Jen Brull, MD Wants To Sell You A Timeshare
It wasn’t as late in the evening as it felt, and I was long since ready for this trip to end. The bar was almost empty, just myself and another figure two stools down. In an incredible waste of a weekend, through a series of bad decisions, I had ended up dragged to one of those second-rate time share resorts, where the room, mediocre food, and intolerably cheap liquor were all “free” in exchange for sitting through some progressively harder sales pitches. Morning checkout could not come quickly enough, so there I sat, trying to speed the process along. I had requested of the terminally disinterested bartender his driest possible martini, from which I shuddered at first sip. “What vodka did you use?” I asked, and tasted the bile rising when he held up a bottle of Aristocrat. It serves me right I thought, for not making specific inquiries before committing. I chugged it, and held up two fingers.
Trying to choke the rotgut down, I glanced to my left and recognized the main sales person from the afternoon seminars, a middle-aged lady with bobbed blond air. She looked thoughtful, almost pensive, until I cleared my throat, and then she turned on me with the automatic fixed smile I had seen on the stage and in all the sales posters. “Why hello!” she brightened, “are you enjoying our wonderful bar?”
I looked at the large neon logo sign lighting up the entire area behind the bar, that read “Aledade” in hot pink and pastel blue. It flickered occasionally, probably a short. I noticed that she didn’t have a glass, and wondered if she had just followed me into the bar to make another vain pitch. “Not drinking?” I asked. “When I don’t feel healthy, I can’t do as good of a job at helping others be healthy,” she said.
“To be honest, I was hoping for a little better quality,” I replied, nodding sideways at my half-empty glass. “In the old days of paper, when you did quality improvement, you’d pull 30 charts,” she said. “In the day of electronic, we look at our entire population. So, if I’ve got 400 people who qualify for pneumonia vaccinations, I’m looking at all 400 and how many had it done.”
I looked warily at my glass, wondering what in hell I had just drunk. The woman beamed even more in the gloom, and slid a glossy pamphlet on the bar toward me.
The glossy pamphlet title was “Roadmap to Awesomeness.” Her shiny gold name tag read “JEN BRULL, MD, FAAFP.” “It’s an improvement tool for practices to assess data and follow best practices,” she offered. Oh no, I inwardly groaned, not one of these. “You’re selling Aledade, it’s like selling AmWay,” I said, “no wonder you’re pushing time shares.”
Brull made a little confused face, and just like that she slipped effortlessly back into her sales shtick. “We talk with our practices and health centers every month and leverage our relationships, data and our connections on the field teams to help drive change in the space of value-based care, she said, “If you are a physician who owns a practice and signs up to be a part of an ACO, it does not generate less work, it creates more — but it is better work.” My gut lurched a little, and I simultaneously wondered whether I had eaten too many of the cheap cocktail weenies at the happy hour, and if they had an in-house way to measure lipase levels.
“When we roll out initiatives to the members of our ACOs we ask them their thoughts and if there is anything we can do within that initiative that would make their connection with the patient stronger, or make their work easier,” she said, “We are able to then bring that feedback to Aledade and be an advocate for practices and CHCs by detailing the issues they see in the initiative.”
“Now hold on,” I countered, “Isn’t Aledade the same ACO scam that government lackey ‘Mosty’ Mostashari was pushing years ago, the same one that was making money off of physicians’ data while bashing Direct Primary Care as ‘retreating’? I heard Aledade was getting sued for upcoding and overcharging, but basing it on their chumps, er, ‘member providers.’ Why would anyone be associated with that dude, or buy anything you’re selling here?”
Brull continued to beam, in a weird, fixed gaze, and rapidly tapped an entry on the inner panel of the pamphlet. “That’s the golf course, and I don’t play,” I said. She shook her head and tapped lower, where a faux elegant font stated: “Dr. Jen Brull is a true servant leader,” said Farzad Mostashari, CEO and co-founder of Aledade. “Whether running her own practice or leading the largest primary care medical society in the nation, she has always focused on what is most important: bringing the highest quality care to patients and their families. We have been so fortunate to call her a colleague and leader here at Aledade, and are thrilled for her and our nation’s primary care professionals as she takes on this new role.”
More bio filler between absurdly widened photos of the too-small pool described Brull as “A primary care physician and former practice owner… for more than 20 years … national recognition for her efforts to improve patient care…HIT Fellow for the Office of the National Coordinator and was recognized as a Hypertension Control Challenge Champion by the Centers for Disease Control and Prevention in 2014.” Geez was her pitch ever wordy.
“Yeah,” I noted wryly, “The CDC liked you. They’re a reputable bunch. Remember what a super job they did with COVID?” I hoped she could see my exaggerated eye roll in the gloom.
“I absolutely empathize with and understand people who have hesitation around being vaccinated,” Dr. Brull says. “And I always want them to hear me, as their doctor, say that I think the vaccine is safe, I think it’s effective and I think it’s right for you.”
“Right, right,” I laughed, “That was from that YouTube documentary you were in sponsored by Walgreens. I would ask if you received an … honorarium, but I suppose there could always be in-kind considerations down the road. ‘Relationships’, I mean. Sort of like those cred points you racked up pushing EMR’s for American Medical Software and in the NYT, huh? But you never really made the point that it was all coerced with government cash, none of which was paid up front the way the rest of us pay our bills, huh? Or that you wrangled more free press as a “Software Advice 2013 All-Star, and you were ‘featured in a Center for Medicaid and Medicare Services (CMS) national meaningful use campaign’, huh? No wonder you and Mosty get on so well, having helped him push his ‘value-based’ agenda with the AAFP.”
“We don’t have anybody who would ever want to go back,” she said.
“Well, I want to go back, I said. “Back to my room, back home, and back to a time when being a doctor meant training and working as a physician and not having a lot of parasites like you partner with government to force me into making profits for you, while taking the blame for your unethical screwups.” The cheap well brand vodka was making me surly. “Primary care is almost dead, and your kind, Mostashari and you, are making sweet bank off NOT practicing, while bossing others around. The degree of incestuous collusion is even more nauseating than the open common fees you charge any sucker that buys one of your lousy units.” I burped painfully, and held up a finger to the bartender. One more, just to make sure I could lose consciousness quickly, I thought. “And now you’re prez-elect of the AAFP, a group that could not help to destroy family medicine any faster if it were their actual damn mission statement. How do you sleep at night, how in hell can you justify what you represent?” I summed up.
“I’ve always drawn inspiration from the saying, ‘Ad Astra per Aspera’ – to the stars, through difficulty. To me, it’s a reminder that every journey presents challenges but, by staying focused on your guiding star, you can draw lessons through those difficult moments. My guiding star has always been, and will continue to be, bringing excellent primary care to patients all across the country. I’m deeply grateful to have the chance to advance that mission in this new role,” she said.
I shook my head and stumbled back to my “free” room, that had taken up my weekend and left me feeling more tired, older, and angrier than when I foolishly filled out the application. That night in fevered sweat dreams, I tossed through visions of working in ER’s, behind on multiple patients, and receiving my hourly-wage paycheck on time so that I could spend it on pursuits NOT involving medicine, and weirdly, feeling like all the characters in my dreams were accusing me of quoting them out of context. The next morning upon waking, after shaving my tongue, I sped out of that dump and headed for the nearest Waffle House, where I would show these bastards the true meaning of “quality outcomes” after I got my fork on some hash browns. Scattered, covered, and smothered, baby, and you elitists can stick my lipid numbers in your damn Aristocrat bottle.
Dr. Brull’s career path is pretty stunning – it’s a nearly complete narrative of everything that has gone wrong and destroyed primary care over the past quarter century.
Just so glad I was able to retire at age 64 and tell the ABFM to efff’ off when they wanted something like $927.00 to list me as a “retired Dipomate.” What the hell were they thinking? As a result, I’m no longer listed as a past board certified member of which I don’t give a “chit” as I will never go back to the practice of F.P. Sure I have a lot of patients I miss because they tried to do their best to work with me but I DO NOT miss all the needless computer work that made record keeping hell. Geez, I dictated and signed off on all my paper records too so anyone, including lawyers, could see what I did.
After I left, I ran into a new doc just out of residency that went to work at the clinic I retired from. At a social affair he said, “Oh Kurt, your paper records are so good I was able to step in and pick up where you left off. I could see where you were going.”
I only had to put up with computers for 6 years before walking out to retirement. It was a major reason I left but not the only one. Oh, I dictated and a transcriptionist typed my notes in the “machine”. It was so much more a PITA than when on paper.
Computers only made it a PITA for primary care docs to practice but I doubt many do hospital work, office work and take call like I did anymore. “Pay me X number of dollars to work in the office only with no call and that’s it.”
it turns out teaching is hard. It has been a long adage that those who can, do. And those who can’t, teach. Much more accurate is, those who can, do. And those who can’t, administrate.
Pat, one of your very best rants! Thank you!
Bravo!
There has never been a more deserving subject of your contempt and disdain.
You got to hand it to them – just when you think the AAFP has hit rock bottom, they always find some new way to get even worse.