I Don't Care

Who is really running healthcare when the physicians delivering care no longer have a meaningful voice in how the system operates?

On this episode of I Don’t Care, host Dr. Kevin Stevenson speaks with Dr. Krishna Vedala, a practicing internist and obesity medicine specialist at Norman Regional Health System, about the economic and administrative forces reshaping American healthcare. Dr. Vedala argues that the system’s dysfunction is no longer theoretical. Patients with insurance still struggle to afford medications, access diagnostic testing, or secure timely appointments, while independent practices face mounting financial pressure and physicians increasingly work within a small number of dominant health systems.

The conversation examines why primary care is essential to a healthy system yet is often managed using productivity models that fail to reflect its complexity. Physicians are expected to see more patients while completing hours of administrative work outside the clinic, leaving many to choose between burnout, leaving medicine, or adopting care models that may be inaccessible to some patients.

Dr. Stevenson and Dr. Vedala also challenge the idea that artificial intelligence will replace physicians. Instead, they explore how AI could reduce documentation and administrative burdens, improve communication, and allow clinicians to spend more time caring for patients. The greater risk, Dr. Vedala suggests, is not that the technology will fail, but that healthcare leaders will implement it without addressing the mistrust and structural problems already separating administrators from clinicians.

To restore physicians’ influence, Dr. Vedala offers a provocative possibility: greater organization and even unionization across specialties. Giving physicians a unified voice could bring clinicians back to the decision-making table, but doing so would require the profession to overcome internal divisions and refocus on its shared responsibility to patients.

Ultimately, the discussion returns to accountability, prevention, and collaboration. Healthcare cannot be repaired by physicians, administrators, patients, insurers, or policymakers acting alone. Meaningful reform will require each group to set aside some combination of ego, politics, and financial self-interest to build a system that protects both the people receiving care and those providing it.

Connect with Dr. Vedala: https://www.linkedin.com/in/drkvedala/

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Healthcare organizations are investing rapidly in artificial intelligence, but technology alone cannot create better decisions, stronger operations, or more compassionate care. In this episode of I Don’t Care, Dr. Kevin Stevenson speaks with international healthcare executive Dr. Julia Rehman about the leadership, governance, and trust required to use AI responsibly.

Drawing on nearly two decades of experience across the United States, India, Saudi Arabia, and the United Arab Emirates, Dr. Rehman explains why organizations should begin with a specific operational problem, involve frontline teams early, and keep human judgment at the center of every AI-supported decision. She also examines the strategic importance of data ownership, quality, oversight, escalation paths, and auditability. Their conversation explores the potential of AI to support rural health systems, reduce workforce strain, and improve decision-making, while reinforcing a central principle: healthcare innovation must ultimately serve clinicians, patients, and communities.

Connect with Dr. Rehman: https://www.linkedin.com/in/juliarehman/

I Don't Care on MarketScale: https://marketscale.com/creator-hubs/i-dont-care/

Healthcare leaders often blame financial pressure, labor shortages, and market forces for the industry’s challenges, but Mark Van Sumeren argues that one of healthcare’s biggest constraints is self-imposed: the inability to make decisions quickly enough.

On this episode of I Don’t Care, Dr. Kevin Stevenson sits down with Van Sumeren, a healthcare strategist with more than four decades of experience spanning health systems, consulting, supply chain, publicly traded companies, and private equity-backed organizations. Together, they examine why healthcare organizations are uniquely prone to “paralysis by analysis” and why seemingly responsible delays can ultimately leave leaders with fewer and worse choices.

Van Sumeren introduces the idea that “decision pace is capacity.” Every delayed decision continues consuming executive attention, staff time, analytical resources, and organizational bandwidth. Rather than advocating for reckless speed, he makes the case for deliberate speed: establishing clear decision ownership, defining the information required upfront, creating a decision window, and holding leaders accountable for reaching an answer.

The conversation also explores how healthcare’s governance structures and incentive systems can unintentionally reward consensus and caution over execution. Stevenson and Van Sumeren discuss the value of measuring decision latency, creating greater accountability for outcomes, recognizing early warning signals, and adopting a “fail fast” mindset that allows organizations to change direction before an unsuccessful initiative consumes even more resources.

They also turn to healthcare supply chain strategy, particularly the significant amount of nonclinical spending that often escapes the same scrutiny applied to medical supplies. Van Sumeren argues that health systems can learn from retail, manufacturing, and consumer goods companies by applying greater discipline to areas such as IT, facilities, construction, marketing, and professional services.

Ultimately, the episode makes the case that healthcare does not have to abandon its mission-driven values to operate with greater urgency. Instead, leaders need structures that allow them to protect quality and compassion while making timely, accountable decisions before circumstances make those decisions for them.

I Don’t Care on MarketScale: https://marketscale.com/shows/i-dont-care/

Connect with Mark Van Sumeren: https://www.linkedin.com/in/markvansumeren/

Health Industry Advisor: https://healthindustryadvisor.com/

Childcare has quietly become one of the biggest pressure points in the labor market, reshaping how people choose jobs, stay in jobs and build careers. What was once treated as a private family problem is now showing up in employers’ bottom lines through absenteeism, turnover, delayed returns to work and unfilled roles. The pressure is especially acute in industries like healthcare, where work is often in person, shifts are long and staffing gaps can quickly affect both operations and patient care. With childcare costs now rivaling or exceeding major household expenses in many states, the question for business leaders is no longer whether families are struggling, but how much workforce stability depends on helping solve it.

So if childcare is affecting who can work, who stays, who calls out and who accepts a job offer, why is it still so often treated as an HR side issue instead of a CEO-level business strategy?

On this episode of I Don’t Care, host Dr. Kevin Stevenson speaks with Nicole Riehl, President and CEO of Executives Partnering to Invest in Children, known as EPIC. Their conversation explores why childcare access is now tied directly to recruitment, retention, absenteeism, workforce planning and long-term economic competitiveness—and why business leaders may need to rethink what counts as core infrastructure for their employees.

Top insights from the talk…

• Childcare affects business performance. Riehl explains that childcare shortages show up in turnover, call-outs, delayed returns to work, reduced productivity and difficulty filling specialized roles, especially in healthcare and 24/7 operations.
• Employers need better data before choosing solutions. EPIC works with employers to survey workers, assess local childcare supply, understand affordability challenges and identify whether solutions should include stipends, backup care, on-site childcare or partnerships with providers.
• Childcare benefits can produce measurable ROI. Riehl says employers often recover their investment through improved retention, faster recruiting, fewer absences and stronger engagement, with some childcare investments generating returns ranging from 100% to 400%.

Nicole Riehl is President and CEO of Executives Partnering to Invest in Children, where she helps employers, executives and policymakers address childcare as a workforce, economic development and business competitiveness issue. Her career spans early childhood education, nonprofit leadership, finance, program strategy and systems-building, including senior leadership roles at Denver’s Early Childhood Council and quality improvement work with Qualistar Colorado. Recognized by the Denver Business Journal as an Outstanding Woman in Business and Power Book honoree, Riehl brings deep expertise in employer childcare solutions, early learning policy, workforce retention and cross-sector collaboration.

Biotech is living through a paradox: the science has rarely looked more powerful, while the institutions behind it have rarely seemed less trusted. The sector that helped accelerate vaccines, advance cancer treatment, and open new frontiers in brain disease is now facing public skepticism, political pressure on science, and rising competition from countries that see biotech as a strategic national asset. That frustration is being sharpened by affordability concerns, with recent polling finding that nearly six in ten U.S. adults worry about paying for prescription drugs. For an industry built around lifesaving innovation, the challenge is no longer just discovering what comes next; it is proving to the public that those breakthroughs are being developed in patients’ best interests.

So, how can biotech and pharma restore public trust while continuing to deliver the breakthroughs patients are waiting for?

On I Don’t Care, host Dr. Kevin Stevenson speaks with Dr. Jeremy Levin, Chairperson of Ovid Therapeutics and author of Biotech in the Balance: Saving a Strategic Industry in an Age of Distrust. Their conversation explores why the public has lost trust in pharma, how pharmacy benefit managers and rebate structures complicate drug pricing, why biotech should be treated as a strategic national asset, and what the industry must do to reconnect with patients.

Top insights from the talk…

• Trust is biotech’s central challenge. Dr. Levin argues that the industry’s biggest mistake has been losing sight of its covenant with patients. While biotech has delivered transformative medicines, he says the public often sees the industry as profiting from illness rather than partnering in care.
• Drug pricing is more complex than the sticker price. Dr. Levin points to pharmacy benefit managers, insurers, rebates, and opaque intermediary structures as major drivers of patient frustration, arguing that patients often blame drug companies without seeing how money moves through the system.
• American biotech faces a strategic test. Dr. Levin warns that if the United States does not protect scientific institutions, support the FDA, and recognize biotech as a national priority, innovation and investment may move elsewhere, including China.

Dr. Jeremy Levin is a physician-scientist and biotechnology executive with deep experience leading life sciences companies, boards, strategy, alliances, and business development. He is Chairperson of both Ovid Therapeutics and Opthea, and he previously founded and led Ovid as Chairperson and CEO. He is also Chairman Emeritus of the Biotechnology Innovation Organization, where he helped guide industry leadership across biotechnology policy, innovation, and patient-focused drug development. Earlier in his career, he held senior leadership roles at Teva Pharmaceuticals, Bristol Myers Squibb, and Novartis.

Modern healthcare is caught between extraordinary clinical possibility and an increasingly strained delivery system: patients have more treatment options, data and information than ever, while hospitals and physician networks must coordinate care amid workforce pressure, rising complexity and limited tolerance for waste. That pressure is only expected to grow, with the Association of American Medical Colleges warning that the U.S. physician shortfall could climb as high as 86,000 by 2036, underscoring why better care now depends not only on medical innovation, but on whether clinicians, administrators and networks can build enough trust to make hard decisions together.

How can healthcare leaders move beyond transactional relationships and build the trust needed for physicians and administrators to make better decisions together — for their networks, their practices and the patients they serve?

On I Don’t Care, host Dr. Kevin Stevenson speaks with Dr. David Foster, Founder and Principal of Clinical Network Collaborative, about leading with purpose across medicine, administration and faith-based healthcare. Their conversation explores Foster’s decades of clinical and executive experience, the role of mission in leadership, the need to unify the physician voice, and why clinical integration may be one of healthcare’s most urgent priorities.

What you'll learn...

• Physician alignment starts with listening, but it cannot stop there. Foster argues that physicians often feel unheard, while administrators are actively seeking clearer clinical input. The opportunity, he says, is to move from a “cacophony” of individual complaints to a unified physician voice that can help leaders set priorities.
• Collaboration is becoming a survival skill in a constrained healthcare environment. Foster emphasizes that practices, hospitals, payers and health systems all operate within networks. When resources are limited, clinicians and administrators must work together to decide what services to invest in, what duplication to reduce and how to keep patient care as the shared North Star.
• Healthcare leaders should stop fighting the tools and start improving the system. Asked what leaders spend too much time worrying about, Foster points to the electronic medical record. His view: EMRs are not going away, so leaders should focus less on resisting them and more on optimizing them to support better practice, workflow and patient care.

Dr. David Foster, MD, MBA, FAAFP, is a physician executive and healthcare strategist with more than 30 years of experience spanning clinical practice, medical group leadership, governance, clinical integration and system-level transformation. He founded Clinical Network Collaborative to help clinicians, administrators, health system leaders and payers strengthen network performance through clearer dialogue, physician engagement and patient-first alignment. Previously, he held senior leadership roles at CommonSpirit Health, CHI St. Vincent, CHRISTUS Health and CHRISTUS Spohn Health System, where he led multi-state physician enterprise operations, grew provider networks, advanced value-based care, improved quality and access, and built governance structures that elevated the clinical voice in organizational decision-making.

For years, nutrition has sat awkwardly between personal responsibility and medical care: important enough for doctors to mention, but rarely supported like a real treatment plan. That gap is becoming harder to defend as diet-related diseases continue to strain patients, employers and the healthcare system. A study in JAMA Network Open found that expanding medically tailored meals in the U.S. could prevent an estimated 1.6 million hospitalizations a year, making the case that food can be more than general wellness advice — it can be part of how care is delivered.

That raises the real question for healthcare leaders, employers and retailers: how do you turn food from a recommendation into a system of support?

On I Don’t Care, host Dr. Kevin Stevenson speaks with Adam DeVito, Founder and CEO of Monj Health, and Maggie Biscarr, a food-as-medicine subject matter expert, about whether food can play a more central role in prevention, healing and healthcare strategy. Their conversation covers the history of food-as-medicine, the behavioral barriers that make healthy eating difficult, the role of culinary skills and community, and why employers and retailers may be uniquely positioned to connect food, pharmacy and long-term health.

What you'll learn...

• Food-as-medicine is having a moment because healthcare costs, chronic disease and GLP-1 demand are converging. Biscarr explains that employers and payers are recognizing that nutrition is not just a lifestyle issue, but a workforce health, productivity and cost issue.
• Behavior change is the missing link. DeVito argues that people do not “eat nutrition”; they eat food, flavor and comfort. Monj aims to make healthy eating joyful through cooking, confidence-building, behavioral science and community.
• The future may depend on connecting systems. The guests discuss opportunities for employers, retailers, pharmacies and food-as-medicine platforms to work together so people can access education, incentives and practical support where they already live, work and shop.

Maggie Troope Biscarr is a food-as-medicine strategist and independent consultant working across the food, retail and healthcare sectors, with current roles including co-lead of the NOURISH Movement, subject matter expert with Clareo Partners, and lead of the GLP-1 Advisory Group for Georgetown’s Portion Balance Coalition. She previously served as Director of Global Partnership Solutions at PepsiCo, where she built cross-sector partnerships focused on health, wellness, sustainability and consumer behavior change, including healthier-choice and recycling pilots with major retail partners. Earlier in her career, she led AARP Foundation’s SNAP and nutrition incentive portfolios, including fruit and vegetable incentive and Food Rx programs, building on her MSW and long-standing focus on health equity and social drivers of health.

Adam DeVito is the Founder and CEO of Monj Health, a food-is-medicine platform that uses behavioral science, technology and coaching to help address obesity, diabetes and metabolic health at scale. He has led innovation and growth across food, digital health, enterprise platforms, nutrition and play, including senior roles at Kraft Foods and Sterling-Rice Group, where his teams developed major new products and brand strategies for leading food and wellness companies. Earlier in his career, he trained in classical French cooking, co-authored a healthy cooking book series for Time Inc., and later became Kraft’s first Executive Chef, helping develop DiGiorno Pizza and launch it into a $1 billion brand.

Healthcare leaders spend their careers designing better systems for patients, but the work looks different when they have had to move through those systems themselves. For Patrick Makarewich, a diagnosis of HPV-related head and neck cancer transformed familiar operational issues — scheduling, access, support services, staff flexibility, and communication — into deeply personal lessons. His experience reflects a larger reality in cancer care: HPV-linked oropharyngeal cancers have been rising, particularly among middle-aged men, making prevention, early detection, and patient-centered care urgent leadership concerns.

How does a cancer diagnosis change the way a healthcare leader thinks about access, empathy, and the people behind every clinical process?

On this episode of I Don’t Care, host Dr. Kevin Stevenson speaks with Patrick Makarewich, FACHE, Clinical Practice Manager for ENT, Head and Neck Surgery at UT Southwestern Medical Center, about how surviving HPV-related head and neck cancer reshaped his approach to leadership. Their conversation moves from Patrick’s diagnosis and treatment experience to clinic operations, workforce retention, generational leadership, patient access, and the cautious but promising role of AI in healthcare documentation and care delivery.

What you’ll learn…

• Lived experience can deepen healthcare leadership. Patrick explains that going through cancer treatment gave him insights into patient fear, scheduling friction, support needs, and survivorship that he could not have fully understood from an administrator’s seat alone.
• Staff retention starts with daily leadership. He argues that the most important recruiting happens with the people already on the team, through flexibility, goal-setting, quality interactions, and support for employees’ real lives outside work.
• AI may help reduce provider burden, but healthcare still needs human judgment. Patrick discusses UT Southwestern’s creation of a Chief AI Officer role and describes how AI-supported note-taking could help providers with documentation while still requiring accuracy, oversight, and empathy.

Patrick Makarewich, FACHE, is a transformational healthcare executive with deep experience in physician practice management, service line leadership, operational improvement, and patient-centered care. He currently leads Otolaryngology/Head and Neck Surgery clinic operations at UT Southwestern, overseeing a large multidisciplinary team while improving patient access, provider efficiency, and employee engagement. Across roles at UT Southwestern, Acclaim Physician Group, JPS Health Network, Children’s Health, Cook Children’s, Premier, hospice leadership, and Kaiser Permanente/SCPMG-related consulting roles, he has driven service line growth, Lean process improvement, revenue cycle optimization, workforce efficiency, accreditation success, and multimillion-dollar cost savings.

Primary care in America is under pressure from nearly every direction: physician shortages, long appointment wait times, rising patient demand, and a care model still built around physical offices. The U.S. is expected to face a shortage of up to 86,000 physicians by 2036, according to projections from the Association of American Medical Colleges, while federal shortage-area data continues to show gaps in primary care access across the country. At the same time, virtual care and AI are moving from pandemic-era workarounds to core infrastructure for how patients find, receive, and navigate care.

But as the technology catches up to the need, can healthcare use it in a way that preserves what matters most: the relationship between patient and doctor?

Welcome to I Don’t Care. In the latest episode, host Dr. Kevin Stevenson sits down with Dr. Geoffrey Rutledge, Founder and Chief Medical Officer of HealthTap, to explore the evolution of virtual care, the failures of traditional primary care, and the proper role of AI in medicine. Their conversation spans the early days of online medical information, the rise of telehealth, HealthTap’s shift toward virtual primary care, and why Dr. Rutledge believes technology should strengthen clinicians rather than replace them.

What you’ll learn…

• Virtual care is no longer just “digital urgent care.” Dr. Rutledge argues that telehealth began as a transactional service for immediate needs, but its real potential is longitudinal virtual primary care, where physicians can build relationships, understand lifestyle factors, and guide patients over time.
• Access problems are not limited to rural communities. While telehealth is often framed as a rural health solution, Dr. Rutledge and Dr. Stevenson discuss how patients in urban and suburban markets also face barriers such as traffic, childcare, mobility issues, and months-long waits for appointments.
• AI should support clinical judgment, not substitute for it. Dr. Rutledge says large language models are powerful tools for information retrieval, differential diagnosis, and reminding physicians of possibilities they may not have considered. But he cautions that AI is still weak at planning, prioritization, and understanding patient preferences, making physician oversight essential.

Dr. Geoffrey Rutledge is a practicing physician, entrepreneur, and digital health leader with more than 30 years of experience applying technology to improve healthcare access, delivery, and outcomes. He is the founder and Chief Medical Officer of HealthTap, and previously held senior leadership roles at Healtheon/WebMD, Epocrates, Wellsphere, San Mateo Medical Center, and First Consulting Group. Dr. Rutledge earned his MD from McGill University and his PhD in medical computer science from Stanford, and has taught medicine at Harvard, Stanford, and UCSD while conducting NIH-funded research in medical informatics.

Emergency departments have become the place where nearly every fracture in the healthcare system eventually shows up: behavioral health gaps, delayed primary care, staffing shortages, transfer disputes and inpatient bottlenecks. As demand rises and care becomes more complex, the ED is no longer just a clinical entry point — it is a pressure test for the entire hospital. Research has linked ED crowding to treatment delays, poorer patient outcomes, violence against staff, turnover and burnout, making emergency care a window into the broader strain on hospitals.

So what happens when the system’s safety net is treated less like a strategic entry point for care and more like a holding area for everything the rest of the hospital cannot absorb?

That’s the question at the heart of the latest episode of I Don’t Care. Host Dr. Kevin Stevenson speaks with Dr. Jim Augustine, a renowned emergency department physician leader and medical director, about what is broken in emergency care, what can still be fixed, and why hospital leaders need to rethink the role of the ED. Their conversation covers emergency department overcrowding, boarding, benchmarking, EMTALA, behavioral health, post-COVID facility design and the future of hospital-at-home models.

What you’ll learn…

• Boarding is not just an ED problem. Dr. Augustine argues that when admitted patients remain in the emergency department because inpatient beds or processes are unavailable, the issue reflects whole-hospital flow, not ED failure.
• Low-acuity patients are not the real cause of emergency department dysfunction. He warns that blaming ED crowding on sprained ankles or minor complaints distracts from larger operational problems, including inpatient throughput and community care breakdowns.
• Emergency departments need new planning assumptions. Dr. Augustine says older design formulas no longer fit today’s patient population, which is older, more medically complex, more behavioral-health intensive and more likely to require extended diagnostic workups or boarding.

Dr. Jim Augustine is a longtime emergency physician and EMS medical director whose career spans emergency department leadership, fire and EMS operations, clinical governance, benchmarking and system design. He has held national leadership roles with the American College of Emergency Physicians, US Acute Care Solutions, the Emergency Department Benchmarking Alliance and the International Association of Fire Chiefs. A clinical professor, consultant, author and speaker, Dr. Augustine is widely recognized for his expertise in emergency care operations, ED data, department design and prehospital care.