This. 1000x this.
@DrDiGiorgio
My colleague @molsjames - who has a spotless record - has been trying for over a year to get a Texas medical license.
Meanwhile, Texas Medical Board is recruiting doctors from other countries to apply for licensure.
The response to Jesse Singal’s NYT oped about the unreliability of US medical organizations regarding pediatric gender medicine is best characterized as a 24-hour tantrum, one with violent overtones.
Let me tell you what happened before I got to the OR this week.
My patient needed surgery. I recommended it. My training, my board certification, and my years of clinical experience all pointed to one answer. The insurance company had a different one: not yet.
That’s prior authorization and it is breaking American medicine.
Here’s the number that should stop you cold: in a prospective multicenter study of orthopedic subspecialty practices across 6 states, 98.5% of prior authorization requests were ultimately approved when recommended by a fellowship-trained, board-certified orthopedic surgeon.
98.5%.
The system isn’t catching bad medicine. It is a delay machine that consumes enormous resources, causes real patient harm, and exists primarily to make the economics of denial work in the insurer’s favor.
The 2024 AMA survey of 1,000 physicians put numbers to what every physician already knows:
- 39 prior authorizations per physician per week averaging 13 hours of physician and staff time
- 93% of physicians say PA delays patient care
- 82% say patients commonly abandon their recommended treatment because of PA
- 29% report PA caused a serious adverse event — hospitalization, permanent damage, or death
- 61% are concerned insurers are now using AI to systematically increase denial rates, with some tools producing denials up to 16 times higher
This is not utilization management. This is obstruction at scale. Surgery is precision and focused on minimizing collateral damage. Prior authorization is brute force with disregard for the collateral damage.
In my world, delay has a clinical cost. A patient waiting on PA for fracture repair, joint replacement, or spinal stabilization is losing function and sometimes losing the window for the best possible outcome. That cost never shows up on an insurer’s earnings call. Given that the average patient is on an insurer’s books go 3 years, delays can sometimes mean making someone else pay the bill for the necessary treatments.
The consensus statement insurers signed in 2018, promising PA reform? Seven years later, only 16% of physicians working with UnitedHealthcare say anything has actually changed. They made another promise to Secretary Kennedy and Administrator Oz recently but is there any real change coming?
Voluntary reform has failed. Legislative and regulatory action is the only path forward and physicians need to be loud enough for long enough that lawmakers act.
It is deeply problematic that federal funding flows to institutions that disproportionately hire H-1B visa workers over American workers.
@TheJusticeDept will continue to root out this problem and protect the employment @CivilRights of Americans!
Apparently Too much competition is bad!
6 is the magic number. (Take a listen)
I am still waiting to hear a single thing from Zeke that would actually work to reduce healthcare costs.
Great idea from Jermaine on a simple fix to healthcare : instead of giving money to private insurance companies, just give it to the government.
That will go great. lol.
Listening to Zeke Emmanuel - Using AI to reduce billing admin will not mean hospitals will pass savings to patients - they will just take those $$ and hire other useless compliance admins.
The whole idea that IMG/FMG have this magic love in their hearts for the rural poor is somewhat laughable. Given the choice, they will live and work right where most others want to be…and it’s not a rural setting.
Boomer Esiason was an NFL quarterback that played 14 seasons.
Seems far from mediocre.
Similar experience 4 years ago. Father in law died alone of Covid . They only let us in to see him after he died .
Th FDA is absolutely correct, and confirms what I’ve said all along. This $IBRX @DrPatrick “lymphopenia” push means nothing until or unless they come up with real data showing patient benefit. The “number” doesn’t matter.
Curious if John Oliver will do a profile of bluesky — because that’s the good version of @x , right ?
The hurdle to becoming a U.S. medical graduate especially if you’re white / Asian / male are significant even if you have the academic ability to make it.
Affirmative action may have been outlawed, but the medical schools and competitive residencies are controlled by a cabal that still very much practices it.
Add to that 400-500k worth of total debt.
Creating an easy pathway for IMGs to hit the U.S. market is a middle finger to US citizens who are perfectly capable of filling the need.
The obvious solution here is to create an accelerated low cost pathway for gifted high school students to practice medicine, and simultaneously work to fix the practice of medicine that is under assault from a number of entities seeking to commoditize physician (provider) labor and keep labor costs low.
IMGs that are coming here with an interest in serving the rural poor in the US for some reason reject serving the rural poor in their own countries who would surely greatly benefit from their skills.
Dr. Makary will end up being the best @US_FDA commissioner in US history! He is pushing very hard to revolutionize the drug approval process. Especially in the age of AI, this is absolutely critical. We are very lucky to have him lead an institution that impacts millions of lives
A Brazilian guy trying to fit in during his Arab company interview 😂
FDA's pediatric priority voucher program has been a huge success.
X timestamps must be malfunctioning. This tweet must be from 2011.
Even in the relatively short follow up in studies of low/zero calcium scores there are still lots of cardiac events..
I’ll say provocatively that the decline in usefulness of guidelines over time has a lot to do with the rise of the professional subspecialty societies.
As an example - Nuclear medicine society guidelines and Society of Cardiac CT guidelines are going to come to very different interpretations of the same data.
Great piece.
340B should be reformed as a capped safety net grant.
https://www.healthaffairs.org/do/10.1377/forefront.20251029.834131/
Well-written counterpoint to CAC CT in risk prediction/preventive cardiology, worth a read by my #YesCCT enthusiasts and skeptics alike (@khurramn1, @RonBlankstein). Importantly, I don’t see the CAC Consortium or SCAPIS data mentioned. Thoughts from the imaging community?
the truly ironic part of this is that the basis of the roe v wade decision was essentially "dr patient confidentiality."
watching those who championed it now oppose doctors being able to speak freely with patients and treat them as they deem fit just proves, yet again:
none of this is about principle. it's all about power and getting what they want, not what others want.
x.com/i/article/202627341411…
x.com/i/article/202627135225…
Follow along as Dr Bruggerman exposes the many reasons US physicians have less time with their patients than ever, and ends the week with solutions!
Foxes auditing henhouses-classic healthcare edition. 🦊 Who’s holding them accountable?
This post is spot on.
The reproducibility crisis is a signal that science needs a cultural reset.
Status is conferred to scientists by the scientific community based on their willingness to collaborate with other scientists in pursuit of the important truths.
Now it is confrrred based on ability to signal alignment with favored political agendas, or on arbitrary metrics of influence, funding levels, and the volume of output regardless of its importance, reproducibility, or quality.
“I want to live” - Canadian Patient
Canadian Doctor Prescribes Euthanasia For Sore Knee
👍👍This sounds very familiar…
@DutchRojas @DrDiGiorgio @anish_koka
It is because of the gold standard research conducted at NIH that children with rare diseases are provided the opportunity of lifesaving therapies and treatments.
We are proud of our friends at @US_FDA launching a framework for accelerating the development of individualized therapies for ultra rare diseases.
Read more about FDA’s plan to accelerate cures here ➡️ https://www.hhs.gov/press-room/fda-launches-framework-accelerating-development-individualized-therapies-ultra-rare-diseases.html @HHSGov
Greedy health systems abuse American doctors ➡️ American doctors leave➡️health systems cry “doctor shortage” ➡️push new laws to allow FMGs to fill jobs too abusive for American doctors
💯
Easy litmus test for anyone in public health is if they support 👇🏽