The Washington Times about it. And then this was in the paper where I'm on the editorial board, and I don't get paid for that either. But to be on the editorial board, but this Todd Ebert came at me three times and used much of the same diction each time. So it's almost that he's just sort of like recycling. I mean, I guess he's, he's busy tooling around DC doing whatever it is that lobbyists do. I don't consider myself a lobbyist. I consider myself an advocate. And so as he's tooling around, he's just copying and pasting and calling me a conspiracy theorist. And I guess my answer is is like, you know, well, Mr. Ebert, how much are you getting paid to do your job? How much am I getting paid to do mine? And honestly, I'd like to thank him, because if this very, I'm guessing he's fairly moneyed. I think I looked up the salary at one point, it was, it wasn't quite a million at the time when I looked it up, or what he was receiving. But, you know, I had seen him speak at a conference and he had very nice fancy Italian looking loafers, you know, the kind of things that, you know, I mean, I still shop at my thrift stores, you know who I am, I don't hide it, you can find that out about me. But that's all fine. I think to myself that I must have touched a nerve, because not only is he responding to something written in The Washington Times in the major Harrisburg newspaper, my Bucks County courier times as a county newspaper, it's a wonderful newspaper. I love my editorial board. I think my editors are fantastic. I honestly think I wish that they'd be New York Times level, because they're, they're that good. But he took the time from Washington, DC to write something back. I think I must have gotten to him.

Rebekah Bernard MD 16:57

You definitely hit a nerve. And you know, it's so interesting how the first thing they like to say is conspiracy theories. That's just the thing. They say that about me and Niran, they said that about Eric Starkman. It's just a kind of like the the quick - so I guess if anybody accuses you of conspiracy theories, then that's probably a good thing. That means you're probably getting something right and you're touching a nerve. Well, I want to get into some of your solutions. I'll post the link to the PPA website, where you posted a three-part blog on this. But let's talk about some of the points that you made. First of all, you said number one, we need to bomb the Safe Harbor. Talk about what that means?

Marion Mass MD 17:32

Sure. So the Safe Harbor is that statute that allows these kickbacks. I mean, honestly, America, how hard is this should to Section sections of our economy, two groups PBMs that control the you know, what goes on the formularies? And are pretty much having their way in like prescription drug benefits? And you know, driving up the price, should those pbms? And should these GPOs group purchasing organizations that are choosing all of the medications and solutions and the all of the stuff that goes into the hospitals, the oxygen tubing, the devices that are all there like that? Should should those two groups should those two entities have the right to legalize kickbacks? No one should have the right to legalized kickbacks. And please don't even tell me it's not a kickback because you don't need an exemption from the anti kickback statute if it's not a kickback.

Niran Al-Agba MD 18:29

I mean, this is just absurd. It's absolutely absurd. And you should say Marian, that it's all the other industries in America, all the other business sectors, this would be illegal, but because it's the pharmaceutical it is the drugs selling business, right? Essentially, it's drugs. That's the only business sector that is allowed to do this. But please keep going. I just want to be really clear.

Rebekah Bernard MD 18:51

I want to say - and Dr. Mass explains some of that in that article - she says that these GPOs, they spend a lot of money, and they work very hard to maintain this status. They throw big lavish parties with the big players in DC. They lobby like crazy. In fact, five out of the top 10 industries that lobby that spent money on lobbying had to do with healthcare and GPOs are a big part of that. They network very carefully. They have been associated with quite a few politicians. So it's going to be tough to actually put a stop to some of this, wouldn't you say?

Marion Mass MD 19:25

Absolutely, because it's working for all of those people, isn't it? So if you think about it, and I'll give another example like Dr. Al-Agba, you brought up it has to do with drugs. And you're right, it has to do with drugs, but it has to do with those masks and those gowns. And like I think it's even even more insidious. Like because if you look at even before COVID started it I mean, you could go back and you can find this article. There is a distributor, it's called Cardinal. The GPOs and the PBMs - they don't even get their hands dirty shuttling things back and forth. They're not they're actually not a warehouse. They have distributors to handle the shuttling. And you know, the distributors are all in the top 15 of the Fortune 500 companies, McKesson, Cardinal Amerisource Bergen. Those are the three big distributors. Seems to me they have some kind of special relationship with both the GPOs and the pbms. But who knows? Because all these things happen behind closed doors. How do I hate no transparency! I hate it, let me tell you. But in any case, January 2020, right before COVID hit, Cardinal, one of these big distributors announced that they recalled 8 million surgical gowns. Because, you know, Cardinal, it almost appears to me that they owned the plant in China where the gowns were being made. And then there was a problem with these gowns that were being made in China, because they were contaminated. They had pathogens in them, and they could have dirty the, you know, patient room. And we all know that unsterile things, when you're operating on someone is a bad idea. This is where we were getting most of our gowns, we started out down on gowns, because we were getting most of our gowns from China, we were getting most of our masks from China, we all realize this during the pandemic, we were getting, you know, the other things that we needed for protecting ourselves against COVID. They were coming from another country. How is this happening? I mean, it seems as though there's all these cronies together, that are controlling the supply chain. And they're the ones that are seemingly owning companies in a foreign country. It's against everyone's interest, isn't it, especially if it's crappy products that you're shoving into bottles.

Rebekah Bernard MD 21:29

And that's your second point where you have solutions. The second point is bring back 'made in the USA.' And you point out that we really need to bring back the manufacturing of medical supplies back to our country. And there is a house bill that's been put out, and it has a companion bill in the Senate as well to try to incentivize more made in the USA, because this You're right, this is a problem. We were completely dependent on Chinese masks. And then we didn't know if what we were getting was legitimate or not. And I mean, it definitely came home with the COVID-19

Marion Mass MD 22:01

I want to make sure that we're doing the right bill, because there was a bill that came out of the house last year in April, I forget the number. And then they just reintroduced it, but it was a terrible build. We do need a good solid bill. But there was a bad one that was essentially just creating a bureaucracy that was going to make sure that it was all being done the right way. And 10 congressmen were going to help us decide, but it's sort of like, Listen, Congressman, you haven't been listening the whole time. And we've been telling you the supply chain is broken, you are the last people that we should want to hear from on this.

Rebekah Bernard MD 22:32

On that note of politics and bills and trying to solve problems. Dr. Mass, you've become a person that is getting somewhat connected in the political spheres. And it's so great, because it's very hard for physicians to get into that world to get our voices heard. And like you just pointed out, you can have bills that are somewhat well intentioned, but actually have no teeth or do absolutely nothing or bills that actually do something bad because they're, you know, either about intended or because somebody just gets in there and changes the wording and create totally changes the meaning of the bill. So talk about your journey into the world of politics and maybe what other physicians can do to try to help influence health policy.

Marion Mass MD 23:15

Well, for anyone wanting to listen to a woman who's crazy enough to do a video podcast in a bathrobe. So let's, let's listen. Right? So I think first of all get to know your lawmakers state level and federal level. And I don't care what your letters are behind your name, what party you're registered with. I don't care what their letters are. I mean, I talked to politicians across the aisle. And I think we all should, I think most Americans are tired of the partisanship. So we've got to get over that. And like, I think if there was one rule that I would say, when you're talking, you are never wrong when you're speaking for the patient. If you are speaking for the patient, you are never wrong. You're not there to speak for that politician make that politician look good. You are there to tell that politician This is how my patients are suffering. And in some cases, this is how our profession is suffering. And when our profession suffers, our patients suffer. I try I don't always succeed to treat people fairly. So you know, they may decide that they're going to put out bill x and maybe they got some advice from someone else. But just because I plaster you in the press for a dumb bill doesn't mean that I dislike you don't need it's like the Godfather. It's not personal case. It's business, right? Don't make it personal. If you've put out a bad bill and you've done something wrong and you're going to take a shellacking then you'll take it doctor a large budget A few years ago, you wrote a wonderful piece. There was a direct primary care bill, I think there was something about a tapeworm that you had written about and it was it was just so well done.

Niran Al-Agba MD 24:46

It was called slapping slapping lipstick on a tapeworm. Thank you - the government was trying to do this pilot program for direct primary care and, you know, direct primary care practitioners are like Dr. Bernard over here who, you know, have their own small business. And you know, they take money directly from the patient and provide care to the patient. And so it was the government's way of scaling up to put these DPC years essentially out of business or control them. And what's interesting is a couple of anonymous physicians who were pulled into the political, you know, wrangling sent me the information. And it's so interesting to me that I was told later by someone in the DPC group that my article actually almost derailed the entire thing, because the CMS was so upset that someone had figured out what was going on and kind of disrupted it, and released it. And then a lot of the clinicians were really up in arms about this. And I think that's what we have to do. I mean, thank you for remembering that. I mean, I think it's hard. It's hard to disrupt as you are finding out doctor mess with the GPOs. And PBMs, it's a little bit like the mafia.

Rebekah Bernard MD 25:53

It kind of is, in general, just just like what you experienced, you're trying to shed light on an important situation. And then, because maybe people didn't fully understand all of the issues or because they were going to be negatively impacted. They almost like attacked you. And unfortunately, we are all sort of seeing that whenever we're trying to speak truth. First thing we're getting is attack. So I guess we're gonna have to just see that as a badge of honor, because we can't just stop talking about these issues, because they're important.

Niran Al-Agba MD 26:23

Well, and Dr. Mass's point is well taken that patient's right patients first, I keep saying this, every podcast that you know, I've given up on politicians, I've given up on the physicians, even in the C suite leaders and everybody else, and I'm going with patients. And I think if you start with patients there, you you can get to good politicians and good doctors and good hospitals. But you got to start with patients and what patients need. And Dr. Mass always remembers that.

Rebekah Bernard MD 26:49

Patients, we have to get them galvanized to speak out to, you know. Seaking of - I know you've given up on politicians, but Dr. Mass has not, thank goodness, because we need somebody in there fighting for us. I want to ask you, what are your thoughts on the possibility of us regaining physician owned hospitals? Again, this was banned some years ago, when the Affordable Care Act was enacted. And a lot of us think that that's a terrible thing, because physicians probably should own hospitals. Any thoughts on how we could try to get that going again?

Marion Mass MD 27:19

Sure. So actually, I love it that you brought up a singular issue, like how we could make this better. And, you know, so first of all, let's like frame it. Why should patients care? Well, because overall, if you as a physician own hospital, the patients are getting better care at a better cost. They should care about that, you know, so it's not as though physicians are saying, whoo-ha-ha, here I am, I'm gonna own the hospital and rake you all over the coals. It's just not happening that way. So first of all, define it in terms of the patient and why they should care. And secondly, what we all do, you know, the three of us, we are all, we've all been speakers, we have all been writers, you guys have written a book, I haven't gotten that. You don't necessarily have to write a book, you can write op eds, in terms of educating. And then you can start gathering supportive voices around you, I think it's very helpful to go to patient advocacy organizations and physician advocacy organizations. So PPA is part of the Free2Care Coalition. We're now 8 million citizens, 70,000 physicians, bringing back physician owned hospitals is something that we put in our initial position paper from 2019. I'm actually in process of helping to re put together the next iteration of that paper, it's a lot of work, but it's okay, it's gonna be great, a lot of great authors on it. So writing about it, and then bringing it to the attention and then using coalition members to talk about it. But then past there, it has to be I think, like a concerted effort, and we have to use everything at our disposal. So way back when when I said, I think that we all need to be connected to our state level lawmakers and our national level lawmakers. Everyone should be making that connection. I mean, we should really have a databank of physicians across the whole country and who's connected to what lawmakers so that if an article were written, those physicians could tweet it, send it to the Chief of Staff, have those people tagged the people in their tweets, share it with their communities, so that the communities were getting riled up and we understand, hey, community, this is why you need this position, owned hospital and then understand as well, there's going to be people that are like, you guys are just amazing, you know, same thing. You wrote a book, and you've written articles, you've gone out and you've spoken, not everyone's ready to do that. That's okay. But plenty of people can share. Plenty of people can have a singular conversation with their lawmaker. It does take some time. I mean, but none of us should be afraid of this. I mean, all those lawmakers. They're supposed to be us, right? I mean, this is we the people our country was made as a republic. We're supposed to be telling them what to do. We've forgotten that they work for us. So how could we get it done? Well, look for a bill. I know that in the last Congress, it was Dr. Michael Burgess, and then Sanjay Gonzales. So it was an R and a D. They're both lawmakers from Texas that brought up the physician on hospital bill. I mean, what's the big deal? Like, you know, someone should contact them, get them to bring it up again? and ask them, could you do this and like, make a plan, and let's get behind them.

Rebekah Bernard MD 30:14

That sounds like a really good place for us to start. And I really appreciate you speaking to the fact that we all have a voice. And we all just need to speak together about the same issues. And we have a lot of power. And one of the things that both of you did was create an organization to help physicians have that voice. And that's the practicing physicians of America. Can you guys tell me how you founded that and tell us about the organization?

Marion Mass MD 30:38

Niran, my throat hurts you talk

Niran Al-Agba MD 30:40

I was going to say, I mean, it'd be silly for me to talk, although because I was recruited by Dr. Mass, we were in Washington, DC. And she said, you know, look, we've got Wes and Judy, and we essentially sat down and had coffee and talked about something I think every physician in America absolutely despises or prefers to not have to be involved in, which is the maintenance of certification, which involves us having to retake tests every 10 years. And it pulls us from our patients. If you don't pass that test, which can be very stressful. The test itself is stressful. And if you're a new mom, and there's no palms, you can't, it's this terrible experience. And mine was one of the horrific ones as well. And so I think we all get really angry about that. And so we kind of sat down and started talking about how do we bring back autonomy to physicians, so that they can bring better care, more affordable care and more autonomous care to patients, right. So you have to be a physician in your right mind and functional insane, in order to then be able to help patients. And if we're burnt out or distracted, doing all these silly things that aren't necessary, then we can't serve patients properly. And so I think, essentially, that's why it was started. But I should, I should let one of the founders Dr. Mass is actually one of the founders.

Marion Mass MD 31:53

So, you know, kind of funny story, I actually stalked Westby Fisher of Chicago, he's a interventional cardiologist and EP cardiologist, and I recognized his work on maintenance of certification. And I knew that mark wouldn't be my big issue and my big topic, but I recognized, you know, it's one of those obstructions for us, right, something that other people are making us do. Other people are making money off of it. And by the way, it's a GPO premiere, and one of the GPOs is collecting the mock data, you know, so they're all in on it, too. But, Wes, he's just a master at dissecting conflicts of interest and his writing and his blogging. It's it's very thick stuff. It is like a lot to read through. But he's, he's brilliant. And I went to another friend that I knew knew Wes. And I said, Look, I've looked, I've watched, I've followed like other groups, and it seems to me, physicians are just silly enough that they form organizations that are partisan organizations, like we want to repeal Obamacare, or we want to hold on to Obamacare, you know, like, these have been like, over the past 10 years, some of the big, you know, forces and the new grassroots groups, but it's not helpful when you're partisan. The public doesn't like it. And if you're busy being partisan, then you're either holding up or bashing down. And you're gonna get to the same spot where all of the all the moneyed conflicts of interest when So instead, I you know, I got in touch with Wes. And I said to him, Look, I want to, for us to be able to remove the obstructions that are preventing us to practices as we were trained, and we talked to some others. We talked to Niran, we talked to Judy Thompson, a breast surgeon from Texas, and then we pulled up Brian Jamaal Dixon, a child psychiatrist from Texas into our happy little band. So we are we cross the aisle, we cross specialties, we crossed the country, and we just don't get it. Like, you know, when people say that physicians, it's like herding cats to bring them together. Well, we all agree, we have a lot of differences, but we're trying to find the commonalities. And, you know, that's really how PPA formed.

Rebekah Bernard MD 33:56

I really love that. And I dropped MOC myself a couple years ago, I donated to the lawsuit for with PPA and Dr. Wes - that's how I know him from his blog. In fact, I would love to invite him on to the show. So Marion I may have to ask you to see if you can pull some strings because I'm a big fan of him. I'd love to get into that issue. That would be awesome. Well, I want to thank both of you so much for joining us. I wish we had a little bit more time we'll have to do it again soon. If you'd like to learn more about these issues, we encourage you to get our book. It's called 'patients at risk the rise of the nurse practitioner and physician assistant in health care.' It's available at Amazon and Barnes and We will give you the information for practicing physicians of America in the show notes and of course, we would encourage you to join physicians for patient protection. Our website is physicians for patient Thank you so much and we'll see you on the next podcast.

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