Saturday, August 16, 2014

Health Reform Game Changer: Interview with Mitchell Brooks, MD, Orthopedic Surgeon, Dallas, Texas

The chess-board is the world, the pieces are the phenomena of the Universe, and rules of the game are what we call the rules of Nature.

T.H. Huxley (1894-1963), A Liberal Education

Doctor Mitchell Brooks, an orthopedic surgeon who has practiced in Dallas for 30 years, is a man of deep convictions and fundamental beliefs.

He believes Americans consider health care a right, ObamaCare is wrong for America because of its adverse consequences, downsizing of our hospitals can be a health reform game changer, reform ought to focus first on the patient, catastrophic insurance is essential, and life is short and ought to be preserved at all costs.

These beliefs stem from his diverse life experiences: growing up in Brooklyn, college education in Toronto, Canada; medical education at the Medical College of Virginia; a spinal surgery fellowship at Bellevue; visiting lectureship at the University of Cardiff in Wales; private practice in Massachusetts and Texas, legal and compensation consultant for law firms, a leader in a real estate development company, associate for Directions International, an international management consulting firm, and recipient of a heart transplant in 2007.

He is perhaps most proud of his work at an innovator and designer of a 45,000 square foot “jeep hospital,” which he believes will be capable of providing 70% to 80% of the surgical procedures now performed in traditional hospitals at 30% of the fixed costs with much greater convenience.

Q: Why Dallas?

A : Before I came here, I was practicing in Massachusetts. The governor at that time, Michael Dukakis, basically told physicians “It’s my way, or the highway.” I chose the highway. I did a market study of states that were physician-friendly, and Texas came out number one.

Q: You had a heart transplant in 2007. Based on that experience and your multifaceted career, what would you say your working philosophy is?

A: My working philosophy is:

One, as a physician, we have very special responsibility because people trust us. That comes first. It is paramount. It is the raison d’etre for what we do. When patients lie prostate on the operating table, they are absolutely vulnerable. Most patients know little about health care. It is our job to teach them.

Two, I received nothing from the government to be educated. Government should not be able to tell me what I ought to be paid.

Three, because I set my own fees, I have to give value, and value-added services for those fees. That includes pre-operative, operative, and post-operative care. To me the most important thing is the history, and only I can take that. You can’t do a history on a drive-by visit. Your PA can’t take that history It may take an hour and a half to get a good history.

Q: You have said a lot of people who write about health reform don’t write about it from the patient’s point of view. What is that point of view?

A: It depends on the patient. It is incumbent upon us to educate the patient. The patient is your customer more and more these days because of the high deductibles. You have to put yourself in the patient’s shoes, where I have been, and find out what the patient wants and what the patient needs. That determines who you approach the patient and the manner in which you make suggestions. If the patient thinks their wants and needs are attended to, it is incredible what happens. I have been practicing orthopedic surgery since 1982, and I have never been sued. I am very selective. If the patient is not a good fit for me. I will see them for the first time, and I won’t charge them for the visit. I will suggest they see another doctor.

Q; You frequently appear on Fox News and Fox Business. Among other things, you talk about why the young invincible are not flocking to ObamaCare, why ObamaCare is killing the middle class, how innovation will reduce health costs, why ObamaCare has so many unintended consequences, and why the doctor shortage will surely worsen.

Have these media appearances been productive for you?

A: Yes, they have. The appearances have permitted me to get information out to a large number of people, and it has allowed me affect change. Change one person’s mind, the saying goes, and you have changed the world. I seek to get people to see things through a different set of eyes. I don’t want people to change their minds. I want people to think about something in a different manner. I think that’s critical in changing health care.

Q; You have been critical of the health law because it “robs the middle class.”

A: Absolutely. Because of the changes in ObamaCare and the way the law was written, of the various classes in our society – lower, middle, and upper class – the middle class is going to be hurt the most. The income taxes are going to hurt them the most, the hidden taxes are going to hurt them the most, the higher deductibles are going to hurt them the most, the stifling of the economy is going to hurt them the most, and ObamaCare approaching reform from the supply side rather than the demand side will hurt them the most. They have done that in Canada and Great Britain, and it doesn’t work.

I’ll let the statistics about cancer survival in Great Britain, and the waiting lists to be seen by a doctor or have a treatment speak for themselves, In Buffalo, New York , Canadians flock across the border to get their CT scan or MRI. In Ontario, the largest province in Canada 54% of the budget goes to health care. That is unsustainable. And it results in rationing. Call it what you will, it is what it is.

Q: You spent time in Wales. What did you bring away from that experience?

A: One of things I came away with was a design for a self-pay sports medical clinic. What I also took away was a good knowledge of the British system. When you consider my experience there, as a general practitioner, in Canada, in Massachusetts, my experience as a patient paying up to $60,000 for a heart transplant, those experiences give me a very special perspective of what works and doesn’t work, both from a patient’s and a physician’s perspective. I look at things from my own and my patient's perspective, and that is critical.

Q: You have made a number of talks about the importance of innovation, and one of your personal innovations is something called “The Jeep Hospital.” Why is that such a big innovation? What does this innovation bring to the table?

A: It retools the idea of a hospital as a “factory.” People pretty much agree the present hospital system, where everything is done in big hospitals, is outdated. Yet all of these bricks and mortar are constructed, and have to be paid.

But wait a minute, even given the embedded costs, do we really need beds anymore? More than 70% of surgical procedures done in the U.S. are done on an outpatient basis. Why do we need complex buildings of 100 of thousands of square feet,where you are charged for parking with detailed instructions of how to get to the ER or a doctor’s office, where you spend a substantial amount of time to get into and out of out of a complex hospital system. It may take an hour to two to navigate the complex, and that is productive time. Like their doctors, patients are busy people, and they need as much productive time as they can get.

That’s silly. If you take the same “factory”, redesign, decentralize, and downsize it, and apply it to 70% or more of surgical procedures, soon to be 80% or even 90% of surgeries you can do the same procedure at 20% to 30% of the fixed costs, and you reduce hospital costs by 35%.

The change I am suggesting is threatening. It represents what Joseph Schumpeter ((1883-1950) called “creative destruction” and what Clayton Christensen of Harvard Business School now calls “disruptive innovation.”

The analogy is the United States automobile industry in the 1970s and 1980s. The industry had to change to meet foreign competition.
The hospital industry is where the automobile industry was in the eighties. When interest rates go up, occupancy goes down, and Medicare and Medicaid payments get squeezed, hospitals will start falling like a stack of cards.

Only the large systems will be left standing. Of the 3500 current separate small hospitals, perhaps 700 of the larger systems will survie , which I personally believe was one of the goals of the Affordable Care Act.

I don’t care what the government wants. It is our government, our money, and our taxes. Government derives its power from us. If we don’t vote, we have no power. I believe if the private sector can offer a better product at a lower price with added-value and more convenience, we have something that is a game-changer, and people will vote for it.

Dr. Brooks can be contacted at

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