Dog supporting his best friend in his first steps.. 🙏

Congrats to Dr. @hedvighricak at @MSKCancerCenter for Luminary Award @PMWCintl #PMWC25 and an outstanding keynote on Precision Imaging for Precision Oncology @Dr_R_Kurzrock

I asked ChatGPT: If I were the devil and wanted to systematically destroy independent medical practice, how would you do it? ChatGPT: I would take a multi-pronged approach that slowly erodes physicians’ autonomy, financial viability, and ability to compete. Here’s the blueprint: 1. Regulatory Capture & Bureaucratic Strangulation •Certificate of Need (CON) Laws: Ensure that new physician-owned facilities—surgical centers, hospitals, imaging centers—are nearly impossible to open by requiring government permission, which will conveniently favor large hospital systems. •Site-of-Service Payment Disparities: Manipulate CMS and insurance payment structures so that hospitals receive 3-5x the reimbursement for the same service that independent physicians provide, making it financially untenable for them to stay independent. •Increased Administrative Burdens: Require excessive documentation (MIPS, MACRA, prior authorizations, etc.) that siphons time away from patient care and makes it impossible for small practices to function without selling out to larger entities. 2. Insurance & Payer Monopoly Control •Eliminate Fee-for-Service: Force physicians into risk-based contracting where they assume financial liability for patient outcomes while insurance companies collect premiums with zero risk. •Narrow Networks: Make it difficult for independent physicians to get into insurance networks, while ensuring hospital-employed physicians are always covered. •Ban Direct Contracting & Cash Pay: Push for regulations that prohibit physicians from opting out of Medicare/Medicaid and limit their ability to offer cash pricing or direct employer contracting. 3. Debt & Financial Manipulation •Medical School Debt Trap: Ensure new physicians graduate with $300K+ in debt, making them dependent on high-paying hospital jobs. •Reimbursement Cuts & Inflation: Keep physician reimbursement stagnant while inflation erodes their real income. Meanwhile, keep hospital and insurance executive salaries skyrocketing. •Malpractice & Compliance Costs: Drive up liability insurance and compliance costs, making independent practice too expensive to sustain. 4. Big Tech & EMR Entrapment •Force EMR Adoption with High Costs: Ensure all practices must adopt bloated, expensive EMRs that are cumbersome and designed for bureaucratic billing rather than patient care. •Restrict Data Ownership: Ensure hospital systems and insurance companies control patient data so that independent physicians are at a disadvantage in managing population health or transitioning between systems. 5. Cultural Warfare & Public Perception Manipulation •Demonize Private Practice: Run a media campaign suggesting that private practice physicians are “greedy” while hospital-employed doctors are “team players” who put patients first. •Use Burnout as a Weapon: Overwork and overburden physicians while portraying burnout as an individual failure rather than a systemic problem caused by monopolization and bureaucracy. •Encourage Mid-Level Creep: Expand scope of practice for non-physician practitioners (NPs, PAs) while cutting physician reimbursement, making them cheaper alternatives and devaluing medical training. 6. Legal & Legislative Warfare •Strengthen Stark & Anti-Kickback Laws: Make it illegal for independent physicians to band together to compete with health systems while exempting hospitals and insurers from the same restrictions. •Ban Physician-Owned Hospitals: Ensure hospitals are owned only by corporate entities, which can then consolidate power and eliminate competition. •No Surprises Act Weaponization: Craft laws that appear patient-friendly but actually benefit insurers by shifting financial power away from independent physicians and toward insurance companies. 7. Corporate Takeover & Consolidation •Private Equity Buyouts: Encourage venture capitalists and PE firms to buy up independent practices, squeeze profits for a few years, and then dump them into hospital systems or insurers. •Encourage Hospital Employment: Make hospital employment seem like the only viable option by cutting physician reimbursement in private practice while increasing it for hospital-employed doctors. •Create Dependence on Large Systems: Ensure that independent practices can’t survive without being a part of hospital networks, whether for referrals, technology, or payer negotiations. The Endgame Within a generation, independent practice would be a relic of the past. Physicians would be reduced to shift workers for hospital systems, insurers, and private equity-backed MSOs, stripped of autonomy, forced to comply with bureaucratic nonsense, and unable to directly serve patients or compete in a fair market. The good news? Physicians can fight back. Price transparency, direct contracting, captive insurance, coalitions, and independent alliances are all weapons to counteract this systematic destruction. But they must act before the devil’s plan is fully realized.

Great discussion about drugs that are toxic. Before dumping these drugs, what can be done? 1. Maybe it’s not toxic. Consensus was that imatinib would be toxic because it would not differentiate normal vs bcr-abl kinase—wrong

Lifetime Cancer Risk Associated with High- and Moderate-Penetrance Mutations in Selected Genes #hereditarycancer

Webcam at the Kennedy Center caught an explosion mid-air across the Potomac.