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!

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Dr. Jay Parkinson is a pediatrician and founder who’s been reinventing healthcare from the outside in for nearly two decades. From launching one of the first tech-enabled house call services in Brooklyn to pioneering virtual primary care with Sherpaa, Jay has always believed that doctors can design better systems. Now he’s back with Automate Clinic, a new venture training physicians to fine-tune clinical AI models with real-world judgment and insight.

In this episode of How I Doctor, Dr. Graham Walker talks with Jay about bucking the traditional medical career path, designing more human-centered systems, and what most startups (and health systems) still don’t get about primary care. They also dive into Jay’s new work building AI you can actually trust, and why the doctors best positioned to shape its future are the ones curious enough to break stuff and ask better questions. If you’ve ever wanted more freedom, more creativity, or more control in medicine then this one’s for you.

What You’ll Learn in This Episode:

• Why Jay bet on the iPhone, and not the EMR, as the future of medicine
• 
  
• What healthcare can learn from previous startups like Uber and Google
• 
  
• Why most doctor visits don’t need to happen in person and how to rethink the “front door” of care
• 
  
• How AI can surface consensus, not just “the right answer” and why that’s so powerful in medicine
• 
  
• Why design is a form of protest, and every patient deserves a more beautiful experience
• 
  

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📝 For a full transcript of this episode click HERE

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Dr. Ami DeWaters is a hospitalist, medical educator, and one of the leading voices reimagining how we prepare residents for the realities of modern medicine. She’s an associate professor at Penn State College of Medicine that’s known for her sharp insights and deep commitment to building physicians who are not just clinically excellent, but also financially, professionally, and systemically fluent.

In this episode of How I Doctor, Dr. Graham Walker talks with Ami about the disconnect between what doctors are taught and what they actually need to succeed. From FTEs and RVUs to PSLF and prior auths, they unpack the hidden curriculum of becoming a practicing physician - and why not understanding how the system works is no longer an option. If you’ve ever felt like medicine handed you the keys without teaching you to drive, this episode will tell you how to take back control.

What You’ll Learn in This Episode:

• Why understanding FTEs is essential for your contract, your income, and your loan forgiveness
• How to negotiate your first job like a pro and the surprising reason your desk might be the first red flag
• The hidden power of residents to drive change and how one radiology resident helped redesign their entire overnight workflow
• Why every doctor needs to speak the language of RVUs, billing, and insurance regulation if they want to lead and not just survive
• The one lesson every intern should learn by the end of their first year

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📝 For a full transcript of this episode click HERE

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Dr. Greg Murphy is a practicing urologist and four-term Republican Congressman representing North Carolina’s third district—and the only physician in Congress who still actively sees patients, entirely pro bono. Before entering politics, he served as an affiliate professor, urology group president, and chief of staff at a Level 1 trauma center in Greenville, NC. These days, he’s sounding the alarm about what he sees as a crisis in the medical profession: a generation of young doctors who, in his view, are losing their sense of calling.

In this episode of How I Doctor, Dr. Graham Walker talks with Congressman Murphy about the tweet that sparked backlash from younger physicians and the deeper frustrations behind it. Together, they explore the erosion of autonomy, the death of private practice, and what Murphy calls “the ultimate sacrifice” that medicine requires. It’s a fiery, honest, and civil conversation that cuts across generations, full of tough questions, uncomfortable truths, and a shared commitment to fighting for the future of patient care.

What You’ll Learn in This Episode:

• Why Congressman Murphy believes too many doctors are using the system as an excuse to stop doing what’s right for the patient.
• What he means when he says medicine is “a field of sacrifice”—and why he thinks too many young physicians are prioritizing lifestyle over service.
• His critique of how medical schools admit, train, and prepare students—and what needs to change now.
• Why he thinks physicians need to give more than just their time to advocacy—and why money matters in politics.
• How doctors can get more engaged, whether it’s through policy, protest, or running for office themselves.

If you’re a doctor questioning the future of medicine or just looking for a straight-talking take on what it means to stay in the fight this episode’s for you.

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📝 For a full transcript of this episode click HERE

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Dr. Paul Tran is a pediatric gastroenterologist, award-winning medical educator, and the creator behind Alimentary School — an online platform using storytelling, mentorship, and dad jokes to make medicine more human. He’s on a mission to break down outdated hierarchies and rebuild medical education around trust, real-time feedback, and genuine connection.

In this episode of How I Doctor, Dr. Graham Walker talks with Paul about what’s broken in medical training and how we can actually fix it. With warmth and wit, Paul explains why seeing students as “just students” undermines patient care, how virtual interviews and pass/fail boards have reshaped the residency match, and why the way we give feedback needs to change yesterday. He also shares the killer interview question every applicant should ask, and how social media can help bridge gaps traditional training leaves wide open. If you’ve ever wondered what it would look like to blow up med ed and start fresh, this is the conversation for you.

What You’ll Learn in This Episode:

• Why medical training still relies on outdated hierarchies — and how that hurts future doctors and patients alike.
• How the move to pass/fail Step 1 and virtual interviews is reshaping residency applications (and adding new pressures).
• The big flaws with “Feedback Fridays” — and Paul’s practical advice for giving and getting better feedback every day.
• The exact two-part question every med student should ask to uncover a residency program’s real culture.
• How Paul uses humor and short-form videos to make medical education more accessible, honest, and fun.

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📝 For a full transcript of this episode click HERE

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The world of medicine is entering a new era. One where AI isn’t just a buzzword, but a daily presence in the lives of physicians. That’s why Offcall recently hosted a live webinar We're Sharing AI Secrets for Clinicians, featuring Dr. Graham Walker, ER physician and co-founder of Offcall, and Dr. Sarah Gebauer, anesthesiologist and founder of Valara Health. Longtime friends and Stanford med classmates.

Their goal? Demystify AI for busy clinicians and provide practical tools to navigate this moment of transformation. Not in five years, but right now. Throughout the session, Graham and Sarah unpacked the real-world impact of AI in clinical practice, offering a blend of foundational education, cautionary guidance, and hands-on tips. 

You can watch the full video presentation at https://www.linkedin.com/events/7331694686937530368/about/

Physicians, visit Offcall.com/AIGuide to download Graham & Sarah’s AI Guide.

For everyone else who doesn’t have an NPI number you can download that guide at https://docsend.com/v/3t6h4/offcallwebinar

What You’ll Learn in This Episode:

• AI Is Already Here—You Just Might Not Know It
• Know Your AI Types: Generative vs. Deterministic
• Use Cases Are Expanding Rapidly
• Ask the Hard Questions Before You Adopt
• Bias and Hallucinations Are Real Risks
• Overreliance Can Weaken Clinical Judgment
• Legal and Ethical Guardrails Are Still Being Built
• Clinicians Need to Lead the Conversation

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📝 For a full transcript of this episode click HERE

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Shawna Butler is a nurse, economist, and creator of the EntrepreNURSE movement — but above all, she’s a force for rethinking how healthcare systems are built and who gets a say.

In this episode of How I Doctor, Dr. Graham Walker talks with Shawna about what we lose when we treat nurses like costs instead of collaborators. They unpack the deep roots of burnout and moral injury, explore why innovation often fails without frontline input, and ask a radical but overdue question: what if nurse wellbeing were a quality metric?

It’s a bold conversation about power, trust, and how healthcare can only heal when the people delivering it are heard, valued, and supported.

What You’ll Learn in This Episode:

• The Real Reason Nurses Burn Out - It’s not just stress. Nurses are seen as expenses, not expertsm and that perception shapes everything from policy to paychecks.
• Why Burnout Isn’t Just Exhaustion — It’s Moral Injury - Healthcare workers know what their patients need and are powerless to provide it. That’s not just frustrating, it’s ethically devastating.
• How Innovation Can Actually Keep Nurses at the Bedside - Nurses aren’t afraid of change, they’re afraid of being left out of it. When nurses lead innovation, they stay longer and solve more.
• The Untapped Power of Team-Based Care - Doctors and nurses are on the same team, but the system wasn’t built to reward teamwork. Fixing that is key to fixing care.
• 
  

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

📝 For a full transcript of this episode click HERE

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Aniq Rahman is a two-time tech founder, but when he turned his attention to healthcare he did something most disruptors don’t - he shut up and listened. Aniq embedded himself in hospitals, shadowed physicians, and absorbed the daily frustrations that don’t show up in EMR logs or admin dashboards.

In this episode of How I Doctor, Dr. Graham Walker talks with Aniq about what he learned by watching before building, and how that humility shaped his approach to transforming healthcare with Fabric. They dig into what’s broken in the current system, why software often makes doctors’ lives harder, and how a product-first mindset can fail in a field where people - not features - are the real complexity.

It’s a rare conversation that bridges tech optimism with physician realism and makes a compelling case for designing with doctors, not just for them.

What You’ll Learn in This Episode:

• Why Tech Usually Gets Healthcare Wrong - The classic startup playbook fails when applied to medicine.
• What Happens When You Listen First - How a year of shadowing and silence led to insights most founders never hear.
• Fixing the Wrong Problems - Why too many platforms are optimized for metrics instead of meaning and how Fabric is different.
• Doctors Aren’t the Problem, The System Is - A candid look at how current tools make good physicians feel ineffective, and what needs to change.
• The Case for Physician-Led Innovation - Why tech needs more co-design, less command-and-control and what healthcare can learn from infrastructure.

❓What's the biggest question you have about AI and healthcare? ❓

We’re throwing our first live event, and you’re invited! Graham Walker, MD and Sarah Gebauer, MD are two of the country's leading MD experts about AI and they'll be answering your questions in an urgent live webinar on June 3rd. Register at https://www.linkedin.com/events/we-resharingaisecretsforclinici7331694686937530368/theater/

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📝 For a full transcript of this episode click HERE

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Dr. Kaveh Hoda is a practicing gastroenterologist and longtime podcaster. He’s part of a cohort of doctors who trained on paper charts, watched the rise of EHRs, and now find themselves navigating mid-career questions that older generations rarely asked. Questions about purpose, burnout, and identity beyond the white coat.

In this episode of How I Doctor, Dr. Graham Walker talks with Kaveh about what it means to hit your clinical stride and still feel a pull toward something more. They unpack the hidden costs of professionalism, the subtle slide from skepticism into cynicism, and the permission every mid-career physician needs to explore life beyond the hospital. It’s a candid, funny, and deeply reflective look at the decade of your career no one warns you about, but nearly every doctor will face.

Whether you’re feeling stagnant, questioning your purpose, or just wondering what’s next, this episode is a reminder that you’re not alone. and it’s okay to want more than medicine.

• The Mid-Career Medicine Trap - Why hitting your clinical peak can leave doctors feeling stuck—and how to shift from autopilot to intentionality.
• Beyond the White Coat - How today’s mid-career physicians are building identities outside medicine, and why that’s a strength—not a failure.
• When Skepticism Turns to Cynicism - The warning signs of burnout masked as indifference—and how to reclaim curiosity and compassion.
• Why You Don’t Feel Like a “Young Doctor” Anymore - Aging in medicine, the end of being called “too young to be a doctor,” and finding empathy through shared experience.
• Redefining Success in the Middle - Letting go of outdated goals, learning from the next generation, and making space for joy, hobbies, and reinvention.

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

https://www.offcall.com/

📝 For a full transcript of this episode click HERE

https://www.offcall.com/learn/podcast/the-mid-career-physician-crisis-identity-burnout-and-reinvention

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Dr. Farzad Mostashari is the former National Coordinator for Health IT, the CEO and co-founder of Aledade, and a longtime champion for independent primary care. He’s spent his career trying to answer one question: how do we fix American healthcare by paying doctors to prevent illness—not just treat it? In this episode of How I Doctor, Dr. Graham Walker sits down with Farzad to unpack the financial forces behind physician burnout, the byzantine mess of incentives driving consolidation, and why empowering small, independent practices could be the key to turning it all around.

They talk about how value-based care is finally beginning to deliver real results, with independent practices earning more through shared savings than through fee-for-service billing. Farzad breaks down the math behind a billion-dollar primary care group, what it really means to have leverage with payers, and how doctors can reclaim both their autonomy and financial upside. Whether you’re an early-career physician wondering what path to take—or a veteran feeling stuck inside a system you didn’t design—this conversation offers a clear-eyed look at what’s broken and what’s finally working.

What You’ll Learn in This Episode:

• Why the Payment Model Is the Root Problem – How the current system rewards volume over outcomes, and what happens when that finally changes.
• The Hidden Power of Primary Care – Why independent doctors can drive massive savings—and how a 100-physician practice can become a billion-dollar enterprise.
• Who Built the Machine—and Why It’s So Hard to Escape – A candid look at the patchwork of well-intentioned policies that now trap physicians in burnout.
• The Business Case for Independence – How some practices are now earning more in one check than in an entire year of fee-for-service billing.
• Control, Respect, and the Right to Say No – Why owning your schedule matters as much as your paycheck—and how it connects to professional satisfaction.
• Rebuilding a Career on Your Terms – What it takes to go independent today, and why the future might finally be tipping in favor of small, physician-led care.

This conversation is for anyone who’s ever wondered: What happens when being a doctor isn’t enough — and what else might be possible?

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📝 For a full transcript of this episode click

https://www.offcall.com/learn/podcast/independent-practice-is-reshaping-primary-care-and-making-doctors-more-money

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