In this episode, Dr. Carl Gregg talks about his experiences with racism in the American College of Surgeons and how it affected his career. Dr. Gregg is a plastic surgeon who served as a surgeon for over 30 years and is now a fellow of the ACOG.
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00:23:33.980Because, you know, when you're the guy with a knife in your hand, first off, you know, if you're a decent human being, you want to feel like you are competent and doing the best you can for your patient.
00:23:45.020But, and I apologize, by the way, for putting you on the spot when we spoke.
00:24:03.700And if you are wondering if you're going to get the best care because your surgeon looks different than you do, right off the bat, you're starting handicapped.
00:24:10.500I mean, you're really, you know, hurting yourself and the patient if you can't get that trust pretty quickly.
00:24:17.360Because when you walk into the ER, you don't have a lot of time to connect.
00:24:20.920You can't be doing those nice social things.
00:26:04.220You know, they'll remove the cancerous breast sometimes.
00:26:06.980A lot of times, they'll remove the other breast simultaneously.
00:26:09.900And then I will come in and do the reconstruction.
00:26:11.580And I was doing a lot of these cases where you take the abdominal tissue and you create one or two breasts with the abdominal tissue, which is a great procedure, but very significant, time-consuming, and whatnot.
00:26:24.320And there's a lot of things that have to be done.
00:26:26.680And this surgeon offered to help me close the abdominal part of the operation or to do it for me so that I could concentrate on the breast.
00:38:29.180It's the most straightforward kind of medicine.
00:38:31.020So, but in addition to that, they overlay these racial mandates.
00:38:40.640They decide that racism is the real problem, not incompetence.
00:38:43.480And then they put these mandates in where, like, you have to somehow have doctors of all these different backgrounds, which you don't have.
00:38:52.720So what happens when everything starts to go downhill really quickly?
00:39:00.300I have, I get people contact me just because of my, my profile has been elevated by being out there a little bit.
00:39:07.320But I got a call from a young plastic surgery resident that had been fully trained in general surgery and went on to begin her plastic surgery training.
00:39:20.280And she was concerned because she wanted to get the most out of her training.
00:39:23.520And so she reached out to me to find out what things she could do.
00:39:27.100She told me things that were unbelievable.
00:39:28.420I mean, I never imagined these things.
00:39:30.340And this has been confirmed, not, it wasn't just my conversation with her.
00:39:33.920I've confirmed it from other sources as well.
00:39:37.760One is she talked about the difficulty getting enough cases under your belt.
00:39:42.160That is, you know, not getting given cases to do, not having operations that you can actually perform, not having the attendings turn things over to you.
00:39:51.420So, um, this, I could not believe, uh, one of the, the requisites to become board certified, at least in surgery, is you have to turn over to the board of examiners for the American board of surgery, the American board of plastic surgery, uh, a log of the cases you have done in the course of your residency program.
00:40:12.760So they list, you know, every case you've done as a surgeon, as an assistant and whatnot.
00:40:18.260Well, they're now permitted to list operations in there as part of the surgical experience that they've only watched.
00:40:26.760So if they sit behind the anesthesia screen or look over the shoulder of the surgeon, um, and watch an operation, they can list that in the logbook as part of their surgical experience.
00:40:39.080And I can tell you personally that you don't learn surgery that way.
00:40:42.140You learn about getting your hands in there.
00:40:59.220Well, the ACS has already anticipated there's going to be a shortage of 19,000 surgeons by 2030.
00:41:06.400Five years from now, we're going to be shy on nearly 20,000 surgeons in this country.
00:41:10.220Right now, the USA is short 1,200 trauma surgeons.
00:41:14.860There are places that need a trauma surgeon that can't get one because they're just not around.
00:41:19.100So one idea, you know, as bad as it may be, is to put out anybody and everybody and you don't want to drop anybody just so you can get the numbers up there.
00:41:28.940Um, the, the, gosh, this, there's so much to this, Tucker, that, that goes into this.
00:41:36.480Um, well, back, back to the, I mean, all, all of this begins at the front end of the pipeline, which is medical school.
00:41:53.000Yeah, they've, they've taken the, the medical licensee examination, the three-part medical licensee examination, taking it from a graded exam to a pass-fail.
00:42:02.180And to pass it, you only have to be in above the bottom 5% in grade.
00:42:08.280If you, if you are above the bottom 5%, you are going to pass the medical licensee examinations.
00:42:13.780And in spite of that, which is an abysmal standard when you think about it, in spite of that, something like 10% or more students at UCLA, 10% or more students flunk one or more of the exams.
00:42:27.580And a number of them flunk these exams two and three times.
00:42:30.920And yet, they're still being put through medical school.
00:42:51.420I, I had, and while I was in training, there were surgeons or people that came into the program that were dropped after a year or two because it was clear that they weren't going to be able to do it.
00:43:03.500Today, if you do that and you, and it's a minority or underrepresented in medicine, you know, minority surgeon, as intending, if you hold them back or if you drop them, what's going to happen is you're going to get reported.
00:43:19.160They'll get reported to the DEI establishment in that program.
00:43:24.520And invariably, they're going to side with the resident and not with the attending.
00:43:29.020Why do they have the moral high ground if they're putting people's lives at risk, which they are?
00:43:32.300I mean, I think that's a crime, but how did they get to attack you for upholding objective standards of surgery?
00:43:40.420I just don't get the, like, are there, are there no sane people left in American medicine?
00:43:45.080Well, the thing is this, how do you recognize the quality going down?
00:44:43.580In my particular profession, if I do a flap reconstruction, I may not know if that flap's going to live or die for five, six, seven days or more.
00:44:52.180So, when you do have complications, they occur after the patient's out of the system, so to speak, out of the hospital system.
00:45:29.840The other issue, and I got this directly from one of the examiners.
00:45:32.760I know someone who has been examining surgeons for 15 years for their boards.
00:45:38.360So, when you go to take your board examinations, say, he's one of the people that sits in the room and asks you questions and whatnot.
00:45:44.420And what he's noticed is that a lot of these residents are coming in, and he's looking at their cases, and he's thinking, oh, my gosh, they're taking way too long to do these operations.
00:45:56.220Now, one thing that's interesting is when you go for your boards, the cases that they look at are not cases you did in training.
00:46:05.000These are cases you've done since you've been out.
00:46:07.940You know, when you finish your residency, you're allowed to go out and practice.
00:46:11.960I practiced for two years before I became board certified because it took two years to get my board certification.
00:46:17.120So, of course, I have to be able to practice.
00:46:18.580And I'm regarded at that point as a board-eligible surgeon, and I'm entitled to full privileges and all those things.
00:46:26.240So, when I go to take my board examination, I present them, you know, in my case, I present them with a log of everything I had done for the past year.
00:46:34.980And they select cases to examine you on and so forth.
00:46:38.620It's an interesting experience to do that.
00:46:41.240So, these are the cases that these examiners are looking at, and he's saying, they're taking way too long.
00:46:45.980You know, here's an operation that should normally take three to four hours.
00:46:48.780It's taking seven to eight hours for this person to complete this operation.
00:46:52.480I've seen this in my own community where, you know, nurses who know the good surgeons from the bad surgeons say, Dr. So-and-so, he's so slow.
00:47:00.680He just takes forever to do, you know, this operation.
00:47:04.500And complications are directly tied to length of surgery.
00:47:26.240They've come out, and they said, we are not going to pay for anesthesia beyond a certain time.
00:47:32.480So, if we have, for example, a breast reduction, which for me is about a three and a half to four hour operation.
00:47:39.380You know, we'll pay for four hours of anesthesia for breast reduction.
00:47:42.360If it goes beyond that, we're not paying for that additional time.
00:47:46.400And the idea is they recognize that, you know, people are taking too long to do these things.
00:47:53.600Point is, anesthesia has nothing to do with the length of surgery.
00:47:56.940They're just there to keep the patient asleep and stable and alive for you while you're doing an operation.
00:48:01.140But that's the only way they can think to penalize the surgeon, because the surgical time does not come into play unless you look at hospital charges or anesthesia charges.
00:48:11.260And so, they recognize this, and this goes back to what I said.
00:48:15.020You know, a lot of surgeons are not getting enough surgical experience to be able to operate, one, independently, and two, I would say, you know, efficiently, competently, you know, to do.
00:48:25.580I'm not a speedster, but I can certainly hold my own with my peers in terms of how long it takes me to finish an operation and do a good job on it.
00:48:33.560And I've never tried to be the fastest guy on the block.
00:48:37.300So, all those things go to the fact that you're not going to really recognize this decline because it's so subtle in so many respects.
00:48:47.820And that's the other reason why I'm here, Tucker.
00:48:50.740I want this to be a wake-up call to my fellow surgeons.
00:48:53.460This is what can happen to you if you speak up and you try to promote excellence in surgery and you try to object or push back against a liberal ideology, politics, ideology, call it what you will, in surgery.
00:49:09.640And I would love for there to be a groundswell of surgeons coming in and saying, hey, wait a minute, what's going on in my profession?
00:49:16.300Well, the fact that there isn't really bothers me because it's more than physical dexterity you're counting on as a patient reason.
00:49:25.320You want a fact-based, logical physician or else you could die.
00:49:31.560And so anyone who accepts clearly illogical, unreasonable suppositions and doesn't push back against them is basically involved in witchcraft, right?
00:49:45.080So if I could say to you something that is provably untrue and just on its face stupid, which is, you know, a black female patient needs a black female doctor.
00:52:11.460And now she says what happens is when she goes into the ER, that patient has already heard from multiple staff what a wonderful surgeon they're getting.
00:52:21.260She's going to be in there to see them.
00:52:23.120So, I mean, she's earned her place, okay?
00:52:26.040But think how unfair it is for the people coming up now, the minority, if you will, surgeons that have to face this idea when they go into a room,
00:52:36.940that person may look at them and say, gee, is this a DEI hire or is this a person that really-
00:52:42.640That went through, that got here because of their excellence, because of their excellent academic performance in college and medical school,
00:52:50.520because of their excellent performance in their residency, because they met all the standards,
00:52:56.000the standards that everyone should have to meet.
00:52:59.000Or am I getting someone who's a little bit less because of this?
00:53:04.140And that's part of the inference of it.
00:53:05.640You're getting someone less, overwhelmingly, and that's obvious.
00:53:10.140And it has nothing to do with race, by the way.
00:53:12.120It's that preferences are always destructive of excellence.
00:53:16.420So, if you tell me that you're the CEO of a company that your family owns and you got the job because you're the first son,
00:53:25.420my first assumption is they lowered standards to make you CEO.
00:54:26.500You know, the harder you pull to get out, the more stuck you are.
00:54:28.440But why would anybody, you're a surgeon, like you're at the very pinnacle of our system, like the science-based, reason-based civilization that we've built, which we consider superior to like, you know, to the witchcraft-based societies of the rest of the world.
00:54:47.400How in the world could you sit and let this happen?
00:55:14.440So, I got many messages, private messages, which I can't access any longer, from surgeons, including minority surgeons, that said, you know, we agree with you, but we can't speak up.
00:55:25.840Because we're going to get pushed back.
00:55:27.560You know, we're going to be called, you know, Uncle Toms or racist or whatever if we agree with the premise that you're putting out there.
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00:56:47.700No, I mean, of course, I know that you're describing the real answer.
00:57:25.740But if you decide, you know, people will die, but my career is more important, or not being called names is more important, then it's kind of a monster, aren't you?
00:57:37.980I think that if you give the power that surgeons have, the power to cut people open unsupervised, and someone dies, and you're the surgeon.
00:57:46.780You're like God in the operating room.
00:58:41.420I have to say, maybe I could use stronger terms, but I get a lot of private affirmation from colleagues, from surgeons.
00:58:50.000I don't get a lot of public affirmation for that very reason, because some of them are older and don't want to deal with the blowback, the repercussions, and the recrimination that can occur.
00:59:01.180However, some of them, a few agree with the whole situation, crazy as it may be, all the DEI and so forth.
00:59:08.140And most of them were kind of like me.
00:59:10.100They were just going along and too busy taking care of their patients to the best of their ability.
00:59:14.440And, you know, I've been doing this for 38 years, and it's really not until about three or four years ago that I popped my head above the water, so to speak, and looked around and said, my gosh, the landscape out there has really changed.
00:59:26.640This is not the field of medicine that I went into.
00:59:31.480And, you know, you'd like to think when you've devoted your life to a career, a profession, that you're going to leave it a little better than you got it.
00:59:42.220You know, I'm building my, I built my practice on the shoulders of the people that went before, and I have a very strong sense of responsibility that I have to honor the traditions and the efforts on my behalf to get me to where I was.
00:59:58.140And you want to think that you've done somewhat the same.
01:00:00.820Now, I'm not, I wasn't a professor, I wasn't a researcher, but in taking care of patients, I've always tried to honor the efforts of the people that trained me and feel like I could go off.
01:00:13.440Well, I've got a generation behind me now.
01:00:15.540I've got a daughter who's a physician.
01:00:17.420I've got a son-in-law, her husband, who's a physician.
01:00:19.460And I feel a very strong sense of obligation to someday, when I can't do this anymore, to say, okay, I did the best I could to leave medicine in their hands better than I got it.
01:00:34.020And that's tragic when you think about it, to think that you're leaving a profession that you love and have committed your life to, and it's in much worse shape than when it was put into your hands.
01:00:49.240I take my own, but at the same time, I think it's what happened to me.
01:00:53.540If they can, if the AECS can ban me with the impunity that they have done without accountability, without even following their own bylaws, for God's sakes, and they have no reason to engage with me, they can do this to anybody.
01:01:12.400I mean, there's nobody out there who's safe.
01:01:15.020And that's a pretty frightening proposition.
01:01:16.680And, you know, for those of us watching who, you know, aren't doctors, it eliminates all trust.
01:01:36.460And what happened in COVID was so egregiously wrong that I just couldn't, I mean, I don't look at the CDC, the NIH, FDA in the same way any longer, public health officials.
01:01:48.500And the other issue, I don't want to open a can of worms here, but the gender affirming care.
01:01:53.680I mean, how in God's name did we get to a point where you have, in my profession, as far as surgery is concerned, is probably the one most closely involved in the whole process of gender affirming care because of the work we do.
01:02:08.960And to have this concept that there's no such thing as male and female, that you can take a biological male and convert them to a woman and they're really a woman.
01:03:43.600But my sense is now in practice, if not officially, that is the case.
01:03:50.160And it's extremely hard to be an OBGYN resident and not participate in that.
01:03:57.300And I wonder if we're moving toward that scenario with transgender surgery where maybe you don't get certified as a plastic surgeon unless you participate in, you know, mutilating minors in the service of ideology.
01:06:01.700And we're talking, you know, back in 1984, thereabouts.
01:06:07.520And, of course, I remember one young woman who died, you know, directly as a result of the operation, which was pretty, it wasn't that big a group of patients.
01:06:17.460So, you know, you're not always allowed to make the decision about what you could do.
01:06:20.880Now, if you're in a residency program and you've got surgeons that are doing, you know, gender-affirming surgery, and, again, in minors, and you don't want to participate in that, I can't speak to this.
01:06:32.680I can't say that the resident has the ability to say, no, I'm not going to do that or I won't do that.
01:06:38.120I do know that, you know, are you familiar with the case of Eitan Heim?
01:07:03.980I've spoken, I've become friends with him, and I've actually, I call these, you know, divine moments, if you will, but I've made a couple of, just felt compelled to call him a couple of times.
01:07:17.980And it just happened to be when he was in a really difficult down period and just needed someone to affirm what he was doing and to encourage him and so forth.
01:07:28.960And so, you know, I just happened to be the person that made that phone call.
01:09:08.600We're going to be seeing the effects of this and paying the price for these policies and these ideologies for probably my lifetime, I suspect.
01:09:17.100Which brings up the issue, you know, I'm a healthy guy, but every one of us is going to be someday needing a doctor.
01:09:24.960And I don't know who I'm going to go to.
01:09:27.300I somewhat semi-seriously told friends and family, I said, don't go to a surgeon or a doctor under 40.
01:10:25.560You know, you'll probably end up going to an urgent care center where you'll see a nurse practitioner or PA or someone that's got a fraction of the education experience of a physician.
01:10:34.360Um, so it's, it's not a real, there's not a simple cure for all of this.
01:10:43.200Um, one thing I wanted to, to try to do, um, with this conversation is not just simply bad mouth, you know, my organization, the ACS or bad mouth medicine or surgery, because I'm devastated by what's happened.
01:10:59.380I, I really want, I want surgery to be elevated to where it should be, which is a, a, a very highly regarded profession, uh, that is dedicated, uh, itself to taking care of all comers, regardless.
01:11:13.000We don't, you know, we don't judge on, on who or what you are when you're in front of us and you've got a problem that we're trained to fix.
01:11:19.560So, my solutions, you know, my first solution, obviously, is get DEI out of medicine.
01:11:25.820Politics and, and, and etiology do not belong in medicine.
01:11:32.080I mean, the idea that, you know, you can take care of a patient if your first, you know, uh, priority is to judge them based on their, their color, ethnicity is, is counter to everything that Hippocratic medicine is all about.
01:11:45.680Uh, the other is to reinstall standards of excellence.
01:11:48.660We have to, we have to quit lowering the bar.
01:11:50.940We got to start elevating the bar again and requiring that, you know, doctors and prospective, uh, uh, doctors meet, you know, minimum standards.
01:12:00.660You know, there have to be some minimum, but they have to be higher than the lower 5% for Pete's sakes.
01:12:06.260We have to free, you know, the doctors in training to do what they have to do.
01:12:11.720You can't have restricted hours when you've got such limited time anyway in, in the overall, you know, a course of a person's lifetime, you know, three, four, five years in surgery is the drop in the bucket.
01:12:26.540I mean, to, to ask a surgeon to devote themselves to learning the craft and what they call the art and the science of surgery, you know, not only do you need the time, you need the, the person to apply themselves.
01:12:40.020One thing I heard, which again is, uh, kind of disturbing is that a lot of young surgeons are more concerned about comfort, you know, uh, work-life balance as it's often called, uh, as opposed to learning to be the best doctor they can be.
01:12:56.440They want to know how much time off they have.
01:12:58.500They want, they, they're very jealous of their time off, you know, five o'clock rolls around, they're done.
01:13:04.320Uh, one thing that they found, uh, in, uh, asking all the program directors about, uh, the surgeons coming into their fellowships was that, uh, a large proportion did not have ownership of their patients.
01:13:17.300And ownership means that, you know, you take that patient as your patient.
01:13:20.940That's, that's not just someone that you take care of for a 12 hour shift and then you turn them over to the next person.
01:13:26.240And then, you know, you may not ever see that patient again or not until, you know, two or three shifts later, you know?
01:13:32.060So a lot of young doctors don't have ownership for their patient.
01:13:35.100I'm hearing that from, from colleagues.
01:14:49.880And, and he, uh, reported that he went to, he interviewed several surgeons, black surgeons, showed the white surgeon for his surgery because he was the most competent.