Introduction and Episode Overview
[00:00:00] Stacey Richter: Episode 495. "Wait … Flip That—A Crazy Revelation I Had About Trying to Fix US Healthcare." Today I speak with Dr. Mick Connors.
Revelation About US Healthcare Costs
[00:00:27] Stacey Richter: Relentless Health Value Tribe in this conversation that follows with Dr. Mick Connors, I had a barnstormer of a revelation. One I have never heard anyone talk about before, like ever. It's a major fundamental bottom line though about the US healthcare system. An insight that once you see it, you kind of can't unsee it.
And don't get me wrong. Why this revelation is true. Why it is, in fact, the case will shock no one. But yeah, we'll get to that after I drag out the suspense just a little bit longer.
Okay. So we, the Relentless Health Value tribe are committed to fixing healthcare and putting patients over profits. We want to find a way forward to manage a $4.9 trillion sector, such that we raise the value of services delivered. Meaning reduce, or at least hold costs static while the outcomes or the health gains, or whatever you wanna call what the patient gets from the spend is realized. The typical formula is outcomes divided by cost equals value.
Measuring Costs and Outcomes in Healthcare
[00:01:27] Stacey Richter: Okay, so let's think about how we measure cost or what we know about cost. And then let's think about how we measure outcomes or what we know about outcomes. And I'm picturing Willy Wonka right now, the Gene Wilder version when he says, "So much time, so little to see. Oh, wait a minute. Strike that. Reverse it". Meme in the show notes.
Challenges in Cost Accounting
[00:01:48] Stacey Richter: Here's the deal. In American Healthcare, we currently measure costs at a macro aggregate level. Most of the time no one knows what it costs to deliver any given individual service. There is no or little effort at unit cost accounting.
Dr. Steve Schutzer talked about this in an episode a few years ago.
So that's half of this revelation and undeniably a problem, one of which many of you are probably fully aware of already, but just right. Like, if you are running any other business and you encounter like any of the sharks from Shark Tank and you cannot tell them the unit cost accounting. Like, you don't know what your cost of goods are? The financial discipline buzzer is gonna be going off like a fire alarm?
But again, I could probably fit around my kitchen table, and I'm exaggerating for dramatic effect of course, but I might not be far off like I could fit around my kitchen table. The number of folks who probably could tell me with any degree of fidelity what the costs of service and cost of goods are for spine surgery or pick any other procedure.
But if we can't, we essentially have no financial discipline on the cost side because if it's unclear what the unit cost of anything is, that is a requirement for fiscal discipline. So therefore you can't have it if you don't have one of the biggest rate criticals.
Quality and Patient Outcomes
[00:03:05] Stacey Richter: Alright, so now let's flip over to the quality side. We track quality and sometimes we even use the term patient outcomes in this context, but we track it to the 10th of a percentage point using extremely, specific narrow, for example, HEDIS measures like A1C or BP control. But on this side of the house, what do patients actually want?
They want whole person health. They want better community health, better population health. But at these roll-ups, whole person health, better community health, better population health, these things are measured by very few, at least with teeth. Dr. Kenny Cole talked about this actually in the episode with him.
Health gains arise when all of the risk factors are reduced in tandem. Not just one of them. And along those lines, if you listen to patients complain about the health system, once they move on from the cost of their latest doctor visit, you will next hear a long story about how some catastrophe is afoot because their cardiologist won't talk to the ortho guy who said he can't do the procedure until the blood thinners are whatever, and then they can't get the Rx for their inhaler.
That is not whole person care. And it's gonna be a problem on the quick for the patient, for their family, for the community. You see the misalignment. We measure costs in the aggregate, but we measure “outcomes at the service level
The Value Equation in Healthcare
[00:04:21] Stacey Richter: So here's the revelation. We've gotta flip it like Willy Wonka style. We need to measure costs at the unit level. We need to measure health and outcomes at the whole person, whole community, whole population level.
It is fundamentally problematic to talk about our financial woes at the hands of the healthcare sector when prices are rising every year, if no one knows how much the service costs to produce, and it's disingenuous, frankly, to talk about amazing HEDIS scores when a community is dying young.
To say no margin, no mission, with the integrity, really that that statement demands, we gotta be doing cost accounting at the unit level and measuring outcomes at the patient and community level.
And that is how this whole conversation with Dr. Mick Connors started out, by the way, as a continuation of the No Margin, No Mission series. But yeah, it went off the rails in like T minus five minutes and became how do we create value in healthcare versus margin that gets siphoned off the top.
Interview with Dr. Mick Connors
[00:05:19] Stacey Richter: Today my guest is, Dr. Mick Connors, who is by training an ER, emergency room pediatrician. His passion has always been how to get all kids better care. Besides working in emergency rooms, Dr. Connors also worked at for-profit institutions and started a telemedicine company. So he has lots of angles to look at all of this through. I love this conversation.
My name is Stacey Richter, and this episode is sponsored by Payerset and Aventria Health Group.
Dr. Mick Connors, welcome to Relentless Health Value.
[00:06:18] Dr. Mick Connors: Oh, thanks so much. It's really an honor and a pleasure to be here. I really love your work, and your podcast. Been following you for a long time, so it's a real pleasure to be here.
Defining Margin and Revenue in Healthcare
[00:06:27] Stacey Richter: Let's start here. As we're thinking about margin, if you had to define margin, how would you define it?
[00:06:36] Dr. Mick Connors: Yeah, I think I would define it the same as most everybody else. I mean, it's what's left over after you delivered the services that you want to deliver, right? So is there a way to make something sustainable, profitable, wildly profitable?
And we in medicine don't talk a lot about margin, even on the physician side. When you're leading physicians, it's about downstream revenue, how many RVUs you can produce. It's about revenue. We don't do a great job of talking about costs. The difference between the revenue and the cost is the margin. And, it's an important concept that most of us physicians don't really get.
For example, when I was in hospital administration, the orthopedic surgeons were so excited about the downstream revenue they were creating from a spinal surgery until we figured out that the rods that they were using in the spinal surgery were costing more than the actual reimbursement payment that we were getting.
So it was, though it was high downstream revenue, there wasn't any margin. There was actually no margin. It was actually unprofitable. And so there's that oftentimes that disconnect for us, especially medical folks of thinking about, you know, we've kind of been addicted to RVUs as value and revenue as value. When in reality you have to have something left over that's called a margin to make anything sustainable.
[00:07:55] Stacey Richter: It's interesting how you are teeing this up. Many times I think especially when we rattle off no margin, no mission, what we're thinking about as margin is all of the money coming in, which to your point, isn't margin by your definition, it's revenue. And because as has been said any number of times on this podcast, there's a whole show with Dr. Steve Schutzer about this.
Very few healthcare organizations, clinical organizations are even able to calculate the cost of any given... so you guys figuring out that the rods cost a lot, like anyone who's been in the private sector for more than two minutes is like, what? But it is, it's really unusual for any clinical organization to actually figure out what is the cost of delivering any given care service.
[00:08:48] Dr. Mick Connors: That's always the challenge that we have. Is one, what is the margin? To your point, one cost accounting is not part of healthcare, right? Nobody wants to do cost accounting. There's a great Harvard Business Review article from I think in the 2010s talking about cost accounting. I mean, we've been talking about cost accounting, but nobody wants to do cost accounting.
Everybody wants to drive RVU, drive revenues, move to healthier, wealthier environments, drive more revenue, and then kind of reduce cost that way.
[00:09:17] Stacey Richter: What you're saying makes me think of, some health systems spend every dollar they're given.
That's a quote from the episode with Shane Cerone and Dr. Sam Flanders, episode 490, I believe, which puts a little bit of a spin on the term nonprofit for sure.
Throw into this on the seller side of the equation, because as we both just said twice already, it's an edge case to find somebody who knows what the unit costs is.
But wait, there's more. How many purchasers buy discounts? So not only does anyone not know what the cost accounting for any given unit service is, no one actually knows what the price is either.
All I know is that someone chucked 90% into the Tilt-A-Whirl and said it was the discount. Right? So anyone who's buying discounts does not know the price that they're paying. It's very common also actually on the seller side to not know what that price is either.
So like we've got, no one knows what the bottom line is, the cost of anything is, and it's odd to know what the top line is for any given service. So you can kind of see like how all of this would go horribly wrong, because what winds up happening is the only financial move then is to try to get as much revenue as possible like in the aggregate, which is exactly what's happening.
[00:10:34] Dr. Mick Connors: If you go to the foundational level, like healthcare is very complex. To your point, there's so much opaqueness, there's so much, you know, whether people don't know the total cost of care or whether they don't want to admit the total cost of care. At the end of the year, there is a spend and there is a cost, and we see the spend just go up and up and up, and people then say, well, it costs too much to provide care and yet all these people are taking margins out of it.
[[00:11:04] Stacey Richter: Yeah, there is an infographic by Andrew Tsang showing 27 streams of income in between plan, sponsor pays, and doctor gets paid. So yeah, maybe no one wants to know what the unit cost is of any given service because then it would be possible to see how much of the 4.9 trillion is leaking out around the edges into things that sometimes, not always, but sometimes have nothing to do with patient care. Nothing to do with mission, nothing to do with outcomes.
There is a reason why knowing unit costs is such a very basic, fundamental rate, critical of even the most basic fiscal discipline approach because it's a really powerful thing to know.]]
[00:11:44] Dr. Mick Connors: Yeah. And I think Stacey, to kind of the first point is, is the margin the goal, right?
So when we say no margin, no mission, we begin to focus on the margin. So to your point, what we typically do in healthcare is we try to generate more and more revenue. We work harder, we work faster, we streamline, we make things more efficient because we want more revenue.
So if we're just focused on margin and the not the unit cost, then it's pretty easy to create, to monetize, a sore throat, a runny nose, a kid with a fever, you know, a kid with a broken arm. We simply just, we don't do an outpatient x-ray anymore. We don't splint them in the office. We send them to the ER. The chronic kid that has asthma, it shows up. They're outta their inhaler, they're in the ER. We don't necessarily lower cost.
But as in the title of your podcast, it's about value. And what is value is margin and mission aren't in the value equation, right? The value equation is outcomes over cost. So how do we switch our focus to how do we improve outcomes and or lower cost?
And if we're just in the margin mission game, you know, I worked at private equity, if we can roll up as many things that we can make them more efficient and we create more margin, are we offering value?
So that's where the pivot becomes, okay, the value equation is outcomes over cost, or are we improving outcomes and/or lowering costs, or are we just making more margin?
[00:13:07] Stacey Richter: Yeah. And again, it goes back to this cost accounting thing because how are you gonna lower costs if you don't actually know what the costs are? So there is, I just wanna point out and underline that there's a very fundamental flaw in the pursuit of value. If value is outcomes divided by cost. If no one's keeping track of actually what from a cost accounting on an individual unit basis, those costs are.
Because if all we're doing is doing that math at the corporate system level, systemic level, and if the go-to is then just raise your prices. And that's where the, you know, margin is coming from, then the value equation turns into a how are we gonna raise our prices next year? Equation.
[00:13:49] Dr. Mick Connors: If we're consolidating hospitals, if we're consolidating primary care and we're creating great margins by streamlining efficiency, but we take all that money out of the system without reinvesting in the patient populations that we're trying to serve, and the physicians and nurses, etc, to make care better. Then, you know, those are really two options.
[00:14:09] Stacey Richter: We can be thinking about the margin leftover after costs are paid and throw it into two categories. Relative to thinking about what are we gonna do with this money? One is this investor mindset.
Private Equity and Healthcare
[00:14:21] Dr. Mick Connors: Yeah, I mean, I think my experience with pediatric private equity, there's a big movement in pediatrics for private equity to come in and buy up primary care.
And I think the challenge that I, you know, the mission that I was sold on was, Hey, we've got a high Medicaid population. We want to improve outcomes and lower costs and want to figure out a way to make margin there so that we can get more kids on Medicaid, better care.
But in reality, the way that it was set up, when you're thinking only about the margin is, man, how do we buy up as many practices as we can? So we can streamline efficiencies, we can do offshore call centers, we can create margin by lessening kind of the expertise and the care and the access, drive revenues so that we can, 'cause our goal is 30% margins and so that our investors are happy not only now, but in seven years when we sell to the next bigger fish.
And the challenge is, I mean, pediatrics is generally low margin. We are generally poor business people. Why? Because we're more focused on the mission, right? We're trying to be sustainable as a primary care practice. Sure, we do a lot of dumb things from the business perspective because we're investing in doing non RVU, producing things for our patients.
But again, if your target is, Hey, I really wanna grow my salary, I'm gonna hire more nurse practitioners, I'm gonna pay my physicians less, I'm gonna work them harder. You know, you don't have to be the evil private equity. You can be a pediatrician or a CEO or the like. Right.
[[00:15:55] Stacey Richter: Listen to the shows [EP404, EP466, EP482] with Dr. Suhas Gondi and Vivian Ho PhD and Preston Alexander. About how health system CEOs are often incented and spoiler alert, it mostly has to do with growth ie, higher revenues and more beds. Very much an investor mindset, just pointing out that private equity does not have the market cornered on an investor mindset.]]
Just to underline a couple of things you were talking about there, and there was a show with Yashaswini Singh about private equity and how private equity tends to make money in healthcare, which definitely aligns with some of the things that you're saying. You, you try to buy up as many practices as you can for all the reasons that you said. There's efficiencies that could be realized.
But also, you create market power so you can raise prices, but then also you can diminish service offerings. It's interesting that when you were describing things that doctors do, you described it as we do dumb stuff, and I just wanna highlight that because if you're only thinking about this from an investor mindset, then it could certainly be considered a dumb thing.
Because it's mission focused, especially if you've got people who are very good at calculating ROI with spreadsheets and mission is harder to calculate. Outcomes are harder to calculate.
[00:17:16] Dr. Mick Connors: Yeah, I think absolutely. And I think there's a lot of outcomes that rely on, we'll call it the dumb stuff, right? Like it's the non RVU producing care.
It's the after hours phone call that I pick up. It's the text to the parent the next day, Hey, how's your kiddo doing? It's the relationship with the local community that is underserved, that has someone there to care for them, but chose to work in a place where the, if you were a businessman, you would run away.
Let's face it, whether we're a physician, a hospital of private equity, we all can makes really strong business decisions that are really undermining the value proposition for most of the patients. And that's the struggle that I've always seen, and I've seen the evolution in the fee for service over the last 30 years, how things have changed, where the pediatricians are cranking through 15 minute visits and they don't have time to care for their patient or to do the extra things.
Mission vs Margin in Healthcare
[00:18:09] Dr. Mick Connors: I've heard pediatricians say if I can't bill for it, I don't do it, which is a really scary thing for pediatrics primary care in general, because if we're focused only on the RVU generation and we know the CPT codes better than we know our families, then you start to run into that, “Hey, I got great margin, or I have some margin because I need to sustain myself. But I've really kind of lost mission and then I'm burned out and then I've not seen the impact of the care I'm delivering. I send all the sick kids to the hospital. We turn a strep throat from 200 bucks in the office to 2000 bucks in the ER.”
There's ways to create margin that are just not mission driven. And that's what I've seen at kind of the evolution over my 30 years is it's more handoffs, more fragmented, less continuity, and it's great for heads and beds in the ER and ER volumes.
And to your point, there's a great classic article that is called, "The folly of incentivizing A and expecting B". We're incentivizing margins, we're incentivizing, hey grow margins. But then we, on the flip side, we whine about burnout and lesser income being replaced. We talk about high cost of care. Families, like being a patient, like good luck, right?
I mean, it's uh, when I've been on the patient side, it's amazing to think this is what care looks like from the patient side of the of the thing.
[00:19:31] Stacey Richter: What's being highlighted to me in this conversation is a doctor wrote in a comment he wrote, “Physicians can't save the system with empathy alone.” That is so true here because if the only mission that winds up slipping through the cracks, and I'm exaggerating for purposes of clarity, but really if, the only way mission really truly happens is because a doctor has enough empathy to ignore the financial incentives and the structure of their organization and their own personal compensation, and I've heard of people getting yelled at for helping patients. You're are wasting time doing dumb stuff as, as, as you put it.
[00:20:12] Dr. Mick Connors: The way the system is set up, I'm incentivized to see more patients and do the things that are targeted towards selecting out a healthier population. I'll just be honest. That's why it's so easy in this world of anti-vax and everything else to create mistrust. Like you guys are fee for service like you're on commission.
No, that's never been the mindset of any pediatrician I know. But it's an easy way to corrupt kind of the system in that everything has gotta be a margin because that's how folks get paid and what we really need is outcomes-based care. Because it's really the value proposition, as we've seen with private equity and pediatrics, can easily be gamified with HEDIS metrics and immunizations rate, pay for performance, diluting care, doing more visits.
If I want to grow, if I wanna make the most money I'll pick on pediatrics as a pediatric primary care doc, I'm gonna get the healthiest population. I'm gonna see them very quickly. I'm gonna refer anybody who's sick to specialists in the hospital. I am gonna fill my office with well visits. Sick visits I'm gonna refer to Urgent Care, the ER, because they're gonna slow me down if I can't fit them in quickly or if they don't fit into my schedule. I'm not gonna be focused on anything that's complex or chronic. I'm gonna have a harder time with things that need continual care because I really just need to get my CPT codes. I need to do my well care. But also, gosh, if my patient population is a 50% vaccination rate and I move it to 55%, I don't get any bonus.
But the practice that's at 85% this year and 85% next year gets a bonus. Chronic complex disease, complex disease. The fundamentals are just completely ignored in the current environment where it's just revenue, like this makes no logical sense.
My hope, even though I can't get anybody to do this, is to say in primary care, okay, you have 1500 patients attributed to your primary care office. This is what they spent this year. Right. This is the total cost of care for your patient population. What if we reduce that spend by 1%, 2% next year. And how are we gonna reduce that spend?
We're not gonna reduce the spend by referring more kids to the ER, admitting more asthma patients, not, you know, taking care of obesity, right? We're gonna have to look at the outcomes of our patients, and we're not gonna focus on the 80% that are healthy. We're gonna focus on the 20% that aren't healthy or that have other social determinants needs. That's the idealistic Dr. Mick nature of how do we get to outcomes based practice.
[00:22:46] Stacey Richter: You said a number of really interesting things.
One idea I am really drilling in on when you start to pick apart outcomes and you try to drill it into these distinct process types of things, which is what we have tended to do thus spawning the measurement industrial complex. What winds up happening that can get games really fast. Listen to the show with Rebecca Etz from the Green Institute about how to evaluate primary care because one of the things that she says, it's all about trust.
The more a patient trusts their primary care doc, the better their outcomes. So she's like, measure trust, because the second that you start measuring primary care performance based on biometric anything, those organizations who are rich enough to afford the consultants and the fancy EHR and the coders and whatever, those organizations are gonna wind up doing better.
Whereas doctors who may not have all that fancy stuff, and I'm talking about independents primarily now, who actually have trust with their patients, may actually wind up with better patient outcomes are the ones that wind up inadvertently not doing well.
We split everything down to the unit and we don't roll everything up to, as you said, the population level or the community level, or even the patient level if we're being honest here. So what we're talking about is: “Hey, maybe we should flip that.”
On the cost side let's drill down to the individual service level. Let's really do cost accounting. Let's really understand what any individual cost is. And then on the mission side, let's worry about the whole patient, shall we? Or the whole community or the whole population.
[00:24:20] Dr. Mick Connors: Right? Absolutely. I think it always comes down to the 80/20 rule.
We've lost sight of as the 20% that are driving a lot of the healthcare costs and not through any fault of their own typically. I have kids that are in the ER for a school note because they're gonna get kicked outta school because they can't get into a primary care office. It's just kind of crazy town.
But if we targeted the 20% and said, “Hey, who are the kids that need healthcare the most? Who are the kids or the families or the patients that are the outliers that are really driving high costs?” We would turn everything on its ear, right? I mean, we would not function in the way that we function now.
Let's not even be idealistic about mission. Let's say, Hey, we're really smart people. Make money by keeping kids out of the ER, out of the hospital, or lower that cost. I think the fundamental question is, do we really wanna lower costs? We all are listening to W-I-I-F-M. What's in it for me.
We all are there. I've been there. I've made plenty of mistakes where my mission didn't really overtake my margin desires, or I helped families get a higher bill because we were able to charge a facility fee and that helped the overall revenue.
You know, at the end of the day, there's just no incentive for us to do the non RVU to do the better care, to take an extra 20 minutes with a family to follow up to do all those things that make us such better physicians, happier physicians, happier caregivers, happier nurses.
It's just becoming, if we get a US News & World Report high ranking families are gonna trust us. They're gonna believe that. Even though I can tell you having worked at lots of different places and lots of different, the rankings don't measure up with the quality of care that I see delivered.
[00:25:59] Stacey Richter: The first thing that you talked about was like, Hey, let's focus on the 20%, and you gave a number of different examples and I'll tell you who you sounded like, a doctor.
Dyad Leadership and Team-Based Care
[00:26:13] Stacey Richter: This goes back to dyad leadership and just the vital importance of it. There has to be enough doctors in actual leadership positions, and we're not talking here about doctors who have hung up their stethoscopes and now don't see patients because, and you mentioned this to me in an earlier conversation, but these days a physician, can make a whole lot more money as an administrator not seeing patients, than seeing patients.
Dr. Tom Lee, the founder of One Medical, also talked [EP445] quite a bit about this as well as Dr. Rushika Fernandopulle [EP460].
So here we have just guest after guest on the show basically saying the same thing. If you actually want to have a mission return rate, there must be dyad leadership here. And you gave a number of different things for what that could look like, but ultimately, at the end of the day, it's gonna be some kind of roll up. Whole patient, not just the well patients, but also the patients that are pretty sick and require a bunch of time.
[00:27:00] Dr. Mick Connors: Stacey, that's so well said. I mean, when I started I was a head of service lines in a hospital that was losing $20 million a year, and I said, we need dyad leadership, right? You gotta have the mission side, you gotta have the margin side. There's gotta be a meeting in the middle.
[[00:27:14] Stacey Richter: Dyad leadership by the way, means when you have a clinical lead, which might be a nurse or other clinician, it doesn't have to be a physician. But this individual is a co-leader with someone on the finance or business side. And neither of those roles, by the way, is ornamental and just for the marketing, both have actual decision making authority.
I would also listen to episode 492 with Shane Cerone and Dr. Sam Flanders where everybody in organization helps solve problems. This is another spin on dyad leadership or an extension of dyad leadership.]]
[00:27:49] Dr. Mick Connors: There's gotta be common ground here. We can't be all of one or all of nothing. So even most of the problem with our money loss was physicians didn't feel like they really needed a bill for their services. They didn't really feel like they need to see more than one patient hour. They felt like they were, you know, that the state should continue to subsidize us and we should just be special because we care for kids.
That was kind of the mentality as a physician that I had to come in and say, this isn't gonna work. You got no margin. You're not gonna be here. Like you could be as Pollyanna as you want on the mission, but there has to be something more in there.
Like seeing 10 patients a day instead of 20 patients a day. Well, is it really gonna be a lasting way to kind of get this done if you really are about the mission? Because we often talk about being mission driven, but yeah, I don't really want those phone calls. I don't really want to text that family. Oh that.
You know what I mean? Like let's not be like one sided here. I get it on both sides of the physician side. We are human, just like the financial people are human. To your point. Everybody kind of has their play.
And I do pick on physicians. I've done a lot of business, so I've learned a lot. But I've also always fallen back on, I'm really a physician. I'm not gonna make the greatest business decisions. Me getting an MBA is kind of, you know, silly. Like we need to embrace the fact that we need teams in our care delivery systems. We don't need hierarchies, we need more team-based kind of care.
The same with the CEO and the finance people. If they're not listening to the physicians, if they're not coming down to the ER or the clinic or seeing what the impact of their Excel spreadsheet manipulations are doing to patient care and how it's, how it all, everything affects everything.
Until we kind of get some of that mission back, some of that cost accounting, some of that decreasing the variation that nonrevenue focus and mission focus. Like, man, I am so tired of seeing kids significantly ill going to the ICU because they don't have a primary care doctor.
Most of the time in the ER that I see, it's kids that don't have their medications or they don't know how to take 'em, right? Because we prescribe 'em and send 'em on the way. It's just mind boggling kind of to that whole ripple effect of total cost of care. I mean, if you talk to pediatricians, they'll be like, well, patients don't wanna learn. Patients just don't wanna do what they want to do.
Like, you talk to the patients, they're like, I can't get ahold of my physician. He doesn't listen to me. All This mistrust that kind of fosters this. And I think we have to take our accountability that how much margin do you really need? Where's it go?
[00:30:13] Stacey Richter: Yeah. I mean, it is mission that puts the care in healthcare and if patients. Feel like they are seeking healthcare and they get a visit, which is devoid of feeling cared for, then certainly you get to the place where, to your point that we are, where there is, everybody thinks that the doctor standing in front of them, which, is pains my heart. Is doing things to make money.
You get this plummeting trust with everyone and everyone within the system, and there's a bunch of different polls that show this bearing out. I think hospitals are some of the least trusted. They're coming in right behind insurance carriers, the most untrusted organization across the country, and that definitely has a spillover effect.
So there's some work to be done here because it's the mission side of the equation that fixes that.
[00:31:09] Dr. Mick Connors: I think everything's a pendulum. I've seen over the 30 year, my career started as fee for service started. When I started, we didn't even know what a CPT code was. We didn't really bill. We checked everything as a level two, and then the coders came in and started to train us.
Now we don't even see the billing, the billers do, right? I mean, it's just very interesting to see how fragmented we've become in healthcare, how margin driven we've become and everybody's miserable. Like it's like it, I don't know who's happy. Maybe the high margin, high salary. People are really happy. I mean, I know CEOs salaries have grown a hundred percent in 10 years, whereas physicians have decreased.
But you know, heck, I'm a pediatrician. If I was, if I wanted to be rich, this would be the last thing I would've chosen. It's kind of some of that dummy stuff of like, oh, I'm idealistic. I want to take care of kids. I want to take kids better care. And yet you're making it so hard for me to do it. Like I don't get it. I already make less than a 10th of what you make.
I'm hoping that through these discussions like that you have on this podcast that people can see another aside that Hey, margin is great and invest is great, and selling in seven years is great and 10 times, and Hey, I make a lot as a physician, so I'm gonna do real estate invest.
Like at some point we gotta figure out how we can get some of these dollars to flow back into the mission and get back some of the trust that we've lost if we're just focused on margin, and I think we need that pendulum to edge back the other way.
Conclusion and Final Thoughts
[00:32:31] Stacey Richter: Dr. Mick Connors, if someone is interested in learning more about your work, where would you direct them?
[00:32:37] Dr. Mick Connors: I've got two newsletters on, on LinkedIn. One is about "Transforming pediatrics", and the other is just "What the Doctor Sees.”
[00:32:43] Stacey Richter: J Michael Connors, MD on LinkedIn. I would highly recommend to follow. Dr. Mick Connors, thank you so much for being on Relentless Health Value today.
[00:32:53] Dr. Mick Connors: Thanks, Stacey, and thanks for your podcast, everything that you're doing. I think it's phenomenal. Just, gosh, we need more perspectives, more dialogue. I certainly don't have the answers, but it's, it's fun to learn from you and from those that you have on as well.