Memo to the DOGE cc: Fox Docs

First, let's make it clear that people should not confuse the DOGE with the Venetian Doge, although many will find them strikingly similar.

For more than 1,000 years, the chief magistrate and leader of the city of Venice and later of the Most Serene Republic of Venice was styled the Doge, a rare but not unique Italian title derived from the Latin Dux. Doges of Venice were elected for life by the city-state's aristocracy. The Venetian combination of elaborate monarchic pomp and a republican (though "aristocratic") constitution with intricate checks and balances makes "La serenissima" (Venice) a textbook example of a crowned republic.

I have four suggestions to streamline the federal bureaucracy that is in keeping with your 3-part stated mission of regulatory rescissions, administrative reductions and cost savings.

First, privatize the VA. While I have not appeared as a news show contributor, I worked at the VA,?in part,?for the majority of my clinical career. The debate seems to revolve around a few main questions:

1. Is a separate VA system still relevant in a changing sick care environment?

2. Is the VA terminally wounded to the point where trying to fix it will mean throwing good money, and lots of it, after bad?

3. Would outcomes change if all or parts of the system were privatized?

4. Do we "owe" veterans a separate system?

5. If the system were privatized, would the veteran patient experience improve and what would be the costs of implementing the change? What would be the benefits?

6. Does 'crony capitalism" extend not just to the medical-industrial complex, but to politically influential veterans organizations as well?

7. The VA represents 3.9% of the federal budget and employs hundreds of thousands. What would be the impact of?layoffs?

8. Is the VA being used as a single payer and provider testing lab to promote a political agenda and what have been the results?

9. Can the culture of the VA be changed?

10. If the VA is privatized, will the model be extended to other federal sick care agencies like the Indian Health Service?

11. How much will privatizing the VA cost? Since no federal bureaucracy ever goes away, what will be the net price tag?

12. Does anyone really trust the VA to do anything on time and under budget?

Second, eliminate the Office of the Surgeon General, most of whom have been neither a surgeon nor a general and seem to be redundant given the multitude of other agency talking Heads of Agencies.

Third, create the US Office of Truth. Recent events have caused some of you to question the veracity of the claims of our system leadership both publicly and privately. These unfortunate outbursts have compromised our brand and make it increasingly difficult to compete in our market. Consequences could include rethinking our staffing patterns and the qualifications of our staff.

Thus, we have instituted the following policies effective immediately.

1. Table tents in cafeteria advertising or promoting that you send us your suggestions for improvement will be removed.
2. Those?accused of propagating fake news about our hospital system will be referred to HR or the medical staff office
3. All copies of "1984" and "The Origins of Totalitarianism" have been removed from the patient library
4. We have started a national search for a new Chief Truth Officer and?we expect?your cooperation and collaboration
5. From now on, 2 + 2 = 5, except on your paycheck
6. If you propagate falsehoods or alternative facts on social media, it?will be a cause for disciplinary action
7. Going rogue will be included in the definition of what is a "disruptive physician"
8. We expect all employees to be vigilant and adhere to our honor code, reporting those who are violating Truth Health policies and procedures. Using our new HR analytics software (it cost even more than our EMR upgrade-fact check) we intend to identify more snoopers, snitches and snipers.
9. We will take all necessary measures to address any effort or attempts to influence or misinform patients
10. We will continue to monitor all cell phone, EMR and Internet use in Truth Health facilities. Yes, it is legal.
11. Since much of our research is publicly funded, we will be scrubbing our website for factual inaccuracies.
12. Anyone who indicates they are burned out on a survey will be rehabilitated.

Tell the truth at your confirmation hearings, if we still do that sort of thing.

Finally, tear down sick care consolidation and corporatization that is destroying the private practice of medicine.

Is it worth saving private practice??I believe it is essential because:

1.?A significant percentage of patients prefer to get their care from private practitioners.

2. Private practitioners are more nimble?innovators

3. There are limits to BIG MEDICINE consolidation and private practitioners?fill the void. Like the states are to the federal government, private practices are laboratories of creativity.

4. Medical practice entrepreneurs want to work for themselves, add value to their patients and keep what they earn

5. Innovation ecosystems, the engines of regional and US global competitiveness, are driven , in part, by medical practice entrepreneurs

6. Successful medical practice entrepreneurs have a multiplier effect, providing high wage jobs

7. Generational attitudes are driving the demand for opportunities in the sick care sharing and?the gig economy

8. Voters have lost confidence and trust in the ability of "big anything" to improve their lives and that of their families

9. Historic lows in US productivity, particularly in the sick care sector, needs attention and will only come from innovation

10. It is the American thing to do and why other countries look towards us as the global leader in biomedical and clinical innovation and how we create innovation ecosystems

11. Less burnout compared to employed physicians. Just 13.5 percent of providers who work in SIPs reported being burnt out,?according to a study published in the Journal of the American Board of Family Medicine, titled “Correlates of Burnout in Small Independent Primary Care Practices in an Urban Setting.”?Physician burnout is a major driver of turnover, resulting in direct costs associated with recruitment. It also contributes to lost revenue during recruitment, onboarding, and the time it takes for a new physician to reach optimal efficiency within a new system. Replacing a physician often costs a practice two to three times the annual salary of the physician who left.

For example, if nothing were done to address burnout, almost 60 physicians would leave?Stanford Medicine?within two years. The cost of recruitment for each physician—depending on the specialty and rank of faculty—would range from more than $250,000 to almost $1 million. And, for those 58 physicians, Stanford’s economic loss over two years would range from a minimum of $15.5 million to a maximum of $55.5 million.

12. Here's how to start and run a private practice taking advantage of the opportunities

RE: Making federal employees work from the office 40 hours a week to get them to quit.

Nice touch. For more reasons to get people to quit, talk to all those doctors that are being named to lead federal agencies about why so many doctors are quitting even when they work 120 hours a week "at the office".

Maybe you can get one of your Fox docs to prescribe a DOSE of the DOGE if they still have their medical license.

Thanks for your consideration and happy to kiss your ring, DOGE, via a Zoom call at your convenience. I am confident that if you can land a rocket between giant chopsticks, you can do this.

Mille Grazie Your Excellency.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack