Nicole Johnson, a staff pediatrician at Cleveland’s highly regarded Rainbow Babies Children’s Hospital, is the rare physician who not only dares to speak truth to power, she shouts it. It’s a potential career-ending move and given that Johnson loves her job and still paying back medical school loans, her outspokenness is even more daring.
“Telling the truth is not a safe thing in medicine,” Johnson, 47, acknowledges.
But Johnson, who emphasizes that her public comments are hers alone and that she doesn’t speak on behalf of her hospital, says she can’t practice medicine and remain silent about what was she says is the rapidly declining quality of U.S. healthcare.
“My goal is educating the public about the opaqueness of U.S. healthcare and ensuring Americans get better medical care at a lower cost,” Johnson says. “Doctors have to be honest with people why the U.S. healthcare system doesn’t work and is in decline.”
Johnson, known to friends and colleagues as Nikki, doesn’t mince words explaining why U.S. healthcare is the most expensive and least efficient in the western world. She says the industry has been overtaken by a “healthcare cartel” of middlemen, who sponge off the system driving up costs while offering no value. Johnson’s list of healthcare industry moochers includes well known culprits like group purchasing companies, pharmacy benefit managers and health insurance companies, as well as organizations like the American Medical Association.
Group purchasing organizations (GPOs) are companies that buy medical and other supplies on behalf of hospitals, nursing homes, and home health agencies. The theory is they get better pricing because they buy in bulk, but studies show that the kickbacks they are legally allowed to receive drive up costs and that hospitals can get better pricing negotiating their own deals. Hospital CEOs earn lucrative fees sitting on the boards of GPOs, effectively making them part of the healthcare cartel.
In Johnson’s native Ohio, the attorney general recently negotiated a landmark $88 million settlement with a pharmacy benefit manager for ripping off patients and taxpayers. Johnson’s issue with PBM’s isn’t just financial; they often force pharmacies to substitute drugs on which they get rebates rather the ones doctors prescribed and are better for their patients. Johnson outlined her issues with PBMs and health insurance companies in this recent commentary published in the Cleveland Plain Dealer. Johnson praises Ohio AG Dave Yost for his PBM efforts, an initiative she says began with Gov. Mike DeWine when was head of the state’s law enforcement.
“Change needs to be at the state level,” Johnson says.
The AMA is perceived as the premier organization representing physicians, when in fact most doctors don’t belong. The organization does a tidy business licensing treatment codes used for billing. Johnson considered it a disgrace that the AMA at the height of the pandemic partnered with a company to sell PPE to doctors and sent out a letter inviting nonmembers to sign up for membership and receive a discount on the PPE supplies.
“Instead of being charitable with the supplies, (the AMA) chose to extort doctors for membership,” Johnson says. “The AMA makes the majority of its money marketing its brand and selling member information. I don’t know of any charitable work it does to support practicing physicians, or patients for that matter.” (CEO James Madara, a Harvard-trained pathologist and a former tenured professor at the medical school, earns more than $2 million in annual compensation.)
Johnson doesn’t fully embrace the AMA’s statement declaring systemic and structural racism in medicine. “I’m hesitant to use the word racist,” Johnson says. “I don’t think everything that happens in medicine is inherently racism. It’s ignorance and bias.”
Johnson is a signatory member in “Free to Care,” a grassroots organization of patient advocacy groups, including 70,000 physicians. The organization’s driving principles are that healthcare is fundamentally about the physician/patient relationship and that the industry can be transformed through price transparency and choice. Although Johnson receives no compensation, she hosts a podcast, actively reaches out to elected officials and routinely publishes provocative editorials, including this one applauding President Trump’s hospital price transparency edict and other initiatives, which the American Hospital Association rigorously opposed and most of its members are flouting.
“It was really hard to watch people dog everything (Trump) did rather than focus on what he was doing right,” Johnson says.
Although registered as a Republican because the party’s healthcare and other initiatives are more aligned with her “conservative” views, the support is lukewarm. “I’m not excited about any political party,” Johnson says.
Where Johnson is aligned with Republicans is opposing “Medicare for All,” which she says would never work in the U.S.
“It all sounds so great,” Johnson says. But she says that when so-called progressives tout the Swiss and Scandinavian models, they don’t understand the benefits are limited to citizens and involve expanded wait times to see specialists that Americans wouldn’t tolerate.
“Universal healthcare has gloriously failed our veterans,” Johnson notes.
What especially upsets Johnson are the spate of hospital mergers taking place in America.
“It sickens me when I see hospital leaders celebrating the takeovers of community hospitals and physician practices,” Johnson says. “Hospitals are integral to local communities, and they become less friendly and familiar to residents when they are merged into corporations.” President Biden has called on the FTC and the Justice Department to curb hospital mergers, but indications are that some high profile hospital CEOs, notably Beaumont Health CEO John Fox, think Biden is all talk.
Johnson was born and raised in East Cleveland, now one of the poorest suburbs in the country but was lower middle class when she grew up there. Johnson’s father worked at a GM factory and her mother did clerical work.
Despite her advocacy and outspokenness, Johnson is very soft spoken, chooses her words carefully, and is exceptionally modest. Johnson says she was very shy growing up but gained confidence when she attended Laurel School, a private girl’s school in the Cleveland suburb of Shaker Heights. Johnson says her mother encouraged her to fight for what she believed.
Johnson says her motivation to become a doctor was watching The Cosby Show, whose lead character was an obstetrician. Johnson attended Case Western Reserve as an undergraduate to study biology, and then was admitted to its medical school. She did a dual residency in internal medicine and pediatrics at Metro Health Medical Center in Cleveland and then a fellowship in pediatric critical care at Rainbow Babies and Children’s Hospital.
Johnson is a proud Clevelander, where she lives with her husband and two young daughters. Family is extremely important to her, as is her Christian upbringing. “Religion is the foundation of my core beliefs and values,” Johnson says.
I asked Johnson if she could explain why pediatricians are at the forefront of the physician movement to reform healthcare and protect patients. Marion Mass, another advocate I recently profiled, is a pediatrician, as are two other founding members of Practicing Physicians of America, a grassroots organization that seeks to empower physicians to fight against the corporatization of healthcare and put patient care and safety ahead of profits. The head of pediatrics at Michigan’s Beaumont Health was fired after challenging budget cuts he said would impair patient care. Interestingly, Beaumont’s pediatrics head was hired away from Rainbow Babies Children’s Hospital.
Johnson initially couldn’t give a reason why pediatricians are at the forefront of physician advocacy. But after a moment of reflection, she says: “Maybe it’s because we are natural advocates for our patients because they can’t speak for themselves.”
This profile is part of a series showcasing doctors, nurses, and other professionals who dare to speak about the causes and greed that makes U.S. healthcare the most expensive and least efficient in the world. If you know of someone in your community deserving of a profile, please contact me privately at firstname.lastname@example.org