>>> HEALTH CARE IN AMERICA IS NOT YET A BIG ELECTION ISSUE, DESPITE PATIENTS FACING MANY HARDSHIPS.

DR. CHAVI EVE KARKOWSKY IS A MATERNAL FETAL PHYSICIAN AND JOINS MICHEL MARTIN TO DISCUSS HOW RED TAPE COMPLICATES ACCESS TO CARE, AND ALSO ENDANGERS LIVES.

>> DOCTOR, THANK YOU SO MUCH FOR JOINING US.

>> THANK YOU FOR HAVING ME.

>> YOU WROTE A PIECE FOR "THE NEW YORK TIMES" ABOUT THE ADMINISTRATIVE BURDEN THAT AMERICANS EXPERIENCE IN THE U.S. HEALTH CARE SYSTEM.

NOW, THAT'S KIND OF A FORMAL WAY OF TALKING ABOUT WHAT WE'RE TALKING ABOUT, BUT WE'RE TALKING ABOUT PAPERWORK, RIGHT?

IS THAT WHAT WE'RE TALKING ABOUT HERE?

>> I THINK WE ARE TALKING ABOUT PAPERWORK, BUT EVERYTHING IN MEDICINE IS ALSO BORING AND ALSO HEARTBREAK, RIGHT?

SO, WE'RE TALKING ABOUT PAPERWORK, BUT WE'RE ALSO TALKING ABOUT HUMAN SUFFERING.

>> YOU OPEN THE PIECE WITH A SCENARIO THAT JUST IS TERRIFYING AND HEARTBREAKING, AND ENCOURAGING IN SOME WAYS.

SO, AS BRIEFLY AS YOU CAN, JUST TELL US HOW YOU OPEN THE PIECE FOR PEOPLE WHO HAVEN'T HAD A CHANCE TO READ IT.

>> SURE.

I STARTED THE PIECE WITH A STORY FROM SEVERAL YEARS AGO, I'M A HIGH-RISK OBJECTIONS TRIGS.

I WAS WORKING A SHIFT IN THE HOSPITAL AND I WAS CALLED TO OUR TRIAGE UNIT, OUR SMALL EMERGENCY ROOM THAT WE HAVE FOR PREGNANT PATIENTS.

AND THERE, I FOUND A PATIENT WHO WAS ABOUT 28 WEEKS PREGNANT, SHE HAD A VERY HIGH FEVER AND SHE WASN'T BREATHING WELL.

AND THE STORY THAT SHE TOLD ME WITH THAT, SHE HAD STARTED TO HAVE SYMPTOMS OF A URINARY TRACT INFECTION, WHICH IS COMMON, BUT VERY COMMON IN PREGNANCY.

SHE HAD GONE TO HER DOCTOR AND GOTTEN A PRESCRIPTION, BUT WHEN SHE WENT TO THE PHARMACY, THEY WOULDN'T FILL IT.

AND SHE WASN'T REALLY CLEAR ON WHY, IF THERE WAS TROUBLE WITH PAYMENT OR HER IDENTIFICATION, BUT SHE JUST DIDN'T GET HER MEDICINE.

SHE STARTED TO GET SICKER, BACK PAIN, STARTED TO CONTRACT, AND SHE EVENTUALLY CALLED 911 WHEN SHE BECAME SHORT OF BREATH.

WHEN SHE CAME TO SEE US, WE VERY QUICKLY WERE CONCERNED ABOUT A KIDNEY INFECTION, WHICH IS SOMETHING THAT HAPPENS IF YOU HAVE AN UNTREATED UTI, AND CAN LEAD TO PRETERM LABOR, OR EVENLESS PROTOIR DISTRESS, IF IT'S REALLY UNCONTROLLED.

>> SO, THEN, WHAT HAPPENS IS, PEOPLE RUSH IN, THEY FOCUS ALL THEIR ATTENTION, YOU KNOW, YEARS OF TRAINING AND EXPERTISE AND DEDICATION, TO SAVING THIS PATIENT'S LIFE, BUT YOU JUX POSE THAT, HOW MUCH WOULD THAT ANTIBIOTIC WOULD HAVE COST?

>> THE ONE WE TEND TO USE AND THE ONE I BELIEVE SHE WAS GIVEN IS A REALLY OLD, GENERIC MEDICATION, I THINK $12 TO $20 FOR A FIVE TO SEVEN-DAY COURSE.

WE'RE TALKING ABOUT SOMETHING THAT'S VERY CHEAP FOR WHAT IT IS.

>> $12 ANTIBIOTIC, IF SHE GOTTEN IT ON TIME, WHEN IT WAS PRESCRIBED TO HER, SHE DIDN'T, NOT TO PUT A DOLLAR PRICE ON THIS, BUT HOW MUCH DO YOU THINK ALL THAT MEDICAL INTERVENTION COST TO SAVE HER LIFE WHEN SHE DIDN'T GET THAT ANTI-BEE YOTIC?

>> I HESITATE, BECAUSE I CAN'T FACT CHECK ANY OF THIS, BUT BALLPARK, A DAY IN THE HOSPITAL IS $2,000, $3,000.

BUT ICU-LEVEL CARE, WHICH WE PROVIDE FOR SOMEBODY WHO IS EXPERIENCED PRETERM LABOR AN NEEDS THAT HIGHER LEVEL OF CARE, IT'S OFTEN $5,000 A DAY, RIGHT?

SO, IT'S VERY COST EFFECTIVE TO PREVENT THAT KIND OF ADMISSION.

EVEN AT THE SAME TIME, I'M REALLY, REALLY PROUD OF MY TEAM THAT DOES ASSEMBLE SO QUICKLY FOR A PATIENT WHO IS SICK AND BRINGS SO MUCH EXPERTISE AND SO MUCH PASSION AND SO MUCH DEVOTION, YOU KNOW, I'VE GOT A TEAM THAT'S ANESTHESIOLOGISTS AND THE NICU TEAM, WE ARE READY, BUT YOU'RE RIGHT, WE'RE VERY EXPENSIVE.

>> YOU'VE ALSO WRITTEN A BOOK CALLED "HIGH RISK: A DOCTOR'S NOTES ON PREGNANCY, BIRTH, AND THE UNEXPECTED."

AND YOU ALSO WROTE AN OP-ED IN 2021 FOR "THE ATLANTIC."

VACCINE USERS HAVE COMPASSION FATIGUE.

THE REASON WE CALLED YOU TODAY, FOR THE OP-ED YOU WROTE FOR "THE TIMES."

BUT TAKING THOSE ALL TOGETHER, DO YOU THINK THERE'S A THROUGH LINE THERE?

>> IT'S REALLY INTERESTING, ONE OF THE CHAPTERS IN MY BOOK, MY BOOK THAT CAME OUT ONE WEEK BEFORE THE PANDEMIC, WHICH WOULD NOT RECOMMEND AS A MARKETING TECHNIQUE, JUST IN GENERAL, MY LONGEST CHAPTER IS ABOUT SYSTEMS.

AND SYSTEMS ALWAYS SOUND LIKE SUCH A BORING TOPIC, RIGHT?

PAPERWORK AND RULES AND WORK FLOWS AND ALGORITHMS.

BUT I THINK, WHAT I'M HOPING I'VE SHOWN IN THAT CHAPTER, IS THAT IT'S ALSO PEOPLE'S LIVES.

AND PEOPLE'S TIME.

AND PEOPLE GETTING SICK OR PEOPLE GETTING WHAT THEY NEED, BECAUSE OF THOSE RULES AND ALGORITHMS AND ADMINISTRATIVE BURDENS.

AND THIS HAS BEEN SOMETHING THAT AS I BECOME MORE EXPERIENCED IN MEDICINE, AS I BECOME SOMEBODY WHO MANAGES MORE AND MORE OF MY COLLEAGUES, I'M STARTING TO SEE THE BIGGER PICTURE.

AND I'M TRYING TO PUT THAT TOGETHER IN MY WRITING TO SHOW ALL OF US, TO SHOW ALL OF YOU SO WE CAN HAVE THESE CONVERSATIONS.

SO, SOMETHING I TALKED ABOUT IN MY BOOK AND YOU CAN SEE MY EVOLVING UNDERSTANDING OF THE SYSTEM THAT I WORK IN, THAT I SOMETIMES SAY I SWIM IN LIKE A FISH IN THE OCEAN, AND TRYING TO BRING THAT TO EVERYBODY, BECAUSE I ACTUALLY THINK IT HAS A BIGGER AFFECT ON YOUR CARE, ON THE CARE THAT I GIVE AND THE CARE THAT YOU RECEIVE, THAN ANYBODY REALLY KNOWS, AND I THINK IT DESERVES SOME ATTENTION.

>> YOUR PIECE IS TITLED "THE OVERLOOKED REASON OUR HEALTH CARE SYSTEM CRUSHES PATIENTS."

I HAVE TO TELL YOU THAT -- BEFORE OUR CONVERSATION TODAY, YOU KNOW, I MENTIONED TO A COUPLE PEOPLE I WAS GOING TO TALK TO YOU.

TO A PERSON, EVERYBODY HAD A STORY.

EVERYBODY HAD A STORY.

HOW IS THIS OVERLOOKED?

>> I HAVE TO TELL YOU THAT I THINK THIS IS SORT OF THE CURRICULUM THAT I LEARNED IN MED SCHOOL, RIGHT?

IMMEDIATELY AFTER LEARNING ALL THE ANATOMY, YOU START WORKING WITH PATIENTS, AND THE FIRST THING YOU START TO LEARN IS THAT NOTHING THAT YOU NEED TO DO IS HELPFUL IN ANY WAY UNTIL YOU CAN GET IT TO THE PATIENT.

RIGHT?

AND GETTING IT TO THE PATIENT IS ITS OWN DISCIPLINE.

ITS OWN SORT OF ACADEMIC PURSUIT.

IT'S A COMPLICATED EXPIANOER AGAINST.

AND I THINK FOR PATIENTS, THEY'RE LEARNING THAT, AS WELL.

SOMETIMES OVER YEARS OF A CHRONIC ILLNESS, AND SOMETIMES VERY, VERY QUICKLY, AS THEY GET VERY ABRUPTLY SICK.

>> HOW DID IT START, THAT FILLING OUT FORMS BECAME SUCH FUNDAMENTAL TO AMERICAN HEALTH CARE?

>> I DON'T HAVE A HISTORICAL VIEW FOR YOU, WHAT I CAN SAY IS THIS.

THE AMERICAN HEALTH CARE SYSTEM, AND WHEN I TALK ABOUT THAT, I DON'T JUST MEAN ME OR A HOSPITAL, OR EVEN A CLINIC.

I MEAN ALL OF IT.

YOUR INSURANCE PROVIDER, THEIR CLAIMS ADJUSTERS, EVERY SINGLE ONE OF US IS ADJACENT TO HOW HEALTH CARE GETS PROVIDED, PAID FOR, APPROVED, DISAPPROVED, ALL SORTS OF THINGS.

IT'S A MASSIVE BEAST OF AN INDUSTRY, RIGHT?

MOST OF WHICH IS THERE TO HELP YOU, BUT LIKE ANY LARGE SYSTEM, I THINK HAS TO EVOLVE.

I SOMETIMES COMPARE IT TO THE MILITARY, EXCEPT UNLIKE THE MILITARY, YOU ARE ALL GOING TO END UP IN IT AT SOME POINT.

AND THERE'S GOING TO BE A LACK OF TRANSPARENCY AND ORIENTATION TO THE PROCESSES WHICH ARE GOING TO GOVERN YOUR LIFE, OFTEN WHEN YOU ARE AT YOUR MOST STRESSED OR FEELING YOUR LEAST WELL AND ABLE TO HANDLE THEM.

SO, I THINK THERE ARE THINGS THAT ARE PARTICULAR ABOUT THE AMERICAN SORT OF MEDICAL SYSTEM THAT WE CAN TALK ABOUT, THAT MAKE IT PARTICULARLY DIFFICULT, EVEN AS SOME OF THOSE THINGS ARE THINGS WE ARE VERY PROUD OF.

>> WOULD YOU SAY MORE, YOU KNOW, TELL US A COUPLE OF OTHER STORIES?

>> I MENTIONED IN THE PIECE THAT I WAS IN CLINIC, I HAVE A CLINIC WHERE I OVERSEE OUR HIGH-RISK FELLOWS ON A WEDNESDAY, AND I HAD A PATIENT WHO HAD NOT BEEN ABLE TO PICK UP HER GLUCOSE FINGER STICK, TESTING STRIPS, AND SHE HAD BEEN THREE, FOUR WEEKS WITHOUT THEM, WHICH FOR PREGNANCY IS AN I TERNTY, RIGHT?

EVERY WEEK COUNTS, EVERYTHING I DO IS TIME SENSITIVE.

AND SHE HAD TAKEN OFF THE MORNING OFF OF WORK, SHE IS AN HOURLY WORKER, THAT'S NOT WORK SHE'S GOING TO GET BACK, SO THAT SHE COULD FERRY BETWEEN, YOU KNOW, HER INSURANCE OFFICE AND THE MEDICAID OFFICE AND THE PHARMACY, AND SHE FINALLY GOT THE TEST STRIPS.

AND I HELPED HER.

I WENT WITH HER TO THE MEDICAID OFFICE, BECAUSE IT'S RIGHT ACROSS THE STREET.

I WENT WITH HER TO THE PHARMACY AND WE CLEARED IT ALL UP.

AND SHE GOT HER TEST STRIPS FOR $5, $10 COPAY, BUT IT COST HER ALL OF THE MORNING, WHATEVER CHILDCARE SHE HAD TO GET FOR OTHER CHILDREN, RIGHT?

ON THE OTHER HAND, I WAS HAPPY TO DO IT, BECAUSE IT WAS MUCH CHEAPER THAN ADMITTING HER FOR A DIABETIC COMA.

SO, I KNOW THAT ESPECIALLY IF YOU WORK WITH AN UNDERSERVED POPULATION, I WORK IN AN AREA THAT SERVES SOME OF THE POOREST ZIP COLDS IN ZIP CODES IN THE ENTIRE UNITED STATES.

LIFE IS VERY HARD ALREADY FOR THESE PEOPLE.

THESE BARRIERS BECOME INSURMOUNTABLE, BUT A LOT OF TIMES OUT'S THIS ADMINISTRATIVE WORK.

>> A LOT OF PEOPLE ARE GOING TO SAY, WELL, YOU KNOW THIS IS FOLKS THAT ARE UNINSURED OR, WELL, MAYBE PEOPLE WHO -- ENGLISH ISN'T THEIR FIRST LANGUAGE, OR PEOPLE WHO DON'T REALLY NAVIGATE SYSTEMS -- YOU CITE IN YOUR PIECE A HARVARD MEDICAL SCHOOL STUDY THAT FOUND THAT A QUARTER OF INSURED ADULTS REPORTED THAT THEIR CARE WAS DELAYED OR MISSED ENTIRELY BECAUSE OF ADMINISTRATIVE TASKS.

>> YEAH.

I WORK IN NEW YORK STATE, AND NEW YORK STATE, AND I FEEL VERY BLESSED BY THIS, EVERY SINGLE PREGNANT PATIENT IS INSURED.

DONE.

ELIGIBLE FOR MEDICAID.

I FEEL VERY, VERY LUCKY IN THIS SETTING.

I NEVER HAVE TO WORRY IN THAT WAY.

POSTPARTUM COVERAGE COULD BE BETTER, BUT ONCE THEY'RE PREGNANT, AND BECAUSE I EXCLUSIVELY TAKE CARE OF PREGNANT PATIENTS, THAT'S ALL OF MY PATIENT POPULATION, AND I STILL SEE THIS TREMENDOUS BURDEN.

IT'S NOT JUST ABOUT BEING UNINSURED.

I THINK ANYBODY WHO HAS INSURANCE HANDLES THIS.

HOW MANY PHONE CALLS DID YOU HAVE TO MAKE TO GET TO A SPECIALIST?

HOW MANY FORMS DID YOU HAVE TO FILL OUT TO GET YOUR RIGHT MEDICATION?

HOW MANY TIMES DID YOU PRESS THE WRONG NUMBER ON A PHONE TREE AND YOU SPENT ANOTHER HOUR WAITING FOR SOMEBODY WHO REALLY KNEW WHAT THE RIGHT ANSWER WAS AND COULD PROVIDE YOU THAT EXPERTISE?

>> HAS THE MEDICAL ESTABLISHMENT ITSELF PLAYED A ROLE IN THIS, TO BE FAIR?

>> I GUESS I FEEL LIKE I WORK WITH SOME OF THE MOST DEVOTED PEOPLE, RIGHT?

WHAT I WOULD SAY IS THIS, I SPEND A LOT OF MY TIME OVERCOMING ADMINISTRATIVE BURDEN FOR PATIENTS.

AND THAT IN ITSELF IS BOTH VERY BEAUTIFUL AND EXTREMELY DUMB.

IT'S A DUMB USE OF, LET'S SAY, MY TIME.

I AM SOMEBODY WHO IF I COULD SEE FIVE MORE PATIENTS THAT DAY, IT'S PROBABLY A BETTER USE OF MY PARTICULAR 20 YEARS OF TRAINING TIME.

BUT I WORK IN A SYSTEM THAT I CAN BE SMART AND GIVE YOU THE RIGHT INSULIN, GIVE YOU THE RIGHT ANTIBIOTIC, BUT IF IT DOES NOT GET TO YOU, YOU WILL END UP SICKER.

I'M GOING TO TAKE THAT 10, 15, 30 MINUTES, TALK TO YOUR PHARMACY, TALK TO YOUR INSURANCE OFFICE.

THE CHOICE I OFTEN HAVE IS NOT, DO YOU WANT TO BE EFFICIENT FOR THE, YOU KNOW, FOR THE MEDICAL SYSTEM AT LARGE, THAT'S NOT THE CHOICE IN FRONT OF ME.

THE CHOICE IN FRONT OF ME IS, ARE WE GETTING THIS PATIENT WHAT SHE NEEDS OR NOT?

AND I HAVE ALWAYS GOTTEN THE PATIENT WHAT SHE NEEDS.

BUT I WILL TELL YOU, TO BE ANGRY AT PROVIDERS OR DOCTORS, I THINK, IS THE WRONG THING.

I AM DOING SOMETHING THAT'S SUB OPTIMAL, BECAUSE THE SYSTEM I AM IN IS SUB OPTIMAL, AND THE CHOICES I HAVE ARE BAD.

>> AND I'M ASKING YOU, HAVE NOT MEDICAL PROFESSIONALS BEEN OBSTRUCTIONISTS IN FIGURING OUT HOW TO PROVIDE AFFORDABLE CARE AND ACCESS ACROSS THE BOARD?

IS THAT NOT THE CASE?

>> I DON'T KNOW IF THAT'S THE CASE.

I DON'T KNOW WHO MEDICAL PROFESSIONALS ARE.

IS THAT ME AND MY DOCTORS?

I DON'T KNOW, WE'RE PRETTY -- WE'RE PRETTY IN THE TRENCHES KIND OF FOLKS.

IF MEDICAL PROFESSIONALS ARE CEOs OF INSURANCE COMPANIES OR GIANT MEDICAL SYSTEMS, THEY HAVE A DIFFERENT AGENDA.

I'M EXTREMELY CLINICAL, I'M BOTH VERY FOCUSED ON THE PATIENT IN FRONT OF ME, BUT AS I HAVE BECOME MORE SENIOR, MORE AWARE OF THE WAY THE SYSTEM AFFECTS THEM ALL.

>> IN THE REAL WORLD, DO YOU THINK THAT POLICYMAKERS THINK ABOUT THE TIME COSTS FOR BOTH PATIENTS AND PROVIDERS, PHYSICIANS, IN THEIR RULE-MAKING?

>> I THINK THAT'S IT.

I THINK WE DO NOT COUNT TIME COSTS.

AND TIME COST IS A REALLY, REALLY INTERESTING SUBJECT, BECAUSE TIME COST IS VALUABLE, ONLY IF YOU VALUE SOMEONE'S TIME, RIGHT?

SO, A LOT OF THESE PATHS ARE DONE BY PEOPLE WHO THE INSURANCE COMPANY DOESN'T PAY THEIR SALARY, SO, TWO HOURS SPENT ON THE PHONE ISN'T ON THEIR BOTTOM LINE.

I WOULD ARGUE THAT MANY TASKS ARE DONE BY WOMEN AND ARE PART OF THE UNPAID WORK THAT MANY WOMEN DO TO SUSTAIN THEIR HOUSEHOLDS.

AND WE TEND TO NOT VALUE A LOT OF THAT HISTORICALLY.

BUT IT IS COSTLY.

IT DOES TAKE TIME.

AND IT SHOULD BE COUNTED.

WHEN IT'S NOT COUNTED, WE DON'T ULTIMATELY VALUE IT, BECAUSE WE DON'T EVEN UNDERSTAND WHAT WE'RE PAYING.

>> HOW WOULD YOU FIX THIS?

HOW WOULD YOU FIX THIS?

>> YOU KNOW, IT'S VERY INTERESTING, BECAUSE I ASKED THIS QUESTION TO SOME OF THE PEOPLE I SPOKE TO FOR THE ARTICLE, AND THEY REALLY SAID THAT THEY DIDN'T HAVE A LOT OF GREAT IDEAS.

IT'S VERY, VERY HARD TO ESTIMATE TIME COST.

IT'S VERY, VERY HARD TO KNOW HOW MUCH TIME PEOPLE ARE SPENDING.

BUT I'LL SAY THIS.

I SEE HOW WE FIXED OTHER THINGS.

SO, THE WAY THAT WE PAY ATTENTION TO MATERNAL MORTALITY AND MORBIDITY.

WE DON'T DELIVER BABIES BEFORE 39 WEEKS WITHOUT A VERY GOOD REASON.

THE WAY WE DO THAT IS, WE PAY ATTENTION.

WE PUBLISH METRICS, WE GRADE PEOPLE.

WE SORT OF SHINE LIGHT ON THE SUBJECT AND WE ALSO MAKE THAT KNOWLEDGE PUBLIC.

WE TELL PEOPLE, THIS CLINIC HAS AN A-PLUS.

THIS CLINIC HAS A B-MINUS, WHERE WOULD YOU RATHER GO?

AND I GUESS I WONDER IF THERE'S ANY ROOM FOR CALCULATING TIME COSTS AND REQUIRING A METRIC THAT REFLECTS THAT KIND OF TIME.

MAYBE SOMETHING THAT WE WOULD DO ACROSS THE COUNTRY SO THAT PEOPLE WOULD KNOW, THIS PLACE IS A PLACE THAT VALUES MY TIME.

THIS PLACE DOESN'T.

AND IT WOULD ALLOW, I THINK, FOR MORE KNOWLEDGE FOR PATIENTS TO PURSUE THINGS THAT ARE IN THEIR BEST INTEREST, PERHAPS.

>> WELL, YOU KNOW, I MEAN, THE IRS DOES THAT.

I MEAN, THE IRS WILL DESCRIBE HOW LONG THEY ESTIMATE IT WILL TAKE TO FILL OUT ONE FORM OR ANOTHER IN TAX COMPLIANCE.

IN OTHER SPHERES, THIS IS PART OF PUBLIC CONVERSATION, BUT IT DOESN'T SEEM TO BE WHEN IT COMES TO THIS, AND I'M JUST WONDERING IF YOU HAVE A THEORY ABOUT THAT.

>> I DO THINK THERE'S SOMETHING HERE THAT WE HAVEN'T DISCUSSED, WHICH IS COST.

AND THE UNITED STATES PAYS MORE OVERALL PER PERSON, YOU KNOW, AS A PERCENTAGE OF GDP, THAN ANYWHERE ELSE.

AND THERE ARE WAYS IN WHICH WE GET LESS FOR IT.

THERE'S OUR MATERNAL MORTALITY IS AWFUL, OUR MATERNAL MORTALITY FOR WOMEN OF COLOR IS TRULY SHAMEFUL.

AND WE SPEND MORE MONEY THAN ANYONE ELSE.

AND SOME OF THIS, I THINK, IS FROM THE COMPLEXITY OF THE SYSTEM WE'RE IN.

DON'T HAVE A SINGLE PAYER.

WE DON'T EVEN HAVE A SINGLE PAYER PER REGION.

WE HAVE A CAPITALIST MARKETPLACE, RIGHT?

MOSTLY.

COMBINED WITH PUBLIC INSURANCE, WHICH IS A VERY LARGE PLAYER.

AND SO, I THINK IT'S JUST A VERY STRANGE AND COMPLEX SCENARIO AND ONE THAT'S VERY, VERY HARD TO DRIVE, ONE THAT'S VERY HARD TO DRIVE CHANGE IN, BECAUSE IT'S REALLY COMPLICATED.

THERE'S A FAIR AMOUNT OF GOVERNMENT INTERFERENCE, BUT THERE'S ALSO A FAIR AMOUNT OF JUST MARKET FORCES, AND BECAUSE OF THIS UNIQUE MIX THAT WE HAVE, WE HAVE SOME WONDERFUL THINGS.

I AM REALLY PROUD OF MY TEAM THAT CAN PROVIDE AMAZING CARE IN UNDER AN HOUR FOR A SICK PATIENT, BUT WE ALSO HAVE THESE COSTS, WHICH IS THAT EVERYBODY'S GOT SIX DIFFERENT FORMS, BECAUSE THEY HAVE SIX DIFFERENT INSURANCE COMPANIES AND SEVEN DIFFERENT PHARMACIES AND NOBODY'S COME TO AN AGREEMENT OR STANDARDIZATION.

BUT THE COST, I THINK, IS REAL, AND A REAL DRIVER.

AND I DON'T THINK IT'S WRONG TO WANT TO BRING THAT COST DOWN.

WE ALL PAY FOR THAT.

WE PAY FOR PREMIUMS, WE PAY IN THE FEDERAL BUDGET.

BRINGING THE COST DOWN IS SOMETHING THAT I THINK WE'RE GOING TO HAVE TO DO.

IT'S JUST THAT SOMETIMES COMPANIES MAKE THE DECISION TO BRING THE COST DOWN BY MAKING THE ADMINISTRATIVE BURDEN HIGHER, AND THAT ONLY WORKS IF YOU DON'T COUNT THE ADMINISTRATIVE BURDEN AS A COST.

>> I'VE HEARD -- I THINK THERE MAY BE DATA TO BACK THIS UP, THAT THERE ARE DOCTORS WHO HAVE LEFT THE FIELD BECAUSE OF THE PAPERWORK BURDEN.

HAVE YOU EXPERIENCED THAT?

HAS ANYBODY, FRIENDS, PEOPLE YOU WENT TO MED SCHOOL WITH, DO YOU THINK THAT MIGHT BE TRUE?

>> THIS IS VERY PERSONAL TO ME, BECAUSE I FEEL LIKE I AM JUST SEEING SUCH PROFOUND BURNOUT IN THE MEDICAL PROFESSION RIGHT NOW.

WHICH IS HARD.

MOST OF US LOVE THE WORK WE DO, WE LOVE OUR PATIENTS, WE SPENT A LONG TIME BECOMING GOOD AT THIS WORK AND THIS WORK IS VERY, VERY HARD.

BUT IT IS ALSO TRUE THAT MANY OF US SPEND HOURS AND HOURS AND HOURS ON ADMINISTRATIVE BURDEN.

YOU KNOW, THESE ARE TASKS THAT DON'T BRING IN REVENUE.

THEY'RE NOT BILLABLE, FOR THE MOST PART.

BECAUSE OF THAT, THEY MAY NOT BE SUPPORTED.

AND I DO THINK IT ALL ADDS UP.

IT ALL ADDS UP, AND ADDS TO DISSATISFACTION ON TOP OF SORT OF POST-PANDEMIC DIFFICULTIES, FATIGUE, AND MALAISE.

I THINK THERE'S A TRUE BURDEN HERE THAT IS CONTRIBUTING TO CLINICIAN BURNOUT.

AND I THINK IT'S GOING TO HAVE TO BE ADDRESSED.

>> DOCTOR, THANK YOU SO MUCH FOR TALKING WITH US.

>> THANK YOU SO MUCH.