Harry W Severance, MD’s Post

FTC - NON-COMPETES Delayed ----As PREDICTED - from my previous post-  https://lnkd.in/e44bSpTa - there are now multiple court actions and lawsuits attempting to block enforcement of the recent FTC ban on non-compete clauses.   In the article from the firm of Holland & Knight LLP - the authors (David Santeusanio, Bryan Neal, Sara Schretenthaler Staha, Howard Sokol, Jasmine M. Tobias), first analyze a Texas district court order of Wednesday July 3rd (Ryan LLC v. Federal Trade Commission) - then discuss several other pending actions against the non-compete ruling.   MY TAKE: In HEALTHCARE - For doctors and other practitioners subject to non-compete clauses - who are trapped in abusive and toxic workplace conditions (conditions promoted by these non-compete clauses) - now with no way out except to LEAVE a city and possibly the State in which you and your family reside and have become firmly established and connected  - and MOVE to a distant local, thus profoundly DISRUPTING your financial stability, and disrupting the life, connections and relationships  you, your spouse, your children  have established throughout your living system.   Managements know this well - and uses this as leverage to keep you from leaving – as well as not feeling any need to improve abusive healthcare workplace conditions.     – Thus, such delays and a possible cancelling of the FTC’ non-compete ruling - ALLOW these non-compete-promoted healthcare workplace ABUSES to continue unchecked - further contributing to healthcare system workplace failures and sub-optimal patient outcomes. #toxicworkplace, #burnout, #healthcareworkers, #moralinjury, #doctors, American Medical Association American College of Emergency Physicians Tennessee Medical Association Gillian Schmitz Aisha Terry (formerly Liferidge) Alison Haddock, MD, FACEP Jonathan Fisher, MD, MPH Samuel A.A. Levine Lesley Fair Rahul Rao Tara Isa Koslov Lina Khan Doug Chesson Tisha Titus, MD, MPH Leon C. Adelman, MD, MBA, FACEP, FAAEM Adriana Alvarez Melissa Rudy Erika Edwards Aja Whitaker-Moore Kelley Kramer Katie Johnston Michael Arroyo Peter Stavros David Whitestone Chadd Kraus Aria Bendix Joseph Choi Ryan Stanton Sarah Owermohle Deidre McPhillips Erin Schumaker Linda Restrepo Linda Lawrence Susan Morse

Most Doctors Are Looking for a Change - Many are Leaving Healthcare! In this fact filled Doximity-posted article by Abraham Kim, he provides data points, charts/graphs and commentaries-interviews highlighting many areas of disruption and crisis within our healthcare workplaces and - thus why increasing numbers of doctors (as well as other healthcare workers) are thinking of or continuing to leave clinical healthcare altogether.   My Take: The numbers of physicians and other healthcare workers leaving clinical care (as I have previously reported) are both astounding and deeply troubling (20% of all U.S. healthcare workers in the last 2-3 years, including 10% of doctors in one year alone - 2021).   But, the most critical departure – for the FUTURE of CLINICAL CARE - is with our bright young minds. As I previously reported, in a recent survey, almost 25% of medical students report they plan on quitting - and 61% of medical and nursing students report that though they will complete their degree program, they are going into NON-patient care careers.   Until and unless we come together and FIX the disruptive and increasingly deplorable conditions in many of our nation’s healthcare workplaces - our healthcare system will continue to erode! American Medical Association American Hospital Association American College of Emergency Physicians Tennessee Medical Association Tait Shanafelt Colin West Rebecca Pengilly   DOUGLAS LINDSAY SHEPARD  Aja Whitaker-Moore Larry Beresford Donna Brazile Linda Lawrence Linda Restrepo Jesse Ehrenfeld MD MPH Katie Johnston Peter Stavros Chadd Kraus Tara Morrison, CAE, CMP Lara Vanyo Aria Bendix Sarah Owermohle Mitch Kayle RN, PHN #burnout #workforce #healthcareworkforce #moralinjury #toxicworkplace

Healthcare Workforce Carisis - Mandatory Staffing Ratios Won't help - IF there are NO workers to fill the slots! In this Axios article by Caitlin Owens, she reviews some of the issues causing doctors and nurses to continue to EXIT healthcare (or UNIONIZE), and how resultant exit-related understaffing is increasingly undercutting patient care delivery and safety. She goes on to discuss the concept of mandatory staffing rations.   My Take: ·    Over 20% of all U.S. healthcare worker left healthcare in the last 2-3 years.   ·    10% of practicing U.S. physicians quit in one year alone (2021)   ·    Almost 25% of surveyed current medical students say that they plan to quit and 61% of medical and nursing students say that they will complete their degree programs - but will NOT see patients.   ·    A vast majority of all health workers report that the various unaddressed aspects of their disrupted, toxic workplaces - violence and assaults, impossible-to-complete workloads, oppositional goals between workers and management (suits vs scrubs), and multiple other factors, have created these conditions that have caused and are continuing to cause workers to increasingly abandon healthcare.   THUS - this article-discussed “staffing ratios” mandates will be of no value – IF there are NO workers to fill these “mandated” positions.   Until the underlying DISRUPTIVE condtions in our nation’s healthcare workplaces are addressed - condtions will just continue to WORSEN - as more and more workers leave healthcare.     I thumbnail 18 of these critical disruptors:   Link – part 1 - https://lnkd.in/ex_wBN6j   Link -part 2 - https://lnkd.in/eNaCR8gz American Medical Association Tennessee Medical Association American College of Emergency Physicians U.S. Senate Committee on Health, Education, Labor, & Pensions Donna Brazile Lynn Cook Bowen Garrett Jeffrey Lyles Kelley Kramer Katie Johnston Peter Stavros Larry Beresford Erika Thomas Mitch Kayle RN, PHN Margaret Maddox Nalani Tarrant PMP, MPH Gillian Schmitz Michael Arroyo Lara Vanyo Rita Manfredi Herman McKenzie Aria Bendix Linda Restrepo Linda Lawrence Jesse Ehrenfeld MD MPH Larry Bucshon, M.D. Sarah Owermohle Lee Katherine Moore, MD FACEP Aja Whitaker-Moorev Alison Snyder Mike Allen Peter Sullivan Victoria Knight Erin Brodwin Bill Siwicki

Why is the US still in such Poor Health, Despite its Wealth? "A decade ago, a study showed that the US had the lowest life expectancy among high-income countries. Why are things still getting worse?"      In this New Scientist article by Laudan (Laudy) Aron, a senior fellow in the Health Policy Center at the Urban Institute - she revisits a question she initially posed, researched and first published over 10 years ago – NOW noting that, during this interval, things have continued to worsen. She focuses on even lower life expectancy and continued worsening of chronic diseases in the U.S. as compared to peer countries, progressive additional worsening in child and adolescent wellbeing again comparing to peer countries - AND one of, if not the MOST complicated system of health care insurance among all peer counties worldwide – making access to adequate baseline ongoing healthcare economically impossible for MANY tens of millions of Americans – as compared to ALL other peer countries.   MY TAKE: These VITAL issues are sadly but a FEW of the MANY CRITICAL disrupting problems impacting our current U.S. healthcare system - reducing the quality of U.S. healthcare to our health, our lives & longevity, our children’s future, our patients and families – all suffering the full impact of these mounting deficits! This list of disruptors includes: 1. World’s MOST expensive healthcare – but – quality ranked as ‘poor’! 2. WORST health outcomes among high-income countries – decreased access to timely effective healthcare: 3. Prescription drug prices continue to rise – reduced availabilities accelerate – compared to peer countries. 4. Disintegrating conditions within our healthcare workplaces – increasing oppositional attitudes – accelerated worker departures: 5. “Moral Injury” – An increasing thereat to clinical healthcare workers – and to patients: 6. Violence, abuse, & assaults – rising physical dangers in the healthcare clinical workplace: 7. The Specter of the Toxic, Abusive, Unsafe Workplace – The Responsive Rise of Unionization : 9. Impossible-to-Complete healthcare workloads: 11. Hospital Bed Availability/ Overcrowding Crisis/Reductions in Services (Boarding).   And the list goes on.   To see this full list - you can review a thumbnailed breakdown of 18 of these critical disruptors - along with over 116 references to allow deeper dives into each topic - in my 2-part publication - first released in Emergency Physicians Monthly magazine. Part 1 – https://lnkd.in/ex_wBN6j Part 2 – https://lnkd.in/eNaCR8gz American Medical Association American Hospital Association American College of Emergency Physicians Tennessee Medical Association U.S. Senate Committee on Health, Education, Labor, & Pensions Catherine de Lange Sophie Bushwick Molly Glick Leah Crane Daniel Cossins Sarah Rosen Wartell Kimberlyn Leary Mary Kate Cunningham, CAE Larry Beresford

Physicians celebrate their release from non-compete restrictive clauses – NOT SO FAST! Many physician groups celebrated the FTC 'final' ruing that would invalidate non-compete clauses from many physician contracts! However: 1. FYI: Not ALL physicians are reported to be covered by this ruling – such as those working for “non-profit” hospitals, namy working for “safety net’ or other government related facilities, and possibly many physicians classed as “independent contractors”?   2. In this Seyfarth Shaw LLP article, authors Jesse Coleman, Daniel Hart, and Eron Reid, note some of the legal challenges now emerging. It is possible that some higher court may attempt to postpone application of this new ruling - until these challenges are addressed.   Meanwhile., physicians continue to suffer the abuses caused by these clauses!   FYI: FTC has announced that there will be an upcoming online Zoom briefing on Friday May 31st, to provide an overview of this final rule, and its impact on healthcare. Link -  https://lnkd.in/eajSN8AH           American Medical Association American Hospital Association American College of Emergency Physicians Tennessee Medical Association U.S. Senate Committee on Health, Education, Labor, & Pensions https://lnkd.in/eyJ2Un-5

CLINICAL NURSING CAREERS????? In this LinkedIn article by Beth Kutscher - she notes that there is increased interest in INITIAL entry into nursing - and, certainly, with a nationwide shortage of nurses, there is a strong suggestion of job security - as opportunities abound nationwide for filling these open positions.   As nursing is another healthcare “sellers” market - due to these expanding shortfalls – there are also increasing salary opportunities in various markets. - Related REF -https://lnkd.in/gB_TMtrT |   However, though I am not a nurse, what I am seeing from my nursing colleagues is EVOLVING disenchantment - OVER TIME - by those who have been performing ‘hands-on’ clinical care within their difficult workplaces - and increasing moves by more and more, to then leave the CLINICAL workforce.   In addition, recent surveys of medical and nursing students report that 61% of current medical and nursing students report that they will finish their degree programs - but will NOT enter into active patient care, choosing instead to go into non-patient care fields such as research, administration, etc. - REF = https://lnkd.in/eGGmqCpC .  American Nurses Association American Medical Association American College of Emergency Physicians Tennessee Medical Association Mitch Kayle RN, PHN Kelley Kramer Katie Johnston Michael Arroyo Peter Stavros Louise B Andrew MD JD FIFEM (MD Mentor) Shannon Firth Mel Cortez

“Only 40% of physicians recommend a career in medicine. What reforms are needed to abate this?” In this Becker's Healthcare ASC article, Patsy Newitt posed this question and received over 20 physician responses. From the tone of these responses, it should not be surprising that - now over 20% of workers have left healthcare in the past 2 to 3 years, and 10% of all practicing physicians quit in one year alone (2021). We now also hear that almost 25% of surveyed current medical students are wanting to quit, and 61% of surveyed medical and nursing students say that they will finish their degrees - but are going into NON-patient care careers.  https://lnkd.in/ebEhhs68 We also hear that interest in “pre-med” interest groups may be waning.  https://lnkd.in/esvysVXk   At a time when our healthcare system critically needs MORE doctors, midlevel’s’ and nurses - this waning interest in ‘hands-on’ healthcare is a disastrous scenario.   These attritions are likely to continue and accelerate until healthcare workplace conditions are improved.   There are multiple disruptors plaguing our nation’s healthcare workplaces and systems that need to be tackled. Links - https://lnkd.in/ex_wBN6j - https://lnkd.in/eNaCR8gz   But little is being done by our leaders to address these issues.   Will UNIONIZATION – being driven by this sad scenario - play a role in forcing workplace improvements - or just make the system worse?   I will be speaking on this topic at an upcoming national medical conference in October in Las Vegas. – Conference LINK = https://lnkd.in/eb7jx-sp American Medical Association American Hospital Association American College of Emergency Physicians Tennessee Medical Association U.S. Senate Committee on Health, Education, Labor, & Pensions Michael Arroyo Peter Stavros Chadd Kraus Jesse Pines Aria Bendix Ryan Stanton Molly Gamble Deidre McPhillips Alison Haddock, MD, FACEP Heather Landi Wendy Dean, MD Tisha Titus, MD, MPH Louise B Andrew MD JD FIFEM (MD Mentor) Shannon Firth Erika Thomas Hannah Miao Linda Lawrence Linda Restrepo James Dugal MD Edwin Leap Mitch Kayle RN, PHN Roneet Lev Nari (Nariman) Heshmati MD, MBA, FACOG Tara Morrison, CAE, CMP Shamie Das, MD, MBA, MPH, FACEP John Sy Mackenzie Bean

On one of my visits to DC Capitol Hill, I received some "counseling" by a DC politician (I won't say House or Senate - as this was 'off the record') that he firmly believes that one of the biggest problems in medical and nursing schools today is that TOUGHNESS is NOT being taught - like it was when he was in the military. He goes on to say that today's healthcare environment 'is what it is' - and that healthcare workers - JUST NEED TO GET USED TO IT!!!!!!

Physician-Owned Hospitals versus Corporate Healthcare - Is That the Real Question? This Medscape article by Charlotte Huff discusses existing Federal regulations essentially banning physician-owned hospitals - and new legislative proposals (H.R. 977/S. 470) to lift some of those bans.   This article notes that available reports, analyses, and debaters on f this issue are conflicted on whether physician-run hospitals improve patient outcomes - or just “cherry pick” optimal patients, increase or reduce competition or costs, and improve rural healthcare?   MY TAKE: What SHOULD be looked at - the OTHER SIDE of the equation: What happens when you REMOVE all clinically-practicing doctors and nurses from hospital management decision making groups = totally NON-physician-run hospitals? - Studies should look at similar outcomes analyses from Corporate Healthcare Systems where CLINICALLY PRACTICING doctors and nurses have been progressively and purposefully ELIMINATED (citing conflicts of interest) from senior decision-making boards and policy groups. Link - https://lnkd.in/e35CQxDx FYI: current Federal mandates including Stark Laws, Anti-Kickback Statutes, the Affordable Care Act - all support this corporate mantra of Doctor/Nurse conflict of interest!   I think we would find that – in such corporate situations (now increasingly dominating healthcare) where these major decision-making boards are now made up of and recruited from successful “Captains of Industry” with no clinical backgrounds - and with their focus entirely on profit (what they were recruited for) and with no clinically practicing physician/nurse input= no conscience – that patient outcomes and other measures the article mentions -are worse, healthcare workplaces are more turbulent, violent and increasingly in disarray, more doctors and nurses are quitting healthcare.    – BUT - profits are up. U.S. Senate Committee on Health, Education, Labor, & Pensions American Medical Association American College of Emergency Physicians Tennessee Medical Association Paige Haeffele Michael Arroyo Peter Stavros Chadd Kraus Noah Tong Aria Bendix Joseph Choi Ryan Stanton Molly Gamble Susanna Vogel Molly Fredriksson Deidre McPhillips Gabe Kelen, Erin Schumaker Alison Haddock, MD, FACEP Susan Morse Heather Landi Steven Ross Johnson Ben Leonard Amy Feldman C. Scott Franklin Claire Sandström Christina Jewett Jesse Ehrenfeld MD MPH Kevin Hern Larry Bucshon, M.D. Samantha Koehler Linda Restrepo Linda Lawrence Tisha Titus, MD, MPH Jonathan Fisher, MD, MPH Leon C. Adelman, MD, MBA, FACEP, FAAEM Shannon Firth Hannah Miao

Artificial Intelligence could actually INCREASE Healthcare Workloads - researchers say! In this Fox News Media article by Angelica Stabile, she focuses on three separate research studies suggesting that adoption of generative AI may have some unanticipated negative effects in healthcare - including false information generation, possible HARM to patients, workload increases, all leading to further burnout by healthcare workers?   MY TAKE: A reminder – Electronic Medical Record systems (EMR’s) were THOUGHT by SO MANY to be such an n OBVIOUS panacea for the host of problems in clinical workplaces, that they were brought forward – by Federal Mandate to all healthcare systems – without any preparatory large-scale, time-driven trials to see what cumulative effects they might have on clinical environments - and what unintended consequences might evolve over time.   EMR’s did correct many of the issues they were designed to address.   But - we have also seen the unintended results of this “rush to judgement” – how EMR’s have profoundly increased workloads, led to medical documentation errors, and significantly slowed down patient care and throughput - often in unanticipated ways. All this contributing significantly to healthcare burnout.   Now there is a push for adoption of AI in healthcare workplaces. But the research results noted in this article suggest that AI might also bring unintended consequences - if allowed to be instituted rapidly and in a similar overbearing, unchecked, unresearched fashion.   Many of the mistakes made by AI systems will be improved over time – but who remains responsible for decisions made and supervision of these AI systems. Will they be allowed to self-supervise and be held independently liable for their mistakes made – if harm is caused? I doubt it. Thus = increased workloads = increased burnout – for the near future.   I remain optimistic about the future of AI - but I encourage study of and caution in the implementation of such systems in healthcare and other workplaces! American Medical Association American Hospital Association American College of Emergency Physicians Tennessee Medical Association U.S. Senate Committee on Health, Education, Labor, & Pensions David Atashroo Linda Restrepo Joseph Choi Ryan Stanton Sarah Owermohle Laura (Miller) Dyrda Molly Gamble Deidre McPhillips Erin Schumaker Mark E Green MD Chelsea Torres Amy Feldman C. Scott Franklin Claire Sandström Tanner Cox Kevin Hern Ryan McBride Ge Bai Larry Bucshon, M.D. Samantha Koehler Shannon Firth Hannah Miao Michael Arroyo Robert Pearl, M.D. Katie Johnston https://lnkd.in/ecuZy7tB