Thread by @usnehal

Show me a doctor-only staffing model that allows us to care for all Americans, including rural and inner city, those on Medicaid, uninsured, undocumented. The system is broken. We need a range of clinicians.

https://twitter.com/anthonythenp/status/1302966369919463424

I am fine being unpopular with doctors. I don’t give any clinician a pass, tho. I don’t give any faculty a pass either.

What I ❤️❤️❤️ @MIT @MITSloan @MITSloanFellows is get to be honest, creative, expressive, fail, try again.

Pushing past boundaries is the goal. Have an impact.

We need fewer silos and turf wars. We need to break down walls and boundaries.

Fail often but fail smartly. Expect to fail. Have a disciplined process by which to learn from failure.

Every time you learn you have pushed a boundary of your mind or skills or effectiveness.

https://twitter.com/usnehal/status/1301508622351040512

Stay away from the “don’t” and people issuing commandments like they are suddenly God (even in jest -what people joke about is actually pretty telling)

“Professionalism” is also a way women, minorities, LGBTQ, those with disability, etc are discounted

In fact successful ppl:

I am currently getting the world’s most expensive #MBA, yes, but you know what, these people with lots of 💰💰💰now (or will have it) are going to be running healthcare. In class they are forced to listen small group (including me) on social & economic justice.

Let’s be frank: major financial barriers to be a doctor in the U.S. Who does the process select for? Are most doctors those w/ any real lived experience or authentic community ties to underprivileged? Are we at surprised American healthcare disparities?

ncbi.nlm.nih.gov/books/NBK51888…

At age 19 left undergrad at Wellesley for @AKUGlobal, a med school in #Pakistan with a deep commitment to community health, public health, scholarships & special pathway for those from villages/rural areas. I “grew up” as a doctor with authentic mission

aku.edu/mcpk/chs/Pages…

Spent time in #Pakistan Nov ‘19 teaching nursing students in Urdu to give back to the university, @AKUGlobal that gave me quality education such that I got into @bcmhouston then @HarvardChanSPH on full scholarship + stipend vs having any loans. Now am paying for @MITSloanFellows

There are two types of people who criticize me most. 1-A fraction of those “with” credentials but earned within a system of inequity/bias who feel threatened by diversity (think #Medbikini “scholarship”) 2-Non-URM, non-social justice without credentials who align with former.

Two types of insecurity find each other as are natural complements. Unpopular opinion:
There is pattern of: an embattled male, finds a woman to speak for him or defends him. An “Amy Cooper.” She will launch sudden “I am being attacked vs POC
or: npr.org/sections/codes…

But is NOT about credentials. Carefully observe patterns of behavior over weeks, months, years

The true mission & service oriented folks stand out by... service

Those with empty words & optics also reveal themselves

Find the people who share your mission across silos

I see med students & residents engaging in these turf wars

Makes me incredibly sad and concerned on behalf of patients

1-this is the wrong battle
2-you can’t unring this bell even if it were right battle
3-focus on the system
4-promote teamwork

We need everyone in workforce

To be clear, am not making any specific policy or scope of practice recommendations. Of note we also have a nursing shortage which none of these legal or #MedTwitter battles address. Administrators care about more clinicians who can bill for them and will overburden RNs = unsafe

I care about outcomes, safety, efficacy, teamwork. I see none of that right now. I see the most underserved suffering. I see all clinicians burning out. I see non-clinicians hired to control, shame, bully the people doing actual clinical care. I see this

nytimes.com/interactive/20…

Please, people, please, overcome bad educational systems and perverse system incentives. It frustrates me to no end when I see young faculty hired to perpetuate past harms rather than this group of “leaders” saying “stay in your lane” passing out.

blogs.jwatch.org/hiv-id-observa…

And as long as my service on disparities & diversity has earned me ear/respect of deans, chairs, & C-suite, as long as I can cite being former c-suite of $100m 14-center FQHC or $1.8b in CMS funding for Medicaid, will keep holding institutional leadership to their stated ideals

https://twitter.com/usnehal/status/1129021838384934912

Clinicians are missing real issue - majority of clinicians are employed. Who do you work for? Do you even know where the revenue you generate goes? Or are you too busy reporting the Black resident on “professionalism”? #blackmensmiling #BlackExcellence

newyorker.com/business/curre…

Yes, we know that patients had care disrupted. Residents starting at the hospital had the rug pulled out from under them, trapped in leases, hospital leadership not giving advance notice. But step back. What is the driver/root? Who is buying up hospitals?

blogs.scientificamerican.com/observations/t…

This “doctors are the problem” narrative is no more valid than “not a doctor = unsafe” narrative - both sides crafting political strategy and talking points while patients left behind. PE increases its footprint, driving up prices & selling assets.

hbr.org/amp/2019/10/th…

Let’s hope he can teach me something because I am super duper uber worried by trends I am seeing in who is ABOVE the c-suite of #healthcare #MedTwitter and by what I am leaning on how #business folk think. There is an opportunity to do it right and still keep the lights on.

Anyhoo, I think I ruffled enough feathers by being messy & not staying within silo/boundary/box, having a multi-stakeholder perspective. The system harms all within it from patients to clinicians. Fix the system at a higher level - fix perverse incentives, structure, culture.