Doctors' Declaration Of Independence

The most common and gratifying word I have heard from doctors since trumpeting the importance of the?Quadruple Aim ?and co-founding the Health Rosetta ?is "hope." It's been striking how many doctors have said that they had lost hope and hearing the stories of the highest-performing healthcare delivery organizations restored their hope in their profession. The primary reason why is that virtually every high-performing model I've chronicled is led by doctors -- overwhelmingly outside of large health systems.

If you study the?tricks the healthcare industry uses that has led to healthcare's hyperinflation , doctors have little to do with them. Yet, as the most prominent member of industry, they tend to get disproportionately blamed for out-of-control healthcare costs. One could cut all compensation for doctors and we'd still have a catastrophic cost problem. The innovative doctors who have?solved healthcare's most vexing problem --pricing failure--didn't take a big pay cut to make it happen. Rather, they cut out the administrative burden and the massive overhead from the?bubble-like 40% over-capacity of hospital beds ?that is effectively a?redistribution tax on every citizen in the country .

I understand the reasons why there is frustration by doctors and an?epidemic of burnout amongst clinicians . Some chalk it up to knee-jerk resistance to change and financial concerns. I don't doubt that is the case for some; however, the vast majority of doctors see the?under-performance of the status quo healthcare system ?and want something better. However, a key challenge for them, as powerfully told in the video below by Dr. Zubin Damania, is doctors have been rule-followers to get where they are. They endured years of gratification-delaying and the hazing of medical school and residency to get where they are. There is a growing awakening by doctors that the best people to transform healthcare are doctors themselves, and many are stepping up to the challenge--they feel their own identity and the profession depend on it. In the video, Dr. Damania describes how he has been personally transformed following his awakening after being liberated from a high-prestige academic medical center:

When people would talk about their careers or their lives, the ones that were most passionate and were loving what they did always aroused in me an unease. It was almost an anger or jealousy and I would see them and go, "Why is he so happy and fulfilled and doing what he loves to do and I’m doing everything I’m supposed to do but I feel empty?" On the other side of this waking up and being who I am, suddenly I felt like, "Oh my god, that’s me now."

The?#Unbreak campaign ?catalyzed by?athenahealth captures the desire doctors to have to fix the system they suffer in every day. Here's how athenahealth?puts it:

Everyone knows healthcare is broken. With the Unbreak campaign, we’re just shining a bright, harsh light on it—and laughing at the absurdity of the system. But though we embrace humor, we couldn’t be more serious about our desire to address and fix what’s broken.

Listed below are some of the doctor revolutionaries I've been inspired by. Over the last year, I have highlighted these doctor revolutionaries (and issues they are tackling) from a number of perspective including the following:

The doctor revolutionaries

"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." -- Buckminster Fuller

The pendulum is swinging back from medical practices becoming simple referral machines to high-margin services in health systems. Unfortunately, that has become the norm for many health system-based doctors. I sometimes find myself telling doctors and even medical students that they should realize there are many options available to them beyond being a?tool for a mega-organization that is more concerned with milking as much volume and revenue as possible than fulfilling what is written in their mission statements. Many doctors are starting their own organizations while others are transforming more established practices.

I believe the doctors listed below would be some of the signers of the doctors' declaration of independence and ascribe to the spirit of Buckminster Fuller's quote. As with the framers of the Constitution, these individuals span the political spectrum. The common thread is they?share a set of goals that transcend political party ?(to the chagrin of political hacks who want to protect the existing regime). Many of them directly contributed to the?guiding principles for success in the new health ecosystem .

• Dr. Orly Avitzur ?is the medical director for?Consumer Reports, among other things
• While Dr. Bill Cassidy (R-La.)?has been an opponent of the Affordable Care Act (ACA), he's worked across the aisle on?common-sense legislation ?he co-sponsored with Rep. Jay Inslee (D-WA)--HR 3315--designed to support the reinvigoration of primary care when each of them were in the House
• Dr. Rebecca Coelius ?was the director of Health and Human Services for Code for America and is now the?VP of product at Vital Labs, going after how hypertension and other chronic disease is managed outside the clinic walls
• Dr. Zubin Damania was the founder/CEO of Turntable Health and also the famous?ZDoggMD ?pointing out some of the absurdities pervasive in healthcare and how things can be made better
• The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a?white paper ?(PDF) finished by his colleagues after his untimely passing.
• Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the?most challenging patient populations ?and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the?support?of a Nobel Prize winner .
• Dr. John Grohol ?has been the founder and CEO of Psych Central, mental health & psychology advocate, author, researcher and online innovator for two decades
• Dr. Paul Grundy know as the "Godfather of the Patient-Centered Medical Home" is a key figure in developing what has become the platform for transformation that is the underpinning of value-based delivery and payment
• Dr. Sachin H Jain ?is CEO of one of the?population health heroes , Caremore
• Dr. Daniel Kraft ?is the chair for medicine at Singularity University and founder and chair of Exponential Medicine, which pretty much define the opposite of the status quo
• Dr. Rob Lamberts showed how an independent?family physician can strike out on their own ?and provide better care and be more professionally satisfied
• Dr.?Risa?Lavizzo-Mourey led the Robert Wood Johnson Foundation, spearheading its major re-focus on creating a?culture of health ?that is impacting communities throughout the country.
• Dr. Marty Makary , author of?Unaccountable, has shaken up the medical establishment by shining a light on a system that puts good doctors in a bad position
• Dr. Geraldine McGinty ?for her work creating innovative radiology payment models and spearheading payment reform (h/t Bunny Ellerin)
• Dr. Farzad Mostashari?described Aledade's goals ?as follows:?"It’s to help independent primary care doctors re-design their practices, and re-imagine their future. It’s to put primary care back in control of healthcare, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind."
• Dr. Elisabeth Rosenthal hasn't practiced medicine for a long time since becoming a journalist. However, her medical training/practice has informed her outstanding work -- the latest being her book, An American Sickness , that is awakening people to the absurdities in our system that have become the norm.
• Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true?transparent medical market ?and making that available to employers—both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties
• Dr. Vikas Saini ?is tackling the scourge of overtreatment as leader of the Lown Institute
• Dr. Danny Sands ?cofounded the?Society for Participatory Medicine ?while practicing and famously taking care of ePatient Dave
• Dr. Neel Shah was the founder of Costs of Care and advocate for more transparency, value and rationality in healthcare
• Dr. Jordan Shlain ?has been a leader in?value-based primary care ; founder of healthtech startups and a multi-contributor Medium publication called Tincture; and is the founding chairman of the Institute for Responsible Nutrition (IRN), a nonprofit which seeks to raise awareness of illness related to the production, distribution and marketing of processed food
• Dr. Prabhjot Singh ?works on?how U.S. healthcare can learn from other industries and low-resource settings to improve health and healthcare and?cofounded the One Million Community Health Worker Campaign
• Dr. Keith Smith has catalyzed a movement to break free of insurance companies that they view as not adding value. Instead, Dr. Smith and his colleagues make transparent, bundled prices for surgery easy for any type of healthcare purchaser to take advantage of.
• Four years ago, I observed how doctors such as?Wendy Sue Swanson ,?Natasha Burgert ?and?Howard Luks ?were doing something similar to how Sal Khan had “flipped the classroom.” This led to the Robert Wood Johnson Foundation initiating a major program called?Flip the Clinic ?to improve outcomes and participation by patients.
• Dr. Mike Sevilla ?for using?#hcsm ?to educate, elucidate and save family medicine?#FMRevolution ?(h/t Bunny Ellerin)
• Dr. Craig Tanio ?was previously the chief medical officer of the highly regarded ChenMed. He founded Rezilir Health, which improves health by integrating healthcare with communities, recognized that most?health outcomes are driven by factors outside of clinical care
• Dr. Bill Thomas ?is an international authority on the emerging culture of aging and the Eden Alternative and Green House Project founder
• Dr. Eric Topol has written and spoken extensively about?how central the patient will be ?as a participant in their care compared to traditional practices and highlights how the smartphone is the equivalent of the Gutenberg press for medicine
• Dr. Josh Umbehr has been a pioneer in the direct primary care movement including packaging what he built for his practice,?AtlasMD , and made that available to others.
• Dr. Bryan Vartabedian ?is showing other doctors how to be a “public" physician and the impact that can have on outcomes
• Dr. Pamela Wible who has been a leading voice for ideal medical care and been a powerful voice on addressing doctor suicide.
• Dr. Sue Woods ?has been a pioneer in the open notes movement as well as user-driven healthIT
• Dr.?Sheldon?Zinberg founded CareMore, creating a national leader in?treating the frail elderly

It's clear to me that there's no greater threat to the American Dream than our wildly under-performing healthcare system. Thus, I believe there is no more patriotic action a doctor can take than to step out of a system doctors realize is failing. The doctors listed above are a small sampling of doctors who don't want to be a Loyalist to a failing regime that is harming patients and clinicians alike.

Add your comment below on a revolutionary doctor who has inspired you and who was overlooked. Let us know what they are doing to overachieve on the Quadruple Aim. Whether it is private practice, investor-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own ways, they have declared independence from the status quo. Their liberation is key to the revolution sweeping through the healthcare industry. I've been fortunate to get a sneak peak behind what some very creative doctor-entrepreneurs are doing. I'm also used as a sounding board for doctors plotting their next step due to their frustration with the status quo. Suffice it to say, the transformation of healthcare has barely begun.

An earlier version of this article ran on Forbes .

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Dave Chase is the co-founder of the?Health Rosetta ?(a LEED-like organization for healthcare), and author of the book, “The Opioid Crisis Wake-up Call: Health Care is Stealing the American Dream. Here's How We Take it Back. ” Follow the link to the book for a free download of the book. Chase's TEDx talk was entitled "Healthcare stole the American Dream -- here's how we take it back. " See the Health Rosetta website for how to get involved, resources and how to join others to support its mission.

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