43cc

Crozer was not an island, and what happened to them affects all the nearby health systems. In the fourth installment of this special series, we break down how one community's loss becomes a neighboring community's nightmare, lay out the ‘private equity playbook', and explore how the financialization of medicine is everywhere - in every state - and how it affects us all.

This is bigger than Crozer.  Just ask anyone from a neighboring hospital dealing with the fallout, or who is in another hospital similarly bought and bankrupted. Follow up this Thursday for more.

When health systems are underwater, you might want to look up upstream to see what the trouble is. When you get there, sometimes you'll find out why those systems are falling into the water. . . and sometimes you'll find out who's pushing them.  In this episode, we're going upstream to look at how we got to the point where a health system that served more than a hundred thousand people per year suddenly closed its doors, and what went wrong along the way.     Correction to an ealier version of the podcast: Michelle Henry was the PA Attorney General at the time she made her remarks featured in this episode, not at the time of the sale, as previsoulsy suggested.  A correction has been made.

A health system is gone.  How did they end up underwater . . . and who pushed them in?  Follow up this Thursday to find out.

The story of private equity in healthcare is often told in numbers, spreadsheets and transcripts from bankruptcy court. But in Part 2 of our series, we hear from the people in the trenches and on the front lines of Crozer Health, a collapsed hospital system in Pennsylvania, who are living out the awful consequences of decisions made, not by clinicians in Delaware County, but by executives in California and a judge in Texas.

You need to hear this while it's fresh and raw.  We'll have more on Thursday but, for now, here's what we heard late last week.

The Crozer Chester Medical Center in PA is closing as we speak, but the fall of Delaware County's largest hospital system has been building for years.  In interviews with the doctors, nurses, paramedics,  and legislators who kept Delaware County healthy, Wendy and Matt go behind the headlines and speak to the people who are living through these changes right now.  This is the first episode in a multi-part series focusing specifically on Crozer Health.  New episodes drop each week.

We're never more aware of the need for real human interaction than when faced with an automated Patient Portal.  In this special bonus ep., Wendy and Matt share a listener voice memo about the challenges of navigating patient care through AI, and talk about how we can - and must - do better.

The 'social architecture' of an organization can make or break meaningful connections between patients and physicians, and physicians and the administration.  In Part 2 of our two part series, Allison Pugh, a research professor of Sociology at Johns Hopkins University and author of The Last Human Job: The Work of Connecting in a Disconnected World joins us to talk about how we can foster connective labor within larger organizations, what happens when that connection fails, and where AI fits in to all of it.

There's a growing sense of disconnection in our lives, and a growing number of reasons why.  But instead of focusing on what's forcing us apart, we want to look at the work we can do to bring people together - and why it matters.  In Part 1 of a two part series, Allison Pugh, a research professor of Sociology at Johns Hopkins University and author of The Last Human Job: The Work of Connecting in a Disconnected World, joins us to talk about the art and science of the most important cognitive exercise you've likely never heard of: Connective Labor.

Lately, there's been a lot of talk – and fear – about violence against healthcare executives. Less talked about is the near doubling of violent incidents against healthcare workers. Well, we're going to talk about it. What's behind the violence? Who's involved? And, importantly, what can we do about it?   Need Support? Physician Support Line 1 (888) 409-0141 Other healthcare professionals: https://www.nami.org/your-journey/frontline-professionals/health-care-professionals/confidential-and-professional-support/

What happens when people are betrayed by the system they took an oath to protect? Tim Heaphy, lead investigator for the January 6 Committee, as well as the independent investigation into the 2017 riot in Charlottesville, VA, joins us us to talk about what these events reveal about preparing for (and protecting yourself from) moral injury within government systems, and what healthcare practitioners can learn from them.

Clinicians have agency, but leveraging it on our own behalf means knowing sh*t and owning it.  Matt and Wendy breakdown what you need to know on the practice side, and the business side, of medicine, and what it means to 'own it' as a physician.   To learn more about CME credits, go to 43ccpodcast.com/cme.

"Who Kicked the Keg?" is a bonus segment rounding up the news you need to know in the business of healthcare. Today's update is on the status of the FTC's rule on noncompete clauses, the latest healthcare orgs circling the drain, and one bold choice that's raising some eyebrows.

Corporatized healthcare increasingly views physicians as ‘interchangeable workers' rather than the irreplaceable specialists they are. Many are turning to unions to strengthen their voice.  Kelly Nedrow, a lawyer and senior advisor for health issues with the American Federation of Teachers, talks with us about how organizing in healthcare unions can help physicians strategize for shared governance and better work environments.

We're losing play in medicine.  Why should that matter? Because play isn't immature, idle nonsense or about just blowing off steam in the moment. It has deeper roles in how we engage in groups, how we connect with each other, and how we process difficult situations.

In our version of a stock ticker, this new segment will get you up to speed on who's gone bankrupt, who's sold out, and any other juicy healthcare market news you need to know to be an informed participant in this thing called US healthcare.

It's all about the money... until it isn't.  Ron Howrigon, a former health insurance executive with some of the largest insurance companies in the U.S., takes us behind the scenes to look at how these companies put profit over patients, why he left the business, and what he's doing now to help doctors fight the very industry he started in.

Medical practices around McAllen, Texas have been under a journalistic microscope for years. But no one knows what's happening on the ground better than the doctors themselves - especially those who are trying to build up, not tear down, their local medical systems. Dr. Carlos Cardenas, Chairman of the Board and Chief Administrative Officer at DHR Health in the lower Rio Grande Valley, joins us to talk about the challenges he faces in delivering patient care, and how he overcomes them.

Corporate practice of medicine laws are on the books, but the loopholes are widening and seemingly endless. Does legislation work? Or will CPOM forever find a work-around?  To help sort this out, Matt and Wendy get wonky with Hayden Rooke-Ley, a federal judicial law clerk, a recent graduate of Stanford Law School, and Senior Fellow for Healthcare at the American Economic Liberties Project.

Brian Thompson's murder was shocking. But how much public hatred of the health insurance industry was smoldering just below the surface, was equally so.  Wendy gives a powerful editorial on the events unfolding, and how schadenfreude is an attempt to restore moral balance that we condemn and dismiss at our peril.

The discussion about work structure in medicine can easily descend into a toxic altruism-fueled race to the bottom, but we think there's more to it.  Matt and Wendy wrestle with whether the quest for a work-life balance should have more to do with how we work, rather than how long we work.

One year, 30+ episodes, thousands of downloads, dozens of guests, and countless f-bombs.  We're celebrating our first anniversary in this special episode addressing listener emails, reviewing some of the most popular episodes in year one, and toasting the best part of our show: you.

The 2024 election is over.  Navigating the results has just begun.  Our advice?  Ski the gaps.   To learn more about some of the ideas mentioned in this episode, check out Jennifer Pahlka on Substack, and Ezra Klein in the New York Times.

Are our “free markets” truly free? How can we achieve a balanced healthcare economy when we privatize profits but socialize losses? Andrew Leigh, member of the Australian House of Representatives and professor of economics at Australian National University, joins us to talk about how "economics can be defined as a social science that studies how people maximize their well-being in the face of scarcity", and how that applies to healthcare.

We're bringing you into the 'room where it happens' and broadcasting a panel discussion that we recorded live at the PHA leadership conference in Naples, Florida last month. Moderated by Dutch Rojas, speakers Mike Lipomi and our own Wendy Dean led a rousing conversation on what physician-led healthcare means, and what doctors and patients lose when we don't have control over care.

Successfully operating an independent hospital in a sea of large hospital systems is no easy task. How do you maintain negotiating power? How do you retain staff? How do you keep private equity at bay? Kurt Barwis, President and CEO of Bristol Health in Bristol, CT, joins us to talk about how to stand out - and stand up - for his hospital's independence, and his community.

The PHA is focused on how to reclaim physician-led care, and what we can do to create and facilitate the structures needed to help physicians become, and stay, independent.  In our first ever live record (outside, and in the rain) Matt, Wendy, and a few members of the audience tell their personal stories of how they became, and remain independent.

To be a part of something bigger than yourself is one of life's greatest gifts, and when the daily acts of life and work are challenged by love and loss it's the community that we've build around ourselves that gets us through.

43cc is proud to share this "Turn on the Lights" episode focused on how can health care organizations align their values to support both high-quality patient care and the well-being of their staff.  Wendy Dean, MD,  Eileen Barrett, MD, and J. Corey Feist, Esq., bring personal stories and professional insights on the rise of moral injury, systemic challenges, and legislative efforts to make meaningful changes. To listen to the full series, visit  Turn On the Lights.

Dr. Don Berwick brings decades of healthcare leadership to a conversation with Matt and Wendy about the effect of social, moral, and structural determinants of health on the physician experience. He offers a welcome reminder of the essential good at the heart of our profession and implores us to work together for the change we wish to see.

AI in medicine is here to stay.  But do we like it?  In the first of many episodes to come on this topic, Wendy and Matt discuss AI's growing influence in healthcare, and ask, "Does AI help or hurt the patient/physician experience, and what can we do about it either way?"

Dr. Pedja Stojicic, Executive Director of People Power Health, and Adjunct Lecturer at Harvard T.H. Chan School of Public Health, has led movements that empowered clinicians and toppled governments. Now he teaches clinicians those activism skills - story-telling, community organizing, and building social movements.

"Another Round" offers short, follow-up news and commentary on stories 43cc has covered in the past. In this episode, Wendy and Matt revisit noncompetes and some spicy Steward Health Care news.

Changing healthcare can feel like an insurmountable task. But when change isn't limited to what's within an individual's control, and when the scale of change is massive and urgent, as is the case in healthcare right now, coming together is essential. Matt and Wendy talk about how to break down the process of change so it's within our grasp - starting with getting off our chairs and getting mad as hell.

The Surgery Center of Oklahoma opened in 1997 with one key goal: make all medical fees predictable, transparent, and complete - no surprises.  Dr. Keith Smith, co-founder of the Surgery Center, joins us to talk about his free market approach to medical service delivery, and how physicians across the country can apply his model to their practice.

Once upon a time, physicians were in charge of their profession and how they cared for their patients. Our dedication to medicine hasn't changed, so why do so many of us feel we're no longer holding the reins? If doctors aren't in charge, who is?

Physician orgs are splintering into ever narrower specialty groups. Is there one voice that can unite us and advocate for change? The American Medical Association, once the preeminent physicians organization in the US, has faced declining membership and increased criticism for years. Dr. Michael Suk, the new Chair of the AMA Board of Trustees, joins us to share the new 5 point plan for how AMA will support and advocate for physicians in 2024 and beyond (and he takes a little heat from Matt and Wendy in the process).

"The Next Round", a new, bonus addition to 43cc, offers short, follow-up news and commentary on stories we've reported on in the past.  In this episode, Wendy and Matt give an update on Steward Health Care.

What do we lose, as physicians and as patients, when society no longer treats medicine as a profession?  What are the moral, ethical, and practical consequences of treating healthcare practitioners as shift workers?  Matt and Wendy dive into a deep, and at times emotional, conversation about what it means to be a medical professional.

Why is private equity trying to take over healthcare? And what does the law have to say about it? Erin C. Fuse Brown, an expert on private-equity investment in healthcare and Professor of Health Services, Policy & Management at Brown University, joins us to talk about the official - and unofficial - corporate practice of medicine from a legal perspective. Have a rant of your own on this topic?  The FTC wants to hear it!  Send in your comments at: Request for Information on Consolidation in Health Care Markets For more information, go to the FTC's RFI on Impact of Corporate Greed in Healthcare.

Thirty million Americans are bound by noncompetes... or are they? A new FTC ruling signals a seismic shift in favor of physicians and patients, and we're all for it. Matt and Wendy break down all 500 pages of what banning noncompetes could mean for healthcare, and the contractual language doctors still need to look out for buried in the fine print.

A massive health system in the Northeast on the brink of collapse, private equity waiting (hiding?) in the wings, and hundreds of thousands of patients at risk of losing care?  We need to talk about Steward Health.

To put it bluntly, private equity is laundering their greed through the good will of healthcare. Brendan Ballou, a federal prosecutor who served as Special Counsel for Private Equity in the Justice Department's Antitrust Division and author of "Plunder: Private Equity's Plan to Pillage America", joins us to talk about how PE has taken over healthcare, and what we can do about it.   Have a story to share?  Tell the FTC. The Federal Trade Commission, the Department of Justice and the Department of Health and Human Services launced a cross-government inquiry on the impact of corporate greed in health care. They want to hear from you. Share you story here: FTC.gov

What happens when "Feelings Bro" and "A Guy Who's Good At Science and Can Lift 300lbs Directly Over His Head" meets Dr. and Lady Glaucomflecken?  Laughs, of course, but also a deadly serious conversation about how to use humor and insight not just to entertain, but to mobilize change in the US healthcare system.

Is it a podcast?  A movement?  A random show title that Wendy came up with because she couldn't think of anything else?  What the f**k does "43cc" actually mean?!?  Matt and Wendy explain what "43cc" is, but more importantly, why it is.

Healthcare professionals have long thought that insurance companies were lying to us. According to our next guest, we're right. Wendell Potter, former Senior VP of CIGNA, opens up about 'how health insurers make promises they have no intention of keeping, flout regulations designed to protect consumers, and skew political debate with multibillion-dollar PR campaigns to mislead the press and public.'

Earlier this year, Wendy shared a post from a physician friend who saw news of a door blowing off a Boeing 737 as a metaphorical omen for the state of US healthcare.  That post struck a nerve. So, we wanted to talk to someone who's been on the frontlines at Boeing – someone who saw that lives were at risk and spoke up - someone who the healthcare industry can learn from.  Ed Pierson, a former Senior Manager in the Boeing 737 MAX factory, joins us to talk about how the drive for increased production schedules and profits trumped safety and experience.  Sound familiar?

Last week, we aired a show about a rural hospital in Ohio.  As it turns out, the former CEO of that very hospital, Phil Ennen, was listening.  And he called in.  Here is our conversation.

Brian Alexander, author of The Hospital: Life, Death, and Dollars in a Small American Town, joins us to talk about how rural hospital culture and independence are collapsing under pressures to consolidate and corporatize, and how, ironically, those epicenters of care have precious little control over the factors most important for health.

Why, as doctors, do we do what we do?  Through a series of personal stories - from Matt, Wendy, and several of our listeners, we'll take a look at the human experience of clinicians. We'll talk about the stories, emotions, experiences - and patients - we carry with us and how that impacts who we are and how we care for others.