“It's not patients against doctors. There's this third thing that's calling all the shots. That's making all the decisions. That all the laws are benefiting. And we need to be focusing on that third thing. Which is the health insurance companies. The corporate entities. The big hospital corporations. Private equity.”

Dr. Will Flanary, better known by his online persona Dr. Glaucomflecken, is an ophthalmologist, comedian, and one of the most prominent social media voices in medicine today.

Beyond his comedic work, Will is a survivor of both cancer and a sudden cardiac arrest, which has shaped his deeply personal perspective on the healthcare industry. His experience as both a patient and a physician has given him a unique lens on what’s broken in our healthcare system, and now he’s using his gift of humor to help advocate for powerful changes.

In this episode of How I Doctor, Dr. Graham Walker, co-founder of Offcall and an emergency physician in San Francisco, speaks with Will about his dual career as a content creator and a private practice physician, and about the key changes he’d like to see in our healthcare system to better support physicians and patients.

While changing such a behemoth industry is hard, Will believes that creating a better healthcare system is very much possible, but it will take many small actions at the local level to get there. Perhaps most importantly, Will believes that every single physician – no matter how big of a social media platform you might have – has an important role to play. Here are five of the most immediate changes Will would like to see in healthcare, and what every physician can do to help achieve them.

1. Redistribute Power to Physicians

“Something has to change in healthcare. And I think that starts with redistribution of power to people who know what it’s like to go in and see a patient.”

Will believes that corporate entities, including private equity firms and insurance companies, are at the root of what’s wrong in healthcare. These organizations are good at shifting blame for systemic failures onto physicians, he says, which in turn sows distrust between patients and doctors. “What these corporations are really good at doing is diverting blame of healthcare to the physicians to say “Oh, look at these greedy doctors. Don’t they make enough money? Why are they so greedy? It’s all these things that sow discontent in society and anger and distrust toward physicians,” Will shares.

His call to action is clear: Give more decision-making power to the people actually delivering care.

2. Better Educate Physicians About How the Healthcare System Really Works

“It’s wild to me that we still don’t just inform medical students about how the healthcare system works. There’s so much complexity, and we do a terrible job preparing new physicians to navigate it.”

It wasn’t until Will became a private practice physician, and then a patient, that he realized how little he was taught during training about the systemic challenges in healthcare or the business side of medicine. This sentiment was also shared by another recent How I Doctor guest Dr. Jared Dashevsky, who founded the popular newsletter Healthcare Huddle (read more here). Will believes more physician education about the operational and financial aspects of medicine – on everything from billing to PBMs, prior authorization, and more – can really help. Arming physicians with a better understanding of these topics would allow them to better navigate and challenge inefficiencies. This would also help to reduce career burnout and frustration.

3. Combat Medical Misinformation on Social Media

“Patients have more autonomy now. Through social media, there's less of a patriarchal type of situation where the doctor's word is final. But on the flip side, it has also brought distrust to an extreme degree. Now we don't actually have the expertise to tell people to recommend treatment or what they should do, and that's dangerous.”

While social media has given patients greater autonomy, it has also led to an erosion of trust in physicians and growing skepticism toward medical expertise more broadly. Will believes this growing distrust fueled by misinformation on social media is also undermining effective care.

Can anything be done about this? Will says yes: Every physician – no matter how large your social media following – can play an important role in combatting misinformation and using your platform to better educate your community.

“People overlook the value that just educating people using your platform has whether you’re like me and have millions of people that watch your stuff or whether it’s on Facebook and you have a couple hundred in your community,” he shares.

4. Don’t Be Afraid to Showcase Your Personality With Patients

“ I just want [physicians] to laugh at themselves. I think that's the biggest thing. It's a kind of weird job that we have. And to be able to look at it through a comedic lens at times, it helps bolster our humanity. In our own eyes, but also in the eyes of the public.”

Humor is Will’s primary vehicle to help cope and to also bolster physicians’ image in the public. But according to Will, you don’t have to be funny to help reclaim physicians’ humanity. Instead, physicians should focus on being more human, and also, less afraid to showcase their emotions with patients.

“I know what I like to see in a doctor from the patient standpoint, and that’s someone who actually has a personality,” he shares. “I also know what it feels like to have to suppress that because we’ve all done that at some point in our careers. You just keep that side of you a secret because it’s not professional to want to tell a joke or want to cry or show any kind of emotion, but I know that I appreciate that from my doctors so I want to emulate that.”

5. Unite and Advocate for Legislative Reform

“We’re not going to have wholesale change overnight. We need to focus on small, incremental wins — like the No Surprises Act or prior authorization reform.”

Will believes that legislative advocacy is critical, and two causes that he believes deserve more attention are overturning restrictions on physician-owned hospitals and prior authorization reform. “We need to collect wins,” he says. For more information about prior authorization reform, be sure to listen to a previous episode of How I Doctor featuring Dr. Tina Shah, who is a pulmonary critical care specialist and chief clinical officer of Abridge and also has been a key leader in achieving prior authorization reform in New Jersey (read more here.)

Beyond legislation, Will encourages every physician to use their platform to educate the public about the major challenges in healthcare. “We know where the pain points are. The public doesn’t know. All they know is that healthcare sucks for them,” he says. “And who do you think they’re going to blame for that? They’re going to blame physicians.”

That’s also why Offcall exists: to help restore balance in medicine and improve the wealth and wellbeing of physicians. Sign up for Offcall here to bring about more physician compensation transparency, and also subscribe to How I Doctor wherever you listen to podcasts to never miss an episode. You can also read the full transcript of the episode below.

Connect with Will and all things Glaucomflecken here, and be sure to also subscribe to his own podcast Knock Knock, Hi here!

Transcript

Dr. Will Flanary:

Something has to change in healthcare, and I think that starts with redistribution of the power in healthcare. To people who know what it's like to go in and see a patient, and take care of them. What these corporations are really good at doing, PBMs are really good at doing is diverting blame of healthcare to the physicians. To say, "Oh, look at these greedy doctors, they're wanting higher reimbursement. Don't they make enough money?"

A lot of people don't realize that. They don't realize it's not patients against doctors. There's this third thing that's calling all the shots, that's making all the decisions, which is the health insurance companies, the corporate entities, the big hospital corporations, private equity.

Dr. Graham Walker:

Welcome to How I Doctor, where we're bringing joy back to medicine. My guest today needs literally no introduction, but I'm going to introduce him anyway. Dr. Will Flanary is a practicing ophthalmologist, but you probably know him as Dr. Glaucomflecken. Dr. Flanary is maybe the most recognizable face and voice in healthcare. Will tackles everything from physician burnout, to cardiology versus nephrology, and takes all the forces that make practicing medicine or being a patient more challenging today. It's not just Dr. Flanary's story that's inspiring, it's his willingness to be open about it, too. He's a survivor of more medical disease than anybody should have to bear. He uses his experiences as strengths to encourage physicians to show each other grace and kindness, and wants us to support one another. I think Will is not the internet identic comedian that medicine deserves, but he is certainly the one that we all need right now. I'm thrilled to talk to him, as a huge personal fan, about how creativity can be a powerful force and antidote to burnout, and find a way to find meaning in the chaotic world of medicine.

Welcome to the show, Dr. Will Flanary. Thanks for being here.

WF:

Ah, thank you so much for having me. Excited.

How Dr. Glaucomflecken Got Started With Using Comedy in Medicine

GW:

It's, yeah, truly an honor. I've followed you since even before GuGate on Twitter. I'm sure a lot of our listeners are familiar with your videos. I want to focus on your humor and how you're using it to address, honestly, some really serious issues in the medical community.

How did you get humor to be your outlet for coping? Has it always been part of you?

WF:

Oh, man. It's a very healthy coping mechanism. I've been doing comedy in some form or another since I was in high school. Yeah, that's when I started doing standup comedy. I've loved making people laugh all my life. I was a class clown, if you could imagine that, in school.

GW:

Where did your comedic voice come from? Are your parents funny?

WF:

My parents never cracked a joke throughout my entire childhood. No, I'm just kidding. My parents were big Letterman fans back in the day, so I was by extension. I remember watching Letterman, and then the old Conan, Late Night with Conan O'Brien. Then also, Saturday Night Live. Those were my bread-and-butter comedy influences.

I'm not a generally big expressive type of person. I'm actually somewhat introverted. I rely really on the writing. I've learned how to do a little bit more of a stage presence, acting for lack of a better way to describe what I do on TikTok.

GW:

You've said that medicine is serious business, but it's also outrageously funny.

WF:

Oh, it is. Yeah.

GW:

How do you bridge that gap between we do some serious stuff and we talk about serious stuff?

WF:

Yeah.

GW:

You walk the line so well.

WF:

Yeah.

GW:

How do you navigate that?

WF:

Well, it's been trial and error. I quickly realized that the best approach is going to be focusing on the interactions between physicians with each other. The interpersonal dynamics, conflicts, all the weird idiosyncrasies that physicians have. In seeing all the interactions between my attendings in med school and residency, it was like, "Oh, man. There's just so much comedy here." Like these people that are arguing about fluid balance in a way that would seem not real to anybody outside of medicine.

By doing that, I was able to really stay away from the more serious grave aspects of life as a physician and work as a physician. My content, really, it doesn't involve that type of material. That's much more difficult to make funny. But the way an orthopedic surgeon and a radiologist interact with each other? Yeah, that's easy. I can do that all day.

GW:

Will, I just love that you don't punch down, as you've talked about on Twitter.

WF:

Yeah, yeah. That's part of the patient.

GW:

It's almost too easy, and we're certainly the ones in the position of power.

WF:

Yeah. There's no comedy in that. The patient's very vulnerable. My ultimate goal with that part of things is I don't want to do anything that's going to undermine trust in physicians. It's already-

GW:

It's already hurting.

WF:

It's already hurting as it is. I don't want to be the one to make it a lot worse.

GW:

A lot of people look at your videos and they say, "Oh my God, I could never do that, I don't have the time." But you obviously have to start somewhere.

WF:

Yeah.

How Dr. Glaucomflecken Balances Being a Private Practice Ophthalmologist With His Social Media and Content Creation

GW:

How do you fit that into your career? You're still a practicing ophthalmologist.

WF:

I am. Well, part of the way to do it is be an ophthalmologist.

GW:

The road to happiness, yeah.

WF:

Honestly, it's part of it because I'm very fortunate in where I am in my ophthalmology life. Because when I started this, I was a resident. And I don't care what field you're in, residency is demanding-

GW:

Grueling, yeah.

WF:

... in terms of your time and energy. I wouldn't have been able to do all this as a resident. No way. In residency, I was just cracking jokes on Twitter and that was the extent of it.

I went into private practice ophthalmology, and got out of the academic environment. I became my own boss. I can dictate when I have time off, what my hours are to a certain extent. Because I'm in this type of clinical practice, I do have time to do more. Sometimes I'm like, "Should I just quit social media and just do ophthalmology?" Then there's other times I'm like, "Maybe I should quit ophthalmology and just do social media."

GW:

Yeah.

WF:

But really, I can't imagine my life without both of them. It's been a work in progress trying to figure out how to balance the two.

GW:

Will, you've created a lot of new personas over the years. Where are these personas coming from? Are they still memories from med school? I would imagine you're not-

WF:

Some of them are. Yeah.

GW:

You're probably not interacting with orthopods a lot right now.

WF:

You don't think so? No? There's no bones in the eye, is that what you're saying?

GW:

No, not many.

WF:

No. I can't remember the last time, honestly, professionally, I interacted with a ... There's one disease that can. It still does not require me to interact with an orthopedic surgeon, but there's this thing called Purtscher retinopathy where-

GW:

Yeah. I diagnose that every day in the ER. It's crazy. Yeah.

WF:

Of course, right? A long bone fracture, you get these little emboli of fat-

GW:

Classic.

WF:

... that go to the eye. There you go, there's your ortho-ophthalmology crossover of the day.

Most of it's still med school, honestly. Some of it's just because I follow different people on social media, different specialties. I either see what they write and I put a personality to their writing, and usually it's pretty accurate. But a lot of it still comes from just my experiences. There's only so many specialties. There's some specialties I haven't hit, just mainly because I don't think I've ever interacted with a plastic surgeon. I have no idea what they're like.

Dr. Glaucomflecken’s Key Message to Help Restore Physicians’ Humanity

GW:

Will, you've made such rich tapestry of recurring characters, the Glaucomflecken Cinematic Universe. What's the unifying theory or the message you're trying to convey in your videos do you think?

WF:

I just want people to laugh at themselves.

GW:

Not take life so seriously?

WF:

Yeah. Ultimately, I think that's the biggest thing. It's a weird job, what we have. It's very strange, what we do. To be able to look at it through a comedic lens at times, it helps bolster our humanity I think, in our own eyes. But also in the eyes of the public, they see us enjoying a little bit of comedic ribbing toward ourselves, toward each other. That shows people, "Oh, this doctor, he's just a normal person that just happens to do this very strange and important job." It just humanizes us.

GW:

Will, that's actually my favorite part of what you do. Even more than the comedy, it's just showing that we're just humans. You really often have a message about self-expression and having to balance that with our professionalism. But we're well-trained humans is the way I put it. We're not robots, we're not gods. Why do you think that's so important to you, that you want to get that message across?

WF:

I have had so many experiences as a patient, I know what I like to see in a doctor from the patient standpoint. That's someone that actually has a personality. I know what it feels like to have to feel like you need to suppress that, because we've all done it at some point in our careers. We just keep that side of you a secret because it's not professional to want to tell a joke, or to want to cry, or whatever it is. Show any kind of emotion. I know that I appreciate that in my doctors, so I want to emulate that.

GW:

That we're flawed, imperfect creatures, but we're trying our best. Yeah, yeah.

WF:

Exactly.

How Doctors Can Fight Misinformation on Social Media

GW:

Yeah. What do you think the state of medicine is like today? And what do you think has changed since maybe you were in med school?

WF:

It's certainly is hard to be a doctor. What's changed is I think the public perception of medicine in general has been a big thing, with social media in particular. There's some good things about it, that patients have more autonomy now, which is a good thing. Through social media, and interacting with healthcare professionals on social media. There's less of a patriarchic al type of situation where the doctor's word is final. People are taking ownership over their health, which is I think a great thing. That's so important. Have the agency to ask questions, and challenge physicians, challenge healthcare professionals.

But on the flip side, it's also brought distrust to an extreme degree. To where now, we don't actually have the expertise to tell people, recommend treatment, or what they should do, or whether it's vaccines, or whatever it is. That's dangerous.

I feel like we're trying to fight these two things. We want patients to have autonomy, but we also need them to respect our expertise, and sometimes listen to us. Hopefully listen to us all the time, just like we need to listen to patients. It needs to be a back-and-forth. I think it's getting harder and harder to find that balance.

GW:

Yeah. It does feel like there's an erosion of expertise, or that doing our grueling training isn't sufficient or is equal to somebody else reading something online, or something.

WF:

Yeah, the misinformation.

GW:

Yeah.

WF:

There's so much of it now. People are designed to you want to believe somebody saying something. Especially if they're a very charismatic, engaging person, like you see often on social media. Because that's what people who are engaging and charismatic do, they go on social media and they become influencers. They may not be correct at all in what they're saying. But they say it confidently enough, you're going to have people that just say, "Oh, this person just looks like they know what they're talking about."

You have to tell people, "No, actually you don't need to sun your perineum. That's not going to treat your rectal cancer." We have to debunk the nonsense. No, you don't need to use aged urine eyedrops, that's not going to do anything for your eyes.

GW:

I saw castor oil recently on TikTok as well.

WF:

Castor oil, yeah. That's another one. We have to tell people, "Don't do this thing that's obviously nonsense." But then also, the actual things that they should be doing. It feels really challenging. It's hard enough just to try to get the quality medical information out there without having to deal with all this other nonsense that really shouldn't be out there in the first place.

GW:

Totally agree. Yeah, it's exasperating.

Medical School Fails to Teach Med Students About Healthcare Topics Like Prior Authorization and PBMs

Will, you've got a lot of resident and med student fans. What would you say you've learned that you only learned once you were an attending, once you were done with training?

WF:

Oh, how the healthcare system works.

GW:

Yeah.

WF:

It's outrageous. It's wild to me that we still don't just inform students, med students about the way the healthcare system works. That's a huge blank spot in our education.

Going into private practice, it was a really large uphill climb trying to figure out how billing works, and what is a prior authorization. What about peer-to-peer reviews? Why do I have to do this? What about this carrier versus this carrier? A PBM, I don't even know ... I hadn't even heard of the term pharmacy benefit manager until I was out of training, in practice.

Our healthcare system is so complex, and we do a terrible job of preparing physicians, new physicians to practice in that complex healthcare system. Some of this wasn't until I was a patient until I actually felt it. I felt the weight of all these moving parts that are bearing down and weighing down patients, and forcing patients to navigate those complex systems.

GW:

You're done with residency or fellowship and you're like, "Oh, God, thank God I'm finally done." Then it's like nope, there's actually a whole third more chunk of stuff you have to figure out. Quality metrics, and billing.

WF:

Oh, yeah.

GW:

And all that.

WF:

Congrats, you learned the medicine. Great. By the way, you're still going to learn just as much medicine out of training than you are in training. But then you also get a PhD in health policy just because you have to.

GW:

For listeners, if you haven't seen Will's 30 Days of Healthcare, he did a series last year. Every single day, did ... I was a health policy major in undergrad, so I particularly appreciated that.

WF:

Oh, good. Yeah.

We Should Overturn the Ban on Physician-Owned Hospitals

GW:

Will, were there one or two topics that, when you had to research them, you thought was the most egregious, or surprising, or you've got to be kidding me? There's no way this is real.

WF:

Yeah. Well, I mentioned the pharmacy benefit managers. That was probably in 2021 or so. Then I re-posted that during that series, just because I love that video because it took me so long to figure out exactly what a pharmacy benefit manager is and does. That was one thing that blew my mind, and the power that they have.

Another one was the whole idea of physician-owned hospitals, and the ban on physician ownership of hospitals. I had no idea that was a thing.

GW:

Yeah. A lot of private equity own them. But God, for a physician, no.

WF:

Right, exactly. Or churches. Any other entity can own a hospital except ... It has no basis in data. In fact, the data shows the opposite. That certain outcomes are better, costs are lower. It's more efficient when physicians own the hospital. But the lobbying effort on behalf of the American Hospital Association and others is so good, they threw so much money at the Affordable Care Act to include that ban on physician ownership. That was one that really just blew me away. I was like, "Whoa, I can't believe this is a real thing."

Because we're so segmented in healthcare and as physicians. We know about our field, and not much about anybody else's. For me, and this is like this with any of my videos, I get to learn a thing or two. Sometimes it's actually really useful information, like how people with disabilities, what additional barriers they have to navigate in the healthcare system. Like getting authorizations for wheelchairs, or hearing aids, or something like that. Sometimes it's not useful information at all. I don't need to know what argument emergency medicine is having with neurology about blood thinners.

GW:

TPA. Yeah.

WF:

But here I am.

GW:

Here we go.

WF:

I got that stuck in my head. That's not going to help me at all in my career. Anyway.

GW:

If you have a CRAO, that's helpful. See? Right there.

WF:

Okay, yeah.

GW:

Boom.

WF:

Sure. How often is that really helpful? Never.

GW:

Exactly.

WF:

Not really.

GW:

You're secretly subversive. You've said you're tricking people into learning things.

WF:

Oh, yeah. Yeah.

GW:

Have you always been-

WF:

That's my favorite.

GW:

... an advocate for change and trying to get people to learn this stuff? You didn't have to do 30 Days of Healthcare. What awakened that side of you?

WF:

I had my cardiac arrest, I had to deal with the healthcare. I had all this surprise billing and everything. That's what really woke me up to the reality of what patients have to experience in our healthcare system. Seeing it from the other side, that really showed me what's going on.

Reducing the Influence of Private Equity and Health Insurance Companies in Healthcare

GW:

The thing that I really love about your content is that you're both trying to look out for patients, and also look out for other medical professionals. Are there things that you think would hit that sweet spot? That, God, if we changed this, God, that'd be so much better for doctors and so much better for patients? Regardless of what it would do to whatever, the health insurance industry.

WF:

Yeah. Well, I think the physician hospital ownership is actually a big one. Just to give more power to people who actually take care of patients. Taking power away from corporate entities, the private equity firms, because they have all the power here. We've seen what happens, what's going on. Something has to change in healthcare, and I think that starts with the redistribution of the power in healthcare. To people who know what it's like to go in and see a patient, and take care of them. What these corporations are really good at doing, PBMs are really good at doing is diverting blame of healthcare to the physicians. To say, "Oh, look at these greedy doctors, they're wanting higher reimbursement. Don't they make enough money? Why are they so greedy?" It's all these things that sow this discontent in society, and anger and distrust toward physicians.

We're trying to protect our own wellbeing, our own jobs, our own way of practicing medicine. And also trying to protect patients. Those two things, they really go hand-in-hand. It's not one or the other. It's a lot of the changes that we advocate for are to help patients, and by virtue of helping patients it's going to help us. A lot of people don't realize that. They don't realize that there's this evil third thing. It's not patients against doctors. There's this third thing that's calling all the shots, that's making all the decisions, that all the laws are benefiting. We need to be focusing on that third thing, which is the health insurance companies, the corporate entities, the big hospital corporations, private equity.

Advocating for Prior Authorization Reform Can Help Physicians

GW:

You hit on a really interesting point that we see what's happening, and I think that's totally true. That's one of the reasons we're doing this podcast and building out Offcall. Doctors are seeing what is happening to not just the system and where they're practicing, but to their patients as well. How do you think we can take back some agency and bring back some power so that we can help support our patients?

WF:

It's got to start through legislation. We've had wins. We have the No Surprises Act. We had prior authorization reform that went through in a few different states. Most recently in New Jersey.

GW:

Yeah. We had Tina Shaw on, who got that done in Jersey.

WF:

Yeah.

GW:

She had the same idea, state by state making changes.

WF:

Exactly. That's what it's going to take. It's going to be the small, incremental ... God bless the people who are like, "We need Medicare for all, we need universal healthcare." I would love for everybody to have easy access and affordability of healthcare. But call me a pessimist, but we're not going to have this giant wholesale change right away. We need to collect wins. We need to make a difference slowly, and then have people benefit from those wins. Like the No Surprises Act, like going state by state and getting prior authorization reform. We need to keep fighting on that level, and then eventually it'll get bigger and bigger.

On the social media side of things, we can do a lot of educating, like what I do with my videos. A huge part of advocacy is just educating, because if you don't know what the problems are, how are you going to work on fixing it? We all, in medicine, we generally know what the problems are, we know where the pain points are. The public doesn't know.

GW:

Yeah.

WF:

All they know is that healthcare sucks for them, it's unaffordable, and they can't get it. Who do you think they're going to blame for that? They're going to blame physicians.

GW:

Yeah. That's the piece that I think is particularly painful and hard to swallow for physicians. It really feels like, "I am doing everything I can!" But we're the face.

WF:

Yeah.

GW:

We're the ones in power.

WF:

Right.

GW:

Versus when it's prior auth, it has nothing to do with me. It's your insurance company that is forcing this.

WF:

Right.

GW:

I would love for you to have the MRI. That's I think the hard part to swallow is that the physicians feel that we're the ones to blame when we're, I don't know, I feel like an innocent bystander.

WF:

Exactly. People overlook the value that just educating people, using your platform. In whatever that is. Whether you're like me, and you have millions of people that watch your stuff. Or whether it's on Facebook, you have a couple hundred in your community. "Oh, let me tell you about prior authorizations for cataract surgery or for a coloscopy." Or this really frustrating thing that happened with a patient recently. Just highlighting that so that people know exactly what the problems are, and they can point their ire and attention to the right place.

GW:

Will, do you think physicians also need a more private place to get the gallows humor out?

WF:

Yeah.

GW:

Like the physician lounge.

WF:

Yeah.

GW:

There's stuff that you probably don't talk about on social media.

WF:

Sure.

GW:

There's certainly stuff that I say in the doctor's room in the ER that-

WF:

We all have to have our outlets. There's always going to be a need for that. Not everything is for social media.

Dr. Glaucomflecken’s Partnership with the New England Journal of Medicine

GW:

You have a partnership with the New England Journal to, again, trick people into learning things.

WF:

Yeah, how about that?

GW:

That was certainly on your Bingo card.

WF:

Who would have thought?

GW:

Yeah, exactly. I love that you required your stuff to be open access.

WF:

Oh, yeah. Yeah, that was a prerequisite there.

GW:

I just think it's brilliant and it's a great way of using your power for good I think. What other changes do you think we should or could make in medicine that we maybe take for granted? Like, "Oh, the New England Journal's subscriber only, I can't access this."

WF:

Yeah.

GW:

What other stuff are we, "Oh, that's just how it works in medicine?"

WF:

I think publishing is a big one. That's a really tricky thing. There's a lot of powerful entities that are controlling access to the latest research. Figuring out a way for research to be open access, I know a lot of people are working on processes and things to do that without gouging the researchers on these APCs, company's publishing fees, which is not the spirit of open access.

We still have a ways to go with how we treat trainees, the amount of debt we're putting them into with education. You can tell just with how many ... In two or three years, I think every resident is going to be in an union. That tells you that they're not being treated fairly. Otherwise, why would they want to join a union? I think we have a long ways to go with how we treat residents.

But also, just practicing physicians, too. That's going to be the next thing. Because now United Healthcare is the largest employer of physicians in the US. Do you think they're going to be treating those physicians well? Probably not. They aren't already, and I've heard from a lot of them. That's a big thing that a lot of people aren't really thinking about other than physicians.

GW:

Yeah.

WF:

And trying to figure out how to make that system better. It might be unionization, I don't know.

Dr. Glaucomflecken’s Advice for Physicians Who Are Burned Out or Looking for a Side Job

GW:

We're already seeing a trend of a lot of brand new attendings, they've been out of residency for one or two years, and they're already thinking, "I don't know that I want to do this."

WF:

Trying to find a way out, yeah.

GW:

Yeah, yeah.

WF:

Yeah, exactly.

GW:

Yeah.

WF:

It's looking for the side gig to try to retire early, or figure out a different pathway all together. It's sad because you put so much of your-

GW:

It's super sad and it's scary.

WF:

So much of your life into this.

GW:

I'm going to need healthcare by doctors that are committed to ... If I have some weird thing, I want that doctor to be like, "What does Graham have?" And be intellectually curious.

WF:

Yeah.

GW:

But not be burned out so that he or she can actually think about that stuff, too.

WF:

Yeah. I feel like a physician's job needs to get simplified to a certain extent. There's too many things pulling us in different directions with documenting, and all the regulatory burden that we have to deal with. Prior authorizations and peer-to-peer reviews. Just reforming this stuff and just making it easier to practice medicine.

GW:

Will, do you have an advice for physicians who want to look at a side job or find stuff outside of traditional clinical practice?

WF:

Obviously, I have a side gig. This is a side gig.

GW:

Yeah.

WF:

Glaucomflecken is one. I didn't say, "I'm going to do comedy so I can make extra money." It was this was just I had a hobby, something I was really passionate about, comedy, and I put time into it. I didn't start making money off of Glaucomflecken for I think it was the first four or five years I was doing it. It wasn't my driving force.

There's all kinds of things you can do as a physician to make extra money, being expert witness and doing surveys, and stuff. But all that stuff, I can't imagine that's going to make your life better.

GW:

Yeah.

WF:

Make your quality of life better.

I would encourage people to have something outside of medicine that you just love to do, that you can turn off the medical part of your brain. Now in my infinite wisdom, I decided to combine my one thing I like to do into medicine, so I never really get to turn off my medicine brain.

GW:

Well, it's that creativity you talk about.

WF:

Yeah. It's the creativity part of it. I get to use a different part of my brain.

But having something that you can enjoy, I think that's so important. That's what I tell residents and med students. Hold onto whatever that thing is that you put in your likes and hobbies section of your application.

GW:

Keep those.

WF:

Keep it. Keep it in your life in whatever way you can.

On the Clock Questions: Dr. Glaucomflecken’s Real Name, His Best Financial Advice for Doctors, and Where to Find Him on Bluesky

GW:

Well, Will, I've just got some rapid fire questions.

WF:

Sure.

GW:

To end us out here. What is the number one thing you wish your patients knew about you, Dr. Will Flanary?

WF:

That my name is not actually Dr. Glaucomflecken. Some people really did not know that.

GW:

Wow, yes. What are the best and worst parts of your specialty?

WF:

Let's see. The best part's easily cataract surgery. Fantastic, so much fun. It takes seven minutes to take out a cataract, and you get patients seeing better. The worst part, pink eye, conjunctivitis. It's awful, it's gross, it's disgusting. Hate it.

GW:

Will, if you could cure one disease forever, what would it be and why?

WF:

I'd go with ALS.

GW:

Oh, that's what my grandma died of. Thank you.

WF:

Yeah.

GW:

Yeah.

WF:

That's a really awful one.

GW:

It's a shitty one, yeah.

WF:

Yeah. There you go. I was thinking about macular degeneration, but I was trying to think outside of the ophthalmology box on that one, so there you go.

GW:

Very good. What's something you did not learn in medical school but is crucial to your daily practice?

WF:

How to manage a team.

GW:

Oh, yeah.

WF:

In private practice.

GW:

Medicine is a team sport.

WF:

Yeah. When you're also an employer, I'd say just as much of my job is peopling, managing people and personalities, and motivation, and just keeping people happy and cared for from the employer's side of things. That was something that I have had to learn on the fly.

GW:

What's the best financial advice you've received?

WF:

Get your disability insurance as early as possible, which is something I was unable to do. It's too late now. I just get laughed at whenever I say, "Yo, by the way, I had a cardiac arrest."

GW:

Yeah.

WF:

"If you don't mind giving me some disability insurance."

GW:

Will, what's the most ridiculous thing you've been dinged for in healthcare? Do you get dinged on ophthalmology?

WF:

I got dinged a lot as a med student. It was the med student's job to hit the automatic door button.

GW:

Okay.

WF:

Early enough so that the surgery team could go through the doors.

GW:

Oh yeah, the timing. Yeah.

WF:

Yeah, the timing. I didn't hit them fast enough.

GW:

You idiot.

WF:

I did not time it well. I got a talking to about that.

I thought of one more.

GW:

There you go.

WF:

Oh, here's one.

GW:

Perfect.

WF:

I didn't calculate Winter's Formula on an ICU patient.

GW:

Will, I created MDCalc.

WF:

Yeah.

GW:

That could fix that for you.

WF:

I still don't really know what Winter's Formula is. But anyway, I remember making my attending mad about it.

GW:

What's a lesson that you learned from a mentor in medicine that you still think about or still shapes you today?

WF:

Don't assume the relationships of the people in the exam room.

GW:

Yeah. That's one that you learn early, I feel like.

WF:

It is.

GW:

If you don't, you don't get very far.

WF:

It is. You never know if someone's going to be a spouse, or father, or mother, or what generation that you're looking at here. Anyway, thinking about that saved me a couple times.

GW:

Yeah. Will, thank you. Where is the best place you're sending people these days to find all of your content and your podcast, and everything?

WF:

Well, to hear my day-to-day thoughts, I've been using Bluesky a lot more.

GW:

Yeah. I saw you joined. Welcome to the Medsky club.

WF:

Yeah. I'm there now more than I am on X.

GW:

Oh, that's great.

WF:

I actually don't personally post much to X anymore. Bluesky. For videos, the videos always go up on TikTok first, and then to my YouTube channel. It's all just Glaucomflecken everywhere. Yeah, Instagram as well.

GW:

Will, amazing. Thank you again. I really appreciate it, taking the time. And honestly, just having humor plus representing the needs of patients and doctors I think is something that you're really special at doing.

WF:

Well, thanks. I appreciate it. Yeah, thanks for having me on.

GW:

Thanks for joining me today. For interviews with physicians creating meaningful change, check out offcall.com/podcast. Make an account on Offcall to confidentially share your details about your work, and sign up for our newsletter where you can hear more about the latest trends we're seeing in physician pay. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly. This has been and continues to be Dr. Graham Walker. Stay well, stay inspired, and practice with purpose.