Updates from the Hill

DocNation welcomes special guest and member Dr. Brian Rich as we discuss the current state of health care and physician advocacy in Washington and what path forward is needed in order to bolster support for physicians.

Webinar Transcript

REID: Good evening, Doc Nation. Hey, thanks for joining our 8th webinar. I’d like to start out by sharing a little story. I had a conversation yesterday with uh, it was a referral from a current Doc Nation signature member. And this individual is ready to throw in the towel and you know, so ready to throw in the towel. I’m not sure Doc Nation is going to be able to do anything to change her mind. It’s a sad story that I’m not going to go into too much detail, but a physician in the United States, a highly touted physician, been in practice for 12 years, is ready to be done because she’s overworked and underpaid. She really didn’t even care about the pay. That’s what bothered me the most. But she’s overworked. No one listens to her and she’s told what to do in the operating room. She’s told how long operations should last. I’m no doctor, but no two operations are the exact same. And so she shared some stories with me and some tears with me and we were talking right before we went live here about how DocNation shouldn’t even exist. It’s kind of a sad story that we even are an entity, that we even are a movement, and that we even have goals to do what we need to do. But here we are. And so I wanted to start out by sharing that story. I’m hoping to revive her professional career. Um, we’re very, very confident that we have the tools and the resources to be able to do that, both on a personal level and a professional level. And so I like to start out these webinars with not necessarily wins all the time but just stories of the previous month. Because you know as serial entrepreneurs, Justin and I, we’ve worked with physicians for well over 15 years and., you know, to see DocNation take off, the way it’s taken off is…we knew there was a need because we had been hearing about it for the last decade. We’ve had clients saying they’re telling their kids not to get into medicine. And so we knew the direction it was going, but just didn’t think it was going to take off this fast. And so I just appreciate everybody being flexible with calendar time and schedules to meet with us and to get the ball rolling for your individual situation, so. Very, very grateful to see how the nation of doctors is growing and growing quickly. Without further ado, Brian Rich is on with us. He was at our last Town Hall and we’ll discuss the Town Hall here shortly. But he was at our last Town Hall and we got an overwhelming response to hear more from him. And that wasn’t even the point of the Town Hall, you know, that was part of it. But just, understanding and having clarity of what we need to do as a nation to get to where we want to be is really the ultimate goal here. So Neil, would you please introduce Doctor Brian Rich.

NEIL: Absolutely. Yeah. I’m very, very grateful and thankful for your time. Doctor Rich. I’ve known you for a couple of years now. You have been teaching and really kind of progressing medicine through new techniques and technology for quite a while now and interventional pain. I want to make sure I introduce your practice, it’s Accelerated Interventional Orthopedics practicing in Texas and Oklahoma here. Thank you for joining us. Like a lot of other members here Reid, they’re connecting with some of the social media stuff that’s out there. So thank you all the members and everybody for sharing those and getting the word out for Doc Nation. I connected with Doctor Rich a couple months ago over social media and like what is this, you know, this is and we had some conversations and I had no clue how much you have poured yourself into this and leadership and representing doctors the way you are. So…Updates From The Hill. Thank you for being our special guest here today. We want you to give us some details about the trip, your presentation, who you were presenting in front of. But first I kind of want to open this up a little differently here because you made a quote you said,  “Doctors have been trying to play a game that they thought that they needed to play and they lost.” But where were you going with that one?

RICH: What did I mean by that?

NEIL: Yes sir.

RICH: Well, I think the…practicing medicine is for most physicians and medical students, residents to come out. You know, you practice medicine, you use your clinical judgment. But at the same time then you’re also trying to make sure you’re dotting the Is, crossing the Ts, so to speak. And then when you get out into private practice, in order to be able to run a successful practice, you know you’re also running a business, small business, sometimes. Most of the time it’s a small business. So you’d have to make sure that you’re following the rules. You have to make sure that you’re doing the right documentation, you know that’s warranted and the particular situation. Sometimes you may have to get on to a peer-to-peer, sometimes you may have to, uh, you know, do send in records, but more importantly, you have to make sure that your practice is running in such a way so you get paid. It was several years ago and we kind of talked a little bit about this. Physicians were encouraged to start using electronic health records. And they were encouraged in such a way, monetarily. And that’s what really gives most physicians ideas. They think, OK, well, I need to make sure I’m running my practice efficiently, and if you’re really smart, you have a practice administrator making sure you’re running your practice officially. At the same time, you know, you’re having to make sure you’re getting on insurance plans, make sure you’re getting on hospital insurance plans, employee insurance plans so you can get referrals. Because if you’re not, you’re not going to get referrals and you’re going to struggle to get referrals. You could, you could be the best doctor on the street, but you’re not getting referrals because you haven’t joined the club, so to speak. And the club is the club of health insurance and facilities, hospital systems and things of that nature. And those two entities work together. And those two entities work together to provide a product that patients use which is the funnel by which physicians practice. So if you’re someone that takes healthcare insurance or others go Medicare, you know Blue Cross, Blue Shield, United, then when you’re signing those contracts you’re dedicating yourself to following those rules. And in a lot of ways that kind of goes against your clinical judgment. And where a lot of physicians struggle is when they see a patient and they have an issue that they want to treat, but maybe it doesn’t perfectly follow the rules that someone is reviewing from a medical record standpoint. And so you’re doing everything that you think is right and correct. But it’s still not a winning strategy. Because at the end of the day, and I’ve said this before, having healthcare insurance does not mean you have healthcare, as a patient.


DR RICH: And the problem, and the problem with that is, is that…. when you… most patients, when you’re talking to them or you’re having a conversation with them about what you want to do, you have to make sure that that square peg is fitting in that round hole so their insurance company accepts that and you can move forward. That’s the game. That’s the game that physicians have been trying to play, whether it’s making sure they’re using the proper electronic health record. And I could talk a little bit about how that is sort of a racket. I could talk a little bit about making sure that you’re in the right payer system, you’re in the right hospital payer system. And it was… it was always sort of assumed by me, but it wasn’t really until I started getting involved in more of the politics of medicine, which I think I’ve been doing now for about three or four years that I truly realized the extent of really where we are. And you know most physicians that want to be involved in politics and medicine and try to be involved, they’re up against a mountain of bureaucracy that I don’t believe they can recover from it by playing the same game. And I’ll give you some numbers. Average  per year, members of Congress through the amount of donations, usually over a year, are given in the form of around $300 million a year in lobbying fees. $300 million. Now when you think about 435 members of Congress, when you think about all the healthcare insurers, think about all the healthcare systems, you think about that, and you start dividing that out and realizing how much these entities are making. That’s a drop in the bucket. But are you going to be able to donate $300 million to a pact to help fight that game for you? And that’s the game that’s lost by physicians. So do you… in order to win this game, we have to learn how to play it differently and play it in a way where we can win it.  And that’s what I’ve learned and that’s what I’ve been working on and when and I served as a medical advisory physician for three members of Congress. And when we have round tables, and stuff like that, I try to give them the small business, private practice physician perspective. And that’s where my value and my importance came into, because most of these members of Congress, they’re kind of fed up with the monopoly of the bureaucracy of healthcare which really is what’s driving the cost in healthcare. So that’s what I meant by that.

ANTHONY: I think one… I love that and one question I have and I kind of want to get this going right off the bat, right? Is anyone on the Hill or any of these health insurance companies worried at all about the physicians finally standing up and doing something, banding together, saying something, striking, stop taking health insurance? Is that even a conversation that they’re worried about that, at all?

DR RICH: Depends on how you approach it. Are you talking about from the pure practice standpoint or are you talking about becoming a healthcare consumer? And what I mean by that is, you know the quickest way and the way that most legislation that’s actually starting to get traction is for physicians to be able to generate some form of healthcare consumerism. Meaning they become an owner facility, an owner in a hospital., something where they can drive the costs. I’ll give you an example and this is something you’re going to understand very, very well. You have a patient that their insurance is only going to pay $50,000 for a spinal cord stimulator. That’s it. That’s all they’re going to pay. You try to take that patient to a facility that wants,  you know $28-29,000 what they normally get for that, for that facility. They’re only going to make maybe about $1,000 or $2,000 off of that stimulator because maybe they can only get it, they can only purchase it for about $13,000. And that’s really low for a spinal cord stimulator. But that’s, maybe, a company that’s doing them a favor, but their net profit’s only about $2000. So a company, like, that’s owned by Blue Cross and Blue Shield, or owned by WellNet or owned by something like that, they’re not… $2000… like, I don’t have time for that. I don’t want that patient or that payer. But let’s say you own your own ASC. Let’s say this is a patient you have a very good relationship with. Let’s say this is a patient that you really want to help and you go to your facility and you say, OK. We’re going to accept $15,000 and we’re going to pay $13,000. We’re only going to make $2000. But guess what? That patient is going to get better and he or she’s going to be better. And what you just did in doing that, I think, is you lowered the cost of that simulator, you lowered the cost of how much your facility makes, you just lowered healthcare costs in one patient. That right there is what is scaring healthcare service providers. That’s what’s moving the needle right now. And that is really where physicians need to come together and work together to make that happen. Because I mean, I don’t know if you know, but 33 states in the country right now banned competition outright through Certificate of Need laws. Which means that in that particular state you can’t just say I think I’m going to open up an ASC right next to my house and I’m going to get it certified and then I’m going to get insurance payers. The problem with that is, when you start negotiating with insurance payers to do that, then those insurance payers let’s say Blue Cross and Blue Shield comes back and says. OK, we’re gonna certify you, we’re gonna put you in network, but we’re only going to pay you 75% of Medicare. You’re like, wait a minute, you’re a commercial payer, you should pay me 100 and 110% of Medicare. No, no, we’re going to give you 75% of Medicare. And now all of a sudden you’re working, you’re basically working almost charity care because you’re not a big player in the game. So you have to, you know, the more physicians understand how working, how what, what battle they need to fight and how to fight it, that’s how you start this process of fighting back, which is what I was up on the Hill recently talking about.

NEIL: So talk to us about that. How did that meeting come up? That was in July.

DR RICH: Yeah, it was the Ways and Means Committee. Ways and Means, I don’t know… So there’s different committees obviously. And in Washington, I mean you know it’s like the biggest, most interesting about Washington is, that when they get bored, they come up with a new committee name. It’s the most amazing thing in the world. They’ve got so many different types of committees. So when you finally, it’s almost like you become an expert once you understand and learn how the committees are formed. Then they kind of… then you become part of the club. It’s like, oh, he gets it. Now he knows what a select sub committee is, he knows what a special committee is, he knows what…it’s just, this particular committee was on Ways and Means. Ways and Means is really what governs the country. Just about everything on Ways and Means, everything in the country, that has any type of teeth goes through Ways and Means. So imagine if you’re a member of Congress, you’re the chair of Ways and Means. You have an enormous amount of stroke. And so because of that, Washington being a 0 sum game, you sometimes have the ability to move legislation that you didn’t normally move because you’re on Ways and Means. So when you get the opportunity to go and testify in front of Ways and Means, even though this is a Select Committee on Ways and Means, it’s something that you know is probably going to move the needle eventually because you understand how that works. And this particular committee meeting was all on over regulation in healthcare and how it affects small business for private practice physicians. Everybody kind of knows and understands, you know, Medicare is always cutting, and Medicare is paying hospitals three to five times more than what they pay individual physicians. Because again, they’re the lobby, they’re the driving the lobby in that situation. Well, on top of all that, you have the insurers that are starting the process of not credentialing positions because they’re sort of squeezing out the private practice physicians. And the way they’re doing that is either A) if you’re already in network with them, they’re starting to over regulate you to make it so difficult for you to provide that service and it becomes just cost prohibitive to be able to do that. Well that has actually created some noise. And so Ways and Means got a hold of that on the small business side of it and they didn’t like it. And so now..

JUSTIN:  They didn’t like it because they wanted to treat them more fairly or evenly?

DR RICH: Right. Well, correct. Yeah, they didn’t think.. they got that… They thought that… I mean, so, insurance companies and hospitals are probably two or three steps away from just being in antitrust court because of basically being a monopoly in some respect. And they know it. They know it, and they understand it and they know it. They know it’s a slippery slope. The members of Congress that are on Ways and Means now are probably more private practice physician friendly than they ever have been ever, in any way, shape, form or fashion. And because most of the members of Congress that are on ways of meetings right now are just regular, average people that don’t like big corporations pushing small business around. And Small Business Administration has not really done their due diligence to try to help the small business side, but this is sort of a new avenue for physicians to sort of create their fight as,  “Look, I’m a private practice physician, I’m a small business physician. I’m not part of a large mega group. I can’t negotiate like those can. But I need to be able to survive.”

And so, this is sort of a fact finding committee meeting. We’re just like how did it affect? And I basically gave my testimony on how it affected, which is some of what I’ve already said. And what’s interesting is, is that this particular issue, these issues are winnable issues across both sides of the aisle. And I actually told one Democrat member and one Republican member, really kind at the same time, as I just looked straight at them and I just said,  “In your district, if you go back to your district and you champion this cause, I will come to your district and help you campaign and tell people that you are somebody that should be in Congress because of this reason.” When you say something like that to somebody and they realize that you’re really having a conversation with them, that you’re talking about something that’s red and blue, essentially, if you look at it from the political spectrum. They want to win. And this is a winnable argument for them and I think that this is where the groundswell is starting to change it.

ANTHONY:I think that’s a great point. Because to me, to me this affects patients, right? More than anything. And it affects… and that’s just one point where people talking about DocNation say, “Well how will the patients take it if doctors band together and really are stepping up.” You know the patients think the doctors are trying to be greedy or any of that.

DR RICH:  Right.

ANTHONY: So, because, in the long run, what’s happening with medicine over the last 5-10 years, I don’t think anyone out there as a patient and we’re all patients in some aspect, or our kids, or our parents have said that it’s gotten easier, gotten better, gotten cheaper, right? So I think if you champion, you know, the patient, which is the public, and then kind of go to these legislators, the people voting for you, you don’t want it to continue going this way. Maybe that’s one angle we can all take. And that’s also an angle… all of you physicians out there, to kind of relax and don’t worry that standing up, banding together is going to hurt your image. It’ll actually help your image in the community, I believe.

DR RICH: In this particular case, yes. Because in this, in many cases but definitely this case, yes, because I think the winnable argument in this situation from what I can see, from talking to members of Congress, and the people in Congress are talking to anyone that really has any kind of salt in the game… the winnable argument is, is that patients’ access to Healthcare is now limited because of what insurance companies are allowing. I mean, you know another really good example, I can always give tons of interventional pain examples because it’s always just from, I mean there was a time when we could do, like, three or four levels of ablations. You know now we’ve got to, like, try to pick two which is never seen. I mean, it just blows me away that there’s somebody that feels like that’s reasonable. But that said,I used that example and I just told somebody… actually what I did is, I redacted an MRI and used it as part of my evidence. And I said that particular patient had, you know, bilateral spots, you know,moderate to severe Spondylosis with facet joint approach be at L2345 and that’s one. And I told, and I asked the patient, I said, now someone’s coming in, and chronic back pain and they’re talking about how much they’re having to take opioids. So I just want somebody to tell me which one should I pick first, because I’ve got limits. And then I’ve got to start charging a 76 year old patient on a fixed income, they could barely pay their pay, their $250 deductible for Medicare each year. Which one should I pick? Should I tell them not to, you know, to just not eat that month and then let me fix their back pain? Which one should I do? And that’s, and that’s really the argument that I presented. I presented the argument that you’re putting me in a bad situation on patients that believe they have healthcare, to have to tell them no, you don’t. And the issue is, that most patients are starting to understand that. So physicians coming together to fight for that is now winnable. It’s not about people thinking, oh, these doctors are just greedy, they’re just trying to make more money. It’s about trying to give somebody access to something that they believe is right.

NEIL: But doctor, it’s you. My mind is blown here. Because, you’re in the room – you’re gracious enough to bring DocNation into the room with your participation here. But, as you present this to them, how are they reacting and how does that work?

DR RICH: Well, I mean, just to that point, just to kind of give you a little background.. So the way it started for me is about three or four years ago when I was teaching. And I was sitting there and I was looking at the procedures that I was doing and the procedures that I was teaching patients. And this was before I was a facility owner. And I realized how much these physicians that were so excited to go deliver this therapy to patients were going to make. But I really realized how much these facilities were going to make and how well these facilities were going to do. And how they were so adamant about how much they were going to charge for these. And what it was going to do to the patient. I just, I just thought that was so backwards because I just felt like the physician was the one that was putting all the risk out there. Even if it’s, you know, primary care physician that’s trying to determine what it is, you’re the one putting all the risk out there. You know, you’re prescribing the medications that the pharmaceutical companies are making a ton of money off of, but it’s your risk. And so one of the members of Congress who I knew, and a couple of them here in the district where I live, I started working with her and talking to her about how I can get involved in the healthcare side of it. And it just started very organically. And I just said let me be your advisor and kind of give you an idea on how it was. And we were at a fundraiser and we were sitting there and there were a couple of members of Congress that were there. And she asked me in front of everybody how I felt about these things. And I kind of responded the same way I talked to you, right? The same way you and I’ve had multiple conversations that I think, you know, Anthony would have multiple conversations. And they’re like, wow, hang on. This is, you know, we need to hear more about this. This is somebody that sort of has a true pulse of actually taking care of patients. And slowly but surely the more I talked about it, the more round tables we did and and the more I got involved, the more and more members of Congress wanted to hear about it. You know, just people around even state legislatures and things like that. And you know, former chief of staff to HHS is now in the state legislature here in Texas. And you know I help him a lot in the state level. And they just want to hear… they’re… to your question about people are really thirsty about hearing about what’s in the room being said? Those people in the room are very thirsty to hear what I have to tell them and the people like what you would probably be able to tell them, what Anthony probably would be able to tell them, about what it’s like, because they don’t feel like they’re getting the true pulse. What they’re getting is, they’re getting the white noise from the people that are donating so much money every single day, and thinking, OK, this is how it needs to be done.

ANTHONY: And that’s a great point.

REID: DocNation’s goal is to be the Messenger, right? We are here to be the messenger.

DR RICH: And they want to hear it.

REID:  say it again?

DR RICH:  And they want to hear it.

REID: That’s the thing. I just don’t think it’s been done before. I don’t think the message has been clear. I don’t think there’s enough people screaming the message. And so Brian, you’re kind of an anomaly where, you know, most people are kind of like I’m going to stay in my lane and focus on what I’m doing. And you kind of reached out and said, “No, no, no, let me explain things.” Did that derive from you being in private practice or has that kind of been a thing welling up inside you for some time now.

DR RICH: I think a lot of it had to do, Reid, was, you know, I watched it and what I saw, I just, I couldn’t believe it. I mean, you know, like I remember, when I see things and it’s happened to me a lot. But when I see things, like, I know somebody probably is getting ready to get a therapy or somebody’s getting ready to get something I think is getting ready to help them and somebody tells them that I can’t do it because they won’t pay for it. That’s not that person on the phone telling that patient they can’t do it. That’s me having to tell that person that I can’t do it. And that… this really makes me nauseous, you know, And it’s very difficult. I saw on LinkedIn just a few days ago, it’s Andy was doing a peer-to-peer and he was trying to present mortality data on kyphoplasty, a procedure that I’m very passionate about. And that person mentioned something about cherry picking data. I’m like, how do you cherry pick mortality data? But that said, it was still the same thing and what happened was, I just told that story and I just told those stories, and I just told these stories to these members. And I just said, you know, this is what’s happening. And this kind of happened pre COVID, and then COVID happened, and then that was kind of a big thing for a while. And then about 21 and 22 it started slowing back down. And they just, they want to hear it. And they want to hear really what the real story is. There was a, you know there was a situation that happened in Louisiana about last year where there was a physician down there that that was doing her procedure and one of the orthopedics that everybody knows about, this one orthopedic surgeon though a situation got mad and was gonna try… and was friends with with one of the state reps.  And told… was trying to figure out how to pass legislation to prevent that physician who was dually trained to do that procedure. Now, bear in mind, it was the procedure and approach that I wasn’t… that I wasn’t part of. It’s not the way I did that procedure. But still, that said, this person was getting ready to be limited because somebody had an issue with them doing something, even though they were dually trained to do it. And they were trying to push… they were getting ready to try to push this through the State House to limit that position, to be able to deliver healthcare to somebody for that particular procedure, that probably would have benefited from it. And everybody was involved. I think Neil was involved. I think Anthony was involved. Everybody was involved. And when I saw it, I got involved and we started making some phone calls.  And just made the right people to make the right phone calls. Sure enough, you know it people started realizing, wait a minute, I never looked at it that way. And I think it’s always been like that really for the past, well, since 2019. There’s a lot of these new members that just don’t look at it that way. And I think they understand that when you personalize what these policies are causing to patients, that’s where it changes. And physicians that are part of large healthcare corporations that come and speak in front of Congress, and there was one literally sitting two inches to my left and was very, very… was sweating when I was testifying because he hated what I was saying. Because basically I was just destroying everything that he just said. And he was uncomfortable, and they kept asking him questions to try to follow up on it, and he was so far out of the private practice, small practice model that he couldn’t really give that personal approach to it. And I think that’s really what I was able to do. And I was able to sort of, you know, really kind of relay my message. But I’m one of thousands of physicians that can do the same thing.

ANTHONY: Well, I think honestly it was. So we’re a half hour in on here and I love this because this might be the first webinar where we’re halfway in and it gives me hope. Because, just to review what you said, and what I’m thinking while you’re saying it, is there’s been $300 million to put us where we are and we’re still not out of the woods.

DR RICH: A year.

ANTHONY: A year, yeah. And we’re still, we’re still not out of the woods and they know that. You know why? Because physicians, unfortunately for them, are pretty darn smart people and you’re not gonna blindside us for too long and stay down. The other thing is that, I really enjoy the fact that you’re pulling back the curtain and telling us that the members of Congress are interested. I was a little worried that they were getting the checks from, you know, pharmacy companies, insurance companies, hospitals, and didn’t want to hear from the physicians. That gives me a lot of hope too. And the third thing is, that what we’re doing here is, exactly what we need to be doing. We just need to get stronger and bigger. And I’ve said this for a long time, DocNation doesn’t need to be 20,000, 50,000, 100,000 physicians. You get 100,000 physicians pulling, or, uh, you get 1,000, you get 500 physicians going in the same direction, it’s going to light up more than $300 million will ever do. if you do what you did in Congress. I mean someone asked here, “How can they help? They work in hospitals and how can they help?” It’s banding together. We need… if we band together as physicians and you get 500 guys to show up with the same message, you can’t stop that. Because, we’ve always had this analogy, right Reid?. The physicians are the players, and if the players want to take their ball home and go elsewhere, I mean our last webinar was about how to get around health insurance and there’s an easy way to do it. We have to come together. And that’s the message I’ve been trying to put out on LinkedIn, the post that you saw. Is that we have to come together, we have to work together, and it sounds like there’s an avenue there and we just have to do it.

DR RICH: Yeah the biggest point that you just made there, which is, will be the biggest point that I would make, is that the only way this path goes forward and you get in the bridge, you cross the bridge, is if you do it together. You know ,you cannot. You know, the biggest way that a lot of these things occur and it’s… if everybody, if people, and I had to do it. Just, full disclosure, I mean, for me to understand all this stuff, I spent a ton of time researching. Because I didn’t understand half of this crap. I didn’t even know what capitation was. And when I started, when these people, somebody said, well, it all happened with capitation and I was like, what the hell’s capitation? I’m like, hang on, Google capitation, you know? So I had to go..

REID: That’s OK. That’s what I want our nation to hear. That’s OK. Yeah,to be honest with you, if you’re a doctor and you show up and you band together as all we need. I’m talking to doctors all day, every day. And one thing that I’m still perplexed by is the simple fact that there is no freedom of medicine.

DR RICH: None. Not really.

REID: No freedom of medicine. So you guys know what the Second Amendment is, right? No, wait, it’s the first First Amendment.

ANTHONY: First Amendment.

REID: Thank you.Yeah, freedom of speech. Anybody, no matter your level of education, no matter your background, it doesn’t matter. You can say what you want to say as long as it’s not harmful to people. Now we get the highest educated group of people, and they’re the most heavily regulated group?


REID: Why? Why? See, for me, for me this is easy. We could either take five or ten years to do this or doctors strike. And everyone gets all squirrelly when I say that, right? People even get squirrely and nervous when I bring up the word union. And I think a big part of this is the physicians want or understanding of the need to fight back. This all could change, and it wouldn’t need to take a very, very long time. So I wrote down, instead of union, I’m going to start saying freedom of medicine. There is no freedom of medicine. So why did I go to school for a decade? Why did I become a specialist? Why? Why do we do any of that, if I can’t do what I’m trained to do? All because of the almighty dollar?

DR RICH: Right. And I think the reason why that occurs, why physicians are regulated, and this has been said multiple times in the room, is physicians are the ultimate delivery of healthcare. It’s just how… and so they want to make sure they are controlling how that healthcare is delivered. You know, in Florida there’s a law, there’s a bill, and I sent this to Neil. There’s a bill that’s going through the Florida house right now, the Florida medical association’s in support of it. And by the way, before I even get into it, this is the first domino. And so in Florida, that physicians, any entity or any, anything that a physician works for in any way shape or form cannot control, or guide, or coerce, or take copy or ownership of anything that that physician has that he or she uses to deliver healthcare. In other words, you work for, let’s say you work for an HMA facility, right? And that HMA facility says, you know, like for example, let’s say, to your freedom point, it would be unfortunate if he all sudden went to work for HMA facility and he’s out there and he’s practicing medicine, he’s doing his thing and then they come to you and they say, “Hey Dr. Reid, here’s your quality measures. You took about 15 minutes too long with this patient. You could have seen this patient, this patient you ordered this MRI and this MRI. Could you have ordered a CT scan to cut costs?” That’s what that bill in Florida is like preventing and stuff like that. So that’s sort of the first domino, stuff like that that falls. But kind of getting back, just taking a couple of steps back as to why we are where we are, and why we’re getting to where we are, because I think people probably want to hear this. Is that enough has happened to where they, the current consumers of healthcare, which healthcare insurers, hospital associations have pushed too far. And now the real bear in the room is obvious when you look at the amount of money that these entities are making. That’s where all the money’s coming from. And COVID didn’t help. Because when you look at what the companies, the pharmaceutical companies made off of COVID, and various companies like that made off of COVID, it’s obvious where it’s coming from. So now, if you’re really trying to cut costs, and we’re going to have to cut cost, cutting cost does not mean cutting physician costs anymore. Cutting costs means cutting the regulatory structure that’s been driving this for a long time. That’s why this is starting to happen. And to your pont, one more point about that, the physicians driving the system in such a way to where they say, hey look, you either change the way we practice medicine or you’re going to lose the physician workforce. It’s happening anyway, but in order to stand up and create some type of actionable cause like, unionize, things like that, something where a physician has the ability to arbitrate something that’s going on with them. Whether it’s with insurance, whether it’s with, you know anything, you know medical board, regardless of what it is, that is really what is the path forward that actually protects physicians. Because it’s one thing for me to talk about bills and legislation that’s going to change it. What going to ultimately codify and protect what physicians happen in the future And that is something that’s sort of an actionable body that is like a union or some type of organization that holds it together to sort of say, look you’re going to have to answer to a large group of physicians if you pass this. Meaning, it’s not about the money, it’s about the votes. And if you go against this physician group, then you’re going to lose this many votes in your district. That, right there, is what wins more than money. Doesn’t matter how much money a member of Congress gets, it’s how much votes they lose for making decisions based on that money that they get. That is a secret sauce right there, and that’s what I’ve learned over the last two years.

ANTHONY: I love that. I mean, I think we need to take that strategy because a lot of people have told me they love the idea of DocNation. No one wants to be the tip of the spear, unfortunately. Everyone’s afraid of retaliation. I just want to answer one of the questions in the chat. They’re afraid of retaliation from their peers, from their employers, and from the patients. And the hardest part for me is when I talk to physicians. Every physician that I talk to about DocNation loves it. No one wants to go out and do anything because they’re afraid that something is going to happen. If it becomes critical mass, you’re not answering to one person anymore, you’re answering to the whole group. And that’s the goal.

DR RICH: Yeah. And I think the problem with that is, you know, you’d have to ask the question. Because I thought about that possibility of what people might think. Because, I mean, it’s well known, and I, for two years while I was doing all this work, I operated in pure secrecy. I never told anybody about what I was doing. I mean, every once in a while I would be doing something and somebody would say what are you doing? I would shoot ‘em a picture, and I was sitting in front of my name in front of the Congress meeting and stuff like that. They’re like, what in the hell is that? U.S. House of Representatives? What are you doing? And every once in a while I do that, and it’s just like they were going… and they just didn’t pay attention to it. But finally when I finally started to talk to people about it and tell more and more people about it. You know, I thought about that and thought, gosh, you know I wonder if somebody’s gonna, you know, have it in for me and stuff like that. There’s really nothing that somebody can do to you, you know, in this situation. You’re trying to do what you think is right for your patients. And at the end of the day, that’s what will win. And I mean, there’s, you know? Again, they’re going to try to fight anything physicians do at the legislative area because they know that’s where it matters for them, is in healthcare law. Where physicians can fight is at the ballot box, by working together to say we will actively campaign against you if you do not, you know, if you pass, if you help pass that law, we will actually campaign for you, right, wrong or different. Because when I said those things, it’s in the most recent committee meeting that I was in, the one that I just went to in July. That’s the one that made them look up and pay attention. Most of the time they’re looking down and talking to staff, right? Because then you know, if you ever see on TV, you know, you hear somebody, you know… by the way, in committee meetings whenever you watch on the TV and stuff like that, and you hear them get up there and they’re talking and the cameras on them and stuff like that, that’s their “moment”. So they’re going to, you know, whatever, you know, they’re going to say their things and try to… they’ve already got those remarks prepared so they can kind of make people happy. Camera gets off of them, then they reach over to all the staff and say this is the things that we’re going to work on, these are things that we’re going to do. Most of the time they’re looking down, they’re not even paying attention. But when I made that comment, that’s what got their attention. That’s how I knew I had their attention. That even what they would tell me. They…she’s a member of Congress. She came up to me after that. She said, yeah, you really freaked them out when you tell them about the votes next. And I just said, yeah, it’s, I mean, I just told him, I just looked at him and I said it’s coming. I said, I just promise you it’s coming. Because physicians are at the point now where they’re either just going to quit the profession altogether and, you know, go try to be a professional baseball player or something like that or…

REID: one of the things I hear a lot about is finance. In my group text, last week, a guy told me in my group text, I’m the only doctor of eight guys. And there’s six of them that are in finance and every one of the guys that are in finance make more money than me. Yeah, that’s a problem.

ANTHONY:  My joke is too, no one fails out of finance school and goes to med school. Right?

DR RICH: Yeah. And I mean you know, that’s what a lot of doctors, you know, do to really kind of get by. And I think that’s another thing that’s interesting that you kind of infer. A lot of times, a lot of the physicians have side hustles so to speak, right? Where they either have real estate, or they have stocks, or they have some ownership. Unless you know, unless they have ownership of a facility, the ownership of the facility is really the winner for a physician. So you have to kind of decide you know, are you fighting for just yourself, which is understandable. Do you have a family, your house payment or you have all these things you’re focused on? That’s understandable. But the real answer, the real game, or the real thing that you really should be fighting for, is your profession. If you truly love practicing medicine, you truly love taking care of patients, you gotta eventually say, hey, I need to do this for my profession. And the way to do that is to help exact change. And…

REID: But the problem is, Brian, over the last two weeks, the only thing I’ve been hearing is I can’t. I love taking care of my patients but I cannot.

JUSTIN: They’re too afraid. They’re too afraid. They don’t have time for it.

DR RICH: Right.

REID: I cannot. I’m handcuffed. So that’s where we are. I have a physician that I’m talking to right now where we’ve just engaged and she said I have to choose between not making money and taking care of the patient, not making money and taking care of the patient. When did that ever…that…. I’m just… a physician side hustle? Ever heard of a professional athlete having a side hustle?

DR RICH: No, no, no, no.

ANTHONY: Yeah, that’s true.

REID:  And so the problem, let me prove that. Justin and I have a company that services physicians and has been for 15 years and we ranked number one on the Google search… fill me in Justin… what’s the Google search?

JUSTIN:  Physician consulting?

REID: Physician consulting, what does that mean? It’s a physician looking outside of what they’re actually doing to then go consult. What does physician consulting mean? And they’re looking for…

JUSTIN: It’s a side hustle.

REID: …other avenues to make money…


REID: …and and it’s just, it’s just, this hurts.

DR RICH: It happens all the time. There was a physician that was sitting two down from me and I actually talked to him a lot after the meeting. And it was, and this is not the first time I’ve heard this, and he told me, he said, you know it’s funny, he actually knew who I was, which was I thought interesting, because he knew me from LinkedIn. And he said, I remember, he said, “I remember you used to teach – did you get paid much for that?” I’m like, you know, I mean, I remember trying to help design a couple of implants once and then all of a sudden it did well. And I’ve never heard anything ever again after that. It was great. You know it’s a certain company out of Austin that does this. I just put it all together and figure it out from there. But, you know, it’s completely pissed me off. But, you know, that said as I, you know, teaching and going and teaching aside, said, I mean, you know, there’s a lot of time involved. I mean, you know, it’s just it’s not a winnable strategy if you’re just trying to do that to make extra money. Really, if you really want to try to make extra money as a physician, you need to do something called consulting. So consulting, like expert review, like things of that nature. And then the problem with it is, that you know, when you do that, you work for a corporation. You work for a company. And they expect those expert reviewers to expert review in their favor. And you know if you ever really have a real conversation with the peer reviewer, they’ll actually talk to you, when it’s not on a recorded line, it will send chills up and down your spine. But the whole point of all that is, that there are so many physicians that are just thinking I’m going to jump onto that bandwagon because that’s the only, that’s the bandwagon, that’s the future. That’s where I see that I’m going to be able to financially support myself. And I can understand somebody being scared of that and understand that. But what I can also understand is, that cat is out of the bag. And most… my testimony, in DC and and really beyond and even in the future, is really the patient experience and what the patients don’t get or what the patients don’t have. You know, taking care of somebody who’s in pain when you’re doing something that you think is going to help them, even if it’s not something that’s, I mean, maybe it’s one more level on an ablation. What’s one more level on ablation on one patient? You know, it’s not that big of a deal. A lot of physicians just don’t bull for it because they know they’re not going to get paid for it, but does that seem fair? And I think the problem with it is, is that that’s what most, you know, members of Congress, you know, get. It’s like it’s not fair really for physicians to, you know, have to do these extra things just to be able to make their practice successful. That’s how, you know, over regulation, which is what I was testifying on, has affected the small business of healthcare. And I think we’re probably going to see some… uh they come back from recess here soon, provided they’re not tied up in all the other drama and try. They gotta come back from recess and the first thing they have to do is they gotta fund the government, which that’s going to be a mess because they’re probably not. And I don’t think a continuing resolution is going to fly this time. So that means the government is probably going to get shut down. And yeah, so that I think is going to happen, but there’s enough time to get some of this legislation that, and some of it that I sent to Neil that you could send out to other people, that will start this process of changing. They’re already in the process. There is already some legislation out there on advantage plans. There’s legislation out there on paying physicians fair share of Medicare and trying to work on the cost of living increases. And then I think there’s legislation on over regulation. I think right now the time is probably right for physicians to come together and to try to speak with one voice. But speak with one voice in such a way from what I could tell and from what I notice… the patient experience. What is the patient getting for their health care?

REID: That is exactly what I really like.

NEIL: I really like that doc. That’s a good way to keep us, keep everyone focused and together. But I want to go back to really harp on this thing where you said the game was. It’s not about the money, it’s about the vote. We have some comments here in the chat. I think…

REID: Neil, Neil, Neil, let me let me read one

NEIL: Hold on one second. Hold on one sec. They’re really connecting with, like, what our power is. And so we’re not, it’s not that we’re going to do a… we need to figure out who to vote for. Because our campaign right now…it’s not really a “rock the vote”, it’s “doc the vote”.

DR RICH: That’s right. That’s right. And, I think, the thing is, is that it’s like. Oh my God. I mean, I’m, you know, I, I come from a sports background and have a sports medicine background and stuff, and I’ll actually use sports analogies. But the reality is, is that there’s a lot of football teams, there’s a lot of teams that won what they were doing by playing their game and not letting somebody else make them play the game that they couldn’t play. The game that wins, ultimately, is exposure. And good or bad exposure and votes or no votes. And yeah these companies, what they say, and I will explain, I will tell you exactly how the conversation goes. “Thank you for wanting to donate to my super pack, or my pack or my campaign. However, I have a significant amount of constituents that don’t like you, or don’t like what you’re doing. We are going to have to do something and you are going to have to either come to the table and work with us or I’m going to have to do something to pass legislature or co sponsor, sponsor legislation to make it work. So you’re not going to win the game of trying to compete against $300 million a year. It ain’t happening. You’re not. Unless you’re Elon Musk. It’s still probably not happening. But what you can do is, is coming together as one entity and working together to try to affect the change through the ballot box. It’s what, you hear it all the time. Change happens at the ballot box and that is so true. And I used to hear that all the time. And I, and I mean, I would hear it and I would see it. I mean there’s some members of Congress, some that I was working with, they got voted out of office. You know it’s one in South Texas who really just once she got in she just.. she just… see I think she thought she was a short time person so she immediately started taking the special interest money. And just quit listening, and I mean she got destroyed. And so I think that’s the game that you fight – you fight the vote game – that’s the one that physicians can win. And you win that in numbers and in mass.

ANTHONY: I love last saying here – the physicians offices of vote amplifier. And what? What? DocNation is key. And you know, we can have, you know, the whole point of this year of DocNation is to prove the concept. Prove that physicians coming together will work. The goal of 2024 is to implement that concept. And we want to have newsletters. We want to have everything that say, hey, you know, it’s a shame. Here’s a list of your list of Congressmen and women that are pro physicians.

REID: So one of the things that Nation is doing behind the scenes is we are putting together education. Who to talk to, who to vote for, how to vote, why to vote, as we’re building a patient testimonials and physician testimonials. Because here’s what’s going to happen. You have a Brian Rich or or Anthony Giuffrida to get up on stage and you say, “This is why I’m here.” And then you have specific examples of why they cannot – there is no freedom of medicine and that’s what hurts the most. And then the patient comes up and discusses their story and tells everybody. There isn’t one person in the United States besides the people making money, who we’re going to say, “That doesn’t make sense. I don’t like that.” But there is not a group that is banning together to do that – to create enough of a following. And so that’s what we’re here to do. Go ahead Brian, I think you want to add something.

DR RICH:  No it really doesn’t. I think, following on that point, and I’ll make it easy for everybody else, cause I want to make sure that what I really say here tonight, and anybody can always reach out to me if they want to get more information from me, and so, I  went through, sort of…I’ve learned a lot. But I want to make it simple for everybody because I found out a lot of things after how you get that information. Anyone can call up a member of Congress, anywhere, in any district. And call their district office, get a legal aid and say, “Hi, you know I’m Doctor Smith and I am interested in knowing what healthcare legislation Congressman Davis is working on.” And they will then get with legal and find out what they’re co-sponsoring because that’s public information, right? It’s like they can’t tell you not, they have to tell you, and then you say, “Can you e-mail that to me?” And then they’ll e-mail that to you. You don’t need to tell them why you want to know, say just I want to know whether I’m going to support you for the next election or maybe wanted to help her or him or her stuff like that. And then you’re going to get that. Then you could look at that legislation and then you can kind of determine is this person for us or against us. It’s not, you know, never ever, ever trust what somebody’s telling you on TV or a campaign ad or anything like that. Look at what they’re writing or what they’re co-sponsoring, what they’re put amendments to. Look at that, and that’s how you’re really going to make, that’s how you get ahead in the game. And so you find that out, then you take your mass of, let’s say an organization like, let’s sayDocNation becomes, let’s say they become a 10,000 strong entity, and then you take that, and then then you use that to say we are publicly supporting or not supporting this member, because of this, this, this, this, this. They don’t want that. And that’s how you make that change. That’s how you do.

REID: As much as we don’t want to get into politics, we have to to win.  …Yeah, if you want freedom of medicine, this is how we have to do it. So maybe there’s a homework assignment here for DocNation, and that is to build a map. And that map shows all the people who are running for a seat. And what they’re doing, who they’re supporting, what they’re supporting. And we have maybe a recommended vote.

DR RICH: Yeah, you can narrow it down too, because you can narrow down to Ways and Means, Health and Human Services. You can narrow it down to… I can get you all the committees that there’s only about four. I mean, there’s there’s…

REID: Hey Brian, can we do this? Can we do this? Because I’m taking a whole bunch of notes I can’t keep up. What I wanna do is, can we have a debriefing after this?

DR RICH: Sure!

REID: Because I would love if the Nation was able to have a cheat sheet.

DR RICH: Sure.

REID:I don’t want, nor do I expect all of our followers to have to go in the Yellow Pages and find this, and find that, do this, do that.

DR RICH: Right.

REID: If we could serve them the cheap sheet…

DR RICH: The short answer is, the short answer is, Ways and Means and Health and Human services committee. And I can get you guys that committee information and the members. And then you look and you see what healthcare they’re supporting or co-sponsored or supposed to be coming out of that meeting. So Speaker McCarthy, when he became speaker, he made sure that all healthcare…well, he didn’t have a choice. He wasn’t going to be elected Speaker if he didn’t do this. I mean this was part of what some of these guys that were against him said he had to do. He made sure that all new legislation went through the committee. And that’s actually important, because you wanted to go through committee because that’s where you could then go and you could speak on it. You could show up on it, you could do sometimes public forum on it, you could know when it’s coming up for discussion, a vote, whatever it is. And so that’s, when it’s in committee that’s where they craft the legislation and how it’s coming out. And so it goes to that committee. And once it comes out to that committee and then it goes to the floor for a vote. And at that point you may have to take some losses first to see who doesn’t vote for the legislation that you want. Then you can then let them know, hey, we know you didn’t vote for this. And then, so there’s ways to get that message out to say we are representing physicians. And so in a situation like that, that does move the needle. Because they do know it’s like physicians are not, they realize that if a physician is not some executive that’s sitting behind a desk, that still just wants to make sure they’re making their million dollar golden parachute a year. They know this is a true physician that’s out there giving healthcare. That right there is what’s unique about the organization that you’re describing like with DocNation. Because it’s an organization of healthcare providers, physicians. And that’s where it’s different, and I think that that’s probably why it’s going to move the needle. When I was, there were three physicians sitting in front of the committee speaking and two administrators. And one uh, CEO of very very large insurance. The largest, just figure it out. And so the problem was, is that after a while I started realizing, man, I am really going back and forth with that person. And after a while, the members of the committee just got to the point were like, we heard from you, we know what your position is. I need to hear from this doctor. Well,at that point I knew, okay, you’re… I don’t care how much money you’re going to give this person, but did you just hear what she just said? And she’s a Democrat. You know Liberal Democrat actually.

JUSTIN: Is this recorded? Can we go back and watch this episode –  this scene? I want to go see this.

DR RICH: Uh yeah, they record them. Yeah. They record them, transcribed. They do. It just depends, depends on, lot of times the committee meetings in the middle of the summer are not recorded because a lot of people are on recess and they’re just trying to finish business that’s still there that’s on the plate. But I’m pretty sure it was recorded. But it was definitely, it was a mic drop moment. Like okay, I’ve heard from you, I and I’m ready to hear from this doctor.

JUSTIN: Good for you. Thanks for being there. Thanks for being there.

DR RICH: I pretty much. And I mean it was funny too because the guy, the physician sitting to my right, he’s like, oh man, you’re going to be out of network with them soon. It’s like, you know, I said, I said I’m going to tell you right now I’m already out of network with them … but I mean it’s just, it’s just, it’s one of the more difficult ones to deal with. They just don’t want to pay for anything anyway. So it didn’t matter. But I think the biggest take home message that I can tell every physician that may be listening right now, I don’t know who but, don’t worry about retaliation in this situation. Because at the end of the day, me just telling my story, when I started  being more vocal about it, I thought about that. I thought, oh man, this is not gonna be good. I’m gonna piss somebody off. But you telling your story about you trying to take care of your patient and why you’re trying to take care of your patient is always a winning strategy. And that’s the story that at the end of the day, you know, that’s one that a member of Congress cannot fight. It doesn’t matter how much money they’re getting, and they’re getting a lot, but they cannot fight it. They cannot fight it in public. They cannot fight at the ballot box and they cannot fight it in the public sphere. They just can’t. And I mean you still are a doctor taking care of patients. That’s more important. At the end of the day, then, the administrator that’s telling you how to try to practice medicine, and that’s the only strategy that I’ve seen at this point that wins regardless of the money.

NEIL: Doc the vote!

DR RICH: Yeah, that’s what it is. That’s really what it is.

REID: DocNation is going to work with Dr. Rich here to create, I don’t know, quarterly maybe, maybe biannually, cheat sheets to help you guys understand who to vote for. Or just put out this is what this is, what they represent. And it’s not going to be a red or a blue thing at all. It’s going to be in support of physicians and the freedom of medicine. Because when you are in support of the  physician and the freedom of medicine, you’re in support of the patient. I don’t know who wants to argue with that.  Who wants to argue with that publicly? That doesn’t look good.

DR RICH: I can tell you it’s not one that they’re not… that’s a fight that they’re not gonna… they’re not gonna fight. And that’s the point – the word is starting to get out that the drivers of costs and healthcare are not physicians.. That has always been something that a lot of physicians, I think, have been scared of, thinking, oh, it’s doctors trying to make more. That narrative is starting to fade. And I think, it’s like I said, things happen for a reason, I’ve always said that. I think COVID is what drove that because they started realizing how much money these consumers of healthcare were making off of COVID. And a lot of patients now are looking back and they’re like, you know, why do they make all that money, but you know. How did that help, you know, inspire remorse, so to speak, and I think they’re looking at the physicians that tried to deliver their healthcare and they realize that most doctors are truly just trying to take care of patients.

REID: Yep.

ANTHONY: I love this. This is great. We’re really excited to have you on Doctor Rich. Really excited to have more involved too with Doc Nation. I think you’re one of those linchpins that we’re going to need to take us to the next level. So I know we’ll talk more offline. And I hope everyone out there, the number one thing you can do is spread the message. You know we have some links that we put out there. Help us out, get the message out there, get your colleagues involved. Get ‘em on the next webinar. Get ‘em to send us an e-mail. We’ll talk to them. We set up meetings with almost everyone that sends us, you know sends us an e-mail team@docnation.com.

REID: Everybody. Yep, we’re at 100% so far. And so you know, we might not get the right day all the time because this is, it’s like the floodgates opening up. But I’ll write 100% meeting with everybody who inquires. Right now we have a bunch of questions. I know we didn’t get to those.

ANTHONY: Next month, I mean we do have to wrap it up for a little over over an hour, but this has been excellent. We’re going to hopefully be able to get some of this out there to LinkedIn to and get the message out there. I hope everyone out there shares this, but next month we’re having another Town Hall with the members. So that’s where everyone is on the screen and we talk together and that’s where really we’re strategizing on how to drive, kind of thread the needle of where DocNation gonna go. So I really urge everyone to sign up. Become a member so that you can be on the Town Hall and really give your insight, or at least see what other people are talking about during the Town Hall. I think Town Halls are huge. I mean, these webinars are great when there’s five of us up front. The Town Halls will have 30-40 people, maybe even this time if we allow that on the screen, and all trying to push in the same direction. It’s exciting to see, exciting to see how how much force we’re getting. I’m excited about it, I really am.

REID:  If there’s any questions about how to sign up or how to become a part of the Nation, feel free to shoot us an e-mail. We will get back to you in a very short order. Hey Dr. Rich I just want to say one thing –  just really grateful for the fact that you sit in a confident seat now. But you said three or four years you’ve been in politics and I’m guessing on day one you weren’t so confident in terms of…


REID: …do I need to look over my shoulder And so just really grateful for your courage to move forward and to uncover some real injustice that are ultimately costing people a life long amount of time of pain. You know I don’t want to go back into it, but I can’t stop thinking about how people have to choose between opioids and a procedure that could take away the opioids, right? That the pain meds could go away way down. And I think about another significant political issue, and that’s how 125,000 people overdosed on drugs last year in the United States. That’s another thing that I don’t think politicians are going to want to fight against – a public forum discussing that topic. So thank you for your courage and I appreciate you being a leader in every area of life. So have a good night and we’ll be in touch. Thanks so much

DR RICH. Alright! Thank you very much.

NEIL: Thank you for your service.

ANTHONY: Thank you.

JUSTIN: Thank you.

DR RICH: You’re welcome, Thank you.

REID: See ya.

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