Eugene Emergency Physicians, film producer discuss ‘Suck It Up, Buttercup’

Presenter: Envision Films recently offered two screenings of the documentary, ‘Suck It Up, Buttercup: Trust & Betrayal – Health Care in America.’ After each screening, physicians discussed the film and their experiences with corporate health care. Area director of the University of Oregon’s Media Studies program, moderator Gretchen Soderlund:

Gretchen Soderlund (UO, moderator): I want to thank the filmmakers and the producers of this documentary for allowing us to see it pre-release. They thought that what was happening here in Eugene was so important that it was worth bringing the film to the community. 

And as most of you know, Lane County has really been ground zero in the fight against corporate health care. 

Rewinding a couple of years, thousands of Lane County residents lost their primary care doctors when a corporate group, Optum, took over Oregon Medical Group.

And to this day, Lane County is really a primary care desert. I have colleagues at the University of Oregon who were hired in the last two years who have decent health insurance but have realized that they don’t have a primary care physician. They have resolved to simply go to Urgent Care when they get sick.

And so we’ve got many people in this community who are forced to use Urgent Care or go to the emergency room to get treatments that they would otherwise get from a primary care physician.

Not only did about 10,000 people lose their primary care physicians a year and a half ago, which was a huge defeat for the community, but more recently, PeaceHealth here in RiverBend decided to replace a local democratic group of emergency medicine physicians with a corporate group out of Atlanta, Georgia.

But what happened this time was different than what happened with Optum, because these physicians fought back and all 41 health care providers, physicians and PAs, all refused to work for the Atlanta-based group.

And this led to a pretty bruising couple of months, I would say, in which Eugene Emergency Physicians, along with the medical staff at RiverBend, really fought tooth and nail to get PeaceHealth to reverse this contract. 

It ultimately led to a court case in which Eugene Emergency Physicians were asking for an injunction on the grounds that bringing in the Atlanta-based group ApolloMD violated Oregon’s Senate Bill 951, which is an anti-corporate medicine bill that was passed into law in 2025. And this was the first real test of that law. 

For those of you who followed this in the newspapers, you will know that this was a crazy court case. I mean, the corporate raiders out of Georgia—Judge Kasubhai said they had lost all credibility in his eyes.

And in a conflict that led to the ouster of a hospital CEO, multiple instances of perjury by corporate physician administrators on the witness stand, and a judge that had to rule with an iron fist over what was essentially an unruly courtroom, ultimately, PeaceHealth backed down. They reversed their decision and they offered the contract back to Eugene emergency physicians. (Cheers, applause). 

Thanks to these physicians and the help of the broader med staff at RiverBend. 

So Lane County has really seen its defeats and its victories when it comes to corporate medicine. And that’s one of the reasons that we wanted to bring this documentary to town. 

And joining me on the stage, we have Dr. Todd Otten, who is a family care physician, an author, and also executive producer of ‘Suck It Up, Buttercup.’ 

You went from being a health care provider to an author. And now you find yourself the executive producer of a documentary. Could you tell us a little bit about your story and what inspired you to make this film?

Dr. Todd Otten: Sure. Part of my ‘why’ is I went through really horrendous burnout in 2019. 

You know, as a physician, it’s a privilege to take care of other human beings. And most of my career it’s been an absolute joy. But when I was burned out, I hated my job. I remember sitting in the backyard in tears, not wanting to go to work. It was awful. Absolutely awful.

I recovered, and in 2022 my toxic employer decided they were going to move me back to where I had gotten burned out. And so I drew a line in the sand for myself, my colleagues, others, and walked away.

Since then, I’ve worn multiple hats. I still deliver direct primary care. I work for an ED group and do a ton of advocacy and nonprofit work. 

You saw in the film that I’ve lost four of my colleagues to suicide in my career, including two close friends. So I’m incredibly driven to make change. 

And part of the reason for that is the frustrations I saw from patients on a daily basis when I was in the fee-for-service world.

I mean, there’s a lot of shenanigans going on around how care is being dictated and mandated. So when we talk about contract management groups or corporate medicine, I mean, literally, it could be as simple as a—one—physician in a different state behind a shell company dictating care that’s being delivered across the country. 

And you can just see the flaws associated with that: Staffing gets cut, supplies get cut, reimbursements get cut, and who suffers when that happens? Frankly, we all do, but patients the most. 

So it’s a massive problem that’s going on right now. And it’s been happening for decades. It’s just accelerated. 

And that’s a big part of what we’re trying to accomplish with this film is to get people to understand what’s going on. So they’re educated, frankly, to get a little p—– off about what’s going on, frustrated, but to get activated and participate in change. 

And I applaud the local ED group EEP, and what they did. You talk about a David versus Goliath story, but leveraging. You know, leveraging all these different resources, whether it’s social media or legislators or politicians to push back against the bulls– that’s going on. It’s incredible. 

Last night I told the small group that they were heroes, and I believe that and we all can be heroes. We all can play our part.

Gretchen Soderlund (UO, moderator): We didn’t know when we booked this venue whether EEP would exist tonight, but I’m really happy to say that we have EEP emergency medicine physicians here to share their stories.

Dr. Jeremy Brown: Hi, I’m Jeremy Brown, I’m a partner with Eugene Emergency Physicians.

I think one of the parts of the movie that spoke most to me was the discussion of the role of private equity and the insertion of the middleman in the process. And what benefit do they provide to the physicians or the patients or the care that’s provided? And where does the money that they extract go?

So ApolloMD is associated with a private investment company. They say that they’re not a private equity company, although I can’t tell the difference. And this company that they’re associated with, VentureBridge, does not own ApolloMD but in the explanation became apparent that what had happened with ApolloMD is that as they grew as a company, they effectively became too profitable and that they needed something to do with the cash flow that they were generating. And so they founded Venture Bridge to manage the cash flow for investments for partners in this company.

And it really makes you wonder, why is a physician staffing management company nationwide? They are very proud of how many sites they own. Hundreds of sites, thousands of physicians, millions of patient encounters a year, and they make so much money that they don’t know what to do with it. So they had to create a company to invest their money. And this is who wanted to staff our hospitals here in Lane County. The perspective I think, to provide to this is our office suite that we run as our business. Most people have trouble finding it. , The second floor over in Springfield used to be near the Sherry’s, but that’s out now. You know, and we have one office manager, Beth, who we all love. 

And I’m just so proud of the corporate model that we employ, as physicians. the difference between that and what we’re up against when we’re trying to fight back against ApolloMD, who has such an enormous and opaque business and corporate structure. 

Nobody can even figure out what their net worth is because they have such a myriad of incorporations in Georgia and Delaware. When you search it at Google AI, it suggested something maybe on the order of like $700 million net worth. 

And so it’s just incredible to think about that, that our group of 31-32 physicians and nine PAs was able to fight back against that. 

But it wasn’t just our group that fought back against that. It was because we were able to educate people on this topic. We were able to engage the media. We were able to engage state and local legislators all the way up to governor, U.S. senators, and representatives. 

The public became involved. The nurses became involved. Obviously, the med staff at the hospital became involved, and that’s the sort of grassroots, bottom up resistance that’s required.

And with the backing of the law through the processes of Senate Bill nine fifty one. without that, maybe we would be here today individually, but we would not be here as Eugene emergency physicians to be able to provide care here in Lane County.

Dr. Bianca Jacobs: Hi, I’m Bianca Jacobs, I’m one of the members of Eugene Emergency Physicians. Watching that film I think the thing that stood out to me the most, or kind of spoke to me the most was the moral injury that we all in health care are facing. And the fact that that has on our lives. it certainly trickles into our home lives and our ability to kind of function as normal human beings.

Jeremy mentioned that he worked overnight last night. I worked a few overnights earlier this week. So trying to deal with different challenges—physical challenges—and then on top of it, having corporations dictate how you’re providing care is very difficult and demoralizing. 

I think we saw that locally a few years ago. One of our beloved primary care doctors and hospitalists died by suicide and I think, that, you know, that happened shortly after the Optum takeover of Oregon Medical Group.

And I think that speaks volumes to the impact that corporations can have on health care and health care providers. 

I think that one of the ways that we can fight back is to recognize the moral injury that we’re all under and try to change it. I think as they mentioned in the movie, trying to make our voices heard.

And the medical staff at RiverBend have been excellent at that over the last couple of months. We’ve been outspoken, and working hard to make sure that we can provide high quality care and that our goals of providing high quality care are known to administration. 

And we’ve seen some change over the last few months in particular. So I’m hopeful that this is a move in a positive direction. And very thankful to the members of my group, the members of the community and the members of med staff.

Gretchen Soderlund (UO, moderator): We’ve got Dr. Gianina Best:

Dr. Gianina Best: I think the thing that resonated most with me was actually what brought me to Eugene Emergency Physicians. And watching the film and hearing a lot of the physicians speak, a lot of us go into this because we truly want to help patients.

And, you know, I trained out on the East Coast at Vanderbilt and when I trained there, you know, coming out of residency, there are many, many corporate managed groups on the East Coast. And so those were the main job opportunities on the East Coast.

So they come to our residencies and they do these lavish parties and they try to recruit you to these groups. But I knew all along that going into medicine, I wanted to do this to help patients. I didn’t want to be beholden to any other corporate entity or have to follow certain metrics to please the people above me. I just wanted to help the patients.

One of my residency colleagues who still currently works for a corporate-managed group was telling me about some of the metrics. For example, one of them is how fast can you see the patient and then print their discharge paperwork. And so that’s one of the metrics that they’re held to.

And I somehow found this unicorn group in Eugene Emergency Physicians. And actually, we moved out here and I waited a year because there were no positions available. And I knew I have to work for this group because this group is just—the entire group, everyone that I met with in the group was very much focused on patient care.

And I think that we’ve proven that through this entire three months that we’ve gone through, that this is something that we truly believed in. 

You know, this fight has been scary at times and anxiety driving and it’s been difficult, but I said at the onset that this is something that I believe in, that patient-centered care is the most important and the best type of care.

I think for me personally, when we kind of set out to stand up against this entity, you know, I made a very conscious decision because I knew that we were going to be all in, especially with Will being chief of staff. And, you know, it took a lot of time away from our kids, time away from our family.

And it was very all-consuming for the last three months. But again, it was because I truly believed in this cause and it was worth something that we should stand up for. 

And you know, along the process, we brought our kids along and told them, you know, why it is that mom and dad are a little bit preoccupied right now, so that they could see what it means to advocate for something that you truly believe in. And for me, that really is giving patients the best care that I can. 

And so that’s why I decided to sign that document and stand alongside, you know, the 41 other EEP members. And again, I think I really, I truly did find a unicorn group in EEP when I started nine years ago. And I am so incredibly proud to say that I’ve stood with these guys for the last three months. And, you know, we stood up for the community. We stood up for the medical staff, for the physicians and the nurses that work at these hospitals. And I’m so proud of us.

And so for me, that’s what touched me the most about the film was just talking about how important that is and why we’ve done this for the last three months. 

Dr. Will Emerson: Hey, I’m Will Emerson, I’m a hospital medicine physician, but currently serving as chief of staff.

Our hospital medicine group is unionized, was one of the first physician unions in the country, 2014-2015, around the time I was starting. And I think that that has given us some benefits to avoid some of the worst of corporate medicine. 

I think that when these national groups take over, there are even more disadvantages both for patients and for the physicians in those models, because at that point, you almost think of it as a mall food court. 

So it’s like everybody’s working there at the food court, but nobody works for the same people—like, you have ApolloMD running the emergency department, you have Sound Physicians running the ICU. You would have maybe another group running the hospitalists. And at that point, no one works for the same group. 

Many people are like 1099 independent contractors, which means they have no employee benefits or rights, employee rights. And at that point, the corporations really control all of the incentives. 

So they say 30% or 40% of your income now is based on whether you meet these metrics for throughput or for spending less time with patients, seeing more patients per day. 

They cut staffing rates. So instead of having eight physicians in the emergency department at a time, now you just have five. And so they want people to see people quicker. 

And all of those things, you would think, ‘Wow, if there’s only five people, maybe the patient should pay less,’ or ‘Maybe the doctor should make more.’ But that’s not what happens. They keep the money. 

So the corporations are billing the same, paying less. And then the money goes to, you know, ValorBridge (Partners, capital management) or wherever else when they can’t figure out where to put the money. So they make new companies. 

And I think there’s so many middlemen and nobody knows who they are, but that’s who’s kind of making the rules and keeping all the money. And it’s bad for hospitals. It’s bad for physicians. It’s bad for patients.

And what was discussed in the film at one point was that the corporate medicine model, with so many administrators siphoning the profits and sucking the blood. And it really does affect the ability to recruit and retain the best and the brightest.

And especially in a community, like Lane County where we really rely on people who were born and raised here. I mean, a large portion of EEP has roots in Lane County and is from here.

And then we also have to recruit nationally because we’re not a city like Atlanta or the Bay Area or Seattle, where there’s just physicians living in town because of married to spouses who work in different sectors in the city. So we rely on groups that are good to their physicians, stable and are able to recruit and retain people.

So to have a corporate group come in, there was an immediate concern on the medical staff that we would lose our stability, we would lose our quality. And all of that really decreases our ability to provide quality care to the community, which is what this is all about.

So I think that that’s the biggest concern from the medical staff and what led to within two weeks of the decision, there was a 99% vote, the largest vote in the history of the medical staff to reverse the decision. And then everything that’s happened since then has all really come from that concern.

Gretchen Soderlund (UO, moderator): Dr. Julie Seo, who is a partner in Eugene Emergency Physicians. Could you tell us a little bit about how you feel after going through this tremendous threat to your career? And are there lessons other doctors could learn about your experiences?

Dr. Julie Seo: I think we’re still kind of recovering from what happened. I think we’re all trauma-bonded for life, I think. And so, and I think the most important thing that I could relate to everyone is how proud I am of our group.

And I think the first thing that made this successful campaign is we all believed in each other and we actually stuck together as a group. And I, I believe it’s the quality of the people that we’ve had in our group that allowed us to do that.

We believed in each other, we trusted in each other and we said, we’re going to do this together. And we were brave enough because we trusted each other that we were going to find courage within each other.

Because a lot of people are in so many different financial states, right? Because medical school is $100,000 a year, there’s providers that are $800,000 in debt. They have mortgages, they have two young kids, and they just are—we’re just all people. We have to pay for our bills.

And we just really wanted to take care of the people that we trained to do. And we just really cared about the community. And because we focused on that, our commitment to community and our commitment to each other, I think we were able to stick together.

And I think I am just so proud to be part of a group that is so multifaceted and talented. I know we have media gurus, we have writers in our group, and we have people who can do legislation.

And I am so proud of how we had all hands on deck and we’ve tried to approach this problem in every facet, like we were actual ER doctors trying to figure out this problem. 

And we took it one step at a time, and we just didn’t give up. And I’m really grateful for the legislation that passed in 2025 that allowed us to have a foothold and actually have some traction. And we’re really hoping that we could continue with legislative progress regarding this bill and have more teeth to have part of the bill that allows us to actually enforce the law instead of just having the law.

It was a budget constraint, and hopefully we could push more so we could be able to not have to end up using a lawsuit to actually get some traction. So we’re looking forward to that.

And I think we’re all just grateful we’re taking a big sigh of relief but right now, during the summertime, it’s all hands on deck trying to make sure that we provide the best care. 

And we are so grateful to be part of this community that supported us and that all rallied together. And I’m just so grateful that we are here.

Gretchen Soderlund (UO, moderator): Dr. Annaleigh Boggess, also a partner. As a practicing physician, do you feel that corporate medicine has been a threat to your relationship with patients?

Dr. Annaleigh Boggess: Yeah, absolutely. I mean, I think we were whispering how glad we are, we don’t have to deal with prior authorization. 

We do in some realm, in that people come to the ER because their prior authorization to get the MRI that they needed failed, and they do need that imaging study, and somebody behind a phone somewhere said that they couldn’t get it.

And then, I have been in that position where I’ve ordered that MRI for the patient and then the administrator told me not to, and maybe the insurance company was correct. 

And it’s a challenge for everybody, but particularly for the patients. And it’s just, it’s really difficult to see. 

And then, you know, of course, with everything that in the last few months with Apollo, I think it was really amazing to watch in the courtroom, just the disintegration of the facade that they had. 

I think Judge (Mustafa) Kasubhai did a really good job of just sort of disintegrating this facade of, ‘We’re not corporate medicine.’ And that was their tagline. And it was an illusion. And I think it was really fascinating to see that kind of fall away.

Gretchen Soderlund (UO, moderator): And Dr. Genevieve Birang, who works for Orchid, which was featured in the documentary…  Here in Oregon, we seem to be in an unusual context. We’ve got now the strongest corporate medicine laws in the country. And they are poised to become stronger. We’ve got Dr. Glaucomflecken living in this state. We’ve got groups like Orchid which are really trying to do medicine and primary care in a different way. 

Could you talk a little bit about Orchid and then maybe talk about ways in which billing and prior authorization do influence your practice style? (If they do.)

Dr. Genevieve Birang: Absolutely. So I have worked under kind of three different models in my career so far. 

During my residency, I worked at an FQHC (Federally Qualified Health Center) in Flathead County, Montana. So very low access to medical care. Most people either did not have health insurance or were on state health insurance.

After that, I came to work for Oregon Medical Group at Optum. That job was not a good fit for me. 

And so I left and one of my colleagues actually had taken a job with Orchid and he was really happy where he was. 

(Orchid) understood that people go into medicine to help people. And if you give them the tools to do so—so you give them a manageable workload. If you give them the support that they need to address multiple aspects of care—so for example, at my clinic, we have a community health worker who helps people who don’t have insurance or have unstable housing, get housing, get insurance, help with groceries. We have a behavioral health worker who addresses the psychotherapy part of mental health, and we have a care manager. So we have a nurse who works to do triage. And then also she does a lot of lifestyle medication classes.

The other thing that was really unique about Orchid—they talked in the documentary about the business model of medicine, because in the U.S., medicine is a business.

Orchid is very transparent with their finances. So usually once a month we have our two monthly staff meetings. One of those staff meetings is partially dedicated to, okay, here’s the budget for our clinic. Here’s how much we brought in. Here’s what we spent on medical supplies. Here’s what we spent on building repairs. Here’s what we spent on salaries. So it’s easier to see where the money is going and It allows people to feel invested.

And when people feel invested in a company and they feel like the company values them, they’re willing to go above and beyond for it.

As far as prior authorizations go, those are the bane of my existence. Sometimes you just kind of have to laugh at how ridiculous they are… Case in point for prior authorizations: I had a patient who was diagnosed with breast cancer. She needed an MRI to get the surgery. The insurance denied the MRI because she had not had surgery to remove the tumor. I could go on.

Presenter: A question from the audience for the producer of ‘Suck It Up Buttercup,’ Dr. Todd Otten: 

Encircle Films event participant: I’m wondering what we can do to help in any way.

Dr. Todd Otten: That’s a fantastic question. If you go to the film’s website, there’s about 70 organizations on there that are divided in different buckets, patient experience, quality care, lower costs, wellness initiatives, that you can explore and find an organization that might resonate with you to participate in. Because if we all do a little bit of something, that’s when the needle starts to move. That’s when the aircraft carrier starts to turn.

Presenter: Encircle Films hosts two panel discussions on the new documentary film about health care in the United States.

Encircle Films panel discussions are a regular feature shared by independent producer Curtis Blankinship for KEPW News. You can hear Curtis and his show ‘Talk Is Cheap’ every Saturday at 4 on 97.3, Eugene PeaceWorks Community Radio.