Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
We dive into the complexities of the U.S. health care system and explore potential solutions before it reaches a breaking point. Alisa Berger, a urologist, shares her expert insights on the root causes of physician burnout, the economics of primary care, and the implications of using advanced practitioners. We also discuss the ethical considerations of covering elective treatments and the influence of politics and lobbying on medical policies.
Alisa Berger is a urologist.
She discussed the KevinMD article, “Why doctors must take charge to save our failing health care system.”
Our presenting sponsor is DAX Copilot by Microsoft.
Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Alisa Berger. She’s a urologist. Today’s KevinMD article is titled “Why Doctors Must Take Charge to Save Our Failing Health Care System.” Alisa, welcome to the show.
Alisa Berger: Thank you so much for having me.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Alisa Berger: OK. All right. So I knew I wanted to be a doctor since I was about 12. And then beyond that, I thought, “Oh, of course, I’m going to do primary care.” I got to med school, and at that time, you still did all the lectures first, then your clinicals. So I said, “OK, well, I think I’m doing primary care.”
I had to choose four surgical rotations. The first three I chose, I knew I wasn’t going to do because they’re high intensity and high call. I knew I wanted to be a mom as well. So I did trauma, cardiothoracic, and neurosurgery. Then I had to choose a fourth, and I kind of randomly threw in urology.
And then I realized, “Hey, these are kind of the laid-back surgeons.” People often say to me—sometimes it seems a little judgy and sexist—”Why did you go into urology?” The point being, it’s a great specialty. There are big open surgeries, small procedures, and a lot of continuity of care, more so than in other surgical practices.
That’s why I chose it—not to mention the lack of crazy emergencies. Usually, you can handle emergencies within 24 hours, not 30 minutes. So that’s why I went into it. I did a six-year program in Connecticut and then found myself wanting to go to a smaller city.
As a female, I knew if I went to a bigger city without fellowship training, my practice would turn into an all-female practice. I wanted to do general urology. So I was in a small-town solo practice for a decade, and that shaped my niche into benign prostatic hyperplasia (BPH).
When I was about 40, still in this town, I realized I still had half of my med school loans, and I was getting paid less each year. I had to see more people, but that didn’t counteract inflation. Of course, you want to give your good employees raises. That goes back to what I put in the article—someone could earn more money at Buc-ee’s than they could as a medical assistant for me.
That was a struggle, but I still loved what I was doing. I wasn’t going to change it. Then, for family reasons—my kids’ schools and my husband’s career—we decided to move back to my hometown. I was employed for two years, thinking I’d like the change, but not so much.
At that point, I wasn’t going to move again. Since 2019, I’ve been doing full-time locums. I travel to work, and when I’m home, I’m home, which is pretty nice. Originally, I had two kids at home; now, I just have one. Having time with her is wonderful. Of course, I also enjoy spending time with my spouse—I actually like him! So that’s where I’m at—still doing locums. That’s my little story.
Kevin Pho: All right. You wrote this KevinMD article, Why Doctors Must Take Charge to Save Our Failing Health Care System. Before talking about the article itself, what led you to write it in the first place?
Alisa Berger: I am big on advocacy. I’m part of both the Texas Medical Association (TMA) and the American Urological Association (AUA). To have a say in medicine, you have to be part of advocacy.
In those roles, I kept feeling like we’re out here trying to make our ability to practice feasible and take care of patients the way we want. No one’s really listening to us. They’re making all these rules, which, to me, lack common sense.
Then, as with many things, it turned into a money issue. I wanted to point out what I see as common sense problems in our system. I wrote a second article as a follow-up because I didn’t want to just point out problems without trying to be part of the solution. The second article explored more controversial, hard-to-discuss steps we might need to take to improve the system.
Kevin Pho: So tell us about the article. What are some of the problems you see with our health care system?
Alisa Berger: I feel the main problem is money. Everybody wants a piece of the health care pie. Right now, the people who have the most are drug companies and insurance companies. The inordinate amount they pay their CEOs is just mind-boggling.
At the same time, we’re unable to allow independent practitioners to continue to practice. That’s frustrating.
Another issue people don’t always think about is health care administration. There’s been an inordinate increase in this middle layer of administration. I’m not sure it’s all needed. Part of the reason is the complexity of our health care system. We have to jump through so many hoops to get adequately paid by insurance companies.
If we simplified the process from the beginning, we wouldn’t need all those layers.
Kevin Pho: So when you were in private practice—and as you know, there is a declining percentage of physicians in private practice these days—tell us about how some of those challenges impeded your ability to run that practice. You mentioned earlier that you couldn’t pay your medical assistants enough and couldn’t keep good people. Go into more detail. How did that affect your professional life as a doctor in terms of the difficulties running a private practice?
Alisa Berger: It makes you disheartened. Within the first couple of years, I never thought I would stop taking Medicaid patients. I thought, “No, of course I’m going to take those patients. I’m not going to turn anyone away.”
But after two years, it just became too difficult. Unlike Medicare—which isn’t the best system but actually pays better than Medicaid and is tolerable—you lose money every time you see a Medicaid patient. If you’re an independent practitioner, you don’t have any cushion to absorb that loss.
So, after a couple of years, I stopped seeing Medicaid patients. Of course, I still cared for them in the hospital and did their follow-ups, but I didn’t take new Medicaid patients because I couldn’t afford it.
Kevin Pho: You mentioned that you’re a member of the American Urological Association and the Texas Medical Association. In terms of advocacy efforts by organized medicine, how are these groups pushing back against the influence of money in medicine that’s making the job of physicians harder?
Alisa Berger: I think we can be doing a better job, but certainly the TMA and AMA are really emphasizing how, for the past two decades, everyone has gotten a pay increase except physicians.
Going into the 2025 year and looking back at 2024, the inflation rate has been matched by increases for inpatient, outpatient, hospice, and surgical centers. But for physician pay, it’s only been a negative. Getting that information out there is helpful because, yes, we make a decent living.
I wasn’t going to stop practicing unless I couldn’t make a living. But it’s hard for physicians to say, “Hey, we’re not making enough money,” because the average person doesn’t take that very well.
Now, though, patients are starting to see their favorite family practitioner or specialist unable to continue practicing independently. When they can’t see their preferred doctor, they’re recognizing, “Hey, this is an issue.”
Our ability to communicate to patients is critical. It’s not just about asking for more money for us; it’s so we can stay in practice, pay our workers, and run a smooth, efficient office. That way, patients aren’t frustrated because the front desk doesn’t return their calls or the staff seems rude. We can’t afford to keep the good employees there without paying them enough.
Kevin Pho: Do you see that particular message resonating with patients?
Alisa Berger: Yeah, I think at this point, because so many patients are frustrated with both the lack of face time with their physician and the inability to see them in a timely fashion—or even to see their preferred doctor.
Kevin Pho: You mentioned earlier the decline in independent physician practices. You had a private practice yourself. What does it mean for the physician profession as a whole that fewer physicians are opening private practices?
Alisa Berger: Our autonomy is shot in that case. When we aren’t independently owning our practices, we’re always beholden to whoever is employing us, and that comes with its own constraints.
Once you’re enveloped by that system, it’s almost impossible to detach unless you’re independently wealthy or take out more loans. Over time, it erodes your ability to set limits or requirements, like saying, “Hey, I need this to practice good medicine.”
We just have less of a voice or leverage.
Kevin Pho: You also mentioned the issue of administration—the many layers of middle people impeding patient care. What are some proposed solutions? If you were the health care czar, how would you fix this?
Alisa Berger: It always comes back to money. We don’t have enough of it, and our system will implode. I am genuinely worried about what will happen in the next 10 to 20 years.
Not only is it humanitarian and ethical to ensure everyone has some basic health care coverage, but it’s also financially smart. These patients are showing up in emergency rooms and getting the most expensive care in acute settings. This care could have been provided much more cheaply in a preventive setting, which is always shown to be less expensive.
Kevin Pho: There are so many approaches when it comes to universal care. Are you in favor of more regulation or government intervention? Across the political spectrum, there are a lot of proposed solutions. Which approaches would you prefer?
Alisa Berger: I don’t have a magic wand, but the first step is getting people to stop being so partisan about the issue. Providing universal care is not some leftist communist agenda.
We’re the only sophisticated society in the world that doesn’t provide some basic health care coverage, and not all the others are communist. Getting past that misperception is important.
We also need to recognize that we already pay for mandated insurance—like car insurance—if we want to own and drive a car. So where’s the outrage about that compared to health care? Getting past this partisan divide is the first step.
After that, we can talk about options like expanding Medicare. I don’t know if that’s the answer or if we need to involve private entities. However, I am not a fan of private equity in medicine.
Private equity’s whole goal is to invest, improve, and then turn around and make a profit within five to seven years. If you look up the definition of a private equity firm, I don’t think that’s good for health care.
That said, I do know one person who’s been very happy with their private equity firm. They listened to the doctors and invested in the practice. But we’ll see what happens when they want to sell and make their profit.
Ultimately, our system cannot provide profits to every entity. We need to get the greed out of health care.
Kevin Pho: And in terms of doing that, are you advocating, like you said, for an expansion of Medicare? Would more government involvement be necessary to get some of that money out of health care?
Alisa Berger: You’re right. The government does need to be more involved. If you look back at the ACA, or Obamacare as it’s often called, I think it was not implemented well, which gave everybody a bad taste.
But there are two things people love about it: keeping kids on their parents’ insurance until they’re 25 and not excluding people with preexisting conditions. That was very important, and it’s one of the successful aspects of that implementation.
I agree the rollout was pathetic, but I think steps like those are heading in the right direction. Again, we need to remove the partisan component and look at the big picture. As physicians, we’re just trying to provide good care and make a living without being controlled by intermediate levels or the drug and insurance companies.
Kevin Pho: Through your advocacy efforts, you’ve mentioned that physicians need to play a role in how our health care system evolves. Give us an example of how physician involvement has moved the needle from what you’ve observed through the Texas Medical Association or the American Urological Association. How has physician involvement improved care or removed obstacles to providing the best care for patients?
Alisa Berger: Unfortunately, it requires talking to politicians who control the purse strings to some degree. I’ve gone to our state capital in Austin for what we call First Tuesdays. We wear our white coats and go to talk to our legislators.
With the AUA, I’ve gone to Washington, D.C., to walk the halls of Congress and advocate for our practices, but more importantly, for our patients. These are the steps we have to take.
I’m a bit of a political junkie in that I enjoy politics, but to some degree, it’s a necessary evil to practice the way we want. Those are the actual steps. Unfortunately, advocacy often involves money and contributing to campaigns.
However, you don’t always have to give money. You can let them hear your voice by writing letters, showing up at their offices, or simply having conversations. Those are tangible actions you can take.
Kevin Pho: When you do that, do you feel that politicians listen to you?
Alisa Berger: They do, but some more than others. It’s funny—they say that if you don’t get to speak directly to the congressperson, it’s not a problem because their health policy aide is the person you want to talk to.
In many cases, these aides are the ones helping politicians make decisions. It’s mind-boggling because these people are often in their 20s, just out of college, living in D.C., and making minimal money. They do have some knowledge, but these are the folks feeding our politicians information.
That’s why it’s our job, as physicians with real-world experience in medicine, to educate those aides and, by extension, the politicians they serve.
Kevin Pho: We’re talking to Alisa Berger. She’s a urologist. Today’s KevinMD article is titled “Why Doctors Must Take Charge to Save Our Failing Health Care System.” Alisa, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Alisa Berger: The biggest takeaway is to be an advocate for yourself and your practice. That means getting involved with larger groups like the TMA or the AUA.
Many people are super busy and feel like advocacy isn’t an issue, but your voice has to be heard. That often requires going through politicians. You don’t have to give away all your money, but you do need to show up, have conversations, and support the cause in whatever way you can—whether it’s through monetary contributions or by being physically present.
Kevin Pho: Alisa, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Alisa Berger: Thank you for having me. It was a pleasure.
