Dr. Devesh

Family physician, father, husband, proud San Diegan.

[Adam Gaffney @awgaffney]

Quality of care has nothing to do with anything private insurance firms are doing. What they do is siphon ~12% of premiums for their overhead and profit. Meanwhile, coverage losses are common, & skimpy coverage e.g. high-deductibles are even commoner. A zero value industry.

[Dr. Devesh @DMVashishtha]

Hi @MayorToddGloria for the Rancho Peñasquitos library branch, your constituents have a petition with 1,100 signatures asking your office not to close it for primarily external repairs. Please read here: https://t.co/0tMne5Xe1x

[Teppo Järvinen @shamteppo]

A widely used knee surgery may not just be ineffective — it may cause harm.

10-year results from the FIDELITY trial, now in @NEJM.

🧵

[Dr. Devesh @DMVashishtha]

@JahangirAsgha10 Agreed, one big issue that can quickly become expensive for young families is pregnancy and delivery costs. Especially with medical complications, c-section, NICU stays, etc. Should families just budget the full deductible cost in years they want to have children?

[John Asghar MD @JahangirAsgha10]

If you want to understand why the U.S. healthcare system feels broken.

Let’s start here:

the patient is no longer the consumer, and the physician is no longer the principal provider of care.

What was once a direct, personal interaction between two accountable parties has been replaced by a managed system optimized around intermediaries, contracts, and scale. In that system, patients become covered lives and utilization units, physicians become labor inputs and cost centers, and care is no longer the product but a byproduct of administrative design.

When neither the patient nor the physician sits at the center of the transaction, both are inevitably commoditized, and the system predictably prioritizes control, leverage, and compliance over judgment, access, and trust.

[Dr. Devesh @DMVashishtha]

@JahangirAsgha10 Sounds reasonable. I read a lot of your posts and appreciate the value of a simpler system. One the huge advantages of decreasing regulatory burden and cash-based practices is that it will free up PCP's to practice independently. More control = less burnout.

[Third_Eye_Prophet @Third_i_Prophet]

Here are some facts about money in healthcare that most people in congress, and many doctors, don't realize-

1. Doctors don't get a tax write-off for charity care or unpaid bills

2. Medicare hasn't increased payment rates to doctors since 1992

3. Seeing a hospital-employed doctor costs twice as much as seeing a private doctor in the same office building, because of facility fees

4. We spend $50-60 Billion per year in facility fees for office visits, enough to fund ACA subsidies and finally tie physician payments to inflation, and still have $ leftover

5. After overhead and taxes, a surgeon takes home about $300 for doing a complex 3-hour revision hip replacement

6. Doctor and nurse salaries account for a smaller portion of Healthcare spending in America than in our peer countries (Combined 16%)

7. Total Administration spending in America is 30% of Healthcare costs, which is substantially higher than any other country (Singapore is 3-5%)

8. Healthcare administrator salaries have tripled since 1992, while physician payments per work-RVU from Medicare have increased 3%

Got any more to add?

[Dr. Devesh @DMVashishtha]

My latest Substack:

Single Payer, Not Corporate Subsidies, Is the Real Fix for U.S. Healthcare https://t.co/nEEx2jC0Ct

[Dr. Devesh @DMVashishtha]

Ask your primary care physician about these vaccines for fall/winter: flu vaccine for EVERYBODY, COVID-19 for adults 18+ and especially those at higher risk, and RSV for older adults.

https://t.co/BOxKlKOj0c

[Dr. Devesh @DMVashishtha]

Remembering Dr. Dave Bazzo https://t.co/fzPXsSm2As

[Dr. Devesh @DMVashishtha]

Started a new series "One Take with Dr. Devesh" to highlight San Diego community members and big ideas. First episode with my good friend
@Ansel, who introduces citizens' assemblies.

https://t.co/jgbEtAuh6j

[Dr. Rob Davidson MD, MPH @DrRobDavidson]

As an ER doctor for over 25 years, I’ve seen what happens when people can’t afford the care they need.
Now I’m watching Trump and Congressional Republicans make it worse—by helping Big Pharma, Big Insurance, and billionaires at everyone else’s expense. 🧵1/10

[Dr. Devesh @DMVashishtha]

Attending @SupLawsonRemer’s State of the County address and happy to hear so much detail about Medi-Cal funding, behavioral health, and environmental health!

[Neil Stone @DrNeilStone]

Before vaccines, babies got breastmilk, sunshine and love.

And 1 in 5 of them didn't live to see their first birthday

[Dr. Devesh @DMVashishtha]

As a family physician I’m not following all the ER-specific jokes here, but I find it hilarious that this letter is signed by a JD MPH.

[Dr. Rick Pescatore @Rick_Pescatore]

Update: finally heard back from HR, but obviously not the outcome we wanted.

I’m appealing, and I appreciate this community’s ongoing support.

[Dr. Devesh @DMVashishtha]

Glad to see CMA prioritizing prior authorization reform, and standing up to private equity groups. Medical care is a sacred relationship between physician and patient. Any insurance company or corporate interest that threatens this relationship has to be held accountable.

[California Medical Association @CMAdocs]

#CMADocs unveil 2025 sponsored bill package! These 7 bills tackle issues relating to bureaucratic delays in providing care, private equity’s influence on medicine, AI in health care, and increasing the physician workforce.
#SB351
#AB489
#AB967
#AB510
#AB539
#AB512
#SB306

[Dr. Devesh @DMVashishtha]

Grateful to nephrologist and fellow Canyon View elementary dad @pranavgarimella who got back to me in 10 minutes on a Sunday night regarding a Medigap reform bill that will lower out-of-pocket costs for dialysis patients in California. Credit to @SenBlakespear.

[Dr. Devesh @DMVashishtha]

Loved attending the ⁦@SDCYBallet⁩ presentation of The Firebird today at Balboa Park! Our city’s youth put on a fantastic program and my daughter is now inspired to start ballet classes.

The auditorium filled up soon after we entered.

[Neil Stone @DrNeilStone]

"Vaccines aren't actually responsible for the reduction in infectious diseases" say Joe Rogan's guests

And he believes them

Meanwhile in the real world 👇👇