A fiery exchange lit up physician Twitter the other day, after Dr. Max Jordan Nguemeni, a public health physician, posted a provocative tweet that touched a nerve within the medical community:
“New rule, if you are at the top of the physician income ladder you do not get to speak about Medicaid, reimbursement or otherwise. You should just be quiet and enjoy your enormous salary. Respectfully.”
Underneath his tweet was a screenshot of what says is “About Anthony Digorgio”, and states that in 2021, Digorgio earned $671,423, by working as Hs Asst Clin Prof-Hcomp at the University of California.
New rule, if you are at the top of the physician income ladder you do not get to speak about Medicaid, reimbursement or otherwise. You should just be quiet and enjoy your enormous salary. Respectfully. https://t.co/lJCXwaUQvj pic.twitter.com/xfgjcnVRU2
— Max Jordan Nguemeni (@MaxJordan_N) May 24, 2025
Nguemeni’s comment appeared to be a direct response to neurosurgeon Anthony DiGiorgio, DO, MHA, who had tweeted earlier:
“I’ve been debating Medicaid in a few spaces lately. One observer nailed it: those of us in public hospitals serving poor patients often have the opposite take from those in private hospitals serving the wealthy, completely counter to what you’d expect.
He’s right. We see Medicaid up close. We see how broken it is.”
The conversation quickly escalated beyond policy differences. Some took issue not with DiGiorgio’s views, but with what followed, when Nguemeni brought up the neurosurgeon’s publicly available salary.
That move prompted another physician, Sravan Panuganti, DO, FACOS, to reply:
“I normally agree with a lot of stuff you post but posting someone’s salary just because you disagree with their takes is sort of low. And honestly, this is underpaid for a neurosurgeon in California, in my opinion.”
Nguemeni doubled down. “His salary is public,” he wrote. “Ppl know neurosurgeons are rich. It’s not like I’m outing a secretly rich guy who pretends to be poor. What I did here is use a rhetorical device. Subtext: if you are among the richest doctor, complaining about Medicaid is in poor taste & seems greedy.”
The tweetstorm has opened a deeper discussion: Who has the moral authority to speak about Medicaid, and does income level affect that legitimacy?
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Context Matters
DiGiorgio’s original post highlighted a divide not commonly acknowledged. Contrary to stereotypes, he suggested that physicians working in public hospitals, who interact most with Medicaid patients, may take a more critical view of the system than their private-practice peers who rarely accept Medicaid yet advocate loudly for its expansion.
That observation drew praise for its nuance, but also backlash from those who felt it lacked the full picture.
Nguemeni’s core argument seems to rest on equity of voice: while anyone can speak on Medicaid, perhaps it’s time to center those who are both closer to the ground and less insulated by high compensation. In a follow-up, he clarified:
“This is what I mean. Ppl are reacting out of bad faith, self interest or just poor reading comprehension. Of course you can say what you want. But there are legions of underpaid pediatricians & ID doctors who have more of a standing + now’s not the time. Medicaid needs to thrive.”
Money, Messaging, and Moral Standing
This moment has exposed a long-simmering tension in healthcare: high-income physicians sometimes dominating policy conversations that directly affect lower-paid colleagues and underfunded communities.
Tyler Olson, EA, stepped in with a respectfully framed question:
“Are you sure what you shared and wrote is actually what you mean?”
Nguemeni’s reply? A definitive yes.
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Broader Implications
What’s emerging is not just a debate about Medicaid, but about who gets to drive the narrative. Does wealth dull one’s credibility on issues of systemic inequity? Should lived experience at the lower rungs of reimbursement speak louder than bird’s-eye-view critiques from high-earning specialists?
And crucially: When public trust in healthcare is fraying, how do we ensure the right voices are amplified, without silencing those who are still acting in good faith?
The answers won’t be found in a single tweet. But they might begin with more listening, and less posturing, from every corner of the physician income ladder.
Editor’s Note: This article reflects a snapshot of an ongoing debate and includes paraphrased and direct quotes from public tweets. The conversation continues across platforms and among professionals navigating the complex intersection of ethics, economics, and healthcare policy. Join our FB communities, where these discussions can continue, under organized threads.
