Ethan Nkana spent over a decade as a hospital executive negotiating contracts on behalf of health systems. He knew the inside playbook: how administrators calculated physician value, what mantras they used behind closed doors, and the quiet ways hospitals exploited physician professionalism. Then he switched sides. 

In this episode of How I Doctor, Dr. Graham Walker sits down with Ethan to explore medicine’s hidden business realities. From the stigma of being called “greedy,” to why the squeaky wheel gets the raise, Ethan unpacks how contracts are really written and how doctors can speak up without jeopardizing their careers. He shares the three buckets every physician should focus on - life balance, practice support, and fair pay - and the practical strategies that turn an uneven negotiation into a fair one.

He calls himself the “Jerry Maguire for physicians,” and in this conversation Ethan shares what every doctor needs to know before signing or renewing a contract.

What You’ll Learn in This Episode:

• Why “greedy” is a trap word and how to reframe fair pay as part of safe patient care
• The 3 contract buckets that matter most: life balance, practice support, and compensation
• What hospital executives really say behind closed doors about new physician hires
• Why the best physicians don’t always get paid the most—and who does
• Simple, non-adversarial scripts physicians can use to ask for what they need

Additional Resource for Physicians:

👉 Contract Negotiation Guide

 Before your next contract discussion, make sure you’ve gathered:

• Your actual weekly workload (clinical + after-hours documentation)
• Recent productivity metrics and patient satisfaction scores
• Evidence of non-revenue work (committees, teaching, outreach)
• Market data for your specialty and region
• A clear ask for at least one improvement in each bucket: life balance, practice support, fair pay\

Find out more about Rocky Mountain Physician Agency

Follow Ethan on Instagram at https://www.instagram.com/physicianagency/?hl=en 

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Dr. Danielle Ofri is an internist at Bellevue Hospital, clinical professor at NYU, and one of the most widely read physician-writers of our time. Through her books, essays, and New York Times op-eds, she has given voice to the emotional realities of medical work and exposed the ways the business of healthcare exploits the professionalism of doctors and nurses. Her clarity and candor have made her a trusted guide for physicians who feel the weight of a system that too often prioritizes profit over patient care.

In this episode of How I Doctor, Dr. Graham Walker sits down with Danielle to discuss medicine’s broken promises. From the erosion of trust and the exploitation of clinicians’ goodwill, to the disconnect between luxury hospitals and patient harm, they explore the hidden economy of modern healthcare and the ethical line between professionalism and exploitation. Dr. Ofri shares why nursing shortages are directly tied to patient mortality, how administrators rely on doctors “doing the right thing,” and what it will take for physicians to reclaim their voice in shaping the system.

What You’ll Learn in This Episode:

• Why the “professionalism” of doctors and nurses has become healthcare’s most exploited resource
• How nursing shortages directly affect patient safety and mortality rates
• The ethical and personal toll of 20-minute visits for medically complex patients
• The hidden disconnect between nonprofit hospital profits and patient care
• Strategies for physicians to speak up without crossing ethical or professional lines

Subscribe to Danielle’s newsletter here

Follow her on Instagram at https://www.instagram.com/danielle_ofri/  

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Dr. Hillary Lin is a Stanford-trained internist and longevity entrepreneur who is cutting through the hype to bring evidence-based clarity to one of medicine’s buzziest frontiers. As co-founder and CEO of Carecore and host of The Longevity Show, she’s built her career at the intersection of clinical skepticism and innovation, challenging what’s real and what physicians need to know about this fast-growing space.

In this episode of How I Doctor, Dr. Graham Walker sits down with Hillary to unpack the science of longevity medicine. From the pillars that actually work to the overhyped products flooding social feeds. They explore supplements, multivitamins, full-body scans, and the influencer-driven myths that confuse patients, while offering physicians a framework for counseling patients who are curious, skeptical, or already experimenting with longevity trends.

💡 Want to Go Deeper?

We’ve created a companion resource to this episode: Longevity Medicine Resource Guide for Physicians: Separating Fact from Fiction. Inside you’ll find curated evidence, peer-to-peer insights, and practical tools to help you counsel patients to cut through wellness industry hype and stay current on what really works.

👉 Download the guide now

What You’ll Learn in This Episode:

• The Lifestyle Pillars That Actually Extend Healthspan
• Supplements And Multivitamins: What’s Worth It (And What’s Not)
• The Most Overhyped Longevity Trends—Debunked
• Why Longevity Medicine Isn’t A Real Specialty
• The Future: Pre-Disease Screening And At-Home Testing

Subscribe to Hillary’s newsletter on evidence-based strategies for extending healthspan

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom 

Dr. Gita Pensa is an emergency physician and nationally recognized advocate who knows firsthand the toll malpractice takes on doctors. After enduring a 12-year legal battle that included two jury trials, she emerged determined to break the silence around litigation and its hidden impact on physicians’ identity, mental health, and careers. Today, she uses her story to teach colleagues how to survive what she calls medicine’s “second trauma.”

In this episode of How I Doctor, Dr. Graham Walker talks with Gita about the day she was served, the years she spent fighting in court, and how that experience reshaped her mission. From defensive medicine to the isolation lawsuits create, Gita offers hard-earned insights and a blueprint for how doctors can protect themselves, find support, and come out stronger on the other side.

The Physician’s Guide to Surviving Medical Malpractice

Offcall has created a comprehensive resource guide to help physicians navigate the realities of litigation. This guide pulls together expert advice, peer support programs, and practical strategies for what to do if you’re sued. Whether you’re early in your career or decades into practice, this guide offers the tools and community you need to protect your career, care for yourself, and move forward with confidence.

👉 Read The Physician’s Guide to Surviving Medical Malpractice

• Common mistakes doctors make after being sued  - and how to avoid them
• How litigation drives defensive medicine and impacts the way we practice
• What every physician should know about malpractice coverage including state-by-state differences
• Reforms that could make the system more fair for patients and doctors
• Why finding support and breaking the silence is critical for surviving litigation
• Watch A World of Hurt: How Medical Malpractice Fails Everyone

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom 

Article Display Title (Social)

Dr. Paulius Mui is a family physician, technologist, and community builder who refuses to fit into a single box. Instead of choosing between clinic shifts and tech projects, he’s built a portfolio career that blends patient care, experimentation, and creativity. Most recently, Paulius is reimagining what primary care looks like by launching a direct primary care practice that lets patients pay what they can.

In this episode of How I Doctor, Dr. Graham Walker talks with Paulius about why full-time primary care has become nearly impossible and why he has decided to choose mission over money for the benefit of patients and his profession. Paulius’ story offers a blueprint for fellow physicians to break the rules — and build something better.

📘 Resource Guide for Primary Care Physicians

We’ve created a companion resource guide to this episode, including tools, communities, and references for anyone who is interested in learning more about direct primary care.

Whether you’re exploring direct care models, looking for innovative tech tools, or are ready to set up a direct primary care practice of your own, this guide offers concrete next steps.

👉 Download the Resource Guide here

• Why primary care has gotten so challenging
• How Direct Primary Care offers a path forward for doctors who prioritize mission over money
• How technology, community, and curiosity can help doctors build better systems instead of just fighting broken ones

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Dr. Annie Andrews is a pediatric hospitalist, public health advocate, and U.S. Senate candidate in South Carolina taking on incumbent Lindsey Graham. Known for her unapologetic advocacy for children’s health, Annie has spent over 15 years caring for sick and injured kids, only to realize that many of their challenges stemmed from broken policies far upstream of the hospital. From gun violence prevention to protecting Medicaid, she’s made it her mission to bring a physician’s voice into the rooms where decisions are made and to speak with a candor rarely heard in politics.

In this episode of How I Doctor, Dr. Graham Walker talks with Annie about why more physicians should step into public life, how to fight misinformation without losing credibility, and the communication skills doctors already have that translate to the campaign trail. They dig into the gender inequities baked into medicine and why telling patient stories matters more than citing p-values. If you’ve ever wondered how to turn clinical advocacy into real political action, Annie’s story will make the case that there’s never been a more important time for doctors to run toward the fire.

What You’ll Learn in This Episode:

• The skills every physician already has that translate to political leadership
• How to fight misinformation without sounding like you’re in an ivory tower
• Why gender inequities in medicine persist even in female-dominated specialties
• The role of storytelling in rebuilding public trust in physicians
• What politicians would learn if they were required to spend a day in a children’s hospital

Find out more about Annie here and connect with her on Instagram at https://www.instagram.com/annieandrewsmd/

Watch her campaign launch video at https://www.youtube.com/watch?v=J8wMNLaSNW4 

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Dr. Shoshana Ungerleider is an internal medicine physician, a public health advocate, and one of the most trusted voices translating science for the real world. Whether she’s hosting th TED Health podcast, advising Netflix on end-of-life storytelling, or calling out hype and misinformation in the media, her work is reshaping how clinicians show up at the bedside and in the public square.

In this episode of How I Doctor, Dr. Graham Walker talks with Shoshana about the skill every physician needs but few are taught: communication. They explore how bias shows up in clinical encounters, why doctors are often unprepared to talk about serious illness, and how media can be a tool for connection and not just distraction. If you’ve ever struggled to explain something complicated to someone who doesn’t “get it,” this conversation will remind you why curiosity, not certainty, is a clinician’s greatest asset.

What You’ll Learn in This Episode:

• Why most doctors are never trained to communicate serious news, and how that’s harming patients
• How media, film, and storytelling can shift culture around end-of-life care
• How unconscious bias shows up in clinical care, and what to do about it
• Why misinformation spreads faster than facts and how physicians can fight back without losing trust
• Why more physicians need to step into public conversations—and what’s at stake if they don’t

Find out more about Shoshana here and connect with her on Instagram at https://www.instagram.com/shoshanamd/

Listen to the TED Health Podcast at https://www.ted.com/pages/ted-health 

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Dr. Josh Green is an emergency physician who’s done what many doctors only talk about. He’s taken a seat at the table and turned it into a platform for real change. After two decades practicing rural medicine in Hawaii and witnessing firsthand the systemic failures that lead to poor outcomes, he ran for office in his scrubs - and won. Today, as Governor of Hawaii, he’s applying the triage mindset of emergency medicine to some of the most complex public health and policy problems of our time, from homelessness and housing to climate change, Medicaid reform, and AI in healthcare.

In this episode of How I Doctor, Dr. Graham Walker talks with Josh about how clinical experience shapes better leadership, why physicians need to be in public office, and what it means to build a healthcare system that actually works - especially when resources are scarce. If you’ve ever felt like your work in medicine should mean more, this conversation will show you how one ER doc turned frustration into a force for statewide change.

What You’ll Learn in This Episode:

• How ER training helps leaders make faster, better decisions during crises
• 
  
• Why housing should be treated as a core public health intervention
• 
  
• How Hawaii’s unique healthcare model delivers lower costs and longer life expectancy
• 
  
• Why physicians make strong political candidates—and how to start your own campaign
• 
  
• How to think like a policymaker without losing your clinical instincts
• 
  
• How low-resource rural practice taught him to rely on relationships and diagnostic skill, not technology
• 
  

Find out more about Josh here and connect with him on Instagram at https://www.instagram.com/govjoshgreen/ 

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Rebecca Mitchell is a physician, product strategist, and founding partner at Scrub Capital - a new kind of venture fund built from first principles to fix what’s broken in health tech investing. Alongside her co-founders, Rebecca is working to make sure that healthcare startups aren’t just built for clinicians, they’re built with them.

In this episode of How I Doctor, Dr. Graham Walker talks with Rebecca about why it’s time to give clinicians more power. Not just at the bedside, but on the cap table. They dive into how Scrub Capital is supporting over 800 physicians, nurses, and frontline leaders as active collaborators in early-stage investing. From prescribing infrastructure and fertility tech to virtual specialty care and IVF lab automation, Rebecca shares where she thinks health tech is headed and why the industry’s obsession with hype has blinded it to what actually matters in care.

What You’ll Learn in This Episode:

• Why clinicians should stop waiting for a seat at the table and start investing in the companies shaping care
• How Scrub Capital is building a community of over 800 clinicians to co-create the next generation of health tech
• What Rebecca looks for in a founder and why “missionary, not mercenary” is her #1 investing filter
• Why many health systems fail at innovation and how digital health can succeed where they don’t
• Which trends in healthcare are overhyped, underhyped, or actually worth the buzz (GLP-1s? Wearables? Psychedelics?)
• How software, not just new hardware, is unlocking the future of innovation
• Why now may be the best time to start a healthcare company - if you’ve got the right insight and a long-term mindset

Follow Rebecca Mitchell on LinkedIn and learn more about Scrub Capital at https://scrubcapital.com/

Apply to join their clinician community here 

Submit an investment opportunity here

🩺 Offcall is more than a platform — it’s a community. Join today!

📝 For a full transcript of this episode click HERE

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom

Attorney Dennis Hursh has reviewed more than 3,500 physician contracts and has seen the same patterns again and again - doctors being underpaid, overworked, and legally trapped by language they didn’t know to question. 

In this episode, Dr. Graham Walker talks with Dennis about how RVUs and non-competes are often used against physicians, and how to push back. They dive into the structural imbalance between hospitals and physicians, the myths of “standard contracts,” and the silent clauses that could cost you tens of thousands of dollars.

From shocking stories of RVU misreporting to seven-figure locums arbitrage, this episode unpacks how the business of medicine quietly undermines doctors’ financial stability and career flexibility. Dennis brings clarity and tactical advice for any doctor negotiating a contract. Whether you’re fresh out of residency, or already practicing and unsure if you’re getting a fair deal, there’s something in this episode for everyone.

If you’ve ever felt like your compensation didn’t reflect your work. Or if you’ve been told “this is just how it’s done”. This episode will show you how to reclaim your leverage and ask the right questions before you sign.

Dennis wanted to make his decades worth of knowledge available to all Offcall physicians. So he’s compiled a Contract Negotiation Guide featuring helpful negotiation resources, key questions to ask during a negotiation, and practical pointers. This is a one-of-a-kind resource and it’s free and available exclusively for Offcall physicians.

Create an Offcall account (or log-in if you’ve already done so) in order to access the guide at https://www.offcall.com/learn/podcast/the-rvu-trap-physician-contract-red-flags-rvu-pitfalls-and-negotiation-tips-with-dennis-hursh

• Why “standard contracts” are a trap — and how to spot the clauses that limit your freedom or earnings
• How malpractice tail coverage can destroy your savings if you’re not careful
• The truth about RVU compensation and why most physicians never get the full picture
• How locums companies profit on your labor — and how to negotiate like a free agent
• The Stark Law loopholes and myths that employers use to shut down fair pay discussions

We’re excited to announce that Dennis is offering a special 10% discount for his legal services for all Offcall physicians. You can book a free consultation here, and be sure to mention “Offcall” during your appointment to claim your 10% discount!

🩺 Offcall is more than a platform — it’s a community. Join today!

🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315

👨‍⚕️Follow Dr. Graham Walker on

LinkedIn https://www.linkedin.com/in/graham-walker-md/ 

IG https://www.instagram.com/ubergraham/ 

Bluesky https://bsky.app/profile/drgrahamwalker.com 

✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 

🟧 Follow Offcall on 

LinkedIn https://www.linkedin.com/company/joinoffcall/ 

IG https://www.instagram.com/offcalldotcom/ 

TikTok https://www.tiktok.com/@offcalldotcom