Lisa A. Smith, MD, FACS

UT-COM Pediatric surgeon, wife, and mom. Pittsburgh Steelers & Auburn Tigers fangirl. Favorite scrubs by @ethreadsgear

[Lisa A. Smith, MD, FACS @LisaASmithChatt]

@NeilFlochMD @YouTube I remember feeling so angry and helpless when I heard the speech. Here was the POTUS describing us all as a bunch of crooks. There have always been snake oil salesmen, but we’ve done a pretty good job of policing our own.

[Chicago Fire FC @ChicagoFire]

Rain or shine, @chicagoinrecess is the place to be for every match of the FIFA World Cup 2026™ 🔥 #cf97

[Lisa A. Smith, MD, FACS @LisaASmithChatt]

Auburn Freddys are a thing

[Freddy🇩🇪 @FreddyLA7]

This is the most “The European mind can’t comprehend this” moment of my life. One of my friends said, “Punch me five times tomorrow and I’ll still think this isn’t real.”

[Graham Carr @grahamcarr2]

What if Messi scoring in JHS was the key to breaking the curse on the football team?

[Freddy🇩🇪 @FreddyLA7]

THE WORLD CUP TRIP HAS MADE IT TO ALABAMA!!!!!!!

The third state of the tour.

[Lisa A. Smith, MD, FACS @LisaASmithChatt]

@FreddyLA7 Totally the right move— avoiding Atlanta by going down 59 and headed to Auburn via Talladega or Sylacauga is the best! Atlanta traffic is the worst.

[Selección Española Masculina de Fútbol @SEFutbol]

🏡 Descubre la Baylor School, el hogar deportivo de España en Chattanooga.

Instalaciones adaptadas y tematizadas para que la @SEFutbol se sienta en casa.

💓 No somos objetivos, pero ha quedado precioso, ¿verdad?

Más ℹ️ https://t.co/5or9qdtsdP

#VamosEspaña | #CopaMundialFIFA

[Auburn Men's Golf @AuburnMGolf]

THE NO. 1 TEAM IN THE COUNTRY STANDS ALONE ☝️🏆

For the second time in three years, the Auburn Tigers are NCAA Champions!

#WarEagle

[Kevin Pho, M.D. @kevinmd]

A 77-year-old marathon walker developed a headache. Over the next four months, she was seen by a nurse practitioner, a PA twice, a medical assistant, and an emergency room. She was given two Medrol dose packs, NSAIDs, and a prescription for fluoxetine after a PA decided she had anxiety. She had never actually seen her primary care physician. She had giant cell arteritis. A sed rate of 41 confirmed it, the moment her neurologist finally examined her, took her history, palpated her temporal arteries, and asked about jaw claudication.

The patient told her neurologist: "if you think I need fluoxetine I'll be on it, but I don't think I'm anxious and this headache is just crazy."

The structural argument matters more than the cinematic detail. Team-based care is sold as a solution to the physician shortage. The math runs the other way. If a physician is the diagnostic instrument that holds the differential together on a multi-system presentation in a 77-year-old, the marginal cost of putting that physician in the room at visit 1 is zero. The marginal cost of NOT putting that physician in the room across this case was four office visits, an ER visit, two courses of steroids that partially masked the inflammatory signal, a misdiagnosis of anxiety, an SSRI prescription, and a delay in identifying a vision-threatening time-sensitive diagnosis. The team did not save physician time. It spent physician time everywhere except with the patient.

Reeta Achari, MD, a neurologist in solo private practice in Houston for 25 years, makes the operational case in plain terms. There is a physician shortage. The response has been to use physician time for documentation, prior authorizations, peer-to-peer calls, board recertification weeks, and electronic-record data entry. The response should have been the opposite. If there is a shortage of the diagnostic instrument, the workflow has to put the instrument in front of the patient, not behind four other people.

Her own response was structural. She opted out of Medicare. She built a quarterly subscription practice with prices middle-class patients can afford and scholarships for long-relationship patients. New patients get a one to one-and-a-half hour intake. Follow-ups get 30 minutes. The model is not concierge. It is continuity, priced to clear.

The diagnostic line from her conversation: "No physician touched her."

Listen to the full conversation on The Podcast by KevinMD. Link in the replies.

What does the cascade in your practice or your own care look like? Where in the workflow did the physician finally enter the room?

#ThePodcastbyKevinMD

[NCAA Baseball @NCAABaseball]

🚨🚨🚨🚨

The Top 4️⃣ have been officially released in alphabetical order.

@AuburnBaseball
@BaseballUGA
@GTBaseball
@UCLABaseball

#RoadToOmaha

[Kevin Pho, M.D. @kevinmd]

A practicing psychiatrist Googled her own name and was the 452nd result. The first seven clinics that came up were not hers. The clinic ranked first had no clinical staff she had ever met.

This is vertical integration in U.S. health care, observed at the consumer-facing search bar.

Three structural notes.

One. Vertical integration in U.S. health care now stacks payor, pharmacy benefit manager, bulk-purchase group, drug distributor, mail-order pharmacy, retail pharmacy, and clinic ownership inside single corporate structures. One parent company owns every step of the chain that connects a patient to a medication. When a market is vertically integrated end to end, the price-setting power and the patient-routing power both consolidate at the top of the stack.

Two. The consumer-facing consequence is search-result routing. Owned-and-operated clinics rank first not because their clinical reputation is stronger but because the search architecture is shaped by the parent company's commercial relationships, paid placements, and directory contracts. The patient typing a doctor's name into a search engine in 2026 is not finding the best clinical match. The patient is finding the result the largest parent company wants found.

Three. The independent practicing physician, the one with the two-location practice, the established patient panel, the clinical track record built over ten years, is now ranked 452. Not because the clinical care is worse. Because the ownership structure is smaller.

The historical antitrust frame applies cleanly. A "trust" was a group holding assets across an industry, and that asset-holding became illegal when it began to harm consumers on price and access. The vertically integrated structures now operating in U.S. health care satisfy that test. The unresolved question is whether existing authority will be applied to them.

The car-industry version of this structure would be one company that owns the factory, the dealership, the bank that finances the loan, the auto body shop, and the parts supplier. That structure was made illegal in cars a century ago. The same structure is currently legal in U.S. health care because corporate ownership is layered behind shell companies, and tracing who owns which clinic, which pharmacy benefit manager, and which clinic-chain back to a single parent is genuinely hard.

If you are searching for a physician right now, the doctor you find first is the doctor the corporate parent wants you to find first. The doctor with the best clinical match for your condition may be 451 results down the page.

Stephanie Waggel, MD, psychiatrist in Northern Virginia, explains how the search result became an ownership question on The Podcast by KevinMD. Link in the replies.

What is the single antitrust action that would most directly disrupt vertical integration in U.S. health care today?

#VerticalIntegration #ThePodcastbyKevinMD

[Tone Digs @ToneDigz]

Yinzers in France

[Lisa A. Smith, MD, FACS @LisaASmithChatt]

Here we go! See yinz there!

[Pittsburgh Steelers @steelers]

Steelers President Art Rooney II on the Paris Game:

[Chicago Fire FC @ChicagoFire]

🎵 ba-da-ba-ba-bah 🎵

We're excited to announce @mcdonalds as the official naming rights partner of our new stadium! See you at McDonald’s Park in 2028. #cf97

[Joseph Allen @j_g_allen]

Why is everyone ignoring evidence from outbreaks of this specific strain that are *very* clear that it doesn’t require prolonged close contact?

[Joseph Allen @j_g_allen]

We're now at 10 confirmed positive cases from the ship. Which makes sense and aligns with: 1) prior dynamics from land-based outbreak (1 infecting many; no close contact required), and 2) what a doc on the ship shared about his experience that later cases were not 'close contact'

[Auburn Football @AuburnFootball]

Happy Birthday, @CameronNewton 🦅

[Lisa A. Smith, MD, FACS @LisaASmithChatt]

@CollegeGameDay You can hear that yinzer accent kicking in now that he’s in tahwn

[Pittsburgh Steelers @steelers]

A beautiful day in the neighborhood 😍

🎥 @NFL