Licensed to Lead

Community, connection, purpose: these values are almost palpable even in a virtual conversation with Dr. Susan Rogers. Dr. Rogers is an internist, educator, and activist on behalf of those who suffer when profit motives bulldoze the institutions that are meant to serve the public. A neon example of a public good which has been targeted by profiteers is traditional Medicare. As president of Physicians for a National Health Program, Dr. Rogers is fighting back against the shape-shifting strategies launched by insurance companies and private equity firms to cash in on Medicare. She fills us in on the importance of preserving the choice of traditional Medicare, and talks about her work to inform the public and Congress about the “predatory DCEs” or Direct Contracting Entities.

She was shaped by growing up in a uniquely integrated community in Chicago as well as by the activism of the 1960s. When she was in middle school, her mom took her to a march led by Martin Luther King, Jr. protesting the state of the public schools in Chicago. She trained at Cook County Hospital in Chicago and then went on to hold leadership and teaching positions there as an attending. While she did defect temporarily to work in other settings in Chicago, she missed the camaraderie and like-minded passion of her Cook County colleagues. She emphasizes the importance of community with colleagues and the significance of a physician’s long-term relationships with patients.

Dr. Rogers is exasperated at the privatization of healthcare by people who know nothing about the practice and profession of medicine. She describes the total disconnect when decisions are made by financially-driven business people: “There should be no role for them.”

“Resources aren’t placed where they’re needed—
they’re placed where they can generate more money.”

She compares the inroads of private equity firms in healthcare to the debacle of private equity firms and charter schools siphoning funds away from public schools in poor communities. As in healthcare, the motives are not to provide the needed services to the public—but to amass profits for investors. Rural hospitals that are acquired and then closed by large healthcare systems are another example of decision-making by those seeking to maximize profit, not community benefit.

Dr. Rogers and other representatives from Physicians for a National Health Program had success on Capitol Hill when they petitioned Congress and HHS to reject DCEs. While PNHP’s efforts were influential regarding DCEs, she describes how it didn’t take long for a new acronym and strategy to emerge. “Same shirt, different color,” she says about ACO REACH (ACO Realizing Equity, Access, and Community Health). She emphasizes the remarkable lack of oversight by Congress for this program that can be hoisted on patients without patients realizing that their traditional Medicare decision has been overruled.

Also in this episode:
•The powerful impact of a high school biology teacher
•Activism in the time of role model Angela Davis
•A Tuskegee airman who exemplified the bond between physician and patient
•She was able to see patients as people: “They shared their lives with me”
•“Are you going to open your own office?” a question rarely posed to medical students now that 70%+ physicians are employed
•Burgeoning full-service hospitals arising in close proximity are as logical as putting a town’s four fire stations on facing corners.

Meet Susan Rogers, MD
Dr. Susan Rogers is president of Physicians for a National Health Program, a national organization with over 23,000 physician members, whose mission is to advocate for Single Payer/Medicare for All.

Dr. Rogers received her medical degree from the University of Illinois College of Medicine and completed her residency in Internal Medicine at Cook County Hospital in Chicago. She spent...

McGill Business Professor Henry Mintzberg is the author of 20 books on management, creator of two revolutionary international management programs, and the recipient of a mountain of accolades and honors for his thought leadership in the business world. Mintzberg minces no words in his pointed criticism of current approaches to management training and the behavior of those in management and leadership positions. In this interview, Professor Mintzberg comments on the value of an MBA in providing management skills:

“Anybody who comes out of a business school should have a stamp on his or her forehead—like a skull and crossbones—that says Warning! Not Prepared to Manage.”

He explains how managers get distorted during traditional business education. Management is a practice where art, craft and science intersect. Because the art and craft cannot be taught in a business school setting, the “science” has become the focus of graduate business education. Thus, MBAs emerge with skills in marketing, finance, and accounting but lack the very “essence” of management—the art and the craft.
He explains why “remote control managers” are dangerous. These are people who manage by the numbers, with monitoring and measuring substituting for actually knowing what’s going on in the business. This lack of understanding has implications for the success and capacity of the organization and disconnection from the ground floor of the organization impairs innovation.
Professor Mintzberg says healthcare should not be run like a business. In fact, he states, “most businesses should not be run like a business.” He makes it clear that this is especially true in professions and in services like medicine and healthcare. Healthcare is not a business, it’s a calling.
Professor Mintzberg points to the pros and cons of various groups such as physicians, nurses, MBAs, accountants and others who seek to lead healthcare institutions. He believes managers must know and understand the services being offered, be unequivocally collaborative, and humble enough to learn. Physicians who succeed in business are those who collaborate and build relationships.
Mintzberg, an internationally recognized iconoclast, believes jail is the most appropriate destination for board members who approve super-sized CEO salaries and for the executives who accept them. He states that huge salaries are dysfunctional nonsense and the opposite of leadership that leads to “a kind of narcissism.” When asked about incentives for physicians, Professor Mintzberg exudes enthusiasm. “Yes! A patient whose life has been saved and who is appreciative is a terrific incentive!” But treating physicians like caged pigeons and giving them little rewards for their work is just silliness.
Professor Mintzberg talks about the structure, purpose, and successes of the International Masters for Health Leadership program which he co-founded. And he shares a high level overview of his important work focused on the need to rebalance society. An imbalance in three sectors, the public, private and what he calls the plural sector, are at the root of many of society’s most harmful and dysfunctional patterns. This is so relevant to healthcare, which is being destroyed by inroads by the profit-driven private sector.
In this episode:
•Why Professor Mintzberg’s quadruple bypass cost $2.50
•How beaver artists find gallery space
•The Supreme Court legalized bribery in the Citizens United decision
•Mintzberg’s Masters Program, Ebola Virus, and Doctors Without Borders
•Dulcie and the Infinite List of Positive Characteristics

Meet Henry Mintzberg
Henry Mintzberg, PhD, is a professor in the Desautels Faculty of Management at McGill University in Montreal. He sits in the Cleghorn Chair of Management Studies and has had extensive visiting professorships at INSEAD in France and the London Business School in England.
As an...

Author and certified lifestyle medicine physician, Iris Schrijver, MD, describes a fulfilling and fast-paced academic career at Stanford as a full professor of pathology and director of a molecular genetics research lab. A few years ago, in an unlikely turn of events, an opportunity to design a leadership project ignited her long simmering interest in wellbeing.

That project culminated in a 2016 research article An Exploration of Key Issues and Potential Solutions that Impact Physician Wellbeing and Professional Fulfilment at an Academic Center. I give you the details here because this is the article that led me to reach out to Dr. Schrijver. I had read everything and everyone with a scholarly approach to physician burnout in preparation for several podcasts. Dr. Schrijver’s article was one of the most outstanding and useful of the scores of articles I read. In our conversation, she describes how important it was for her to have the credibility of being a physician as she interviewed her colleagues about the underpinnings of burnout. She also describes how extrinsic factors, such as restricted autonomy, dominated the findings which contributed to physician burnout.

She and her husband, an astrophysicist, decided there was more they wanted to accomplish and experience beyond their fulfilling but all-consuming careers. The magnificent Oregon landscape was pulling them away.

Dr. Schrijver describes how she consciously made changes to create the life she wanted. She decided to pursue a certificate in lifestyle medicine, write a book on wellbeing, and contribute to medicine and patients in a different way. They moved to Clackamas County, Oregon, and she began volunteer work at the Clackamas Volunteers in Medicine Clinic—including a stint as medical director and a board member. Now she is developing a lifestyle medicine service for the Clinic. She finds the work remarkably rewarding. As she says, “Poverty is not a crime, and it is a privilege to provide good medical care for this population.” She continues to serve as adjunct pathology faculty at Stanford.

Dr. Schrijver describes an interaction with a mentor early in her career who gave her a pointed introduction to her leadership accountabilities as a physician. It served her well. She has served in academic and national leadership roles, including as the President of the Association for Molecular Pathology.

She connects the scientific method, physician leadership, and physician wellbeing to the important task of promulgating accurate and useful information to the public. Dr. Schrijver makes a compelling case in her book and in our conversation that we can take steps to improve wellbeing. We can envision and create a more fulfilling life for ourselves and guide our patients to greater wellbeing as well.
Also in this episode:
•The Six Principles of Lifestyle Medicine
•Mentoring advice to physicians making their first career move
•Does Press Ganey turn doctors into Nordstrom clerks?
•How alliances can serve physicians in attaining wellbeing
•Seeking resilience is aiming too low—aim to thrive
Meet Iris Schrijver, MD
Iris Schrijver is a certified lifestyle medicine physician, also specialized in clinical pathology and molecular genetics. She is an adjunct clinical professor of pathology at the Stanford University School of Medicine and a past president of the Association for Molecular Pathology. Dr. Schrijver served as medical director of Clackamas Volunteers in Medicine, and is now developing a lifestyle medicine service there, because she believes that healthcare is a basic human right.
Her dedication to patients and to medical progress through science has resulted in the publication of many original research articles, book chapters, and books. Together with her husband, an astrophysicist, she wrote “Living with the Stars”, a popular science book about connections between the...

Attorney and author Dennis Hursh helps physicians navigate their employment contracts. He describes his shock early on in his career when he saw the lopsided language in the contracts offered to his highly trained physician clients. He points out that no hospital executive would ever agree to such contractual language for themselves.
A sampling of items Mr. Hursh considers “insane”:

- 24 hour call shifts (and by the way, you will work the next day, too)
- The employer will decide if you’re disabled and has the right to terminate you if you can’t do the job
- No paycheck for you if you can’t navigate their complex credentialing process by your start date AND they reserve the right to terminate you if you aren’t fully credentialed by your start date
- Punitive non-compete clauses (a.k.a., restrictive covenants) that wreak professional and personal havoc rather than simply limit the loss of patients who might follow you when you leave
- “Brutal” provisions in the contract that the administration promises they won’t enforce (but nonetheless they won’t remove the language)
- Low starting pay with a promise (but no contractual language) of partnership to come
- “Integration” documents that provide explanations and promises related to the formal contract (but alas, they are not enforceable unless they are in the formal contract)

In this episode, Mr. Hursh exposes the risks lurking in several areas typically included in physician employment contracts (beware if these points are not explicitly addressed!):

CREDENTIALING: Flexibility can be built into the contract to allow a physician to begin a narrower scope of work if certain hospital credentials or other privileges are still delayed at the start date.

RESTRICTIVE COVENANTS (noncompete clauses): This refers to contractual language that prohibits a departing physician from practicing within a specified distance of the former employer for some period of time. Mr. Hursh draws attention to several issues regarding the distance that is specified and what is being measured: Is it the distance between the physician’s previous office and the office with the future employer? From a specific hospital or the organizational headquarters? Or from any of the employer’s sites anywhere?

MALPRACTICE INSURANCE: He describes the critical difference between Occurrence vs. Claims-Made insurance policies. Red alert if the contract simply says “malpractice insurance is provided.” If you don’t know the difference you could be saddled with expensive “tail insurance” when you hightail it out of there.

COMPENSATION, CALL, DUTY HOURS and LOCATION: Ambiguity is not the physician’s friend when it comes to an employment contract. Exquisite clarity about compensation and call is critical. If your future employer thinks full-time means 40 jam-packed patient-contact hours then, in reality, you could end up with a 60-hour workweek. Similarly, it’s critical to have clarity and security about your office and hospital location.

Mr. Hursh advises physicians to hire an attorney who has experience working with physician agreements and who has the needed resources (e.g., MGMA database, up-to-date Stark regulations). An advantage of hiring an attorney is that shelling out the money for an attorney signals that the physician is taking the offer seriously. Also, contractual challenges can be raised by the attorney so that the physician doesn’t have to directly challenge a potential employer.

Also in this episode:
•We discuss my guest’s article “Are Hospitals Evil? A Physician Contract Attorney Explains”
•How hospitals protect themselves while circumventing the bans on Corporate Practice of Medicine
•The Business School Mindset (BSM) and its many manifestations in healthcare systems
•How disdain for physicians leaks out in the language, action, and inaction of management

In response to listener questions and comments, we dive into two topics in this episode. The first is influence, especially when managing “up” or when dealing with a high profile colleague. The second topic is incentives. Podcast episode #35 featured Alfie Kohn who surprised listeners when he described the negative impact of incentives on intrinsic motivation.
We discuss a model of influence from the work of Jay Conger, who wrote extensively on the topic of influence including his bestselling book Winning ‘Em Over. Linked below is a worksheet that we use in our leadership programs. Conger describes four components of influence that can be useful when trying to persuade an audience to align with your point of view:
• Credibility
• Compelling Evidence
• Common Ground
• Connecting Emotionally

In this episode, as in our leadership programs, we zero in on Credibility as an important foundation for influence. It is comprised of two components: your expertise as perceived by the other party (or your audience) as well as the relationships you have already built with those you are seeking to influence.

Of the other three elements of influence, one that physicians may be tempted to overuse is Compelling Evidence or bringing data to the conversation. Finding Common Ground means walking in the shoes of your audience for a spell. The last one is Connecting Emotionally by appealing to someone’s values and leaning in with your own heart. Unlike the use of logic, emotional connection is often evoked by stories and has a lasting effect.

After we wrap up the influence section, we turn to feedback about the podcast conversation with Alfie Kohn (#35). Based on the questions and comments we received, this incentives episode had an unsettling effect on listeners. We discuss the misguided use of incentives in healthcare and the use of incentives in mundane and repetitive tasks. We raise the possibility that steering away from incentives might steer us into better outcomes and more empowering approaches to leadership. And Lynn makes the point that we must not confuse incentives with an important and often overlooked leadership behavior: the expression of genuine appreciation.

•Influence Worksheet: https://bit.ly/InfluenceWorksheet
•Jay A. Conger, Winning ‘Em Over: A New Model for Management in the Age of Persuasion
•SIGN UP FOR OUR NEWSLETTER: https://bit.ly/LicensedToLeadSignup

Christopher Obetz, MD, is the CEO of an organization which started with a handful of physicians 30 years ago, and now they have over 150 physicians and APPs. The group staffs nine emergency rooms in the Minneapolis St. Paul area. One year ago, Dr. Obetz was my guest on Episode #15 (Title: Emergency Care Consultants CEO: The Incalculable Value of Physician Careers). At the time, the ECC leader and his organization were faced with a trio of crises:
•The Covid pandemic and sequelae in Emergency Medicine
•Unexpected closure of a hospital with resultant overstaffing
•The George Floyd murder devastated the community around ECC’s flagship hospital

Patient volumes dropped by 40-50% during the early months of the pandemic as patients stayed clear of hospitals in order to avoid infection by Covid. ECC, which was already generously staffed, faced overstaffing as a result of reduced volumes and the hospital closure. When I spoke to Dr. Obetz last year, he wasn’t sure if the values of the organization or even the organization itself would survive. Could they get through an unprecedented nosedive in income? Could they honor the employment agreements with physicians scheduled to start in the spring of 2021? And in the aftermath of George Floyd’s death, could they examine their own biases and emerge as a trusted source of care in their stricken community?
Dr. Obetz describes how the impact of the pandemic evolved: from the initial emptied-out emergency departments to a swelling tide of patients overwhelming their EDs. The current “boarding crisis” resulted from greatly increased demand for ED visits and inpatient beds. One reason is the pent-up demand and more advanced disease because care was delayed for typical medical conditions. The second is prolonged hospital stays for critically ill patients suffering from Covid. Patients are “boarded” when there is no ICU or regular hospital beds available and they end up receiving critical care, sometimes for days, in the emergency department. The effect on doctors and nurses and others is “bruising” as they scramble to care for patients on ventilators or crowded in the hallways, still working behind N-95 masks, gloves, and gowns.
The organization has navigated through two years of an unpredictable and seemingly unending pandemic. Dr. Obetz describes the strategy that has underpinned their success: “We are democratic to a fault.” In fact, hiring decisions include an assessment of whether a physician will embrace the hard work, time investment, and collaborative nature of participative decision-making. Listen in as Dr. Obetz specifies how their three core values, their principles, have served the large emergency medicine group. And when it comes to the importance of physician ownership and physician leadership, Dr. Obetz is a believer.
In this episode:
•The expertise of previous podcast guest Alfie Kohn is invoked
•ECC’s prime directive is the overriding priority of outstanding patient care
•The importance of physician expertise in decision-making echoes the research of “friend of the podcast” and two-time guest, Dr. Amanda Goodall
•The real meaning of Shift Nirvana is spelled out
•Do ECC physicians defect to work for competitors? “It has never happened”

Meet Christopher Obetz, MD:
Dr. Christopher Obetz, an emergency medicine physician, is the President and CEO of Emergency Care Consultants (ECC) in Minneapolis, Minnesota. ECC is a “physician-owned, independent, and democratic” organization responsible for both outstanding emergency care and outstanding emergency medicine careers in nine hospitals in the Twin Cities area. Dr. Obetz has been leading ECC for the last decade, a period marked by significant organizational growth.
The organization is known for its consistent high quality care and service, excellent business outcomes and sustained high satisfaction among physicians and staff. Innovation is...

Dr. Keith Smith cofounded the remarkably successful and wonderfully disruptive Surgery Center of Oklahoma. He and fellow anesthesiologist, Dr. Steven Lantier, left their hospital-based practices in 1997 to launch a physician-owned surgery center promising high quality care at a fair, transparent, and all-inclusive price. They had become fed up watching hospital administrators profit mightily while those who were actually caring for patients struggled. The inequitable and often outrageous billing practices of the hospital, the low Medicare reimbursement to physicians, and the cost-shifting to compensate for poor government reimbursement were all affronts to their values.
Dr. Smith is clear on the ethics of medicine (excellent quality at a fair price), the ethics of business (a mutually beneficial exchange between parties) and the importance of free market forces establishing the pricing and the success of an organization. He describes the morass created by government policies that harm patients while offering fertile ground for the “rising administrative class” to step in and profit from the chaos. He doesn’t mince words in his criticism of influence-peddling in Washington, D.C.

Currently, the Surgery Center has 36 physician owners, 107 physicians on staff, 42 employees, and is internationally renowned. Healthcare institutions, including UCLA, have copied the Surgery Center’s transparent pricing webpage with its human form and drop-down menu of prices.
The Surgery Center accepts no insurance or government reimbursement and their prices are often one-sixth to one-tenth the prices patients are quoted elsewhere. This means that patients come from all over the US and beyond for high quality care at a price that is often much lower than what they would pay with their (allegedly) “full insurance” coverage. Dr. Smith describes several examples of the financial foul play patients are faced with when they believe they have insurance coverage but their deductible and co-insurance can bankrupt them.

The uninsured and underinsured (maybe we should call them pseudo-insured) greatly benefit from fair, clear, and transparent pricing. Self-insured employers, who pay employees’ healthcare costs out of their operating revenue, quickly understand the benefits of partnering with the Surgery Center. In this episode, Dr. Smith describes the good will that develops when he passes vendors’ price reductions on to patients and self-insured corporate clients.

This innovation is being replicated and Dr. Smith fans the flames at the Free Market Medical Association, an organization he cofounded.

This means that patients come from all over the US and beyond for high quality care at a price that is often much lower than what they would pay with their (allegedly) “full insurance” coverage.

In This Episode:
•Non-Profit, Not-for-Profit, Tax-Exempt means "Don’t Pay Tax"
•Dr. Smith walks through The Scam: the Charge Master obfuscation which allows collusion between insurance companies and hospitals to profit mightily and do harm
•"And then there were four: BUCA (Blue Cross, United, Cigna, Aetna)"
•Regarding government programs and BUCA: "We didn’t so much tackle them—we seceded"
•Physician leadership + strong operating principles = superb organizational culture
•"We all need our boundaries—so insurance companies are not a part of my day"

Meet G. Keith Smith MD

Dr. G. Keith Smith, a board certified anesthesiologist, cofounded The Surgery Center of Oklahoma in 1997. Dr. Smith serves as the medical director, CEO and managing partner of the Surgery Center while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians, uninsured Americans and...

Alfie Kohn is a prolific author and expert on the psychological and organizational effects of rewards, incentives and competition. As a longtime fan of his thinking and writing, it was a huge treat (no pun intended) for me to talk with him about the counterproductive impact of incentive systems in the workplace. In 2018, the 25th Anniversary Edition of Kohn’s superb book, Punished by Rewards—The Trouble with Gold Stars, Incentive Plans, A’s, Praise, and Other Bribes was released. In the years since the original publication, other experts piled on scholarly articles and best-selling books confirming the deleterious effects of financial rewards—especially when critical thinking, creativity, and collaboration are needed. But alas, organizational leaders continue to fuel the swarms of compensation consultants who promise to tweak the organization’s existing incentive system into an even better incentive-based compensation scheme. You know, into one that actually works…

We discuss intrinsic motivation, which is when motivation arises from within and there is inherent satisfaction in performing a task. And Mr. Kohn contrasts that with extrinsic motivation, when behavior is performed because of outside causes such as rewards or to avoid punishment. Rewards, like punishment, increase compliance and diminish intrinsic motivation which creates reliance on extrinsic motivation in order to perform.

Alfie Kohn points to the fact that attaching an incentive signals the undesirability of a task and thus devalues it. Incentives or rewards are also control mechanisms, and people inherently do not like being controlled by others or manipulated into performing tasks.
And how does a BSM (business school mindset) contribute to the prevalence of incentive compensation systems? By definition, the BSM relies on control, measurement and comparison. Alfie Kohn describes a parallel in the education sector with increased reliance on the sterile formulations of economists to apply measurement and mathematical models to teachers and students. He rails against this relentless tendency of those in charge to “do things to” people instead of choosing more democratic methods of “working with” others in an organization.

In This Episode:
•Gadfly—a person who interferes with the status quo of a society or community by posing novel, potentially upsetting questions, usually directed at those in power
•Perverse incentive—an incentive that results in making the issue worse (if you’re in healthcare you’ll have no difficulty coming up with examples)
•Rewards do motivate because they motivate people to go after more rewards (see perverse incentives…)
•Competition—in order for one person to “win” he must defeat another and this is deadly for collaboration
•Frederick Herzberg—Alfie Kohn cites this author of one of my favorite classic articles (One More Time—How Do You Motivate Employees? Harvard Business Review)

Meet Alfie Kohn
Alfie Kohn is the author of 14 books, including NO CONTEST: The Case Against Competition and PUNISHED BY REWARDS. In addition to his many writings on education and parenting, his articles on management include "Why Incentive Plans Cannot Work" in the Harvard Business Review and "Competition versus Excellence" in the New York Times. Fortune magazine has called Kohn “America’s most biting critic of money as motivator.” He has keynoted conferences across North America and abroad, as well as presenting at such organizations as AT&T, BMW, Dial, Mattel, NASA, and Pfizer. Kohn lives (actually) in the Boston area and (virtually) at alfiekohn.org.

Alfie Kohn's Website: https://www.alfiekohn.org/

Alfie Kohn’s appearance on Oprah with a demonstration of the effects of incentives on teenagers:

My guest is Dr. Roger Fowler, Vice President, and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health in Irving, Texas.
As an expert in population health, quality, and healthcare reform, Dr. Fowler offers a rich perspective on the historical events that underpin our current state of U.S. healthcare. His belief is that we must move away from payment systems that reward the quantity of procedures performed, and move toward those programs that reward excellent outcomes for patients and the community.
Dr. Fowler describes how quality measures themselves have their origins in the way insurance companies ranked desirable vs. undesirable physicians based on each physician’s claims data. It was all about costs. The use of the term Medical Loss Ratio (MLR) is an important reminder of the insurance industry’s perspective about medicine vs. the perspective we as physicians have. MLR means that the resources spent on providing medical care for patients is the Loss referred to in this acronym. A family medicine physician for 40 years, Dr. Fowler says when he first heard medical care referred to as a loss it was like fingernails on a blackboard for him.
Dr. Fowler has compelling stories of how the healthcare system goes haywire. He talks about the unintended consequences of early “hospitalization insurance” and EMTALA regulations and he laments the various ways unscrupulous characters cash in on patients’ vulnerabilities.
His expertise and patience almost meet their match with my ignorance about Medicare programs. He labors to help me understand some of the key points of Medicare Advantage, Traditional Medicare, ACOs, Shared Savings programs, and more. After we finished our conversation, I requested a CME certificate.
As a patient advocate and expert on population health and quality, he is passionate about getting to a reasonable level of spending on primary care (currently only 5-6% of U.S. healthcare spending is on primary care). He believes doubling the dollars spent on primary care would make significant inroads to address U.S. cost and quality woes.
See the newsletter episode #34 for a glossary of some of the terms discussed: https://bit.ly/LTLmoreinfo

Meet Roger Fowler, MD
Dr. Fowler is the Vice President and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health, an international not-for-profit health system with hospitals, clinics, physicians and staff in five states and in Latin America.
Dr. Fowler envisioned, launched and provided leadership for the department of Population Health for the Trinity Clinic in Tyler, Texas, before that organization merged with CHRISTUS Health. Ultimately, he became the Chief Medical Director of Population Health and Health Plans, and CMO for the CHRISTUS Health Quality Care Alliance (ACO) and CHRISTUS Quality Network (CIN). Most recently Dr. Fowler assumed leadership for the Pharmacy and Quality Improvement departments for the health plan and the Medical Management Department.
Dr. Fowler has a broad history of administrative and governance roles, including chairman of the Trinity Clinic board for five years. He began his career as a family medicine physician in a solo practice in 1981 in Kilgore, Texas, providing full spectrum family medicine care. He is a husband, father, grandfather and has been a runner for 43 years.

https://www.linkedin.com/in/roger-n-fowler-md-faafp-14513236/
[email protected]

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Leah Houston, MD is a serial entrepreneur, emergency medicine physician, and activist. She is the founder of: HPEC: Humanistic Physician Empowerment Community is a platform physicians can use to own and store their own digital identity and credentials. A secure, self-sovereign identity is the foundation for restoring physician autonomy. (Find out why!)
EverCred: The system used by institutions to manage certification data and issue physician credentials that puts physicians in control of the primary source verification process.
Dr. Houston joins me on the podcast with Florida attorney Abbigail Webb. Ms. Webb raises an alarm about the loss of physician autonomy and points to the striking differences in professional autonomy between the medical profession and the legal profession. She raises questions about why non-physicians are in control of healthcare institutions and physician practices. She underscores how compromised physicians are in their ability to meet their fiduciary duty to patients because of the obvious conflicts of interest in healthcare systems run by non-physicians. In the U.S., only lawyers are allowed to own law firms—in marked contrast to ACA language (link to glossary below) that prohibits physicians from owning hospitals.
She draws additional comparisons between medicine and law:
•Legal oversight bodies such as State Bars and State Supreme Courts are made up of attorneys—unlike medicine where regulatory bodies have a variety of competing agendas creating oversight policies for the medical profession.
•Law firms are not publicly traded because lawyers are not allowed to be governed by or beholden to the interests of non-lawyer shareholders. Contrast that with the behemoth Fortune 50 healthcare systems driven by a profit motive, not medical professional values.
•Lawyers are not subject to non-compete clauses because it is deemed unethical to restrict clients’ ability to freely seek legal assistance from whomever they choose. The 70% of physicians who are employed are very often hamstrung in their career decision-making by non-compete clauses.
•The legal profession closely safeguards the practice of law, not allowing non-lawyers or paraprofessionals to hang out a legal shingle or use terms like lawyer, attorney, or Esq. Not so in medicine, where consumers and patients are unclear, sometimes misled, about who is a physician.
Ms. Webb believes quality of care for patients would be served by physician leadership of healthcare and she is an advocate for the digital solutions that Dr. Houston proposes.
What are those solutions?
Moving ownership of physician credentials to physicians themselves. This can be accomplished by storing credentials in an immutable, immediately accessible, blockchain wallet. A self-sovereign identity (SSI) means physicians themselves retain control and thus provide the primary source verification of their credentials and decide who has access and for how long. HPEC provides this capacity for physicians to have a wallet containing their credentials (and other digital assets). Dr. Houston’s other company, EverCred, provides a mechanism and platform for certifying bodies to issue credentials directly into decentralized identity wallet systems (like HPEC, but others as well—as long as they use rigorous established security standards). These systems are in development with pilot projects underway including a physician training program that is issuing credentials directly into HPEC.
The use of blockchain for establishing secure self-sovereign identities (SSI) for physicians opens the door to Dr. Houston’s bigger vision of physician autonomy and leadership. This includes: physicians creating their own referral networks; establishing patient records that belong to the patient (and not a healthcare system that uses patient data for their own profit-motivated purposes); and physicians establishing specialty-specific or other groups...