Surgeons measure fistulas with precision—then send them into a dialysis-unit “black hole” where the same injury cycle starts again.Dr. Erin Moore is a Jacksonville vascular surgeon and former Navy physician who left roughly 15 years of military medicine for private-practice independence. There he owned high-volume dialysis access—about two to three hundred fistulas and grafts a year—and later became VP of clinical affairs around chair-side access-mapping software he names Veristra.This is not a war-story sequel. It is the systems problem behind failing dialysis access: thin tech training, on-the-job habits, high turnover, missing longitudinal stick history, area puncture as default, and a field that overbuilt stents and balloons while underbuilding the moment the needle hits the arm. Moore softens the old “micrometer vs ax” joke—staff are not trying to wreck access; they often lack tools, time, and information. His fix is mundane on purpose: photo + QR scale, mark arterial and venous sticks, color-age recent marks, and heat-map hotspots so the chair regains memory.In this conversation, Dr. Aaron Moore reveals:⬛ Why the unit becomes an information black hole after a surgical create⬛ How same-site puncture wears access toward pseudoaneurysm and failure⬛ Why rope-ladder is known to work—and still fails to become habit⬛ What a photo, QR scale, color-aged marks, and a fistula heat map change at the chair⬛ How pilot staff who only recorded points said they were still flying blind⬛ Why treating ~50% annual fistula patency as “OK” is a systems indictment⬛ What a 1973 patient-engineer already plotted on graph paper that centers still lackEducational discussion of workflow and systems—not individualized treatment advice. Early pilot signals are not universal outcome proof.The Dialysis Unit Is a Black Hole: Why Fistulas Keep Failing | Aaron MooreTimestamps:00:00 The dialysis access black hole00:45 Life of Flow intro00:59 Welcome back: entrepreneurship, not war stories01:47 Navy medicine to Jacksonville independence05:02 Owning dialysis access in private practice05:34 Micrometer surgery, missing chair-side tools09:31 Same cannulation paradigm since 196509:55 Why the dialysis unit feels like a black hole10:31 Overbuilt rescue tech, underbuilt point of care12:29 Area puncture vs rope-ladder reality13:44 Photograph, QR scale, mark every stick15:25 Heat maps that show where you’ve been18:26 From curious investor to operator25:24 Pilot lesson: recording without history is still blind32:33 Stop predicting pseudoaneurysms—prevent the pattern34:22 A 50% annual fistula patency bar37:28 The 1973 engineer who mapped every poke50:04 Pilot size, clustering trend, what to prove nextFollow the guest:LinkedIn: https://www.linkedin.com/in/vascularmdjaxProduct named in-episode: Veristra (dialysis access management software; spelling normalized from transcript variants)Resources mentioned:Rope-ladder vs area-puncture cannulation (discussed as established literature; no single paper titled on-air)Guest-stated CMS-scale U.S. dialysis burden and annual intervention needFDA breakthrough device pathway as narrated for their concept1973 dialysis reimbursement moment and the patient-engineer access logIf you operate or cannulate access, watch the black-hole segment, then the heat-map workflow, and ask where your system is still flying blind.Life of Flow is hosted by Dr. Lucas Ferrer & Dr. Miguel Montero-Baker.🌐 Website: https://lifeofflowpodcast.com▶ YouTube: https://www.youtube.com/@LifeofFlowPodcast🎧 Listen: Spotify https://open.spotify.com/show/5GMv47SJ0ePxbjtIb1GZ5U · Apple https://podcasts.apple.com/us/podcast/life-of-flow/id1705596604📩 Partner with the show: [email protected]Connect with the hosts:Prepared for Life of Flow publication. Educational discussion only; not individualized medical advice. The core question is whether better chair-side memory can reduce repeated injury

WARNING: RVUs may measure a physician's activity, but they can keep doctors from seeing the real money their work creates. Hospitals know the value of every procedure. Most physicians never see the numbers.

Dr. Eric Smuclovisky is an interventional radiologist, former academic physician and independent physician-entrepreneur. After opening an OBL/ASC, he watched reimbursement cuts and negative media pressure threaten the model. He then found another route to autonomy: negotiating professional service agreements that allow physicians to work with hospitals without surrendering their independence as W-2 employees.

In this conversation, Dr. Eric Smuclovisky reveals:

⬛ Why physician fees collapsed while hospital facility fees expanded—and how that changed who controls American medicine

⬛ Why he calls RVUs “monopoly money,” and how doctors can begin discovering what is actually billed under their names

⬛ How the No Surprises Act, charge lists, payer contracts, and IDR expose the hidden economics behind a medical bill

⬛ Why the physician shortage may finally give doctors enough leverage to negotiate from strength

Eric explains why a hospital's charge list is its “dirty little black book.” Hospitals set prices then negotiate discounts with commercial payers; those deals are not simple multiples of Medicare. A summary of benefits might show an $80,000 charge, roughly $20,000 paid, and $1,000 owed by the patient. The gaps reveal the private contracts behind the bill. It matters.

Follow Dr. Eric Smuclovisky:

LinkedIn: https://www.linkedin.com/in/eric-smuclovisky-58206927b/

Resources mentioned in this episode:

🏢 Outpatient Endovascular and Interventional Society (OEIS): https://oeisweb.com/

🔗 Stark Law, CMS: https://www.cms.gov/medicare/regulations-guidance/physician-self-referral

🔗 No Surprises Act and independent dispute resolution, CMS: https://www.cms.gov/nosurprises

🔗 CMS Physician Fee Schedule and CPT reimbursement lookups

👤 Ross Perot, referenced during the discussion of RVU history

Life of Flow is hosted by Dr. Lucas Ferrer and Dr. Miguel Montero-Baker.

🌐 Website: https://lifeofflowpodcast.com

▶ YouTube: https://www.youtube.com/@LifeofFlowPodcast

🎧 Listen: Spotify https://open.spotify.com/show/5GMv47SJ0ePxbjtIb1GZ5U · Apple https://podcasts.apple.com/us/podcast/life-of-flow/id1705596604

📩 Partner with the show: [email protected]

Connect with the hosts:

Dr. Lucas Ferrer — [Lucas LinkedIn]

Dr. Miguel Montero-Baker — https://www.linkedin.com/in/miguel-montero-baker-a44354214/

Follow Life of Flow:

Instagram: https://www.instagram.com/lifeofflowpodcast/

X: https://x.com/vascularpodcast

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

A 72-year-old man was sent for a major amputation. One angiogram exposed the anatomy everyone else had missed—and a path to save his limb.

Dr. Mariano Palena is an interventional radiologist and vascular specialist focused on complex endovascular limb salvage and chronic limb-threatening ischemia. In this Case Cast, he joins Dr. Lucas Ferrer and Dr. Miguel Montero-Baker to reconstruct a rescue that began after failed surgical revascularization and ended with a healed foot.

The patient had diabetes, ischemic heart disease, bilateral CLTI, a previous left transmetatarsal amputation, and extensive gangrene of the right forefoot. A prior team explored possible bypass targets and concluded that nothing more could be done. Mariano’s team challenged that conclusion with a rule every limb-salvage program should confront: no major amputation without angiography.

In this conversation, Dr. Mariano Palena reveals:

⬛ Why a foot that looks like a vascular “desert” may still contain hibernating vessels—and the clues that reveal them.

⬛ How an anatomical variation in the plantar circulation can make a reasonable bypass strategy fail before the true target is recognized.

⬛ Why telling patients that bypass is “one and done” creates the wrong expectations for a chronic disease that may require repeat maintenance.

⬛ What changes when clinicians describe limb salvage as remission rather than cure—and why another intervention may still be a successful outcome.

⬛ How Mariano follows angiographic “breadcrumbs,” crosses long chronic total occlusions, re-enters plantar vessels, and rebuilds flow through the foot.

⬛ Why the team debated opening one tibial pathway versus two—and whether extra flow justified more time, contrast, radiation, and devices.

⬛ What happened after the final angiographic “wow” moment: reconstruction, complete healing at three months, and a return to work.

This is not a promise that every threatened limb can be saved. It is a close look at the reasoning, imaging, technical persistence, and honest patient counseling required before an irreversible decision is safely made.

Timestamps:

00:00 — The Life of Flow Case Cast returns

01:20 — A limb referred for major amputation

03:12 — Gangrene, failed bypass exploration, and WIfI

05:31 — Limb salvage as remission, not cure

07:24 — Why bypass is not “one and done”

09:36 — Mariano on repeat interventions and expectations

12:04 — “No amputation without angiography”

16:11 — CO₂ angiography and severe below-knee disease

20:19 — The “desert foot” appears

21:44 — The anatomical variation that changed the case

26:29 — Following the angiographic breadcrumbs

30:07 — Crossing strategy for a long CTO

35:53 — Recanalizing the peroneal pathway

38:41 — Re-entry into the lateral plantar artery and arch

43:58 — One-vessel versus two-vessel revascularization

50:36 — The final angiographic “wow” moment

53:59 — Why a limb-salvage second opinion matters

54:56 — Fully healed at three months

56:18 — Closing perspective

Follow Dr. Mariano Palena:

LinkedIn: https://it.linkedin.com/in/mariano-palena-35b62259

Website: https://marianopalena.com/

Resources mentioned in this episode:

• WIfI classification and the Global Vascular Guidelines

• BEST-CLI trial

• CO₂ angiography

• Navicross and Bernstein catheters

• Terumo and Asahi guidewires

Life of Flow is hosted by Dr. Lucas Ferrer & Dr. Miguel Montero-Baker.

🌐 Website: https://lifeofflowpodcast.com

▶ YouTube: https://www.youtube.com/@LifeofFlowPodcast

🎧 Listen: Spotify https://open.spotify.com/show/5GMv47SJ0ePxbjtIb1GZ5U · Apple https://podcasts.apple.com/us/podcast/life-of-flow/id1705596604

📩 Partner with the show: [email protected]

Connect with the hosts:

Dr. Lucas Ferrer — [Lucas LinkedIn]

Dr. Miguel Montero-Baker — https://www.linkedin.com/in/miguel-montero-baker-a44354214/

Follow the show: Instagram https://www.instagram.com/lifeofflowpodcast/ · X https://x.com/vascularpodcast · LinkedIn https://www.linkedin.com/company/lifeofflow

The Microhospital Playbook with Dr. Adriano Goffi

A physician can own 100 freestanding ERs—but direct ownership of one microhospital creates a completely different legal and financial reality. Dr. Adriano Goffi explains the economics, operating model, and ownership structures behind a more physician-led alternative.

Dr. Adriano Goffi, MD, MPH, is a board-certified family medicine physician.  He is the Director at East Houston Medical Center. He brings an operator’s view of how clinical care, reimbursement, staffing, physician autonomy, and ownership collide.

In this conversation, Dr. Goffi reveals:

• Why he believes a well-run microhospital can complete in eight hours what might otherwise require five to nine separate medical visits

• How physician-ownership restrictions shape the use of land companies, nonprofit structures, trusts, and other arrangements that require expert legal review

• How reserving equity keeps clinicians invested

  
  

Meet Dr. Adriano Goffi

05:14

Why locums gave Adriano control of his time

08:59

Learning medicine “backwards” through DRGs and medical decision-making

12:18

Why sending chest-pain patients home felt incomplete

14:13

The economics of eight ER patients per day

15:00

Turning a freestanding ER into a microhospital

21:19

The 24-hour-shift tradeoff and physician quality of life

22:39

Why doctors can own ERs but face restrictions on hospital ownership

24:08

Delivering five to nine visits’ worth of care under one roof

28:13

What a microhospital actually is

33:34

Staffing and equipping a standalone emergency room

36:52

Why inpatient beds open the door to Medicare participation

39:11

Capital raises, land, debt, and the opening-day clock

40:26

EBITDA multiples and why attached clinics matter

41:32

Why physician ownership changes culture and patient experience

42:20

Is the freestanding emergency-room boom ending?

45:36

The single screening question that generated 50 colonoscopies

47:07

Hypothetical: building a physician-led microhospital in Houston

47:34

Land ownership, trusts, and the need for specialized counsel

49:46

Site selection: traffic patterns, income, and the Walmart heuristic

51:50

What a $20 million state-of-the-art build could include

53:14

Why growth is shifting from standalone ERs to microhospitals

53:54

Building a hospital in six months with modular pods

55:32

Why 10 to 20 beds is Adriano’s sweet spot

57:16

Would you sell to a health system—or keep physician ownership?

59:44

Reserving equity for the clinicians doing the work

61:21

Could an office-based vascular model live inside a microhospital?

LinkedIn: https://www.linkedin.com/in/adriano-goffi-md-mph-81b399a2/

CMS guidance on physician-owned hospitals: https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/physician-owned-hospitals

CMS independent dispute resolution under the No Surprises Act: https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans

U.S. Small Business Administration loan programs: https://www.sba.gov/funding-programs/loans

Life of Flow is hosted by Dr. Lucas Ferrer and Dr. Miguel Montero-Baker.

Website: https://lifeofflowpodcast.com/

▶ YouTube: https://www.youtube.com/@LifeofFlowPodcast/

🎧 Spotify: https://open.spotify.com/show/5GMv47SJ0ePxbjtIb1GZ5U

🎧 Apple Podcasts: https://podcasts.apple.com/us/podcast/life-of-flow/id1705596604

📩 Partner with the show: [email protected]

Connect with the hosts:

Dr. Lucas Ferrer: https://www.linkedin.com/in/lucasferrermd/

Dr. Miguel Montero-Baker: https://www.linkedin.com/in/miguel-montero-baker-a44354214/

Instagram: https://www.instagram.com/lifeofflowpodcast/

X: https://x.com/vascularpodcast

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

#Microhospital #PhysicianEntrepreneurship #EmergencyMedicine #HealthcareBusiness #LifeOfFlowPodcast

This episode is for educational and informational purposes only and does not constitute medical, legal, tax, investment, or financial advice.

Dr. Christoff Heunis is a biomedical and mechatronics engineer (PhD, University of Twente) and the founder & CEO of Flux Robotics, a University of Twente spin-off building a magnetically guided robotic system that steers a guidewire through the body from outside the patient. It started with a single phone call while he was an engineering student in South Africa — a best friend's mother had a stroke, and there were only a handful of surgeons on an entire continent who could treat it.

In this conversation, Dr. Christoff Heunis reveals:

⬛ Why one phone call — a friend's mother's stroke, with "three neurovascular surgeons" for the whole African continent — set the course of his life

⬛ How an external robotic magnet can pull a guidewire around the tightest, most complex angles a surgeon's hands can't reach

⬛ Why surgeons say they don't want to be replaced — yet "do want to press a button and then leave, and when I come back, the surgery is over"

⬛ The first real-world use case: misaligned fenestrations, CTOs and the angles no combination of guide catheters can make

⬛ How Flux got the FDA to confirm a 510(k) pathway — and why the predicate they found changes everything

⬛ What Stereotaxis acquiring Robocath signals about the commercial future of magnetic surgery

⬛ How he raised €3.2M in non-dilutive funding before giving up a single point of equity

Timestamps:

00:00 Intro — the "Afrikaans Slim Shady"

04:58 The stroke that started it all

06:29 Why a PhD in surgical robotics at Twente

11:17 The surgeon's real bottleneck: navigation & radiation

15:42 How the magnetic guidewire actually works

20:02 "Press a button and the surgery is over"

24:58 The first use case: misaligned fenestrations

30:49 A carotid crossing, step by step

34:37 The surgeon's new role: "PAD coach"

36:00 Company update & new CMO Dr. Rob Beasley

37:15 The 510(k) pathway, explained

40:31 Stereotaxis buys Robocath

50:04 Raising €3.2M non-dilutive

59:24 Live: the Afrikaans rap "Soms"

Follow Dr. Christoff Heunis:

LinkedIn — https://www.linkedin.com/in/christoff-heunis/

Flux Robotics — https://fluxrobots.com

Resources mentioned in this episode:

🏢 Flux Robotics — https://fluxrobots.com

🏢 Stereotaxis — https://www.stereotaxis.com

🔗 Stereotaxis acquires Robocath (announcement) — https://ir.stereotaxis.com/news-releases/news-release-details/stereotaxis-announces-definitive-agreement-acquire-robocath

🏢 Robocath — https://www.robocath.com/

🏢 Intuitive / da Vinci Surgical System — https://www.intuitive.com

🎓 University of Twente — https://www.utwente.nl/en/

🎓 Stellenbosch University — https://www.sun.ac.za/english

🏛 RVO — Netherlands Enterprise Agency — https://www.rvo.nl

🏛 NWO — Dutch Research Council — https://www.nwo.nl/en

🏛 Interreg (EU cross-border funding) — https://www.interreg.eu

💸 NextGen Ventures — https://www.nextgenventures.nl

💸 Future Tech Ventures — https://futuretechventures.nl

👤 Dr. Rob Beasley — CMO, Flux Robotics — https://www.linkedin.com/in/robert-beasley-138124145/

👤 David Fischel — Chairman & CEO, Stereotaxis — https://www.linkedin.com/in/davidfischel/

🎵 Eminem — "Lose Yourself" — https://open.spotify.com/track/5Z01UMMf7V1o0MzF86s6WJ

🎵 "Soms" — Christoff's Afrikaans rap single, with his brother Daniel (name only)

Life of Flow is hosted by Dr. Lucas Ferrer & Dr. Miguel Montero-Baker.

🌐 Website: https://lifeofflowpodcast.com

▶ YouTube: https://www.youtube.com/@LifeofFlowPodcast

🎧 Listen: Spotify https://open.spotify.com/show/5GMv47SJ0ePxbjtIb1GZ5U · Apple https://podcasts.apple.com/us/podcast/life-of-flow/id1705596604

📩 Partner with the show: [email protected]

Connect with the hosts:

Dr. Lucas Ferrer — https://www.linkedin.com/in/lucasferrermd/

Dr. Miguel Montero-Baker — https://www.linkedin.com/in/miguel-montero-baker-a44354214/

Follow the show: Instagram https://www.instagram.com/lifeofflowpodcast/ · X https://x.com/vascularpodcast · LinkedIn https://www.linkedin.com/company/lifeofflow

In this episode, we sit down with Dr. Shahla Moghbel, D.O., a board-certified neurologist based in California who works as an independent contractor, and Dr. Santoshi Billakota, M.D., a board-certified neurologist and epileptologist based in New York City who works full-time in locum tenens.

They share why they stepped away from traditional physician employment, how they prepared financially for the change, and what doctors need to understand about credentialing, contracts, taxes, benefits, and retirement before going independent.

They also speak candidly about the identity shift that can come with leaving academic medicine or another traditional institutional path, and learning to separate professional value from institutional affiliation.

04:54 The shame and identity shift that can come with leaving a traditional career path

11:34 The random Wednesday that changed Lucas’s definition of freedom

17:10 Santoshi’s one-year plan for researching and preparing to leave her job

21:26 Shahla’s strategy of reducing her hours and calculating her minimum financial needs

27:32 Using locums as a bridge and learning how to negotiate better opportunities

30:24 The difference between hospital privileges and insurance credentialing

37:08 Why medical training leaves out contracts and the business side of medicine

39:47 Moving from W2 employment to 1099 work with support from a lawyer and CPA

44:10 Solo 401(k) plans, health benefits, and outsourcing financial planning

Who Should Listen

This episode is for physicians considering locums, independent contract work, or a move away from academic or employed medicine. It is especially relevant for doctors who want more autonomy but need a practical view of the financial, administrative, and personal decisions involved.

About Shahla Moghbel, D.O.

Dr. Shahla Moghbel is a board-certified neurologist based in Walnut Creek, California. She completed her neurology residency at Georgetown University, an administrative and business fellowship at Vituity Stanford, and a clinical neurophysiology fellowship at Stanford Medicine. After working in a partnership, she moved into independent contract work across neurology and also does nonclinical work. She co-hosts the Be Empowered podcast, where she and Santoshi speak with physicians about burnout, career changes, and work outside the traditional path.

Connect with Shahla Moghbel, D.O.

💼 LinkedIn: Shahla Moghbel D.O.

About Santoshi Billakota, MD

Dr. Santoshi Billakota is a board-certified neurologist and epileptologist based in Brooklyn. After completing residency at Duke, fellowship at Columbia, and an academic appointment at NYU, she left academic medicine and now works full-time as a locums physician while also taking on nonclinical work. She co-hosts the Be Empowered podcast, which focuses on healthcare issues, including topics concerning women.

Connect with Santoshi Billakota, M.D.

💼 LinkedIn: Santoshi Billakota M.D.

🎙️Connect with Be Empowered: The Podcast

Spotify: Be Empowered: The Podcast

Apple: Be Empowered: The Podcast

YouTube: Be Empowered: The Podcast

Instagram: @Empowermedlife

About Locumstory

Locumstory is a free, unbiased educational resource about locum tenens to answer your questions about the how-tos of locums on their website, podcast, webinars, videos, and a locums 101 crash course.

Visit locumstory.com to find out if locum tenens makes sense for you and your career goals.

Follow Life of Flow

📲 Instagram: ⁠⁠⁠⁠⁠@LifeofFlowPodcast⁠⁠⁠⁠⁠

👍 Facebook: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

💼 LinkedIn: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

🐦 X: ⁠⁠⁠⁠⁠@VascularPodcast

If this conversation changed how you think about physician independence, locums, and what it takes to step away from traditional employment without leaving the financial side to chance, share it with a colleague who’s considering a different path in medicine. And if you’re enjoying Life of Flow, a quick review helps more physicians and healthcare leaders find conversations like this.

In this episode of Life of Flow, we sit down with Dr. Eric Smuclovisky, M.D., an interventional radiologist in Indianapolis, Indiana, affiliated with Elkhart General Hospital. Eric joins us for a direct conversation about physician independence, why the old private practice model became harder to sustain, what changed for OBLs, and how independent physicians can think about hospital service agreements without becoming hospital employees.

04:30 What changed when OBL revenue took a hit

07:56 How physician fees shaped the old private practice model

13:04 Why hospital privileges once gave physicians more control

15:40 The history behind physician lounges and hospital incentives

31:28 Why physicians need to understand how the money moves

40:17 Why OBLs may still matter, even as the model gets harder

43:39 Why RVUs keep physicians disconnected from real revenue

46:01 Charge lists, commercial payers, and understanding what hospitals bill

56:28 Selling a service line to a hospital and negotiating a fixed rate

Who Should Listen

This episode is for vascular surgeons, interventional radiologists, cardiologists, independent physicians, and early career physicians who want to understand the business side of medicine. It is especially relevant for anyone thinking about OBLs, hospital relationships, service agreements, or how to maintain more autonomy without working fully outside the system.

About Dr. Eric Smuclovisky, M.D.

Dr. Eric Smuclovisky is an interventional radiology doctor in Indianapolis, Indiana and is affiliated with Elkhart General Hospital. He received his medical degree from Ponce Health Sciences University and has been in practice between 11 and 20 years. In the episode, Eric shares that he started out in academics, later left, opened an OBL and ASC with a partner, and now works through a professional service agreement with a hospital alongside his partner Brian.

Connect with Dr. Smuclovisky

💼 LinkedIn: Eric Smuclovisky

About Locumstory

Locumstory is a free, unbiased educational resource about locum tenens to answer your questions about the how-tos of locums on their website, podcast, webinars, videos, and a locums 101 crash course.

Visit locumstory.com to find out if locum tenens makes sense for you and your career goals.

Follow Life of Flow

📲 Instagram: ⁠⁠⁠⁠⁠@LifeofFlowPodcast⁠⁠⁠⁠⁠

👍 Facebook: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

💼 LinkedIn: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

🐦 X: ⁠⁠⁠⁠⁠@VascularPodcast

If this conversation changed how you think about physician independence, hospital service agreements, and what it takes to build leverage without becoming employed by the system, share it with a colleague who’s thinking about the business side of medicine. And if you’re enjoying Life of Flow, a quick review helps more physicians and healthcare leaders find conversations like this.

In this episode of Life of Flow, we sit down with Dr. Robert Pearl, M.D., former CEO of The Permanente Medical Group, author of ChatGPT, MD, and a leading voice on how generative AI could change American medicine.

The conversation moves between physician-led systems, private practice, capitation, chronic disease control, and what happens when AI begins working inside the daily gaps between patient visits. Dr. Pearl makes the case that AI is not just an administrative tool, but a way to improve quality, lower costs, and give physicians more time for the patients who need them most.

05:35 Writing ChatGPT, MD, and the malpractice question around AI

08:47 Patient trust, human presence, and vulnerable moments in care

11:14 AI-assisted diagnosis, malpractice premiums, and physician autonomy

18:19 Administrative AI and the bigger shift inside care delivery

25:58 What AI means for physicians entering medicine now

33:42 Why generative AI has to be discussed in the context of capitation

38:33 The tools physicians have today that did not exist three years ago

45:17 Bringing the capitation conversation back to AI

48:10 AI agents and the future of patient follow-up

51:32 Where to find Dr. Pearl’s book and ongoing work

Who Should Listen

This episode is for physicians, private practice owners, healthcare operators, and anyone thinking seriously about how generative AI, capitation, and physician-led care could change the economics and delivery of medicine. It is especially relevant for clinicians trying to understand where independence, technology, and patient trust fit into the next phase of healthcare.

About Dr. Robert Pearl, M.D.

Dr. Robert Pearl, M.D., served as CEO of The Permanente Medical Group, where he was responsible for physicians across the East Coast and West Coast, and describes Permanente as the physician side of Kaiser Permanente. In the episode, he explains that Permanente was physician-owned and physician-run, with its own board of directors, and that the organization established standards of care across settings, including the OR, cath labs, and ERs.

Dr. Pearl is also the author of ChatGPT, MD, a book focused on how AI empowered patients and physicians can take back control of American medicine. He writes for Forbes, posts articles on LinkedIn, hosts the Fixing Healthcare podcast, and continues to speak and write about generative AI, healthcare strategy, capitation, and the future of physician-led care.

Connect with Dr. Pearl

💼 LinkedIn: Robert Pearl, M.D.

🗞️ Website: robertpearlmd.com

About Locumstory

Locumstory is a free, unbiased educational resource about locum tenens to answer your questions about the how-tos of locums on their website, podcast, webinars, videos, and a locums 101 crash course.

Visit locumstory.com to find out if locum tenens makes sense for you and your career goals.

Follow Life of Flow

📲 Instagram: ⁠⁠⁠⁠⁠@LifeofFlowPodcast⁠⁠⁠⁠⁠

👍 Facebook: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

💼 LinkedIn: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

🐦 X: ⁠⁠⁠⁠⁠@VascularPodcast

If this conversation changed how you think about generative AI, physician-led care, and what it could take to improve outcomes without losing the human side of medicine, share it with a colleague who’s thinking about where healthcare is heading. And if you’re enjoying Life of Flow, a quick review helps more physicians and healthcare leaders find conversations like this.

In this episode of Life of Flow, we sit down with Preston Alexander, co-founder of Forward Slash Health, for a practical conversation about the business side of private practice. Preston shares how he went from medical device product management to healthcare startups, consulting, revenue cycle work, and building a financial management platform for independent practices.

We talk through the financial blind spots many physicians face when they leave employed medicine, including revenue cycle, cash flow, accounts receivable, accounts payable, outsourcing, staffing, and why understanding the numbers matters if you want to build a sustainable practice.

07:30 Preston’s path from MBA to medical devices and healthcare business

09:01 Using LinkedIn to learn how healthcare really works

11:02 How Forward Slash Health started from private practice pain points

18:27 Why Miguel keeps his revenue cycle team close to the practice

24:04 Cash flow, seasonality, and why big checks can be misleading

35:00 Where private practices commonly leak money

42:40 Why “doctors are bad at business” misses the point

54:30 What to know before outsourcing revenue cycle management

57:35 How to connect with Preston and Forward Slash Health

Who Should Listen

This episode is for physicians, surgeons, private practice owners, and doctors thinking about leaving the hospital system to build something independent. It’s also useful for anyone in healthcare operations who wants a clearer understanding of how revenue cycle, staffing, vendor relationships, and cash flow affect a practice.

About Preston Alexander

Preston Alexander is the CEO and co-founder of Forward Slash Health and Chief Operating Officer at Underscore Law. His background spans healthcare business, medical device product management, digital health, revenue cycle work, and private practice financial management.

In the episode, he shares how his path from earning an MBA to working inside healthcare companies, launching and selling a medical device company, and helping build independent practices led him to focus on the financial systems physicians need to understand when running a practice.

Connect with Preston

💼 LinkedIn: Preston Alexander

🗞️ Substack: The Healthcare Breakdown

About Locumstory

Locumstory is a free, unbiased educational resource about locum tenens to answer your questions about the how-tos of locums on their website, podcast, webinars, videos, and a locums 101 crash course.

Visit locumstory.com to find out if locum tenens makes sense for you and your career goals.

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If this conversation made you think differently about the business side of medicine, share it with a colleague who’s building, running, or considering an independent practice. And if you’re enjoying Life of Flow, a quick review helps more physicians and healthcare leaders find conversations like this.

Andrew Sponsler, founder of Axiom, joins us this week to talk about agentic AI, personal operating systems, and why physicians should start experimenting before the tools become fully packaged for everyone else.

Andrew builds AI operating systems for businesses, and in this episode, he breaks down what agentic AI means, how founders are using it now, and where it could start removing real operational pain from medical practices, from case logging to revenue cycle management.

03:04 What agentic AI is and why it matters

04:10 Andrew’s four-layer framework for understanding AI tools

07:00 How agentic AI acts beyond a single prompt

08:41 Why most people still have not engaged with AI

10:37 Should people start building now or wait for easier tools?

14:32 Why surgeons are wired to spot problems worth solving

17:44 Lucas’ case logging and billing workflow idea

22:39 Where beginners can start with Claude Code

30:29 Hardware, security, model routing, and basic setup

34:34 How Andrew helps businesses map and automate workflows

43:35 Why revenue cycle management may be the highest ROI use case

Who Should Listen

This episode is for physicians, surgeons, founders, operators, and medical practice owners who are curious about using AI to reduce operational friction without losing control of the work. It will especially resonate with anyone thinking about case logs, billing workflows, dashboards, communication overload, or the practical first steps of building with AI.

About Andrew Sponsler

Andrew Sponsler is the founder of Axiom, where he builds AI operating systems for businesses. His background is in continuous improvement and process mapping, and in the episode, he describes working with small and midsize businesses to create AI native workflows, streamline operations, and automate processes that create bottlenecks for founders and teams. He also runs Builder Weekend in Austin, a hands-on event for people building with AI at different stages.

Connect with Andrew

📲 Instagram: @andrewsponsler

💼 LinkedIn: @andrewsponsler

Follow Life of Flow

📲 Instagram: ⁠⁠⁠⁠⁠@LifeofFlowPodcast⁠⁠⁠⁠⁠

👍 Facebook: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

💼 LinkedIn: ⁠⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠⁠

🐦 X: ⁠⁠⁠⁠⁠@VascularPodcast

If this conversation changed how you think about agentic AI, physician-built tools, and what it could look like to automate the parts of medical practice that slow people down, share it with a colleague who’s curious about where this is all heading. And if you’re enjoying Life of Flow, a quick review helps more physicians and builders find conversations like this.