An Interview With Jake Frankel
Revamping the health care delivery system in the US. We spend more money on health care in the US than any other country, but our outcomes are near the worst. Much of that is because money is wasted on unproven remedies, or on procedures and devices for which the benefit is grossly exaggerated. We need to provide coverage for essential things like pre-natal care, vaccinations, weight loss, and rehabilitation that have proven benefit for a large number of people, and stop adopting technology for the sake of profit. When doctors and hospitals are paid for piece work, they will do procedures that may not be entirely necessary. It’s human nature.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Dr. Peter Kowey.
Dr. Peter Kowey is the William Wikoff Smith Chair in Cardiovascular Research at the Lankenau Institute for Medical Research, a Professor of Medicine and Clinical Pharmacology at Thomas Jefferson University and former Chief of Cardiovascular Diseases at the Lankenau Heart Institute. A leading expert in heart rhythm disorders, he has developed innovative arrhythmia therapies, published over 450 scientific papers, and trained hundreds of cardiology fellows. He is a Fellow of several major medical societies, has served on FDA advisory panels, and received multiple national awards. Dr. Kowey is also a published novelist and author of the book Failure to Treat: How a Broken Healthcare System Puts Patients and Providers at Risk (September 2025).
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
I always wanted to be a doctor, but not because I understood what was required or how to go about it. Neither of my parents graduated from high school and I was the first person from either large extended family to go to college. I admired our family doctor and his ability to make our lives better by ridding people of their illnesses. When I indicated to my parents my desire to pursue medicine, they supported me wholeheartedly and that was terrific secondary gratification for me. What I eventually discovered is that medicine is a difficult and demanding profession and that to become an excellent physician requires total dedication. Had I known how challenging medicine is, I am not sure if my youthful enthusiasm would have seen me through.
Can you share the most interesting story that happened to you since you began your career?
After medical school, I planned to pursue training in neurobiology and psychopharmacology. I accepted a position at a prestigious institution but there was a requirement for me to complete one year of internal medicine training first. My second rotation of that intern year was in the coronary care unit (CCU) where I was responsible for caring for patients with advanced and life-threatening cardiac conditions. My very first patient had ventricular tachycardia, a potentially lethal arrhythmia. I was scared to death that I was going to fail the patient, and she would die because of my inexperience and lack of knowledge. Fortunately, the doctor in charge of the case came to the unit when I called her and together, we sorted the problem. The patient not only survived but was discharged in good condition. I was so taken with the cardiologist’s skill and the impact of her good care as well as the scientific knowledge she brought to the bedside that I ultimately decided to pursue training in cardiology. My career path was completely diverted and for that, I am eternally grateful.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
During that CCU experience I described in the last question, a woman in her sixties was admitted with a heart attack. We were able to stabilize her in the CCU and she did well for the first two days. The second night, I was on call when she had a cardiac arrest. Ruth S., one of my fellow interns, and I responded immediately and began to resuscitate her. We tried multiple defibrillator shocks to no avail. She was quite large and so performing CPR was very difficult. While I established an airway, Ruth climbed up on a stool and began chest compressions. At one point, the gel that remained on the chest from the defibrillator paddles caused Ruth’s hands to slip and she ended up spread-eagle over Mrs. D’s body. As funny as that may have looked, no one laughed. We were frantic about bringing Mrs. D back. We worked on her for over an hour, trying multiple drugs and shocks while doing CPR. The attending physician came in and helped us but unfortunately, Mrs. D died. Ruth and I were totally exhausted. After calling the family with the bad news and doing paperwork, we decided to go to the cafeteria for a well-earned cup of coffee. When the elevator doors opened, there stood Mrs. D, or so we thought. Ruth and I both screamed before we realized that we were looking at Mrs. D’s daughter who was absolutely her clone. It took us a while to compose ourselves, apologize for our outburst and console the poor woman.
I came away from that experience with an appreciation for rest. As an intern in the CCU that year, I was on call every other night. Though it provided an intense and valuable educational experience, it was just too much. Fortunately, new rules are in place to allow interns and residents to work fewer hours. While I think the regulations are a bit overdone and that young doctors need to learn about continuity of care, a rested doctor is much better than a tired one.
It has also taught me that overburdening doctors will certainly lead to burnout, medical errors and generally poor care, another important reason to extend the time doctors can spend with patients while relieving them of nonsensical administrative tasks.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“He is the best physician who knows the worthlessness of the most medicines.” A quote from Sir William Osler. I have endeavored in my practice of medicine to understand that the most important part of being an effective physician is human understanding and compassion. Medicines and procedures are tools to enhance our ability to heal, but touching someone’s soul and relieving them of the agony of disease worry is our most important mission.
How would you define an “excellent healthcare provider”?
In addition to the willingness to be compassionate that I mentioned previously, there is also the need to listen to the patient, to examine the patient, to prove that you truly care about each one. In the end, excellence isn’t just about outcomes, but about the ability to restore the patient’s wellbeing, and help them to resume a reasonable quality of life and function.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I have enjoyed reading books written by master clinicians like Dr. Bernard Lown and Dr. Samuel Levine. Like them, I seek to lead by example. In everything they did, from patient care to teaching to research, the patient was the focus and by their excellent example, they inspired hundreds if not thousands of doctors to practice exemplary medicine. They also liked to use patient stories to educate and that is a big reason as to why I turned to that strategy in my book, Failure to Treat.
Are you working on any exciting new projects now? How do you think that will help people?
I no longer see patients myself (after 45 years of doing so) so I can concentrate my time on teaching and research. I enjoy interacting with young cardiologists and shaping the way they deliver care and think about science. I also spend considerable time consulting for industry and helping in the development of new drugs and devices for the treatment of a variety of diseases. I am proud to have participated in hundreds of such projects and to be improving the lives of millions around the world.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us a few reasons why you think the US is ranked so poorly?
The root causes are that we have a perverse system for hospital and physician reimbursement, and an inadequate medical insurance system. I elaborate much more in the next answer.
As a “healthcare insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
Before I begin, I will point out that each of my suggestions is covered in much greater detail in my upcoming book.
1 . Revamping the health care delivery system in the US.
We spend more money on health care in the US than any other country, but our outcomes are near the worst. Much of that is because money is wasted on unproven remedies, or on procedures and devices for which the benefit is grossly exaggerated. We need to provide coverage for essential things like pre-natal care, vaccinations, weight loss, and rehabilitation that have proven benefit for a large number of people, and stop adopting technology for the sake of profit. When doctors and hospitals are paid for piece work, they will do procedures that may not be entirely necessary. It’s human nature.
2 . Regulating health insurers
Pre-certification and prospective review of payments are necessary in some cases, especially given the proclivity of some providers to abuse the system. However, it is clearly in the financial interest of insurers to deny coverage, especially for new and expensive drugs and procedures. We need a system by which cases can be reviewed by a neutral party, and expeditiously, so as not to interfere with patient care.
3 . Stopping direct-to-consumer health care advertisements
We are deluged with commercials and billboards that advertise every aspect of medicine. I don’t know why drug companies chose to advertise drugs for rare conditions, especially when they are obligated to list side-effects that sound devastating. Alternative medicines are touted as having remarkable benefits when the truth is that they have never been sufficiently studied to prove anything, and some may even be harmful. Hospitals and health systems boast about their programs and make claims about their expertise that are simply not true. Medical insurance companies pay enormous sums to put their logo on the jersey of baseball players or on the hockey ice. I see no good reason for any of these advertisements to continue. The staggering amount of money that could be saved if these promotions were eliminated or at least limited should be used to improve direct patient care.
4 . Malpractice reform
Every doctor orders tests and procedures to cover their ass. The cost of defensive medicine is astounding, estimated to be in hundreds of billions of dollars annually. The reason is obvious: doctors are under fire. Nearly every doctor in high-risk specialties like orthopedics, ob-gyn and cardiology will be sued during their career. It is a horrifying experience and after being sued, they vow never to let it happen again. Patients need to be compensated for medical mistakes, but we desperately need a better system for addressing grievances and settling them equitably. Allowing plaintiff attorneys to take 40% of a patient award is a disgrace.
5 . Get the suits out of medicine
We need to keep private equity and for-profit entities out of medicine and put doctors back in charge of running hospitals and healthcare systems. Non-profit health care institutions need to be just that, dedicated to deliver care to everyone who needs it, and not motivated to make money to overpay administrators. The harm done to our patients when emphasizing profits cannot be overestimated.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
There is no easy solution. Much of the problem is a lack of good communication between healthcare leadership and legislators. This is especially true at the state level where laws are passed that have a direct effect on how doctors practice. Doctors are terrible lobbyists and so what is best for medicine is not impressed on those who can affect change. Our professional organizations have clearly not been able to crack the code. Partnering with patients to pressure people who make the laws is the only way medicine can be salvaged.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
Hospitals are struggling and most of the problems are caused by underfunding. With a significant number of Americans uninsured or under-insured, hospitals are forced to operate with razor thin margins or in the red. Many, especially in the inner city and in rural areas, are closing, leaving vast numbers of patients with no way to access medical care. Private equity has been a major problem as they buy up struggling health systems with the intention of bankrupting them. A better health care insurance system would also be a huge help, especially if tied to an equitable system of reimbursement for all health care providers.
How do you think we can address the problem of physician shortages?
We have to reduce the cost of medical education with government subsidies. We also have to liberalize credentialing of doctors from other countries. We need to incentivize students to train in primary care, at least for a few years after they complete training, with loan forgiveness.
How do you think we can address the issue of physician and nurse burnout?
Fixing the EMR crisis would be a good initial step. And increasing the amount of time a doctor is allowed to spend with a patient. Ten-minute appointments are absurd and destructive. We also need to reduce the amount of time practitioners spend filling out forms and doing computer-based training and listening to irrelevant lectures. Tort reform would also be a big relief, reducing the burden of overdocumentation and overordering.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Healthcare for all in the United States is absolutely necessary. How it is structured may be moot but the need for fundamental reform is not. I know that there is a distrust of “socialized medicine” but setting up a system by which every single American can access the basics of healthcare is as important as guaranteeing a good education and preventing hunger.
How can our readers further follow your work online?
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Author Dr. Peter Kowey On 5 Things We Must Do To Improve the US Healthcare System was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.