DAILY SIGNAL: To Tame Health Care System ‘Monster,’ Do These 3 Things, Pediatrician Says

America’s health care system operates like a big business. Doctors and hospitals are overwhelmed with red tape, which takes time away from the patient-provider relationship.

For the health care system to put patients first again, Dr. Marion Mass says it must “cut the glut, open the books, and make everybody play by the same rules.”

Mass, apediatrician and co-founder of Practicing Physicians of America, joins the “Problematic Women” podcast to discuss how the health care system became the monster it is today, and what can be done about it. She also shares her personal story of learning to balance career and motherhood.

Listen to the podcast below or read the lightly edited transcript:

Virginia Allen: It’s my pleasure today to welcome to the show Dr. Marion Mass. She’s a pediatrician in Pennsylvania. She is also the co-founder of Practicing Physicians of America, and a leading voice and expert in the field of health care. Dr. Mass, thank you so much for being here. It’s a pleasure to have you.

Dr. Marion Mass: Oh, my goodness, it’s a pleasure to be here, and please call me Marion. Let’s have this be a discussion between two great women, if I can say that about myself?

Allen: Oh, obviously we can say that about you. I’d love to begin by hearing a little bit of your own story, how you got into the field of medicine and got such a passion for medicine.

Mass: Sure. I grew up in a small town in Bucks County, Pennsylvania. I’m the only girl, four brothers. I always had a proclivity for science. I thought I was going to be a research scientist, so I did a lot of research during my years at Penn State University as an undergrad. I actually worked for Merck for some summers as an intern and did research there and published.

So, when I went to Duke Medical School I had a full ride from the [National Institutes of Health] as an MSTP fellow, Medical Science Training Program. I got to my first clinical year, which was my second year, and I fell in love with clinical medicine. I mean, research was something that I could work at, and I did well at it, but clinical medicine felt like it was where I belonged.

So, I gave up my fellowship, but most of the tuition was already paid for by that point. I feel really bad for young doctors nowadays. I was actually only paying $14,000 a year, and I only had my last year to pay, so it’s part …

Allen: That’s incredible.

Mass: I know. I know. I feel really bad. The tuition there for undergrad is like $77,000 now. It’s like, what happened? That’s another whole topic. So, I am unencumbered with loans. So, I finished my training in Chicago. I trained at Robert Lurie Children’s Hospital. It was a great clinical training program. Met some wonderful friends. Got some great clinical training.

Then my husband, he’s a surgeon, he and I returned to Bucks County. We started having our children then, and I made the conscious decision that I was going to moonlight nights, as a mom, as a hospitalist, and I would be home with my children.

I was a permanently exhausted pigeon, because we had three children in four years, and I would be, like, reading books to them at 4:00 after a shift, and I would fall asleep, and they would come and they would lift my eyelids.

The youngest is 18 now, but we got through those years, and then I did some outpatient pediatrics, and I’m actually back practicing part-time pediatrics in urgent care. I do a lot of advocacy, and it’s been an interesting road to that advocacy.

Allen: I want to get into talking about that advocacy and some of the problems that we have in the medical system in a minute, but share just a little bit more for you of what that was like. As a mom you’re deciding OK, I’m going to take a little bit … almost a step back from my career, but I’m still going to juggling career and family. What was going through your head through that season?

Mass: Well, all right. I’m sure all of my listeners must be familiar with “imposter syndrome,” right?

Allen: I know I am.

Mass: I remember the first time I heard the word “imposter syndrome.” It was the five of us that were the M.D. Ph.D. candidates met with our adviser, who was this guy with like a 50-page resume, really incredibly bright. The one guy was with our group, he said something like, “Wow, there’s a lot of smart people here at Duke. Sometimes, I feel like …,” and then the adviser is, like, “Like you don’t belong? That’s imposter syndrome. We all have it. I have it. Everyone here has it, right up to the president. Just get over it.”

Allen: Wow, at Duke?

Mass: Yes. Well, I mean, whatever, don’t be impressed. There’s great people … Penn State prepared me well. My public school, from Pennridge High School in Bucks County, Pennsylvania, prepared me well. It is what you make of it.

But I will say that when I hit that point where I was staying home, mostly changing diapers, chasing children, that’s when I felt imposter syndrome really hit, like what am I doing? What am I doing? I used to be a contender, and then I’m doing this.

I remember I went to our 10-year Duke Medical reunion, and I’m, like, oh, boy, you have all these people, and they have these big careers and this other stuff, and what am I going to tell them that I’m doing?

My best friend from medical school, and we’re still in touch today, we text at least weekly, I’m so grateful for these words. She said, “You know, Marion, you’ve always given 110% in everything. Why would you want to do less for this portion of your life?” It really like hit me, and I didn’t deviate.

Allen: Thank you for sharing some of your personal background, because I think it really is inspiring and encouraging to hear women’s stories, because everybody does it a little bit differently, and as women we need to know that there’s permission for that, that there’s permission to have this season where you’re the stay-at-home mom. There’s permission to do both, or have the career, so thank you for sharing some of your story.

Mass: No worries. We all have to lift each other.

Allen: We do. Share a little bit about your passion for medical advocacy. What exactly does that mean and how are you involved in being really this powerful voice in the medical community that’s advocating for transparency, for good policy, and advocating for patients.

Mass: Yesterday, I got to sit on health care roundtable with a lot of heavy-hitters, and I said to a friend of mine, “I feel like I’ve reached the American dream in grassroots advocacy,” my version of the American dream, I guess, maybe.

I woke up when the youngest got out of diapers, and wasn’t that the path, right? Stubborn child, but he turned out great. They all have. I love my kids. But I woke up, and my third was out of diapers, and I was, like, what the heck happened to medicine?

I felt like when I was training at Duke Medical School, we, as physicians, were the voice of the hospital. We were the voice for our patients, and we have not been that for a long time.

I remember going to health staff meetings, and they were showing us, here’s the new [electronic health records], here’s the computer order entry that we have to do, and I’m, like, what? This is a cumbersome mess. Why are we are doing this? People are, like, this is just a way forward. The administrators are telling us what to do. I’d be, like, what’s wrong with you people? I just couldn’t get over how, as a profession, many of us rolled over, and I suppose for different reasons. We just sort of let things happen to us. We became very passive.

So, I was already starting to look at, like, how can I get involved, and I got involved a little bit at the state level, with the Pennsylvania Medical Society at that time. Then I found people that were in grassroots groups, the Benjamin Rush Institute, Docs 4 Patient Care, some other really great groups, and I kind of watched and followed and listened to them, and then I decided no one is really putting together something at the national level.

I was thinking about it, because I wanted something that was nonpartisan. Unfortunately, we divide ourselves, and we become political about medicine, and we have what I call a health care food fight, like, repeal Obamacare and Medicare for All. Frankly, I think neither of those things are going to or should happen. They just start a health care food fight, and they divert us from getting to some real succinct, specific reforms that will take power away from the profiteering, monopolized corporate organizations that are not really … . We don’t have free market health care at all. Everything is controlled.

So, we want a free market. We have cronyism. We have frank cronyism that is, like, nearly monopolized. So, anyway, I was unwinding all this, and it’s very confusing. My own mother … I mentioned that I’m one of five, and I’m the only girl, and my mother had Alzheimer’s and … . You can read the story in [KevinMD.com], but bottom line is, in an accoladed hospital with good Medicare Advantage insurance, whatever that means nowadays, with an advocate like me, three weeks after my father passed, my mother was pretty much medically humiliated and received no care, did not receive the most basic care, and the hospital didn’t even notice.

It’s an outrageous story, KevinMD, Marion Mass. You’ll find the story. But that really lit me on fire, so then I really started to get involved. In 2017, Dr. Westby Fisher of Chicago, he’s a cardiologist, we founded Practicing Physicians of America. We’ve taken on some really big people in doing that.

The rest of our board is … we’re a diverse group. We have a child psychiatrist from Texas, Brian Jamal Dixon; a pediatrician from Washington state, Niran Al-Agba; an osteopathic ear, nose, and throat doctor from New York and Pennsylvania, Roy Stoller, and a breast surgeon from Texas, Judith Thompson. So we’re a diverse board. We’re a small board. We don’t take any money for advocacy.

Then, in 2019, I wrote a position paper with David Balat. He’s the executive director of the Free2Care organization. It’s a coalition, 34 member groups, 8 million citizens, 70,000 of us are physicians, and we just agree with the ideas in the paper. We essentially came along and said OK, Medicare for All, repeal Obamacare, non-starters. Let’s talk about what we can agree on, so things on drug pricing, the drug shortages, and the shortages we’re seeing in a lot of medical supplies. We were writing about that in 2018 and 2019.

The need for transparency, the need for innovative models of charity care. The need for innovative models of medical care delivery and health care financing, and how do we ameliorate the physician shortage? We’re staring down the barrel of a physician shortage, and you cannot have medical care without physicians.

There’s a lot said in the United States about we can have health care delivered by other providers. That’s fine, but medical care is defined by our training in allopathic and osteopathic medical schools, M.D.s and D.O.s. You can’t have medical care without physicians, and you’re not going to have good quality health care without those physicians.

Allen: There’s no silver bullet, but what needs to happen in order to get health care and Big Pharma, and all these things back to a place where it’s not this crazy monster, and medicine can maybe become a little bit more personable again?

Mass: 100%. So, what do we need to do? In the “quickie little phrase” world, “Cut the glut, open the books, and make everybody play by the same rules.”

So, going through each of those things, “glut.” What I call “glut” is all of the crappy crap that we have to do as physicians, as nurses, [as physical therapists, as occupational therapists]. I’m not against documentation, but overdoing it is crazy. Prior authorization is a big issue. There’s a bill on the Hill, on the House side and the Senate side. The House side, it was introduced by [Rep. Suzan DelBene, D-Wash.] on the House side; my good friend, [Sen. Roger Marshall, R-Kan.], who is an M.D. So, Fix Prior Auth, #FixPriorAuth, go look that one up.

But physicians spend an average of 16 hours per week on “prior auth.” What prior auth is, it’s like a “Mother, may I?” for us. An insurance company decides “Nope, your patient can’t have that.” What do you mean? We’re the ones that say the patient needs it. “We’re sorry.”

Allen: It’s red tape, in other words?

Mass: Yeah. It’s red tape. So, then we have to go through this series of steps, applying “Mother, may I?” and the insurance company doesn’t have any culpability for that.

I remember patients that turned out to have … When I was in outpatient primary care, we had to go through a “prior auth” process for a family, the one child turned out to have a brain malformation, needed an MRI, and it took forever to get the first MRI, and then second child had the same malformation, more red tape. It’s like, “But, but, but … ” and you have to do all these phone calls. And guess what? That’s taking time away from your patients.

There’s probably 25 things I could tell you that take time away from our patients that we have to do that we don’t want to have to do, so “cut the glut.”

Open the books. Remember that big red Pac-Man? Where’s the money going?

Allen: Where’s the money?

Mass: Yes. It’s getting sucked away and sometimes … You know, one of my big targets has been pharmacy benefit managers. These are the people that manage your prescription drugs. Just as an example, insulin, 80% of the cost of insulin is going to the PBMs. Let me repeat that: 80% of the cost of insulin is going to the PBMs.

Allen: And that’s sort of like the third-party middleman, is the PBM?

Mass: Yes. Yes. And now they’re owned by the insurance companies, so there’s all kinds of integration going on, and then, like, you know, and who let that integration happen anyway? It’s a giant conflict of interest. And by the way, in some cases they’re also owning the pharmacy itself.

Look at, like, CVS, which is sort of like … I’m just going to say it: It’s like the evil empire. They own the pharmacy. They own the PBM. They own Aetna. They bought Aetna. They had $62 billion sitting around, and why did they get the $62 billion? Because, like, 60% of their revenue is coming from their PBM. Everyone blames the insurance company, but these PBMs are the cash cows for the insurance companies.

Now everyone is talking on the Hill, reconciliation package, drug pricing. What they’re putting out from the Senate in the reconciliation package, if they’re talking about drug pricing and they’re not including PBM reform, then they’re not fighting for the American people.

Allen: They’re not getting to the heart of the issue?

Mass: If you are doing anything with drug pricing that does not include PBM reform, you’re not a real fighter, you’re a faux fighter. I’m going to call you on it. Hear that? You’re a faux fighter. Get it? Get it? Like Foo Fighter?

Allen: Wow, it’s fascinating. It’s a wonky subject, but when you actually start to get into it and realize there’s all of these players who are benefiting, and it’s a large really monster to kind of unpack and to bring it down and make it simpler and get medicine back to a place where …

Mass: Where it’s personal. Because if you cut our glut and open the books, then you’d figure out who’s making the money, and then we’d cut more glut, because those people are tying us up. Then if you made everyone play by the same rules … I mean those [pharmacy benefit managers] that I just talked about, they are legally allowed to receive kickbacks. Check that. In 2003, we’ll look at this industry that’s now controlling the pharmaceutical industry. We’ll let them collect kickbacks, but no one else except the hospital supply people, because they can do it, too.

If you actually take a look at the richest health care companies by revenue in America, out of the top 11, 10 of them are legally allowed to receive kickbacks. Do you think that has anything to do with how they got so rich? Duh. Can I say, “Duh”?

Allen: So, for anyone listening who’s thinking they have a passion for medicine, they want to go into medicine, maybe they’re already in the medical field, but they’re kind of hearing, “Oh, goodness, it is this beast,” what is your advice to them? What is your encouragement?

Mass: I would say if you have a passion for medicine, go for it, because we need bright, young, committed, passionate doctors, physicians. I feel even though it’s a long row to hoe, we’re always going to need quality medical care. And remember, you can only get medical care from an M.D. or a D.O., because we’re defined by our training. It’s a long row. It’s the four years of college, making sure you’re good enough to get into the four years of medical school, followed by anywhere between three and 11 years of residency, which those years, they really kind of stink. That’s when you really need some help being held up.

But you know what? It’s also a really joyful place to be. What an honor to be with people, to hold their hands in their times of need. When I did hospital work, and especially when I did my training, you’d meet really sick patients. They were just so vulnerable and scared, and they need our trust. They need to be able to trust us as a profession, and all of this stuff that’s come up around us, the big red Pac-Man, the Jabba the Hutt beast, it’s causing people not to trust the health care arena.

I have patients now that tell me, “There’s a lot of doctors I don’t trust.” I have patients tell me, “I don’t trust the hospital.” It’s really sad. People don’t trust Pharma. Look at this whole COVID fiasco, and it was a fiasco. We raised the radar for the American public to realize how broken the landscape is, which is good, and I do think we can bring this back and polish off a beautiful profession, but you’re not going to do it unless physicians lead.

Good physicians, ethical physicians, and we’re not going to do it without calling out people that maybe they haven’t … . They’ve been running around in Washington, D.C., spouting what I call convenient untruths, because that’s how this place works, right? Hey, listen, congressman and senator, let me tell you why my big, large, gigantic Jabba the Hutt corporation is just doing wonderful things, but really not so much in the patient, of course. It sounds really good, right?

Then those of us schmucks who are too busy running practices, we don’t have enough time to get down here. Then you come down here and you discover … I was down here with my sister-in-law, so, Tina and my brother. My brother, Martin, is a cardiologist. He actually got the Ph.D. I’m a slacker.

Allen: No, I don’t think so.

Mass: So, we came down here, and she was, like, talking to someone in the cafeteria. She came up to me and she’s, like, “That person I was talking to, they work for a [pharmacy benefit manager] and they told me there’s 200 or 300 lobbyists down here on the Hill today lobbying for PBMs,” and I’m, like … It’s exhausting.

Allen: Never ending.

Mass: Yes. It is a swamp.

Virginia Allen: It is. Well, before we let you go, I have to ask you a question that we love to ask all of our guests on this show, and that is: Do you consider yourself a feminist? Yes or no? Why or why not? No right or wrong answer.

Mass: Naturally, I’m not going to have a one-word answer.

Allen: Of course not.

Mass: Anyone who asks me to talk better be prepared, right? I love being a woman. I am a feminine person. I do believe that we should be empowering women to be strong and noble and full of grace. That comes from my Catholic background, but I do believe there’s many paths to salvation.

I do believe women can achieve anything. But I feel like in America we’ve become sometimes lumpers and sometime splitters, and those are both … . Those words just even sound so negative. Like who wants to be a lump? Who wants to be split? Instead, I think we should be, like, unifiers.

So, what I’d rather do is sit down and talk to people who are feminists and, like, “Why do you consider yourself a feminist, if you do? What can we agree upon as women together?” Clearly, I grew up in a household that most would consider very patriarchal, but you know what I have to say, and both my parents are gone now.

Both my mom and dad had their own unique way of lifting me up, recognizing that I was bossy and bright. I shouldn’t use the word “bossy.” I should say “assertive,” right? I was assertive, and I was bright, and I was heck bent on getting somewhere.

My father, he always encouraged my education, but he was also careful. He tempered it. I remember when I was 18, he said to me, “OK, so, you’re going to leave, and you want to [go to] college and then medical school?” He was, like, “I’m going to tell you something I know you don’t want to hear. You can’t do it all, and do it all really well, all at the same time.” Boy, was I mad, because I can do everything.

But he was right, and I came to see it over time. Finding our balance, I think, is really important. Yeah. Yeah. So, now I come down to Washington, D.C., and I’ve had times where I’m sitting in some important meeting, and the phone is going off, and it’s, like, “Where’s the meatballs in the freezer?” or, “When is so-and-so supposed to be at confirmation practice?” or whatever.

I’m, like—oh, gosh—I still have to handle some of the details, but we’re all making it work. It’s a different season than it was when I was home, always diligently making the meatballs, but we’re making it work.

Allen: Marion, thank you so much for doing this. It’s been a pleasure to have you to hear some of your story and also break down a little bit of a wonky subject, but one that affects all of us. So, thanks for your time.

Mass: Oh, my gosh, it was my great pleasure. People can find me on Twitter, on LinkedIn. They can find Practicing Physicians of America. They can find Free2Care. I really appreciated spending this part of my day with you, and I will go back out into Washington, D.C., and continue to be a Problematic Woman.

Allen: Please do.

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