Cut & Tell

What happens when you become the surgeon, pay off the loans, and still feel empty?

On Cut & Tell’s first guest episode, Dr. Mel Thacker (ENT, surgeon coach, and host of Surgeons with Purpose) joins me to talk about her new memoir, Scrubbing In. It covers her path from childhood neglect to surgery, the arrival fallacy, and the panic attacks in the OR that finally forced her to face it all.

We also get into how insurance incentives quietly shape clinical decisions, why Mel walked away from private practice, why residency needs coaching, and how she built a part-time locums career on her own terms.

📚 Referenced: Scrubbing In: A Surgeon’s Journey from Self-Doubt to Wholeness by Dr. Mel Thacker; “When Incentives Become Instinct” (Hippocratic Collective); The Infinite Game by Simon Sinek

Enjoyed this episode? Rate, review, and subscribe, and find more shows at hippocratic-collective.com.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Administrative bloat, skyrocketing CEO pay, hospital mergers, rural closures. These aren't separate problems. They're symptoms of one syndrome: financialization.

In this episode, Liz breaks down how hospitals and practices went from places that care for people to assets that exist to generate returns, and why nonprofit hospitals now behave almost exactly like for-profits. We cover the vocabulary that gets thrown around in boardrooms (marketization, corporatization, privatization), the administrator arms race between hospitals and insurers, what hospital CEOs are actually paid to optimize for, and how consolidation drives up prices without improving quality. Then we get to what doctors can do about it, from unionization to clinician leadership requirements to cutting out the insurance middleman.

It's Goodhart's Law on a massive scale: when growth and revenue are the targets, healthcare stops being the point.

📚 Referenced:

• Bruch, Roy & Grogan, "The Financialization of Health in the United States," New England Journal of Medicine (2024)
• Blumenthal & Galvin, "The Vocabulary of Our Discontent," JAMA
• "Money has become the mission," The Lancet (2025)

⏱️ Timestamps

00:00 Welcome to Cut & Tell

00:19 From the administrator boom to a bigger problem

02:22 Financialization as a syndrome

04:56 Defining financialization

07:30 Marketization: the 1980s shift

12:52 Corporatization and consolidation

14:14 Why nonprofits act like for-profits

15:15 Privatization and Medicare Advantage

16:38 Money has become the mission

21:02 The administrator boom, by the numbers

24:45 The US vs. Canada and the VA

27:51 The hospital–insurer arms race

29:59 Executive pay

33:20 CEO-to-employee pay ratios

36:05 What CEOs are actually paid for

39:08 Mergers, prices, and hospital closures

44:30 The administrative accountability gap

46:30 Recap

48:00 What doctors can do about it

If you enjoyed this episode, please subscribe, rate us five stars, and leave a review. Better yet, send it to someone who should be outraged, or at least better informed. Check out more shows and content at hippocratic-collective.com.

#HealthPolicy #Healthcare #HospitalCEO #Financialization #PhysicianLife #MedicalPodcast #CutAndTell #DoctorsOfInstagram

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What happens when a well-intentioned healthcare metric gets turned into a target? Nothing good — and Liz has the receipts. Before medical school, she spent two and a half years as study director for a major National Academies report on healthcare measurement. Then she went to residency, and everything she believed fell apart. This episode walks through the VA wait-time scandal, MIPS, and the Hospital Readmission Reduction Program — three cautionary tales about what happens when you attach incentives to healthcare data, and why Goodhart's Law keeps winning.

📚 Referenced: Vital Signs: Core Metrics for Health and Healthcare Progress (National Academies of Sciences, Engineering, and Medicine)

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Would you send someone you love to a hospital owned by private equity? Dr. Liz Malphrus breaks down exactly how private equity works, why it's poured billions into healthcare since 2018, and what the data says about the cost, safety, and physician burnout that follow. Plus: the exact questions to ask before taking a private-equity-backed job.

Referenced: BMJ systematic review on PE and healthcare quality/cost; JAMA analysis of Medicare claims on PE hospital acquisitions and patient safety; physician satisfaction and autonomy survey data.Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Every week, doctors spend 13 hours fighting insurance companies just for permission to treat their patients — and now, under a new Medicare pilot, some of those decisions are being handed to AI. In this episode, Liz digs into prior authorization: where it came from, how it quietly stripped doctors of their professional sovereignty, and why the newest version of this system might be the most alarming yet.

📚 Referenced: The Social Transformation of American Medicine by Paul Starr

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

CMS is proposing a rule that could cut your pay in half just for treating more than one problem per visit — and the comment period closes September 14th. Liz breaks down the proposed change to the 25 modifier, why the "help primary care" logic doesn't hold up, and why the AMA is being sued — again — over its copyright on the CPT codes every doctor has to use. Plus: why physician Medicare pay is down 33% since 2001 while the AMA's revenue keeps climbing.

🔗 Referenced: CMS 2027 Physician Fee Schedule public comment page — [link] (open through 9/14)

Enjoyed this episode? Rate us five stars, leave a review, and send it to someone who should be outraged or better informed. More shows at HippocraticCollective.com.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

How does a doctor's visit actually turn into a paycheck? It's more convoluted than how a bill becomes a law — and almost nobody, including most doctors, understands it.

In this episode of Cut and Tell, Dr. Liz Malphrus (plastic surgeon, Philadelphia) breaks down the claims-based payment system that runs American healthcare: the five data points that determine every dollar a doctor is paid, why a "clearinghouse" still charges $1 per claim in 2026, and how a shadowy 32-person AMA committee called the RUC quietly decides what your appendectomy is worth.

We also go back to 1929 to trace how we ended up with employer-based health insurance in the first place — starting with a Baylor University hospital administrator, a group of Dallas schoolteachers, an FDR-era wage freeze, and a 1954 tax law that changed everything.

WHAT WE COVER

• What's actually in a medical claim (just 5 data points — no clinical detail)

• ICD-10 vs. CPT codes, explained simply

• Why 10–20% of claims get denied on the first pass

• The clearinghouse "middleman" nobody can explain the value of

• The AMA's CPT copyright and why it's worth $285M/year to them

• RVUs: the fixed "pie" that pits specialties against each other

• The RUC — the committee that sets what doctors get paid, and who's on it

• The real history: the 1929 Baylor Plan, Blue Cross/Blue Shield, the 1942 wage freeze, and the 1954 tax exemption that built employer-based insurance

• Why Medicare (1965) inherited this system rather than designing a new one

CHAPTERS

00:00 Intro — why this episode matters

00:00 What is a "claim," really?

00:00 The 5 codes that determine your pay: ICD-10, CPT, place of service, provider, payer

00:00 How a claim moves: coder → clearinghouse → payer → remittance

00:00 The clearinghouse problem

00:00 Claim denials and the appeals process

00:00 A brief history of American health insurance: the 1929 Baylor Plan

00:00 Blue Cross, Blue Shield, and the birth of fee-for-service

00:00 WWII wage freezes and the accident of employer-based insurance

00:00 1954 tax law and 1965 Medicare

00:00 The AMA and the CPT code copyright

00:00 RVUs and the fixed "pie"

00:00 The RUC: who really sets your pay

00:00 Recap and why this matters for doctors and patients

[Insert real timestamps after final edit]

If this made you mad, good — that's the point. Subscribe, rate us 5 stars, and leave a review; it's the best way to help other clinicians find this show. Share it with a resident, an attending who won't stop complaining about RVUs, or anyone who thinks healthcare billing makes sense.

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

This is Episode 2 of our series on health policy and economics for doctors! This episode is about laying the historical groundwork for the rest of this season, because so many of our modern healthcare problems can be traced back to decisions made WAY in the past that set us on this course. In this episode, Dr. Liz Malphrus digs into the 19th-century roots of American medicine — from home-based house calls and bartered payments to the founding of the American Medical Association in 1847 — to explain how doctors chose to model their profession after clergy instead of lawyers, and why that choice still shapes healthcare's biggest problems today.

Drawing on Paul Starr's The Social Transformation of American Medicine, this episode lays the historical foundation for everything Cut & Tell will cover this season: why healthcare is so complicated, why doctors are uncomfortable charging for care, and why patients are too.

Referenced: The Social Transformation of American Medicine by Paul Starr

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What if doctors understood how the healthcare system actually works?

In the first episode of Season 2 of Cut & Tell, Dr. Liz Malphrus kicks off a new series designed to give doctors and residents the health policy knowledge they were never taught in medical school or residency.

Liz has a master's degree in public policy and spent five years working in health policy before becoming a physician. Now, after experiencing healthcare from both sides of the system, she's breaking down the forces that shape how medicine works, and why doctors are often left without the knowledge or power to change it.

From Medicare and Medicaid to RVUs, CPT codes, claims-based payment, healthcare policy, and the people who make the rules, this season is about understanding the "rules of the game" so physicians can become better advocates for their patients and themselves.

Liz also explores the disconnect between health policy and what actually happens at the bedside, why healthcare metrics and reporting requirements don't always improve patient care, and how physicians have gradually lost control over their own profession.

And yes, she's here to radicalize you.

If you're a medical student, resident, physician, or healthcare professional who has ever wondered Who actually makes these rules? Why does healthcare work this way? And why do doctors have so little control?—this season is for you.

In this episode:

• Why doctors aren't taught healthcare policy
• How Liz went from health policy to medicine
• What she learned working at the National Academy of Medicine
• The disconnect between healthcare policy and clinical practice
• Why doctors need to understand how healthcare gets paid
• RVUs, CPT codes, Medicare, Medicaid and claims-based payment
• Why physicians need to advocate for themselves
• How healthcare policy affects the doctor-patient relationship
• Why understanding the system can give doctors more agency

Cut & Tell is a Hippocratic Collective podcast about medicine, surgery, residency, and what it really means to be a doctor.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Choosing a medical specialty is one of the biggest and most stressful decisions in medicine.

In this season finale of Cut & Tell, newly graduated plastic surgeon Dr. Liz Malphrus reflects on her own journey from medical student to plastic surgery. Along the way, she seriously considered hospital medicine, urology, interventional specialties, and nearly changed her career path late in medical school after a single reconstructive surgery changed everything.

Rather than offering a simple checklist, this episode explores what specialty choice is really about: finding the people, work, and environment where you'll build a fulfilling career.

Whether you're a medical student deciding your future or simply curious about how physicians choose their specialties, this episode offers an honest look at one of medicine's most important decisions.

Topics discussed:

• How to choose a medical specialty
• Why mentorship matters
• Hospital medicine vs. surgical specialties
• Why Dr. Malphrus almost chose urology
• The operation that changed everything
• What drew her to plastic surgery
• Personality fit vs. lifestyle considerations
• Shadowing, networking, and exploring specialties
• Can you switch specialties later?
• Advice for medical students who feel uncertain

Cut & Tell explores the realities of medical training, surgical careers, and life after residency.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.