Podcast #21: Are Physicians at the Table—Or on the Menu? Dr. Michael DellaVecchia on the Future of Medicine

Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professionals to reclaim control over health care decisions and advocating for their fair share of the industry’s resources. Please note the views expressed are those of DocNation and not necessarily those of our guest or reference health centers. Today, we have a truly remarkable guest joining us, Dr. Michael DellaVecchia.

If we were to list every accomplishment that he’s achieved, we might need an extra episode. Dr. DellaVecchia is a physician, surgeon, researcher, professor, and innovator with expertise spanning ophthalmology, pathology, biomedical engineering, and even aerospace medicine. He’s held leadership roles in multiple medical societies, advised NASA, worked on cutting-edge medical technologies, and has been at the forefront of health care policy advocacy.

But beyond the titles and accolades, Dr. DellaVecchia is someone deeply committed to advancing patient care, medical education, and the future of physician leadership. He’s a former president of the Philadelphia County Medical Society and has been instrumental in shaping resolutions on everything from contract transparency for physicians to public health initiatives. We’re honored to have him with us today to share his insights on the evolving landscape of medicine, the challenges facing physicians, and what needs to change for the future of health care.

Dr. Michael DellaVecchia
Thank you. Happy to be on board.

Justin Nabity
So tell us about what are some of the things you’re seeing right now within the health care landscape, and what are some things you’re working on?

Dr. Michael DellaVecchia
Well, within the healthcare landscape, it’s very dynamic and it’s going in a lot of different directions. As we all know, as physicians, you have the medical-legal aspect, which in the Pennsylvania area is really tragic and totally unremarkable. You have the reimbursement aspect, which is related to the federal government but also the corporate practice of medicine.

And you also have the corporatization of medicine. So these are all major things that the practicing physician has to face. And on top of that, we have these two magical letters circling above called AI, or artificial intelligence. Personally, I think that’s going to be probably the biggest shake-up in medicine. Being a researcher and a techie, I kind of see the potential with this.

It can be an aspect that greatly helps with the care of patients, but if it’s not limited and controlled and directed in the right way, the forces that are initiating artificial intelligence will eventually finish the takeover of medicine. I think that will be our worst scope of practice issue. It won’t be the lower-level practitioners. It will indeed be artificial intelligence.

Justin Nabity
You said it’ll be the worst what?

Dr. Michael DellaVecchia
Scope of practice issues. You know, doctors are worried about physician assistants, nurse practitioners, and so on. But I think competing against the computer, which has certain advantages, will be something that supplants a lot of the actions of doctors.

Reid Lancaster
Michael, when you say “the computer,” are you talking about AI?

Dr. Michael DellaVecchia
Yes.

Reid Lancaster
Yeah. Okay. Robots. AI.

Dr. Michael DellaVecchia
Robots also. That’s part of the advanced technology. When I was president of the Pennsylvania Medical Society, my initiative was Advanced Technologies in Medicine. We spoke a lot about that, going back about five or six years ago. Robotics, sensors that will be applied directly by the patient—probably through your cell phone, which we’re already seeing.

They can take pictures of things and, with data analysis and image analysis, do things that the doctor, in fact, cannot do. I can look at a lesion, but I can’t measure it within millimeters for noticeable change. I can look at a lesion with my eyes, but I can’t examine it with different spectrums of light, which gives me more and more information.

And on the other side, robotics are becoming more and more refined. It’s not just extension robotics. I used to think ophthalmology surgery or microsurgery might have been too refined to be done by a robot. But lo and behold, there is a robot out there that’s learning how to do cataract surgery.

So how do you compete against this in the future? That’s why I say it’s a great scope of practice issue. Robots don’t show up late, don’t worry about the snow on the way in.

Justin Nabity
Yep.

Dr. Michael DellaVecchia
They don’t take vacations. They work 24 hours a day. Some of them even work in total darkness.

Reid Lancaster
They don’t eat. They don’t sleep.

Dr. Michael DellaVecchia
That’s right. They don’t go on strike.

Reid Lancaster
They don’t go on strike. They’re typically a one-time payment. Michael, I have a question. When we talk about AI, no matter the sector, there’s always a sense of anxiety and fear. People worry, “There’s a loss for me—what is it?” What is the net negative for physicians? And also, what is the net positive? Because some people see AI and robotics as exciting, while others are more concerned.

Dr. Michael DellaVecchia
That’s true. And I think it’s a basic fear of the unknown. If I tell you, “Hey, I’m going to replace you with a machine that can do things better than you,” after you’ve spent decades of education and hundreds of thousands of dollars, that’s a scary thought.

The biggest potential upside of AI is data analysis. AI can take a patient’s genetic profile, environmental exposure, every medicine they’ve ever taken, and cross-reference all that information in milliseconds. No human doctor can do that. That could be an advancement. But the question is, who controls that data?

There are real ethical concerns here. If AI determines a patient is too old or too high-risk for an intervention, it won’t say, “You can’t have it.” It’ll simply say, “We won’t pay for it.” That’s the problem.

Doctors need to decide: Are you going to have a seat at the table, or are you going to be on the menu? That determines your advocacy. This isn’t just about us as physicians—it’s about the ethical, moral future of healthcare.

Justin Nabity
I think we should adopt that as a DocNation slogan.

Reid Lancaster
Yeah, we’re taking that.

Justin Nabity
We might steal that from you.

Dr. Michael DellaVecchia
You’re welcome to it.

Reid Lancaster
Michael, I want to drill down on something you said earlier. You were drawing a correlation between medicine and your semi-pro days. You have three athletes on the screen, and we played high-level sports. We looked around at one point, and I’ve said this multiple times on our podcast, so you really struck a chord with me.

And it’s like we’re looking around, we’re getting paid to throw a ball and making more than physicians. And it’s just a really kind of uniquely odd situation. In basically no other country do you see that? I mean, I know soccer’s big all over the world, but you don’t see that level of disparity. Can you talk a little bit more about that?

Dr. Michael DellaVecchia
I think it’s somehow what was presented to the populace. Before we came on, I had the TV on, and they’re talking about the Super Bowl—go Eagles or whoever you root for. And people are paying $7,000 for a ticket.

Reid Lancaster
Yeah.

Dr. Michael DellaVecchia
And I grew up quite poor. My mother and father only went to the fourth grade.

Okay. My father, at his best earning income annually, was $12,000.

Reid Lancaster
What year was that? Approximately.

Dr. Michael DellaVecchia
That was at his highlight, probably going back to the 80s.

Reid Lancaster
Wow.

Justin Nabity
80s.

Reid Lancaster
Thank you for sharing that with us.

Dr. Michael DellaVecchia
Yeah. Mom was insane. I don’t know how she managed the family, and Dad worked like a dog. You know, they were both pulled out of the fourth grade to go to work full time. And actually, I found out he worked before they went to school—sent out to the farms to pick tomatoes.

And Mom used to go around the neighborhood with a little wagon to collect clothing to clean and repair for my grandmother and bring them back. In the fourth grade, they were pulled out to go into full-time employment. It was really tough for them. I don’t know how they made it. My dad worked his whole life and served the country very well in World War II.

He never talked about it, but he was on the Normandy beach and followed up in the Battle of the Bulge.

Reid Lancaster
Woah.

Dr. Michael DellaVecchia
How he survived and how I got here, I’ll never know. But, you know, that’s part of it. What brings people today—who are what we would call median income—to say, “I’m going to come up with $2,000 to walk into a stadium and stand” or “$7,000 and go to the Super Bowl?”

And then, when they go to their doctor, this same person will say, “Doc, what can you do on this co-pay? I’m a little short. I don’t have the $5 or $10.”

So I think there’s a different value system, and it’s part of the image. We don’t really have star athletes anymore—we have demigods. These people are at such a level.

Reid Lancaster
That’s right.

Dr. Michael DellaVecchia
And their salaries—like Tom Brady. I think in my heyday, I probably threw the ball as good as he did, but he just signed for 300-something million dollars to be a TV commentator.

Reid Lancaster
Yep.

Dr. Michael DellaVecchia
And look at the guy at the top with the Dodgers.

Reid Lancaster
Shohei Ohtani.

Dr. Michael DellaVecchia
Yeah. 700-something million dollars. As a very successful physician, you will not make any fraction of that in your entire life. And these people are going to make more in a season than you made in your entire life.

So what is it about society that has that value system? One of the things I find depressing is the whole issue of the value of life deteriorating.

You know, and it has a lot of different aspects, such as war. When it has a different entry into society, we kind of overlook some things. We justify them. Let me ask you a basic question. Do you think World War II was a bad idea?

You’re hesitating.

The answer is yes. It was a very bad idea.

Reid Lancaster
Whoa, whoa, what was the question? Do I think it was a bad idea? I think any war is a bad idea on anybody’s behalf. Are you saying was it a bad idea for the United States to retaliate after we got attacked?

Dr. Michael DellaVecchia
For the United States? Yeah. Not the retaliation itself, but the bad part about it is millions of people lost their lives. The Americans lost approximately 410,000 lives during World War II, of which a little over 3,000 were civilian lives—maybe nurses, Red Cross people, and so forth.

Horrible figure, isn’t it?

Neil Dougherty
It’s horrible.

Dr. Michael DellaVecchia
Yeah. Well, guess what, gentlemen? Every year, the tobacco companies are responsible for at least that number of deaths in the United States, along with 1.2 million disabilities, chronic lung diseases, other cancers, and so forth.

Same equivalent loss of lives. But I don’t see us going after the tobacco companies or the social issue of smoking.

Justin Nabity
True.

Dr. Michael DellaVecchia
The same way that we look at World War II. And one of the reasons is a lot of people are making a lot of money off of that.

Justin Nabity
Yeah, it’s all about dollars. It’s all about the economics.

Dr. Michael DellaVecchia
Right. And a lot of people with that money know what to do with the social aspect in advertisements.

Reid Lancaster
Right.

Dr. Michael DellaVecchia
You know, when you were growing up as teenagers, you wanted to be a tough guy like the Marlboro Man. If you were a young teenage girl, you wanted to look like the young diva, you know, when you smoked.

So there’s a certain amount of social attitude that has to change. That’s one of the bad things. I don’t think we’re going to be a totally pure society—we need a little variety—but let’s not be harmful in that effect.

To say you can wipe out 400,000 deaths and another million of morbidity in the United States—how much money would that possibly save? What is that human life worth?

Is it worth 20 or 30 years cut short, tethered to an oxygen hose? These are all valid questions, and they have a financial association, too. But this is never brought into the issue.

Justin Nabity
I’m glad you bring this up because this is where the politics comes into play. Because how much leadership is being shared even in like the school system. It used to be back in JFK days, there was this school called a la Sierra High School. If you go look it up, you see elite warriors that are equipped, men and women going through the program, and they had different colored shorts that they would wear to that they get different colors based on advancing kinda like in martial arts, we get different colored belts.

Justin Nabity
And there was an emphasis on physical strength and taking care of yourself on a, on a nutrition level, all these different factors. And it’s like all that has gone away. And it’s just like, like you said, society and culture is missing the mark on really valuing life and and promoting attributes and and virtues and things that are all about valuing life.

Justin Nabity
And so I want to go back to what you said up before about the eye piece. And we’ve been we’ve traveled the world helping with teams do cataract surgery. And I see the blind get their sight restored. There was a 102 year old man who got his sight. He was fully not able to see in both eyes got his vision restored.

Justin Nabity
And he sang a praise song in just complete emotional thanksgiving for having his vision restored. His eighty year old son was walking him up the mountain. This is in Africa, and so we’ve been around the world in various places as a part of these teams. And one of the things that we’ve learned through ophthalmology is that, you’ve got this struggle between who can do what.

Justin Nabity
Optometrist versus ophthalmologist and I’m hearing you say that that’s almost like the small potatoes. The big potatoes. Is this AI machine underway. And if 75% of doctors are now employed and corporate medicine is taking over and we’re not at the table, we’re getting…you’re on the menu and not at the table like we have an opportunity here, I think, in this decade, to do something for doctors to get back in charge of decision making and to be at that table.

Justin Nabity
So tell us about that. As far as what you’ve seen in some of these ophthalmologists, optometrists side of things, same thing with NPs getting more authority and and having clout in health care. How is that how are you seeing that as like a precursor to what’s coming that’s even bigger on the AI side?

Dr. Michael DellaVecchia
Well, what I see, personally, I did a lot of missionary work. I do a lot of volunteer work with the veterans now. And they’re, you know, men that literally live, and women, that risked life and limb come back, you know, and peace is disabled. And the mental aspect is crazy. And I don’t think we’re still taking care of them the way we should.

Dr. Michael DellaVecchia
But to get back to your question, the bottom line is the we use the word curing or treatment of disease. And personally, I don’t care who does. You know, you know, there is some legislation. But the bottom line, I think that we all have to realize is you want the most capable educated person at that point of taking care of people, whether you say they’re a medical doctor, doctor of osteopathy, an optometrist, a physician’s assistant, I think really at the end point matters, but maybe not to the degree that some of the political situation say it and, we don’t want to get into it.

Dr. Michael DellaVecchia
But, I ran a tertiary high emergency room at one of the academic hospitals, and we would see a lot of I don’t want to use the word mistakes, but a lot of things that came in at the end point when things went wrong and we already had treatment that should be avoided. Okay. But if we have a robot that I could take with me and Project Corpus again and go down to the the outback of Africa, where we actually had to bring our own energy system, there was no electricity there, so we sort.

Reid Lancaster
So did we!

Dr. Michael DellaVecchia
You know,

Justin Nabity
Generators,

Dr. Michael DellaVecchia
which was teaching some technicians how to do the cataract surgery. There was one lady that was technically a quote unquote, witch doctor. But, you know, after doing a couple hundred of cases and, and proper instruction, she could do cataract surgery and do it adequately and delivered a level of care that was nonexistent there. Hopefully robotics will be able to supplant that, you know, for all the reasons we just talked about.

Reid Lancaster
Yeah.

Dr. Michael DellaVecchia
But the bottom line is somebody owns that robot, somebody developed that robot, and somebody wants some sort of renumeration for those efforts. Even beyond that, they may want control of that. So the robot may be nice, may be sophisticated, but may be going to the highest bidder. We’ve seen that with laser surgery. You know, it wasn’t available anywhere.

Dr. Michael DellaVecchia
And then it became available. And they went right away to where the best marketplace was. You know, I don’t want to see health care to be a matter of marketplace. I want it to be seen as a matter of elevating the extension and the quality of life. Soif we could focus on that, I think, can we we know what the real note is in the symphony of taking care of people.

Dr. Michael DellaVecchia
So I’m hoping that the directive will be more in that direction. Justin to answer your question, will it be I don’t know. We’ve seen what happened in the past marketplaces, you know, so hopefully it will work that way.

Reid Lancaster
Michael, what can physicians do to be, have a seat at the table and not be on the menu in terms of AI and their contribution to AI.

Dr. Michael DellaVecchia
I think one of the things they have to do is get them off, get up off the seat, the seat that you’re on now, not at the table. And and be aware and have had, you know, your experience, even if you’re not a techie, you know, you look at the older premed guys, they were Latin major, they were botany majors and so forth.

Dr. Michael DellaVecchia
And that’s what won in the med school, you know, being on some med school committees, I used to say to the committee, give me scientist, give me engineers, give me people that are in the humanities too. But I think we’ve got to look at the deployment and the advancement of medicine, and that, for the most part, is going to be made by doctors who work with the scientists.

Dr. Michael DellaVecchia
I think if you look back at the advancements of medicines, you know, catheters, radiology, microscopy, they were all from the outside sources, scientists that were brought in, and they were adapted to focus on medicine. So I think Reid, that’s what we need the doctors to work as a group. If you say I’m old.,I’m not a techie.

Dr. Michael DellaVecchia
You have a lot of experience. You know what the problems are. You know what the solutions are. May not have the modality, but some scientist somewhere may, work with that. That’s great. You know what, I mean, I can’t imagine, doing brain surgery 80 years ago before, you know, 100 years ago, working without radiology or MRI, knowing where are you going to bang in the skull with, you know, it’s it’s almost Frankenstein like.

Dr. Michael DellaVecchia
Yeah. When you look at the equations today and when you look at some of the advancements today, you know, and talk to a physician of only like 30 years ago, it’s not science. It’s almost magical. But let’s proceed in that direction. I mean, and and you don’t know where the answer is going to lie, gentlemen. I mean, if I went up to you and say, hey, you know what?

Dr. Michael DellaVecchia
Give me $1 million, I want I want to study moldy bread. And you say, why, it’s moldy. Throw it the hell out.

Justin Nabity
Yeah,

Dr. Michael DellaVecchia
Here’s a buck to get a new loaf. And then in the course of studying moldy bread, I developed these things called antibiotics. I saved millions of lives. I saved millions of people of a lot of devastating residuals from those interactions, you know, so we don’t know where the true answers are going to lie.

Dr. Michael DellaVecchia
But we know what the true questions are, and we hope we can direct our efforts to providing those answers. And I think with AI, with robotics, with the advancement of medicine in general, you know, we can, establish a quantum leap, which we never had before, along with the education of medicine. One of the things I think about is that, you know, the residents I teach routinely tell me that there are $400,000 to $500,000 in debt.

Dr. Michael DellaVecchia
And, you know, if you talk to somebody like my father, who never made that his entire life, that’s a lot of money. And it’s still is a lot of money now. But what do we do with AI and the media? Just the only education I know, going from physics and math and to med school, I was horrified when I said, you know, this isn’t learning. I’m sitting on my butt trying to stay awake for eight hours in class and I’m going home.

Dr. Michael DellaVecchia
And I had volumes of things just to memorize. And to spit back during a test. Yeah. So suppose we step back. Suppose we made those two years of medical school full on the internet. We have. You can take it and analyze it any time of day that you want. You can go back if you’re studying the foot…

Dr. Michael DellaVecchia
You got a question about the big toe. There’s all these links. They answer those questions and have a good in-depth testing. So look at the expense that you do away with and the education and individual, but also look at the quality of education that you’re bringing up. You know, a lot of people can have access to that. And that’s really not all that innovative.

Dr. Michael DellaVecchia
You know, you have all these online universities, quote unquote. And I have to admit in in the beginning, I really had my doubts about them and they were questionable. But now you have graduate courses at, you know, renowned institutions or I mean, you know, I’m a bachelor home alone at night, you know, I get bored with TV, but if you go on YouTube, you know, Stanford has a YouTube channel, Harvard has a YouTube channel.

Dr. Michael DellaVecchia
Johns Hopkins, Caltech. I took most of the graduate courses in optics, didn’t pay a penny. They were available in MIT. Now, it took me a few years to get through them, but I would never have the opportunity to learn that and advance my field if that wasn’t accessible to me. At this stage, my education with, you know, two doctorate degrees and three residencies.

Dr. Michael DellaVecchia
Do I need another certificate on the wall that’s going to cost me $100,000 to get it. I don’t think so. And I won’t be doing it. I need the knowledge.

Justin Nabity
Yeah.

Dr. Michael DellaVecchia
And that opportunity gave it to me. And hopefully I can apply that knowledge, advance the field and have a for me, a much more satisfying position in life.

Justin Nabity
I appreciate your focus on the value of human life. I feel like that’s been a theme throughout everything you’ve shared with us and specifically with AI. Like if AI is programed a certain way to make decisions, how is it going to decide and who’s deciding what it should be thinking or or how it should be approaching things. And patients need access to care.

Justin Nabity
And you mentioned it doesn’t really matter at the end of the day if they’re getting the care they should be getting and it’s good care, it’s not care coming in with mistakes and issues and things that, you know, it’s it’s a team approach. And so I appreciate your perspective on that. That’s very much patient oriented. It fits so well with what you’ve done up up to now.

Justin Nabity
All these years. And, we appreciate you being on the show with us. And look forward to continuing the conversation.

Dr. Michael DellaVecchia
Be happy to. And I really have to admire you for your effort at DocNation, to have the, the media that you have and really fulfilling a need that wasn’t fulfilled before. You know, I think, the doctors should work with you. We should all go forward. And I think it will be better for humanity. And that’s that’s the bottom line.

Reid Lancaster
Thank you, Michael. Appreciate your time.

Dr. Michael DellaVecchia
Gentlemen. Thank you very much. You have a good day. Looking forward to working with you in the future.

Justin Nabity
This has been the DocNation podcast. If you like what you heard, be sure to subscribe, rate and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We’d also love to hear your thoughts and any topics you’d like us to cover in future episodes. Don’t forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind the scenes content, and to join the conversation. Thanks for listening.