Dear Dr. Mostashari,
Prior to reading your interview in Medical Economics, I had only heard of your office, but didn’t know specifically who you were. Based on your previous job title, I would have guessed that you got your medical degree in the Ivy League, and I would have guessed that you had a real love for population contr-, sorry, population health. I’ve read also that you hooked up a bunch of New York doctors in underserved areas with electronic health records, and that you worked for several government agencies on the way up the ladder to your job as National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
Funny thing, I couldn’t find in any of your online biographical info where you had actually seen patients on a daily basis after you left residency, or that you had any experience in trying to start a struggling small business. It seems like that would have been valuable experience for a guy paid to enforce “Meaningful Use” on the majority of physicians. On the other hand, maybe blissful detachment allowed you the objectivity to make a statement like: “I think Meaningful Use became too much about compliance and not enough about outcomes.” Yeah, if you lived in fear of the government the way most of your less well-connected colleagues do, then you would have already known that compliance has replaced a lot of “outcomes.”
Technology can be pretty cool, Dr. Mosty, but it sure can be pricey. One recent national survey described costs somewhere between $50,000 – $200,000 for a two-physician practice. A 2014 Medical Economics piece noted “nearly 45% of physicians from the national survey report spending more than $100,000 on an EHR.” Many docs have found that the implementation costs and hassles were not worth the MU bonuses from your office, and the majority of large group practices said that EHR’s were not worth the effort. Fortunately you didn’t have to worry about their little gripes while providing leadership, backed of course by government force. Gotta hand it to you Doc, you saw a government initiative, forced it on your colleagues, and jumped on the winning team in the very best tradition of K-Street lobbyists and expensive defense contractors everywhere. As you said, “As bad as some of the usability issues are with the EHR’s today, I don’t see people going back to paper. And it is the foundation for doing more things.” Boy you said a mouthful Dr. Mosty – can I call you that, just to keep it casual ? – like when you asked “How does this now become the infrastructure for doing more and in a more “Internet-y” way? Can I use other tools on top of and around and attached to my EHR? And for that, we need to open up those EHR’s to third-party applications.” You’re clever Dr. M., you never made the mistake of asking any private physician if they wanted to do more, and in a more “internet-y” way – you knew what was good for us and you told us what to do (and psst, Mosty, just between me and you, we both know that the “compliance” unpleasantness that you feigned regret over is what actually lets you tell the rest of us what to do. Wink, wink).
And talk about big brass ones, you da man! It takes major, top-down chutzpah to say straight-faced in an interview that, “I think that one of the major causes of [physician] burnout isn’t the EHR per se. It is this loss of control and feeling that you’re not in control … whether it’s the rising cost of everything and the decreasing reimbursement for everything and new rules that come out that you cant even understand.” And you claim you haven’t per se thrown gas on that dumpster fire? My friend, as an already accomplished bureaucrat, you have great potential as a politician. Then you doubled down with the story of your friend who closed her practice, not over EHR’s, Meaningful Use, or ACO’s – all the stuff you sell, wink, wink – but because of the “accumulated frustrations of trying to be a small business owner and trying to stay independent.” So you don’t think that shelling out half a mortgage for an EHR is an “accumulated frustration”?
Of course Dr. Mosty, you can’t possibly want physicians to be independent, or you wouldn’t have led the charge in cramming all this expensive, independence-shredding gunk down our formerly private throats. I was particularly interested in the double-talk somersault you pulled in the interview with your cute kayak analogy, telling us how we need to paddle hard, or in your words, “So be more active. Don’t be passive. Take control.”
And then in the very next damn paragraph, you say that taking control is NOT “to retreat into some direct primary care model. That, to me, is not a solution for all of our docs to say, “I’m not going to take insurance.” That’s not a solution. We have to find ways of coping with the change and feeling more in control.”
In your own words, you want me to keep giving you control as a way of feeling more in control. In other words, Mosty, you want me to eat spinach and “feel” like it’s ice cream.
Dr. Mostashari, you are a paragon of the New Doctor: a government-funded population control officer, who doesn’t have to meet a payroll, cover overhead, or see patients. You guiltlessly use your connections to build your own career and pad your bank account by selling out your colleagues to lesser bureaucrats, armed with all the “compliance” that comes with government force. You will be praised for your leadership in teaching others to get with the program, and you’ll be able to retire early, and quite comfortably, by selling more bad ideas and products for the government to punish us with. You represent so much of what I hate about medicine, and you embody the dishonesty at the core of this industry. You probably think you are a good guy, doing good work for great masses. But suggesting that escaping into Direct Primary Care is not a way of taking control of one’s profession puts the lie to your success and your sales pitch. Whatever you are in your personal life, you are professionally a bad guy, a slick data huckster selling snake oil that the crowd is forced to drink. Here’s hoping that when you need one, you get the medical technologist you deserve.
With all my data,
Pat Conrad, MDTweet