Featured Guest: Nadeem Kazi, MD

What he does:  Dr. Kazi is the President of the Arizona Medical Association.  Dr. Kazi is also a practicing gastroenterologist and independent, private practice founder-owner in Casa Grande, Arizona.  In his role as President of the Arizona Medical Association, Dr. Kazi works with local, state, and federal government officials as well as local, state, and national organizations on various issues that impact independent physicians.

On risk:  "Number one issue is the lack of providers, physicians, nurses, paramedical staff throughout the country, and we are behind, especially in the rural area. We don't have specialists, we don't have even primary care. And the biggest problem that I am seeing is the lack of private practices.  Private practice is dying away. So that's a big risk that I see lack of provider and private practice slowly, gradually diminishing in the whole country … Lack of patient physician relationship and that's a big risk that I see in medical practice these days. If you don't have a relationship with patient, it's very difficult to manage chronic disease … If something negative outcome is there, what happened, you have to take a proper, appropriate action for that negative outcome. Negative outcome is always there in medical practice, but it's how you approach them, how you solve them, how you resolve them that's the key."

Transcript

Scott Nelson  0:01  
Welcome to The Risky Health Care Business Podcast, where we help you prepare for the future by sharing stories, insights, and skills from expert voices in and around the United States health care world with a mission to inform, educate, and help health care organizations and individuals, ranging from one doctor practices to large integrated systems and organizations throughout the dental, medical, and veterinary health care industry with risk, while hopefully having some fun along the way. I'm your host, Scott Nelson, a guy that grew up in Ohio and has been working all over the United States during my 20 plus year and counting career in the health care industry, with a commitment to accelerating health care performance through creativity, not just productivity. Let's dive in. 

Independent doctors who own their practices in the United States face a unique and evolving set of risks in today’s health care landscape. While autonomy in decision-making and patient care can be rewarding, these doctors often grapple with financial pressures, regulatory challenges, and increasing administrative burdens. The rising costs of running a practice, from overhead expenses to the implementation of new technology, can strain financial resources. Moreover, the complexities of navigating insurance reimbursement and adhering to ever-changing health care regulations add another layer of stress.

The American Medical Association maintains a physician database and as of May 2024 had over 1.1 million active physicians in the United State. The American Dental Association's Health Policy Institute released 2023 data on the supply of dentists with a total of 202,304 dentists in the US . The American Veterinary Medical Association published veterinarian statistics at the end of 2023 that had 127,131 veterinarians in the United States and broke that into two groups: 82,704 in clinical practice and 14,488 in public and corporate employment.  29,939 had no information provided.        

Fierce Healthcare published an article in April 2024 that cited a report from the Physicians Advocacy Institute that had the percentage of doctors employed by hospitals or other corporate entities from the beginning of the new year at over 75%.

Independent doctors are often vulnerable to consolidation trends of larger health care and hospital systems in medical care, dental service organizations or DSOs in dental care, and other corporate and financial entities that also includes veterinary care, which can create competitive disadvantages. The shift toward value-based care, with its emphasis on outcomes rather than volume, further complicates matters, demanding more from independent doctors in terms of data management and reporting. This is not to mention the impact of potential legal liabilities, patient safety concerns, technology advancements and security issues, and the ongoing struggle to maintain a work-life balance in such a demanding environment.

In this episode I'm speaking with Dr. Nadeem Kazi about risk as an independent doctor.  Dr. Kazi is a practicing gastroenterologist and independent, private practice founder-owner in Casa Grande, Arizona. Dr. Kazi is also President of the Arizona Medical Association.  In his role as President of the Arizona Medical Association, Dr. Kazi works with local, state, and federal government officials as well as local, state, and national organizations on various issues that impact independent physicians. Let's talk with Dr. Kazi about risk for independent doctors in health care.

Dr. Kazi, welcome to the show.

Dr. Nadeem Kazi  3:18  
Thank you. Thank you for inviting me.

Scott Nelson  3:20  
Before we begin our conversation about risk in medical care, let's go back to the beginning. How did you get into medical care and into health care and where you are today?

Dr. Nadeem Kazi  3:28  
Well, I was born in Karachi, Pakistan, and many member of my family were physicians, so I think that led me to medical school, and my family moved to United States while I was in medical school in Pakistan. And after finishing my school, I came to Chicago, and I did my residency at Illinois Masonic Medical Center, and then my fellowship in gastroenterology at Loyola University Medical Center. And after finishing my fellowship, one of my colleague who was with me during residency, came to Arizona, Casa Grande actually, because of his visa issue, and he called me, Nadeem, why don't you just come here for a year, and you will like this area. At that time I have offer from Indiana University and Loyola University to stay as a faculty member, but I decided to come to Casa Grande for a year, and when I came to Casa Grande, I was surprised to see how sick population was there, comparing to the Chicago area. I've seen young people with diseases that I have not seen in Chicago. I call my chief, Frank Iber, Dr. Frank Iber, and I asked him, Dr Iber, I'm seeing all this patient with these conditions here, young patient, what's going on? So he said, first thing, Nadeem, don't drink tap water over there because of agricultural area and water goes chemicals don't drink tap water. First thing he said. Second thing, which hits me. He said this is ignored population. So nobody take care of them. So they come to you at the latest stage of diseases. And that hits me. And then I decided to stay. And I call Indiana University kept me on the faculty for two years, two to three years, actually. And then finally I said, No, I'm not coming. I'm staying here. So it's been 27 years. I've been practicing in Casa Grande. At that time in 2000 there was a Pinal County Medical Society. So I became president of Pinal County Medical Society and start addressing the issue that our [inaudible] in rural area was facing, and also patient, because health care was decimal at that time in Casa Grande population over there, they are not Phoenix areas of their insurance maybe was AHCCCS, which was cut down in between because of budget issues. And then we have to go through the whole thing to start, restart their insurances. And we fought for those little battles that we did. And then I became a board member of Arizona Medical Association, as the President in our county medical society at that time, then I continue working with Arizona Medical Association for physician right and patient rights, and that continues until today. Now, I became president of Arizona Medical Association, and we are still fighting this, still fighting for our patient and physician [inaudible].

Scott Nelson  6:18  
Transitioning to risk, how do you view and think about risk in medical care?

Dr. Nadeem Kazi  6:22  
Well, current situation, and throughout the country, it's not great when it comes to health care. Number one issue is the lack of providers, physicians, nurses, paramedical staff throughout the country, and we are [inaudible] behind, especially in the rural area. We don't have specialists, we don't have even primary care. And the biggest problem that I am seeing is the lack of private practices, because the practice medicine becomes so difficult that primary care physicians are leaving and joining big corporations as an employed physician, and they go there two years they work, and they move somewhere else because they don't like the way they were treated or the way they have to practice. So this is ongoing thing, which is not only recognized throughout the country, and that's a big risk. And when you don't have a quality physicians taking care of patient, cost goes up. Secondly, if physicians are changing so often, there is no relationship build up with the patient. And relationship with patient is very, very important, especially for chronic diseases, because they listen to patient physician when they develop relationship, when they after a year or two, they change another physician all everything is start all over again. So physicians can tell them what to do, but they don't trust. Their trust goes on. I mean, in the past, same physician used to see parents and their children and maybe grandchildren. It's not there anymore. It's this private practice is dying away. So that's a big risk that I see lack of provider and private practice slowly, gradually diminishing in the whole country.

Scott Nelson  8:07  
Where do you see risk in health care? We've talked before about financials and how financials ultimately impact and drive a practice, but there are administrative, business and clinical influences as well. Where is risk within your practice in health care in general?

Dr. Nadeem Kazi  8:19  
I am beyond the risk, the main risk since covid, the cost for equipment is doubled. The salaries are 30 to 40%, all my employees making 30 to 40% more than what they used to in the before covid. And that leads to another problem, insurance companies, and Medicare is reducing the payments, like again this year, 3.2% reduction. And when Medicare reduce, all insurance companies follow them, and that brings less revenue and more expense. So unfortunately, I'm at the point that I have decided to shut my doors down the next one to two months. And that happens to many physicians, especially in Casa Grande, four, five and last two years, have just shut the door and walked away and that we cannot sustain our practice. And this is happening throughout the country. Again, private practices keep going down, then we have to join, or do you know, locums, the corporations, and that leads to, again, lack of patient physician relationship. And that's a big risk that I see in medical practice these days. If you don't have a relationship with patient, it's very difficult to manage the chronic disease or flu and those thing, you can do it. But chronic diseases, COPD, diabetes, hypertension, heart disease, obesity, you need to have a relationship. Mainly mental health. It's declining so fast and throughout the country, especially in Arizona, because we don't have physicians to provide mental health, we have a nurse practitioner, counselor, but that's not working, because the change, and especially in health care, mental health care, we need a very strong relationship with the patient, and they cannot have relationship, because every two years, there's some new physician or new provider is there. So that's a big risk for health care that I see personally. But there are multiple other risk, cost of medication, patient cannot living alone, or elderly cannot get to the doctor's office. There's so many other factors, but major factor is lack of physicians and lack of private practices and corporate medicine is just like patient comes and they see computer what they are here for, or they you saw somebody before they are giving you this medication. No problem continue. So there is no so medicine is just 1/10 part of the management. It's a lifestyle change. It's here to tell them how to eat, what to do, when to take medication. If this happens, what need to be done that develop the relationship with patient, not just somebody comes and start telling you they don't listen. Nobody listen. You will not listen if I just tell you do this thing until, unless we have a relationship develop. So that's our very big factor that I see risk for medical care coming years.

Scott Nelson  11:05  
Going further into administrative, business, and clinical influences, you mentioned patient relationships, insurance and reimbursement for a private physician.

Dr. Nadeem Kazi  11:13  
Yeah, any practice is a teamwork. It's not one individual or few individuals, from first person to the last person interacting with patient. It's a team, and if any part of the team is not working properly, the whole process crashed. And we have a standard of care. Every practice follow both the end of care. We have a training sessions between our staff about HIPAA violation, about how to take care of patient. If they have a special need to go to the courses, they have to go to the courses. So every practice has their manager, make sure they are all certified. Every year, they have to go through the insurance to make sure if something happened to patient, how to address that issue, what to call so that all the standards are there and every practice follow that. I believe that everyone should follow it. So that's how you protect yourself, because you have to document everything. If something negative outcome is there, what happened, you have to take a proper, appropriate action for that negative outcome. Negative outcome is always there in medical practice, but it's how you approach them, how you solve them, how you resolve them. That's the key, and that's a training that we have to go through with the staff, and that's how they protect themselves. Then patient care, obviously, as I say, as a teamwork and this training helps how to move so everyone has a specific job, specific task, and that task leads to another task, and then it completed the whole process. And that's a costly process. I mean, I'm talking about one patient comes into your office, at least four to five people interact with that patient and take care of the issues. I mean, if I order something, somebody has to write the order correctly into the system. Then it comes to me to make sure it's right, correct order or not, and that's a whole process. So yeah, it is risky business, but there are standards. If you follow standard, there is no issue with that.

Scott Nelson  13:11  
I'd like you to elaborate on the training in your practice. What are the areas of focus for training within your practice to help protect against risk?

Dr. Nadeem Kazi  13:19  
Oh yeah. I mean, there's a whole course, and your insurance companies also help with this thing. Malpractice insurance, not the payer insurance company. I'm talking about malpractice insurance company. Have the whole courses that we have to follow, and individuals from reception, they have different tasks, so they have a whole standard written for them, what need to be done, how it needs to be addressed. If somebody don't have money, you can already establish patient how to take care of that. So there's all the standard of cares are written. I mean, I can go and take hours to explain each and every process. So we have to follow those standards, and it's all written, and they have to do testing, especially HIPAA, is a very sensitive issue. So big penalty first time, if you did not follow HIPAA, you have to pay 25,000 then 50 then you lose your license. So you have to be very careful with these kind of practices. So there are standards all throughout the technician to train her, my CRNA who provide an assist here, they have to be certified in ACLS, and you know, they not need to know. They have to reference procedure done before they can come and do in my office. So they're all a standard that we have to follow. And it's a very extensive thing, and but because we've been doing it for 27 years, we get used to it. But to us, feel like it's a part of it. But if you're starting a new practice, the first thing you have to do train these people. And if it's costly task, I mean, it's not cheap. And if somebody leaves some new person, you have to train them all over again. And that is also costly, and it's happening quite often since covid, people come and after a year, they leave and a that another burden that private practices is facing is to train their new employees, and you have to go through the whole process. So that's another factor comes into play when you are in a private practice setup that you have to pay from your own pocket to train all these physicians in a corporate world is different because they have a whole system in place. Their department train so they and they get reimbursement incentive from the government. We don't, so we mean private practice physicians. I hope I answered your question.

Scott Nelson  15:35  
You did, and it's a great transition into another topic, practice consolidations and physicians transitioning from independent to employed. From your perspective, as an independent physician and also as the president of the Arizona Medical Association, is consolidation in medical care helpful or hurtful for physicians and patients?

Dr. Nadeem Kazi  15:54
Well, it's not helping independent physicians at all, because, as I said, the cost of practice is so high, ultimately they walk away, they close their door and join the corporations. And that's where I am right now, and I cannot continue doing what I'm doing. But there are other factors, also, in my case, generally different factors, but cost number one, joining the corporations. I have not worked with corporations, so I don't know, but I have my colleagues who is not happy. One year, we call it honeymoon period. They are happy. Everything is good. Then second year comes and they start complaining. You know how they were asked by a person who don't even know how to pronounce that condition of disease, and they're asking them how to write notes on that. So that is mental stress for physician that they are feeling. And that's not my personal experience. I'm just telling what my colleague has expressed to me is what make them more stressful. And after two three years, they leave that place and they join other places. So revolving chair going on. But as I mentioned before, if you don't have a relationship with patient, the revolving physician is harmful for patients and physicians. As I said, the stress level of physician is way up high. The paperwork they have to do way out of [inaudible]. They spend 60 to 70% their time on paperwork and then 30% on patient. I mean, this is totally, totally uncalled for, because in past, we have provided best care. I have not seen any change. In fact, according to JAMA, the cost of health care has increased since we started doing corporate medicine. So I hope I gave you the answer about the physicians feeling on this issue, moving from private practice, their own practice, to a corporate medicine, and that is stressful for them. And when the physicians are stressful, their work affect their work and their interaction with patients and everybody else around them. So this is on going all through the country, not only in Arizona. Common problem throughout the country.

Scott Nelson  18:12  
Well is medical care at risk for not having independent physicians at some point in the future? We talked about consolidation, you've mentioned several points about independent physicians joining practices, whether or not it's those are corporate owned practices, whether or not they're employed models within health systems or hospitals. Is it a risk for medical care and patients to have nothing but employed physicians or a majority of employed physicians and little or no independent physicians?

Dr. Nadeem Kazi  18:41  
Yes, let me explain you what I mean by yes. Number one, as a private physician, practicing 27 years in Casa Grande, I see double the number of patient. I do more procedure than employed physicians because I have to make money to pay all of my employees, rent, malpractice, XYZ, when you're getting a paycheck mentally, mentality, you know, change you don't want to do extra work. I mean, somebody call me four o'clock and my office is going to be just close at five. I said, No, come over. I will see you, somebody in the ER, waiting for too long, and they call my [inaudible], can we bring you right away? I will see them. It's my practice, but in corporate world, it's impossible. And the physicians also why they will put extra time, extra effort, when they are getting x amount of dollar. So that is why I think the what I believe the shortage in physicians in America is because all these physicians who used to be in a private practice has quit. They are not seeing as many patient as they used to. Now in a corporate world, they are seeing maybe 80% 75% I don't know the number, but I'm just they are seeing less than what they used to see. So other patient is left alone, so they have to go to another physician which is not there yet. So that's another, I think, contributing factor to physician shortage. If you give incentive these physicians that you see more patient, you will get 80% of that. They may see more patient, but if you don't have incentive, why to take a risk without getting paid for it. So that's why the employed physician, I don't think they will see more than what they need to see and but private practice, when I used to know the some physicians in Casa Grande, big primary care practice, even some patient called Saturday, the physician used to go and open the door and patient come and see them. So that's the relationship with patient and physician is gone now. So if you call them, third person will answer for the appointment. They may give you appointment after three months in my office, if somebody calls they are having issue acute, you will see same day or next day, because that's my practice. I don't have third person to answer there. My office is aware what kind of patient need to be seen right away, even if you're back then bring them, we will wait late. And that's another cost, because we wait late employee get one and a half times paid so, but we the private practice. We can do it in a corporate world. It's not so that will reduces the, you know, approach how many patients you can see. Secondly, as I mentioned before, in corporate medicine, you have to follow their marks, markers. I mean, if you don't follow, if you don't see this many patient within this many minutes, then they will be written up. And then nurse practitioner, physician assistant also helping them, and they have to monitor them. So it's more stress for those employed physicians in the corporate world, and that is also interfering providing best of the best care to your patient. So there are multiple, again, multiple factors. Not one thing that I can say, okay, if you fix this, everything will be fixed. No, there are multiple factors that we have to address at the same time to get to the solution, and unfortunately, we are far away from that point. But as an organized medicine, AMA, Arizona Medical Association, we are trying to bring all this thing together so we can have an open discussion and see what we can do with what we have right now. So if it continues like this in 10 years, I don't know where medicine will head. Is it going to be a national health care system or what? I'm not sure the way we are going. The corporate system fail, then what will happen? There is no private practitioners left to take care of those patients. So it's a very risky future for health care that I perceive. I may be wrong, but as I said, we need more studies. We need to know where we are. We have not done any studies like Arizona, we have medical schools, but when kids coming out of the medical school, we don't have residencies, so they have to go outside the state to get residencies, because we don't have a GME funding. GME is a graduate medical education. They have a fund to give to the hospital so they can train physicians. There is no money there, so now governors promise Arizona medical school, and she will look into it, and we may have more residency slots so we can keep our kids who's coming out of the medical school in Arizona, so that will provide us more physicians so but then again, we have to give incentives to the physician who's working in rural area. I mean, why somebody will go to rural area and make same amount of money as per person is making a city? So they will stay in cities. Cities are have enough physician, but rural areas short of physicians, and that's why we have to give some incentives. And that's where the lawmakers has to come in. Therefore feds have to come in and make some laws to give some incentive to this physician to provide best care in the rural area.

Scott Nelson  23:59  
As the president of the Arizona Medical Association, where do you see risk in organized medicine? What is the risk? Why is it there and how can organized medicine address it? When I say organized medicine, I'm thinking professional groups like the Arizona Medical Association. I talk and interact with various organized professional groups in dental, medical and veterinary care at local, state, national and federal levels, similar to the Arizona medical group, and many comments are about declining membership. The younger generations are not joining organized professional groups, and from the perspective of the professional groups, in the long term, that will hurt health care, including patients. How is that risk?

Dr. Nadeem Kazi  24:35  
It's huge risk throughout the country, all the state societies, national organizations facing the same what you just said, lack of membership, and our membership dwindling down slowly, gradually. And one of the reason is because majority of the physicians now they are employed physician, so they think, Oh, I'm getting a paycheck. So who, why I have to worry about anything else, but they don't understand you still need organized medicine. You still need somebody fight for you. You still need a platform where you can stand and raise your voice if some injustice happens to you, and that is very important for young physician to understand, or employed physician to understand, you need to be a part of organized medicine, because that's the platform which fight for us and our patient. And example, this year, a chiropractor want to perform MRI and read these results and take action on it. I'm a gastroenterologist. I don't do MRIs. I don't read MRIs. I send them to a radiologist who are five year training to give me the answer what they are seeing in the liver or pancreas, so I don't miss anything. And now this is chiropractor, who's not even a doctor, want to perform MRI and MRI and take action on it. And that bill was in the house. Luckily, it was defeated and it was not passed. But that's for patient care, and that's where we fight the young physician to understand tomorrow, corporate world may decide something different. They say, okay, we don't need you have to cheaper than you you leave, or you have to do certain thing that is not with the oath of that we have a no with the oath first, no harm done. And if there are some certain thing they want them to do which is not good or right for the patient or harmful for the patient, they have to stand up and where they will go, not in their corporation. They will not listen. So you have to come out of that corporation model to organize medicine organizations like Arizona Medical Association, AMA, or any state societies or any nationals, they have to fight for it. They have to go to the lawmakers and make changes, not the way to practice medicine to provide best care to your people. And that's where I believe organized medicine is very important, and especially for younger physician. And Arizona Medical Association working very hard to get to the younger physician. We have a student section, we have a resident, resident section, fellow section, so they are member and they are free members. Then they because during those two, three years, they realize the importance of the organized medicine. And we have, we go to multiple big institute like Mayo, Banner. We try to promote what's the importance of organized medicine, and we also have community events where we invite physicians to train them, or not train them, at least to educate them. What Arizona Medical Association [inaudible] and why it is important, so that, yeah, your question is very valid, and it is we are all feeling this pain that membership is dwindling, but still, we are trying to maintain at least 85% of our membership, membership in Arizona Medical Association, but other organizations that I just met in May, AMA meeting in Chicago or April yeah, April in Chicago, from New York state to Kentucky, they're all facing the same issues and how to get to the younger physician employed physicians and we are working on those issues to see how to address and how to make them understand why organized medicine is important for them.

Scott Nelson  28:20  
Looking back through recent history, what could have been done differently in medical care to strengthen medical care and independent doctors and have a positive impact?

Dr. Nadeem Kazi  28:28  
As I mentioned before, one of the factors financial if somebody is sacrificing city life going to the rural area, they have to be incentivized. They have to be paid more. The insurance company should be giving them extra reimbursement. Medicare should be giving them extra reimbursement. A Medicare used to have a very like 0.2% or so which is not there anymore. So that is number one thing that we fail to address, if we would have addressed 5, 10 years ago and incentivize those physician to stay in rural area by giving them financial incentive, I think it would be a little different situation right now, but now, because the insurance companies cutting pay year after year after year, and this physician has to leave, and when they leave, they join the employed model. And I was just having meeting with the big insurance company that is [inaudible] and I just told them, you know, it's very hard for you to bring them back. I mean, once they out of their private practices in corporate world, it's very difficult for them to start all over again in a private sector, because, first of all, they are already at that age they want to retire. But for new physician, I think it is very important imperative to give them incentive to go into the rural area. And I think it is the insurance companies and the lawmakers started to feel this hopefully in next few years, I'm not sure, but I'm hoping that we may address and try to incentivize those physicians to stay in a rural area. And it may work, I'm not sure yet.

Scott Nelson  30:18  
Looking forward, what do you see as trends and potential risk issues in medical care? How can individuals and organizations play in and prepare?

Dr. Nadeem Kazi  30:25  
I think it's going to be worsened for a while. And as America, we always when we feel it, we correct it. Correction take four to five years. What correction? I don't know the answer for it, as I said, it's a multi factorial, and we have to sit together different organizations and brainstorm and see each organization have their own part to fix things. And I think it will start soon, because we are at the brim and we may start spilling out. So when we get to that as America, we always solve the problem. So I have a hope that next two to three years, we will looking medicine into a different way, with different classes, and we may start fixing the problem that we are facing. How I don't have the answer. As I said, we have to have multiple organization, multiple individuals, who are involved in health care provision, including CMS, AHCCCS, Arizona state, AMA, different national society, Arizona Medical Association, different state societies. We have to come out with a plan and we can. We can, if we sit and honestly discuss the issues that we are feeling right now you know, the corporate world is different. Corporate world different than the AMA or state organizations. Their bottom line is dollars, how to save money and how to provide bulk care when there was a law try to pass here, the medical school, who didn't get residency can work in the rural area one year under a physician, and they can start their own practice. This is not the right way. This is not the right way. The improper care is worse than no care, because you will cause more mistake. You will make things worse. This is not the care we have to sit down and talk. This is not a knee jerk reaction that, oh, we can fix so any medical student who didn't get residency, they can become real doctor after one year working under physician rural area. This is now America is there. So we have to go back and see how to increase GME, how to get this residents into the training program. And then we can, you know, it will take five, six years. Anything we change even today, it will take five, four years to keep the results. So we have to start debating this and come out of the solution so we can implement so we can see the result otherwise, yeah, I'm not that optimistic what's happening right now.

Scott Nelson  33:09  
We'll end our conversation with this, risk can often be viewed and thought about in negative terms, so I want to end our conversation on a positive note. What are you optimistic about in health care now and into the future?

Dr. Nadeem Kazi  33:20  
Well, positive. I just mentioned optimism is that, as America we always solve the problems, and I am optimistic about that, but we have to start the debate. And noticing the debate is already started, and it's smaller, 80, you know, organizations, and they're trying to bring it to a national level. So problem with our federal government is the election comes and the politicians decide to see how we can get more vote, and they can say anything they want. We have to be honest to ourselves. We have to be honest to our people. We have to know where we are heading. Something is not optimal. You have to let them know we are not doing great. I mean, we are spending so much money in health care. We spend what next 16 countries spend with poor outcome than those 16 countries. So there's something majorly wrong here. We are spending so much money with poor outcome than 16 other countries, Western countries. So there's something not right. So we have to debate this thing. What's going on? Why is happening? Is it because the patient demanded I have a knee pain, I have to get a MRI? No, you have to do a physical exam. You have to do simple xray instead of doing $3,000 worth of tests. So we have to sit down and discuss it on multiple things we cannot get, but I'm optimistic that, yes, we are able, and we are capable, and we have done in the past, and we can solve but we have to start debate and discussing these issues openly and honestly, that the only thing will bring us to the solution.

Scott Nelson  35:00  
Dr. Kazi, that's a great point to conclude our conversation. I really appreciate your time and sharing your thoughts and perspectives and experiences today. Thank you very much.

Dr. Nadeem Kazi  35:09  
Thank you Scott. Thank you very much for your time.

Scott Nelson  35:14  
Thank you for listening to The Risky Health Care Business Podcast. You can listen to all episodes from the resource center page of the SpringParker website, springparker.com, or click the Listen link in the show notes to listen and subscribe for free on your platform of choice. And remember, accelerating health care performance is achieved through creativity, not just productivity.