Unlocking The Crisis of Doctor Burnout With Dr. MaryAnn Wilbur

Skot Waldron (00:00.477)
it's supposed to do.

Skot Waldron (00:12.951)
So where are you then, like in the country?

MaryAnn Wilbur (00:15.574)
in California, just outside San Diego.

Skot Waldron (00:17.979)
gotcha. Cool. Well, thanks for waking up bright and early to hang out with me. We were Atlanta.

MaryAnn Wilbur (00:23.768)
You're welcome. Yeah, where are you? I've forgotten already.

Skot Waldron (00:30.837)
Yep. we were in Vancouver like two weeks ago for like a week or so. And it was like the Pacific time. Like I can't function anymore. Like when I get, like, I'm, I'm totally trashed. mountain time. Yeah, it's no problem. Like I can adjust pretty quick and it's not a big deal. One more hour though. And I'm trashed. I can't do it. I don't know.

MaryAnn Wilbur (00:44.001)
I'm

MaryAnn Wilbur (00:56.782)
Mm -hmm. Yep. Yeah, I'm jet lagged. The kids are jet lagged. They're out watching Paw Patrol. Let's hope that continues to work. Yep.

Skot Waldron (01:00.503)
some.

Skot Waldron (01:05.719)
Yeah. Tames them for a while. Oh goodness. Um, okay. Have you ever done a Riverside interview before? Okay. So the platform, um, you're going to see. So yours is saying like 35 % uploaded right now. Mine's at 93%. So what it's doing is it's in the background. It's continuously uploading on your side and on my side. Um, what's going to happen is.

MaryAnn Wilbur (01:13.891)
Nope.

Skot Waldron (01:35.351)
Um, sometimes it's going to get pixelated. don't know if I look pixelated right now. Um, it's just because it's buffering, um, or whatever, if it ever freezes or kind of like glitches in some way or shape, it's still recording high res on your side. still recording high res on my side. The audio is on your side. Audio is on my side. Um, just kind of go with it. If it's like glitched for like 30 seconds and you have no idea what I said, then clearly we can, you know, review

If, if we need to, right. I can edit it out later. So we're just going to, kind of go with it when the recorded, when the, we're done with the interview and I hit stop, don't leave, make sure you stay on. Cause it's got to continue uploading on your side or else it all goes to crap. but yeah, that's it. So you good with that?

MaryAnn Wilbur (02:31.746)
Yep. I'm just looking at how tired I look, but yes, I'm okay with the Riverview stuff.

Skot Waldron (02:37.663)
You, you do not look tired. You actually look pretty eager for being on the West coast. So, it's all good. All right. So I'm really excited about this interview. very cool. Very cool. when's your book come

MaryAnn Wilbur (02:40.778)
man.

MaryAnn Wilbur (02:51.372)
Yeah, me too. I love doing this. It's my favorite thing to talk about.

MaryAnn Wilbur (02:59.534)
So far the date has been said July 31st, but the printing press might be a couple days behind, but first week of August.

Skot Waldron (03:08.043)
Okay. All right. Okay. It'll, this interview will probably go out after that. don't know. I have to see how many are in the, process right now of uploading. So we'll talk about the book as, you know, it's probably already out. Let's just, let's just use it like it's already out. Okay. and, then we'll, we'll go from there. all right. Any, any questions for

MaryAnn Wilbur (03:26.828)
Okay.

MaryAnn Wilbur (03:38.326)
I so. Okay.

Skot Waldron (03:40.343)
Okay. I'll do an intro and an outro after this, so you don't have to worry about that either. we'll just kind of jump right in and, Yeah, jump into this. So you good.

MaryAnn Wilbur (03:50.582)
Okay. Yep. there are rules about sipping coffee. I should probably not.

Skot Waldron (03:58.291)
whatever, whatever. makes it look, it makes it look, more natural. It's all good. We're not, we're not too, we're not too formal here. Mary Ann. So you can, you can slam your coffee.

MaryAnn Wilbur (04:07.342)
so I can sip my coffee. I really want my coffee.

Okay.

Skot Waldron (04:16.276)
OK, cool. Ready?

MaryAnn Wilbur (04:17.773)
I'm ready.

Skot Waldron (04:19.947)
Get your coffee set. Boom. Here we

Skot Waldron (04:27.541)
Maryann, this is so cool. Thanks for hanging out with me. Yeah, good morning to you. You're up bright and early. So thanks for doing that. Thanks for doing that. This is gonna be a really kind of a different spin on what I usually do for this show. But I think it fits right in. And I'm glad that we got the introduction that we did.

MaryAnn Wilbur (04:29.186)
Good morning.

MaryAnn Wilbur (04:33.96)
I am.

Skot Waldron (04:53.953)
and I'm glad that we had a kind of a pre conversation because it got me even more excited for everybody else to hear what we're going to talk about today on the show.

This is a very important topic. And we usually talk about unlocking the potential of people. I think this is about unlocking the potential of our healthcare system, unlocking the potential of us as a society, all types of things. Give us some.

MaryAnn Wilbur (05:21.154)
man.

MaryAnn Wilbur (05:36.844)
Hey, Heidi.

MaryAnn Wilbur (07:35.698)
Sorry.

Skot Waldron (07:37.491)
Yeah, I don't know if that was me and was it

MaryAnn Wilbur (07:41.382)
No, it was me. I was trying to use my hotspot and I wanted to not do that and I hooked up to stable internet.

Skot Waldron (07:49.107)
okay.

MaryAnn Wilbur (07:50.32)
I'm going to turn this off so it does not mess with my computer. Okay. I am so sorry. I do not expect that to happen again.

Skot Waldron (07:58.475)
No, that's cool. So did it, did it, were you switching something on your side or.

MaryAnn Wilbur (08:05.249)
I I joined my sister -in -law's internet instead of using my

Skot Waldron (08:11.229)
while I was talking and then it glitched. Okay. Okay. Okay. I just wanted to, okay. So that makes sense then why I did that. No, no, no, it's totally fine. Cause my intro sucked. So I'm going to get to do it again. So thank you. I appreciate that. All right.

MaryAnn Wilbur (08:17.682)
Sorry. Yeah. Yeah, so that's the way to spin it is we're not talking about the potential of a person. We're talking about the potential of like a workforce of people who all have similar to the same problem. So unlocking, because that's one of the things that I touch on. Maybe we should not do this too much so it doesn't sound rehearsed. But one of the things that I touch on in the book is

Skot Waldron (08:32.639)
Mm -hmm. Yeah,

Skot Waldron (08:38.039)
Mm -hmm.

MaryAnn Wilbur (08:47.688)
is not just how we're losing the physicians today, but we're losing the physicians who are training tomorrow's physicians. Like this is going to have cascading effects.

Skot Waldron (08:58.756)
Mmm. my gosh. Okay, you're gonna bring that up. I want you to bring that up. That's

MaryAnn Wilbur (09:01.948)
Yeah, okay. Yeah, but when you say something like, usually we talk about unlocking the potential of a person, let's talk about unlocking the potential of an entire workforce of trained, skilled, educated people and how things can be lost in a short amount of time. Because when you're teaching any kind of language, language can be lost in a generation.

Skot Waldron (09:07.67)
Mm -hmm.

Skot Waldron (09:25.451)
Yeah. Okay. Brilliant. Love it. Ready? We're going to try this again. Take two. Boom.

MaryAnn Wilbur (09:29.979)
Yep. Okay.

Skot Waldron (09:35.669)
Marianne, thanks for being on the show. Thanks for waking up early. Let's go hang out together. You ready? Okay. This is going to blow some people's minds as it did mine when we first initially were talking and having conversations. Cause I was like, I don't know. Usually we get on, we talk about HR people and HR things, and we talk about, you know, communication things and we talk about all these, but you know, your, your topic of this physician problem that we're having right now.

MaryAnn Wilbur (09:38.236)
Good morning. Okay, yep, I'm ready.

Skot Waldron (10:05.363)
applies to the idea of burnout that we're experiencing in culture, but specifically to the physician and how that's all impacting society. We're to talk about how to unlock the idea of a workforce population. We're going to talk about the problem that we're having. We're going to go into all that. And you are at the heart of experiencing this problem in your own story. Give us that story.

MaryAnn Wilbur (10:24.872)
I am. Okay, so I was a practicing GYN oncologist until almost two years ago. And when you go to medical school and you go to residency, you know that the hours are gonna be long, patients are gonna be sick. That was always part of the deal. But we're having problems in our system now where not only are the patients sick and the hours are long, but

physically couldn't do the right things for my patients. And once that happens enough times, it becomes this overwhelming feeling of, in the beginning it's ineffective and exhausting, and then it becomes sort of gross and you feel complicit in this betrayal that our system is putting on the patients. So it's a deep burnout.

And it's mixed up for me, it was mixed up with moral injury as I just, could not provide the level of care that my patients deserved. And I felt awful about it. And at the same time, there were some needs that were happening in my personal life. And I just got to a point where I was like, this is not sustainable. And so I stepped back from direct patient care and leaned on my two public health degrees and an editorial fellowship and my background in clinical research.

to instead of researching patients, talking to the doctors about what they're experiencing and is my story representative? Because if it is, there's a very big

Skot Waldron (12:08.651)
Were you surprised to hear the stories that were out there? Were you hoping that your story was an outlier? I mean, what were you thinking going into this like inquisitive? Like, why would you even go there?

MaryAnn Wilbur (12:21.148)
Yeah. Yeah. Cause you always wonder, right? Especially when it's yourself and, and so, you know, imposter syndrome and all these things, you're like, yeah, maybe it is me, you know, maybe I'm just broken. I don't know. and then, you know, but luckily I had this training in qualitative research. So I put together this project to talk to physicians across the country. And I mean, on some level I knew that it was the problems were everywhere. I mean, that was sort of the reason I didn't leave my job. I left direct patient care. I didn't just move to another institution.

because I knew the problems were in the other places too. in some level I knew, but I also thought that the extreme duress that I had experienced that led me to basically like divorce the career I had spent decades building, I thought it was probably, my story is probably extreme, right? It's probably, you know, maybe other people are feeling it, but not quite like I felt it. And that was not true actually. I think it's not that I got pushed further than other people.

I think I was very blessed to have the opportunity to step away, whereas a lot of people are trapped in their careers right now. And I heard a lot of expletives and we saw a lot of tears and people literally are feeling trapped. And they feel like they got into this to help people and now they're not helping people, they're hurting people.

hurting themselves, they're hurting their families, and they can't figure out how to get out without causing

MaryAnn Wilbur (14:01.585)
not trauma, disruption to their personal lives.

Skot Waldron (14:06.303)
Is this in the, are we talking about hospital system stuff? Are we talking about private practice? What's the mix there? All of it.

MaryAnn Wilbur (14:14.032)
All of it, all of it. Yep, so the docs we talked to, they are all demographics, all specialties, all across the country, and everything from big academic institutions to little rural private practice, family med, all of it. The symptoms are the same.

Skot Waldron (14:36.171)
Wow. Okay. And your background is, were you private practice or were you a hospital assistant at the university?

MaryAnn Wilbur (14:40.922)
No, I was a GY oncologist. It's really hard to be a GY oncologist outside of a large system because you need ORs and blood banks and ICUs and case managers and all of that. So most GY oncologists, because it's a complicated surgical specialty, most are within a larger system, which can add layers to the difficulty, but still is all the same

Skot Waldron (14:57.985)
Okay.

Skot Waldron (15:06.933)
And you took all this research and all this, this I, these ideas and you put them into the book that is out. The doctor is not no longer in, tell us about why this is a problem. So we sit there and we go, wow, that's really, that's really horrible. Like burnout with our physicians is that's really a problem, but okay. Help us feel the pain of what's really happening as a result of this.

MaryAnn Wilbur (15:36.2)
So in the book, we talk about the background of US history and how this came to be. But if we just sort of cut to today, the situation that we're in today is that we have built a system around the dollar and not the patient. And so we've all experienced this on the patient end. You don't even have to be a physician. On the patient end, you go to see your doctor if you can get in. You finally see the doctor, and

you make a plan with your doctor and then you can't actually access the medications or the treatment plan or whatever that your doctor prescribed. And so then the doctor gets all of this frustration and is already supposed to be seeing many, many patients and is now has to fight with the insurance company. So there's like all this added work, all this added documentation, billing, frustrations, and just feeling devalued. And so that is sort of

the slow burn of burnout, because burnout is a syndrome where you experience extreme fatigue and sort of this sense that it doesn't matter what I do. It's like a learned hopelessness. And then as you start to have these stories where not just was it frustrating to finally get access to my patient or jump through all of these hoops, but you get to a place where you literally cannot fight the system enough.

to provide the care that you know is proper. And it creates this what's called, what a lot of people are now referring to as moral injury. This, which is a feeling that you are so compromised morally that you are part of the problem where you have either perpetrated or participated in a transgression to something that you hold dear.

a belief that you hold dear, which is for most of us physicians, that we would treat our patients the way we would treat ourselves or we would want to be treated or the way we would want our parents treated or that kind of level. And when you don't hold to that...

MaryAnn Wilbur (17:46.49)
It really, it's soul sucking.

Skot Waldron (17:51.137)
So you go into this, this practice, with a certain goal in mind, you experience the realities of what our, our system is. The pressures, all the brokenness of certain things. And then on the other side of it, you start going, this isn't what I signed up for. I did not, I did not. Really?

MaryAnn Wilbur (18:10.214)
Yep, we heard that quote every day. Yep, that one in particular. This is not what I signed up for. This was not the deal. This is not how I imagined it. know, all variations on that theme.

Skot Waldron (18:24.641)
Tell us more like what else did you hear in these interviews?

MaryAnn Wilbur (18:28.26)
gosh. So I mean, the statement that we just said is probably the most mild statement. That was the everyday, like, this is not what I signed up for. This isn't why I'm here. This is not how I imagined spending my time on earth is, you know, to feed the almighty dollar. That's not what it did. you know, so there was this frustration and we heard plenty of that. But then as that happens and then you get frustrated with the system, a lot of doctors start to...

push back, right? Well, I mean, we're, have agency. We're not, you know, generally helpless individuals. You know, we are rule followers for the most part, you know, like we, we went through years and years of education and training. So for the most part, we don't push much, but we are capable individuals. So then what happens is the physicians start to push back against the administration and say, you know, this is unacceptable. You know, I

I can't work like this. This is not okay. Patients are going to get hurt. It's going to be bad for all of us. And once you become a problem for the administration, then either you are told to be quiet and you listen or you don't. And then a lot of us started getting emails with feedback about

whatever label you can put on us that would make us seem unattractive. And you start to either be silenced or discredited. And then as the discrediting process gets uglier and uglier, physicians, start to internalize it. They're like, gosh, maybe I am a troublemaker. For me, was that, you know, everybody's a little bit different. So for me,

I was a troublemaker for sure. I wouldn't be quiet. was like, this is not okay. This is not okay. But I always had great patient satisfaction surveys and everything. So they couldn't say I had complaints. And I always had great teaching awards and the residents and the medical students all liked me. So they couldn't say I was a bully or anything like that. For me, they focused on just a couple of surgical complications and

MaryAnn Wilbur (20:57.333)
It was so frustrating. And they sort of silenced me. And, you know, this story is it's not necessarily about me, but but it happens to everybody on anybody who won't just let the beast, you know, let this factory line keep going. If you speak up, you're going to be silenced.

or discredited to the point of being silenced. And in that process, a lot of us internalize that and start to feel really inadequate and guilty and shameful and a lot of these like really dark feelings. And then if you push hard enough, they're like, maybe you need some time off, right? So that's exiling people. It's a very powerful social behavior and it makes

people feel awful. And that's when the physicians start to either regain their immunity and say, I don't deserve to be treated like this. Nobody deserves to be treated like this. Or they don't. And that's when the real darkness starts to set in. The depression, the anxiety, addiction, divorce. We heard about suicide attempts.

I mean, was, and doctors don't, you know, they don't call for attention. Physicians know how to end a life. So the couple of people I talked to about their own suicide attempts, those are solid attempts that were thwarted. But it gets really, really dark and it's done on purpose.

Skot Waldron (22:52.459)
Let me, let me ask you this. Some of us out there may be thinking, wow, that's, that's really hard. Like that really sucks. hear about that in a lot of industries. Why should, but this is such a, it's probably such a small part. It's probably such a small sliver of your profession. Like, is it really that big of a problem? I don't know. Like.

MaryAnn Wilbur (23:19.463)
Right.

Skot Waldron (23:20.097)
Can you give us some meat on that? How big of a problem is this?

MaryAnn Wilbur (23:21.956)
Yeah. Yeah. So when we started this project two years ago, we knew that my story was maybe an outlier. We weren't sure how extreme the story, my story might be from the norm, but we knew one in five physicians was openly saying, I am looking to leave direct patient care. One in

And we already have a physician shortage. So that number was really scary. And actually since then, just last month, the AMA, the American Medical Association, kind of keeps a track on how many physicians do we have in the pipeline? How many do we have active? How many do we have retiring? You know, they kind of keep those numbers. They just came out and said, actually now it's two and five. Two and five physicians are looking to get out.

Those are the physicians I talked to who were quote unquote planning their escape. They're trying to figure out how to do it without blowing up their lives. Cause that's essentially what I did it. I took a major financial hit and just decided, you know what, I'm just gonna suck it up and be able to look myself in the mirror. Maybe not pay my bills, but I got to a point where I was like, I'm not doing it anymore. I'm not taking this money.

Skot Waldron (24:46.199)
You're 40%. So we're looking at 40 % of physicians are saying, I need to, I need to get out of this. Now

MaryAnn Wilbur (24:48.936)
Yeah, 40 % mm -hmm. Yeah, I gotta get out. This system is so broken. And they all said the same thing. I love medicine. I love my patients. I love teaching. I love science. I love the interplay of science and the art of caring for people. Like I love all of it. Nothing changed except I can't work like this. I can't do this anymore. And the this is

working inside of a system where we're trying to care for the patient in front of us, but the incentives are all aligned with the almighty dollar. And so the administration just wants us to crank more revenue and save them money so that they can siphon it off the top and give it to their shareholders.

Skot Waldron (25:40.075)
Give me a vision of what way it should be. I want a little bit of hope. me some hope.

MaryAnn Wilbur (25:44.524)
yeah. there's a lot of hope here. So medicine is just as beautiful as it always was. And I actually think what's going to happen is physicians and patients are going to team up and say, you know what, this is not okay. This system is for all of us. And so we are going to push back and say, this is not okay. And, and create a new system. Now, when I was younger,

and a little more pie -eyed, I actually thought that the answer was gonna be a single -payer system. But we've tried that in the US multiple times and it doesn't work. there's multiple reasons that we should honor. One is, I mean,

Access to care is only one part of good health care. mean, being healthy

MaryAnn Wilbur (26:39.356)
being in an environment where you can thrive. Physicians don't even have the power to do that in the day to day, right? So step one is actually not access to care, it's access to the things that allow a person to thrive. So we call those the social determinants of health. So even if, if you could pass a single payer system, it still wouldn't necessarily improve health outcomes in the US because we have major inequities anyway.

baseline. The second issue is it sounds a little too socialistic and then it doesn't align with American political ideals. So for those two major reasons, it's not necessarily the right way to go. But so the system that we're in today is such that physicians generate the revenue.

we do by doing things, right? We do surgery, we do procedures, and then we bill for them. More technically, we're all hospital employed these days, or at least 75 % of us are, and the hospital bills. But the insurance company says, we're not paying that price. And then there is this back and forth and back and forth between administrators in the hospital and administrators on the insurance side. In the end, there are 17 people between...

my patient and I who came up with the plan. So for me, that usually that story was a patient was just diagnosed with cancer, usually in the lining for uterus because that's, that was the most common cancer I saw. So endometrial cancer comes to my office and I say, all right, well, you know, the bad news is it's cancer. And they had given you the correct diagnosis. The good news is most people are cured by a hysterectomy alone. So we're going to do a hysterectomy and then we're going to do, you know, check your lymph nodes. We're going to do some other things

most, most you'll probably be cured. And that's wonderful news. And the patient's like, okay, great. Let's do that. We're to do a hysterectomy. 17 people then review that plan that she and I just came up with. Do we need those 17 people? I mean, how much does it cost to keep 17 people on the payroll? That's how much waste there is in our system. Now imagine if we took some of that money and instead put it towards the environment where people live so

MaryAnn Wilbur (29:02.994)
people can just have what they need. So imagine if we built a system where instead of the physician being paid like a mechanic, just based on doing things, what if our healthcare system got paid to keep people well? Now you can still do that with a business model. We don't have to fight about any political changes. It's just that the business model for our insurance companies would have to change.

where their job is not to push back on the care, their job is to say, okay, all right, hospital system, your job is to keep this 1 million people well, and here's a billion dollars to do it. or, you know, I'm making up the numbers, it depends on the demographics and blah, blah, blah. But anyway, here's a chunk of people you have to keep well, here's a chunk of money to do it, go.

And then you look at that community and say, what do I need? All of a sudden it turns it because what do I need to keep these people well? Because anything that you save, so that billion dollars, if you only spend half of it, you get to keep the rest. And then the whole team gets to benefit from that shared savings. So, I mean, what could you do for communities? That's amazing. And it actually saves money.

This has been shown to work and I didn't invent it. It's called an Accountable Care Organization. And these have been trialed. But, and here's the kicker, they started with the ACA and they are good ideas, but there was a very big error in how they implemented them on the first go round. So that when they did this,

those shared savings, because it's all about those shared savings, then you can go back into the community or give bonuses to everybody who's working so hard. So everybody wins and feels like, yeah, I feel good about this. I'm keeping people well. I'm being told that I'm valued. Like everything about this feels right. But if the shared savings gets siphoned off the top to go to shareholders, morale, and the whole thing falls apart.

MaryAnn Wilbur (31:23.324)
do that. again, the error in the original ACOs was again about greed. That's what it all keeps coming back to is that healthcare is a different, if we're going to treat it like a business and there's no sign that America will accept anything else, then we have to change the business model so that greed doesn't have such a powerful effect on how it works.

Skot Waldron (31:53.153)
So why would the shareholders agree to this?

MaryAnn Wilbur (31:57.544)
They, cause they're actually is tremendous savings. mean, look at all that bloat, those 17. I mean, what do business people like to do? Right. They like to cut costs. This system is bloated beyond belief. So there's a lot of ways to do better. The tricky thing is we

MaryAnn Wilbur (32:22.196)
I'm trying to think how to answer the question without going through like a huge history lesson that ends up like in this tangent. So the shareholders are recognizing that there are major profits that can be siphoned off, but it comes at such a cost that they have to recognize that this is not a sustainable system. And so when you've got a business model, what you realize

This we've squeezed about all we can out of this system and it's toppling over because it's now going to cost you a fortune. Trying to replace physicians is tremendously costly. So I mean that alone, so they're starting to recognize it but they're still kind of in disbelief because they want to think that there's still money to be siphoned off. But the reality is the business model needs to change and you have to stop turnover.

You know, so retain your physicians, tell them they're valued, let them do their work so that you can stop a turnover because each time you lose a doctor, it used to cost about a million dollars to replace a doctor. Now it's closer to $2 million just because you lose the revenue while that person leaves. And then there's usually like a severance package and whatever. And then there's the recruiting process, the interview process. All during that time, your hospital is not...

making money because that person is not yet operating, not yet up, you know, needs to get licensed and yada yada and they got to go through. There's like all of this process. And because we're now in a physician shortage, it's harder and harder to find. recruiters call all day, every day. There are jobs everywhere. And the docs really, no, I can't work like this anymore. So they don't take the jobs. And so it's getting harder and harder to refill those positions. And you can't just make a doctor. I mean, it takes, it takes decades.

to make a doctor and there's a huge bottleneck in the training, in the number of training spots we have. So they're getting to a point where they have to, they're gonna have to realize that continuing on this path isn't gonna work and they're going to have to change. They're gonna have to stop wasting money in terms of turnover. And we're just talking about physicians, not even getting into, everybody else on the team is also burnt out. All the nurses and nurse practitioners, everybody else.

MaryAnn Wilbur (34:40.104)
And then the administrative blow of like paying 17 people to fight between me and my patient for a surgery that she was going to get anyway. You know, so they have to recognize that the model isn't working and that it can work, but they're going to have to change how they do

Skot Waldron (34:57.173)
Why does the US struggle with this so much? Do other countries struggle with this? Have you looked into the global aspect of this problem?

MaryAnn Wilbur (35:03.652)
Mm -hmm. That's a very common question. So the truth is this dissatisfaction is actually happening in other countries across the globe, but the US is feeling it much to a much greater extent and much more acutely, like right in the now. So I just did an interview with a physician who is like -minded and comes from a similar background as mine, spends a lot of time in public health and that kind of thing.

and he is in Australia, which is a similar system to ours, except that there's much more public. So there's one public system and it is very well done. So much so that most individuals choose not to pay for the private insurance, which they can. They have the freedom to do it. You wanna pay premiums, you can have the extra insurance. For whatever reason that makes you feel better, then you can have

but you don't need it and if you can't afford it, the public system will serve you. And the physicians are, it doesn't matter. They don't have to think about what kind of insurance you have or don't have because the system is set up to just let the doctors work. Which means that the first time that a patient, say gets a, in my case, I would treat cervical cancer.

And in Australia, the very first time they catch a very small cervical cancer, can just, a very small surgery to just like cut out the cancer itself can stop that in its tracks. So they can just do that surgery. In the US, if that patient's uninsured, I get tons of pushback to not do that surgery. But then when the cancer spreads in six months and it's everywhere, then she qualifies for Medicaid and chemo that is not gonna save her life.

I mean, the system is, it's just so abysmal that so, and you imagine how costly that is. Chemo is very expensive. This tiny little procedure, it was an office procedure. It could have been done. It's wasteful. The whole thing is wasteful. so, you know, I talking to him and he was sort of appalled, but one of the biggest things is, so in our country, we created health, we call it health insurance. In fact, it's illness insurance, right? So,

MaryAnn Wilbur (37:31.354)
Maybe I'll give you a little bit of the history lesson. So World War II happened and before then we didn't really have employer -based health insurance. And then when World War II happened, most of the men went to war and the women went in the factories. The factories kept trying to steal the female workers. So like if Rosie the Riveter was particularly skilled and the other factory wanted her, they would offer her more money. And the factory started doing this. And then the federal government said, you guys.

Like you have to stop doing that. It's affecting how quickly you can pump out planes and whatever else we're asking you to build. So stop doing that. And so federal law said you can't entice Rosie to go to a different factory and factory workers weren't going to stop doing it. So what they did was they said, what can we offer Rosie that is not in a higher salary? And they said, you know what, you know what Rosie's worried about now that ether is available, antibiotics are available.

Now with this quality imaging, she's gonna wanna make sure that if her kids gets some kind of illness, she can afford to access these physicians. We should create something called illness insurance. Insurance if, if somebody gets sick. And that was how the whole system was made. So Blue Cross Blue Shield was in fact the first one to do it. And they put it together pretty much the way it looks today. So they put things in place, but it was really an if.

you get sick, right? But what are the chances a human's going to get sick? 100 % where, where, yeah, it's right around a hundred because we're all going to die. Okay. So the system is flawed, baseline, flawed. And then we, and then the sixties Medicare got set up and the federal government was like, how are we going to, how do you, so we set the insurance company to be up to be the payer. then in the beginning they were just going to pay the bills. That's it. Third payer system,

Skot Waldron (39:01.207)
Yeah, 100, something like a hundred. Yeah. Yeah.

MaryAnn Wilbur (39:25.564)
hospital bills, and then the patient doesn't pay, the insurance pays. That was the plan. But then Medicare was put in place and the federal government was the third payer. And then Medicare said, wait, we're not just gonna pay the bills, like, we're not gonna pay just what you say, we're gonna negotiate the price with you. So then they started doing that and then Blue Cross Blue was like, yeah, hey yeah, we can do that.

there's money to be saved there, right? I mean, if they're doing it, we can do it. So then it starts to become this game. And then it gets to a point where the insurance company isn't paying what the hospital lost to care for the patient. So there's a gap. So then what happens with that gap?

That's your copay and your increased premiums and your and you know all of that. So so we lose So all of a sudden, you know, so the businessmen are like sweet the hospitals like hey We gotta keep the lights on We're gonna push it back on the patient, right? and so that and and that kept happening and you see it get worse and worse and worse over the the next few decades and then it gets worse because we

when we created this business, we gave healthcare, the healthcare quote unquote business, some ease in not doing regulations the same way, thinking, the healthcare is, it's a little special. So we're not gonna make the same rules. We're not gonna make the businessmen play by the same rules. So they didn't put in the same antitrust laws and healthcare is ripe for short -sighted business practices, right.

because it kind of, kind of, federal government said, like, all right, we're just gonna leave them, like, let them self -regulate, which is just a terrible idea, because since when do businessmen just self -regulate? mean, so then the 70s happened, and then this is the part where, you know, I am not, you know, I am business and it's not necessarily my thing,

MaryAnn Wilbur (41:39.856)
I understand that there were some pretty significant changes in 70s and 80s to how businesses think, like the large businesses, GE is kind of the classic example. GE used to take great pride in being both a very profitable business, but also sort of a protector of the employees who worked for them and for the communities that they served. it was definitely a different feel. then when...

the idea came that businessmen really have only one person to answer to, and that is the shareholders. That changed everything. so healthcare business was affected the same way GE was, the same way Boeing was. So all of these large business systems that we're watching now crumble because of short -sighted business practices, healthcare is doing the same exact thing, but even worse because we have even fewer regulations in place to protect against it.

Skot Waldron (42:39.679)
Wow. So, you're now a university professor and you now teach this to all the medical students, right? So it's like, my goodness, it's just so much knowledge and understanding of like, you know, and, I, took, my wife is in the healthcare field and she talks to me about things and I just don't know.

MaryAnn Wilbur (42:45.136)
Mm -hmm.

Skot Waldron (43:02.173)
Us, we just don't know. Cause it's not our thing. We don't go in there. It's like, Hey, I'm sick. I go see a doctor. And then they're all, it's such a pain in the butt and everybody relates. It's like, I can't get my appointment with my doctor until like three weeks from now. And it's like all these issues that come up that we just kind of grown with together. just grown about together.

MaryAnn Wilbur (43:14.448)
Mm -hmm. Mm -hmm.

Skot Waldron (43:24.927)
You know, and we just kind of accept it for what it is. that's just how our system is. And, that's just, and I hear that as to me, that sounds like hopelessness to me. That sounds like apathy. A lot of it is like, well, I don't know what to do about it. It's just how the system is. And, in your book, the doctor is no longer in, do you address.

Some of these ideas of like, what can we do about this? Like, what are we all going to do? And, and with the nonprofit about health equity consulting and the thing that you're doing there, like, what are you doing to take action right now?

MaryAnn Wilbur (44:02.72)
right now it's limited by who is willing to really step up and make change because I don't, it's not a secret to anyone, right? Everybody knows this from everybody's side because yeah, I mean, my, favorite client I don't actually have yet would be the CEO of insurance company. And I would love to say to that person, this system is flawed. The business model is old. We can all see

Skot Waldron (44:14.252)
Are you just saying from the physician side who's willing to step up? Or everybody's side?

MaryAnn Wilbur (44:30.984)
you have like, just about squeezed everything you can off this business, out of this business model, we need to change. And those 17 people, those are still people and they still need a paycheck, but let's do it in a way that actually improves patient care and then shares their shared savings so that everybody can win. So in the supportive role instead of an obstructive role, and let's start rethinking how we do

and then build ACOs and make sure that we don't siphon out any of the extra shared savings off that it goes back into the community. And then you grow, like we'll grow from there. The insurance companies who don't get on board, they're gonna be, they're just dinosaurs and they're gonna die out. so it's the CEO of the insurance company who thinks about this change that is inevitable is the client that I would absolutely love to have. But right now that person is not coming to me.

who's coming to me, CEOs of hospital systems that are like, we're hemorrhaging doctors, what can we do? And then I tell them everything that I heard from all of the interviews and talk about culture changes and making sure that people feel valued and making sure that they have what they need to care for their patients. I tell them like, do not do anything trite, physicians are smart and they can feel the, you know, any kind

Skot Waldron (45:27.383)
Who's

MaryAnn Wilbur (45:56.396)
move that isn't genuine. And so we do that. I work for some public health departments with resource allocation because a lot of states are starting to realize like some places we're all going to feel it for sure. If you're not feeling it yet, you're going to. But like all suffering, the distribution is inequitable. There are communities that are going to feel it worse. And so there

know, politicians and public health departments and basically public servants who are saying, we're bracing ourselves because we know our community is particularly vulnerable. Can you help us plan ahead? So I'm doing some of that to sort of buffer more vulnerable communities. And I have a couple of potential clients actually on Capitol Hill because people are starting to think bigger.

And what they're telling me is I want to be part of the change. I want to work on this antitrust regulation kind of stuff. want to, but the people that I am beholden to, the people who vote for me and keep me in my office are totally aware of, and they're not holding my feet to the fire. How do we educate my constituency so that they understand the risks so that

pushing me to do the right thing on their behalf, on behalf of our entire community. And so that is one of the biggest projects now is I am actually the executive producer for a documentary that will be out next year. And the target audience is everyone, is all of us, because patients, there are a lot more patients than physicians. And so we need the patients to understand what's happening and we need to, because

All of us are human too, so physicians. I'm more worried these days as a mother and a daughter and patient myself than I am as a physician. So we all, because all of us are human, we're all patients. We all need to band together and say, this system is no longer serving us. And it's time that we begin the shift and hopefully not make it too catastrophic. So let's do it now before it really crumbles and becomes sort of like a revolution, which can be pretty messy.

Skot Waldron (48:21.451)
Who's your book for and where do they get it?

MaryAnn Wilbur (48:23.898)
Originally, the book was for physicians, physicians in training, physician leaders, and hospital executives. And anybody who was in a position to make change. But interestingly, as I've done interviews and meet with people, just talk about it, everybody's interested, like everybody. So then we push, we open the target audience so that anybody can read it. We took out any medical jargon and really broke it down so that you don't need.

any particular degree to follow the storyline. So now it's a generalized audience.

Skot Waldron (49:01.208)
Fantastic. That's awesome. And where is it available?

MaryAnn Wilbur (49:04.584)
Right now you can pick up your copy at www .thedoctorisnolongerin .com by the time this interview actually reaches the internet. It is probably already on shelves at Barnes & Noble and Amazon and I really hope that you'll check it

Skot Waldron (49:25.185)
That's amazing. If people just want to talk to you because they're like, wow, this is, I want to step up. I want to be part of this movement. What do they do?

MaryAnn Wilbur (49:34.118)
Mm -hmm. Yeah, so I'm now the director and CEO of Health Equity Consulting, which is a business, but we have a separate side, which is a nonprofit. So the Health Equity Foundation allows us to accept donations, and then we can choose our projects based on merit and not who can afford a consultant. So it's a two -pronged approach. So if you need a consultant, we are available.

I've had the opportunity to have wonderful colleagues and friends around the country, people I've met along the way who are part of a large network that we all work together. And so you can go to healthequityconsulting .org. And if you don't need a consultant but you wanna support these efforts, we are accepting donations also, it's a 501C3 and we would love to use those.

those funds to support efforts to protect communities until the day when we can finally really implement what needs to be done.

Skot Waldron (50:43.159)
Well, I'm, I am grateful that I was introduced to you. this whole, this whole thing, I love these eye opening interviews. I've had a lot of them over the course of years of doing this. And my mind just goes, what? Like that's the benefit of having this show is that I meet people like you that really opened my eyes to things. And then I want to go share it with everybody and say like, did y 'all like, did you know this is happening? You know,

MaryAnn Wilbur (50:48.098)
well, thank you. Same.

MaryAnn Wilbur (50:59.27)
I know, yeah.

MaryAnn Wilbur (51:06.522)
Mm -hmm. Did you know this is happening all around us? And people know it. They can feel it. They're like, something's happening. The hospitals are closing. I can't get in to see a specialist. My primary care changes every six months. Like, what is going on? People want to know.

Skot Waldron (51:11.805)
It's crazy. So

Again.

Skot Waldron (51:22.313)
It's nuts. they do. And I, I'm happy to know that, I mean, I'm sure you're not alone. I'm sure there's other voices out there that we just don't hear yet. And so I'm, I'm grateful that I get to now be an amplifier for the message.

MaryAnn Wilbur (51:31.591)
Yes.

MaryAnn Wilbur (51:35.302)
Yeah, yeah. If you're a physician or a patient advocate or you'll want to geek out about this more than just learning, you can go to www .medicineforward .org. It's sort of like a grassroots effort to start making change and we're aligning with other similar nonprofit organizations to sort of keep things moving.

Skot Waldron (52:02.049)
So cool. So cool. Marianne, thank you for sharing your heart with us. Cause there is a lot of heart in there. I could hear it and I can, you know, experience that from the pain and the trauma and the things that you went through in your life. And now you're trying to help it not be like that for future generations. There's an injustice in the world. You see it. You think it needs to change. and I'm grateful for people like you. So thanks for being on the show and thanks for sharing that with us.

MaryAnn Wilbur (52:09.606)
Yeah.

MaryAnn Wilbur (52:29.33)
Thank you. Thanks for having