Off the Chart: A Business of Medicine Podcast

By Medical EconomicsBusiness

Off the Chart: A Business of Medicine Podcast episodes

January 26 S1 Ep119: The staffing squeeze, with Rihan Javid, D.O., J.D., of Edge
Rising minimum wages, fierce labor competition and persistent turnover are reshaping how physician practices operate — and higher pay alone isn’t solving the problem.
Rihan Javid, D.O., J.D., a psychiatrist and co-founder and president of Edge, a remote staffing organization, about how staffing pressures are landing inside medical practices in 2026.
Javid explains why small practices and rural hospitals are feeling the impact first, which roles are hardest to replace, and how frequent turnover quickly turns into operational and financial strain for physicians. He also shares practical guidance on retention, budgeting for the year ahead, and why flexibility — including remote staffing — is becoming essential as practices adapt to a changing labor market.
Music Credits:
Super Vibe Vlog by Elonix - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Why increasing salaries alone isn’t enough to solve staffing challenges.
0:22 — Intro
Austin Littrell introduces the episode, the Practice Academy note, and previews the discussion with Rihan Javid.
1:34 — Interview begins
Austin welcomes Javid and kicks off the conversation.
1:40 — Minimum wage increases hit practices
How rising minimum wages are affecting physician practices and rural hospitals.
1:53 — Tight margins, big jumps
Why sudden wage increases can blow up practice budgets.
2:55 — Why higher pay isn’t stopping turnover
Competing with large health systems, universities and public-sector benefits.
4:13 — The hardest roles to replace
Why patient-facing staff and billing roles create the biggest bottlenecks.
5:30 — The salary arms race
How pay increases turn into a cycle that practices can’t win.
5:48 — Building a core workforce
Why long-term retention matters more than constant replacement.
7:15 — P2 Management Minute
Keith Reynolds shares a quick note for practice leaders.
8:05 — When turnover hits daily operations
How staffing shortages push more work onto physicians.
8:42 — Budgeting for 2026
Why flexibility matters more than precision.
9:38 — One piece of retention advice
Treat employees well, pay competitively and be clear about expectations.
10:07 — Responding when staff leave
Why practices need to look inward — and outward.
10:22 — Thinking beyond local hiring
How remote staffing is filling gaps practices can’t solve locally.
11:39 — Roles that can go remote
Deciding which positions need to be in-person and which don’t.
12:27 — Closing thoughts
Final takeaways on flexibility and planning.
12:36 — Outro
Wrap-up, subscription reminder and Practice Academy note.
14 min
January 22 S1 Ep118: How to market an independent practice in 2026, with Carl White of MarketVisory Group
Independent medical practices are facing more competition than ever — from hospital systems, urgent care chains, private equity–backed groups and other local practices just down the road.
Medical Economics Content Vice President Chris Mazzolini sat down with Carl White, president and founder of MarketVisory Group, to talk about what it actually takes for independent practices to stay visible, relevant and competitive.
White explains why simply providing good care is no longer enough, how practices should think about differentiation and where marketing efforts often miss the mark. They also explore the growing role of generative artificial intelligence (GenAI) in health care marketing, why fundamentals like search and consistency still matter most and how practices can avoid blending into the noise.
They discuss patient retention, operational friction points that quietly drive patients away and the small set of metrics practice leaders should watch to understand whether their strategy is working.
Music Credits:
Quiet Dawn by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Why independent practices are competing for a shrinking pool of patients.
0:19 — Intro
Austin Littrell introduces the episode and previews the conversation with Carl White on physician marketing.
1:36 — Interview begins
Chris Mazzolini welcomes Carl White and frames the marketing challenges facing independent practices in 2026.
1:49 — The competition problem
Why independent practices are fighting for attention against urgent care, hospital systems and retail clinics.
2:19 — A shrinking patient pool
How rising insurance costs are quietly reducing the number of insured patients.
3:20 — Standing out in a smaller market
Why practices must clearly show value as competition intensifies.
3:35 — Private-pay and concierge realities
Why not every private-pay idea meets real patient demand.
5:00 — “Good care isn’t enough” anymore
Why quality medicine is expected — not a differentiator.
5:26 — Why patients comparison shop
How patients choose between practices when clinical quality looks the same.
6:51 — When marketing gaps start to show
Why ignoring competition is no longer an option.
7:03 — Generative artificial intelligence enters marketing
How artificial intelligence is changing content and visibility.
8:48 — “Teach me” vs recommendations
Which artificial intelligence prompts practices can realistically compete for.
9:33 — Why search still matters most
How artificial intelligence tools pull from Google, reviews and local search.
10:13 — Artificial intelligence and content quality
Why sounding authentic still matters more than speed.
11:18 — Where artificial intelligence actually helps
Using artificial intelligence for internal operations like appeals and documentation.
12:09 — What actually moves the needle
Identifying what’s valuable and different for patients.
13:30 — Consistency beats volume
Why repeating a clear message matters more than chasing trends.
14:32 — Location still matters
Why practice placement can make or break growth.
15:43 — Thought leadership as marketing
How physicians can build credibility without becoming full-time creators.
18:06 — Setting goals for thought leadership
Why marketing must align with a clear objective.
19:04 — Retention vs acquisition
Keeping patients loyal without feeling “salesy.”
21:12 — Operational friction drives patients away
Scheduling, reminders and visit efficiency as marketing tools.
22:26 — Making the practice experience easier
Why convenience matters as much as care.
23:54 — Measuring success in 2026
Which metrics actually predict growth and stability.
25:00 — Reviews, satisfaction and staff retention
Why feedback and employee morale matter more than trends.
26:53 — A critical HIPAA reminder
Where marketing and compliance overlap — and why it matters.
27:48 — Final thoughts
Carl White’s closing advice for independent practices.
28:22 — Outro
Austin Littrell wraps up the episode.
30 min
January 19 S1 Ep117: What patients are hearing, with Colleen Denny, M.D., FACOG
Patients are making health decisions in a very different information environment — one shaped by social media, search engines, generative artificial intelligence (AI) and increasingly politicized medical claims.
Medical Economics Senior Editor Richard Payerchin sat down with Colleen Denny, M.D., FACOG, chief ethics officer for the American College of Obstetricians and Gynecologists (ACOG), to talk about where patients are hearing medical misinformation, how it's showing up in exam rooms and what physicians can do about it.
Denny explains why misinformation now extends far beyond vaccines, touching everything from contraception and pregnancy care to acetaminophen use during pregnancy and reproductive health more broadly. She discusses how patients weigh online claims alongside clinical advice, how conflicting federal messaging can complicate care and why physicians have a responsibility to clarify evidence even when the science is nuanced.
Music Credits:
Sky drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Why it’s more complicated to be a patient today than it was before the internet.
0:13 — Intro
Austin Littrell introduces the episode and previews the discussion with Colleen Denny, M.D., FACOG, on medical misinformation.
1:12 — Interview begins
Richard Payerchin welcomes Denny and asks about trust in medicine and whether science is under attack.
1:35 — The information overload problem
How social media, search engines and generative AI have changed patient decision-making.
3:21 — Erosion of trust — and what hasn’t changed
Why patients still say they want information from physicians, even as other sources grow louder.
4:44 — “Dr. Google” in the exam room
Real examples of misinformation patients bring to OB-GYN visits.
5:00 — Contraception myths and clickbait headlines
From benign concerns to fears about permanent infertility.
5:46 — Depo-Provera and meningioma headlines
How partial data and sensational framing complicate patient counseling.
6:34 — Balancing risk and reality
Helping patients weigh rare risks against the real consequences of pregnancy.
8:05 — Misinformation beyond vaccines
How acetaminophen guidance during pregnancy became a flashpoint.
8:23 — Physicians’ responsibility to clarify evidence
Why doctors must speak up when high-profile claims conflict with training and data.
9:15 — ACOG’s stance on Tylenol during pregnancy
Explaining the disconnect between FDA messaging and clinical recommendations.
10:00 — ACOG resources for physicians and patients
How the college is pushing back on non-medical voices shaping care.
12:52 — Should physicians be on social media?
Why avoiding platforms like TikTok may be a mistake.
14:01 — Meeting patients where they are
Why misinformation is the competition — and how physicians can respond.
15:40 — Supporting physicians who speak online
Why practices may need to invest time and resources.
16:18 — A message for primary care physicians
Why reproductive health misinformation is increasingly landing in primary care.
17:24 — Partnering with OB-GYNs
Using collaboration and telemedicine to improve patient care.
19:25 — Vaccines in pregnancy
Why pregnancy changes the vaccine conversation.
19:52 — HPV vaccination reframed
Why it should be discussed as cancer prevention.
22:09 — Trust, burnout and persistence
Why physicians should remember patients still trust them — even when they say they don’t.
24:59 — Outro
Closing remarks and where to find more Off the Chart episodes.
26 min
January 15 S1 Ep116: Financial independence, with Michael Jerkins, M.D., M.Ed.
Physicians spend years mastering medicine, but many leave training with little guidance on managing money, debt or long-term financial decisions.
Michael Jerkins, M.D., M.Ed., an internal medicine and pediatrics physician and co-founder of Panacea Financial, sits down with Medical Economics Senior Editor Richard Payerchin to break down what financial pressures look like at every stage of a physician’s career — from residency cash-flow strain and student loans to practice ownership and long-term stability.
They explore why so many physicians struggle with traditional banking models, what “financial independence” really means for physicians and how financial decisions can quietly limit control over time. Jerkins also discusses growing interest in independent practice, direct primary care (DPC) and concierge models, along with the importance of financial literacy early in a medical career.
Music Credits:
Healing breeze by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Michael Jerkins, M.D., M.Ed., practicing internal medicine and pediatrics physician and co-founder of Panacea Financial, explains how physicians can earn enough to mask financial mistakes — while debt quietly takes control of their time and flexibility.
0:28 — Intro
Austin Littrell introduces the episode and previews Richard Payerchin’s conversation with Jerkins on physician debt, cash flow and long-term financial stability.
1:30 — Interview begins
Payerchin welcomes Jerkins to the podcast and opens the discussion.
1:35 — Physicians seeking control over their practices
Jerkins discusses growing interest among physicians in independence, the lack of business exposure in medical training and why many doctors don’t know where to start when considering ownership.
4:51 — Employment vs. independence for new physicians
Why most new residency and fellowship graduates still choose employed roles, even as entrepreneurial interest slowly increases.
6:28 — When physicians aren’t ready for financing
Jerkins explains common reasons loan applications fall short and how Panacea focuses on coaching and connection rather than simple rejection.
9:14 — Fixing financial literacy in medical education
Why meaningful financial and business training won’t improve without accreditation requirements—and how current systems waste effort reinventing the wheel.
11:51 — P2 Management Minute
Keith Reynolds delivers a one-minute segment inviting physicians to share real-world workflow and leadership lessons.
12:43 — Financial trends shaping the next decade
Jerkins outlines looming pressures including Medicaid cuts, rural hospital instability, private equity consolidation and maldistribution of care.
15:30 — Defining wealth for physicians
Why controlling time—not income or lifestyle upgrades—is the real measure of financial success.
18:38 — A message to primary care physicians
Jerkins reflects on the pressures facing primary care and urges physicians to seek leadership roles to influence systemic change.
20:02 — Closing remarks
Payerchin thanks Jerkins and wraps the interview.
20:31 — Outro
Littrell closes the episode with subscription details and production credits.
22 min
January 12 S1 Ep115: Reinventing physician training, with AMGA President Jerry Penso, M.D., MBA, and Practicing Excellence founder Stephen Beeson, M.D.
Health systems and medical groups are fighting the same three-headed problem: money, access and staffing.
In this episode, American Medical Group Association (AMGA) President and CEO Jerry Penso, M.D., MBA, and Practicing Excellence founder Stephen Beeson, M.D., discuss their new partnership meant to strengthen physician development without pulling clinicians out of the exam room.
They explain why traditional half-day seminars have lost their edge, how context-driven micro-coaching powered by artificial intelligence (AI) fits into daily clinical workflows and how organizations should measure success — including turnover, burnout, engagement and patient experience.
Music Credits:
Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Why growth and development are becoming central to retention.
0:33 — Intro
Austin Littrell sets up the partnership and what’s at stake for practices and health systems.
1:39 — The partnership, in plain terms
Keith Reynolds opens: what does the partnership entail?
1:56 — AMGA’s “top three” problems
Finances, access and workforce—and why workforce is the root issue.
3:32 — Why human development, why now
Beeson on creating cultures where people feel seen, supported and want to stay.
5:10 — Why AMGA chose Practicing Excellence
Members want solutions; AMGA vets partners through set criteria.
6:19 — The new “must-have” for retention
Clinicians increasingly choose organizations where they can grow and “ascend.”
7:21 — What feels different vs. traditional training
Why half-day seminars and PowerPoints don’t meet the moment.
8:34 — “Context is king”
Personalized, in-work learning that actually changes behavior.
11:12 — Beyond “see one, do one, teach one”
Why clinician development needs new tools in a faster-changing system.
12:10 — How AMGA members access it
Already used by 30 member organizations; AMGA facilitates and offers discounted rates.
13:20 — P2 Management Minute promo (mid-roll)
Keith Reynolds invites listener tips and submissions.
14:13 — What the coaching looks like in practice
Four domains: patient experience, team engagement, leadership effectiveness, clinical excellence/high reliability.
17:27 — Measuring success
Turnover, burnout, engagement surveys, outcomes tracking, use analytics and CME.
20:59 — Scorecards and culture
Why successful orgs define metrics and support clinicians with real tools.
22:53 — “One more tool” problem
Why it’s designed to fit into workflow in minutes/seconds at a time.
25:34 — Trust, guardrails and governance
AI governance expectations from member organizations.
26:36 — Security posture + no patient data claim
SOC 2 in progress; “no patient information” in the ecosystem.
27:38 — Final thoughts
“What got you here won’t get you there,” and a people-first closing.
29:52 — Outro
Wrap-up, subscribe CTA, production credits.
32 min
January 08 S1 Ep114: What we get wrong about vaccine hesitancy, with David Higgins, M.D., M.P.H., M.S.
Pediatrician and author David Higgins, M.D., M.P.H., M.S., joins the show to unpack what’s really happening with vaccine confidence. Higgins explains why true anti-vaccine activists are a tiny minority, how media coverage can exaggerate hesitancy and why most parents still want vaccines for their children — even if they come in with questions. He also digs into the role of social media algorithms in amplifying misinformation and the policy risks of assuming “everyone” is skeptical of shots.
Higgins shares practical, exam room–tested communication strategies that busy clinicians can use right away, including how to open vaccine conversations with confidence, use motivational interviewing without adding time to visits and apply his “fact–warning–fact” approach to defuse persistent myths.
Music Credits:
Kind Winds by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
An individual’s physician remains the most trusted source of vaccine information.
0:19 — Intro
Austin Littrell introduces Medical Economics Senior Editor Richard Payerchin and guest David Higgins, M.D., M.P.H., M.S., previewing their discussion on vaccine hesitancy, misinformation, and communication strategies for physicians.
1:11 — Interview begins
Payerchin welcomes Higgins and asks about the current state of trust in medicine and science.
1:25 — Trust in institutions and experts
Higgins discusses the erosion of trust in public institutions and how it affects confidence in medicine and vaccines.
2:37 — The risks of normalizing vaccine hesitancy
Higgins explains why overstating vaccine hesitancy can distort public health policy and harm provider confidence.
4:20 — Policy and perception
How misconceptions about vaccine refusal influence lawmakers, and why most parents still want vaccines for their children.
6:10 — The provider mindset
Why assuming every patient is hesitant changes physician behavior and weakens communication.
8:04 — Barriers to eradication and the importance of uptake
Higgins underscores that vaccines don’t save lives unless vaccination occurs—and the human factors that determine success.
13:13 — P2 Management Minute
Keith Reynolds shares a one-minute practice management segment on workflow and leadership insights.
14:02 — The Wakefield study and lasting damage
Higgins recounts how fraudulent MMR-autism claims sparked long-lasting fear and skepticism.
18:09 — How anti-vaccine activism spreads online
Higgins distinguishes true activists from confused sharers and explains how algorithms amplify fear-based content.
21:22 — Beyond facts: improving physician communication
Why information alone doesn’t change minds, and the key communication techniques every clinician should use.
25:33 — The “fact–warning–fact” method
Higgins breaks down his “truth sandwich” approach for addressing vaccine myths effectively.
27:05 — Final thoughts: trust in the physician’s voice
Higgins closes with why patients still look to their doctors as “lighthouses in the storm” of misinformation.
29:16 — Outro
Richard Payerchin wraps the conversation and Austin Littrell closes the episode with subscription and contact details.
31 min
December 22, 2025 S1 Ep113: The 2025 Off the Chart Holiday Spectacular
Two hours. One studio. Zero confetti (almost).

In the 2025 Off the Chart Holiday Spectacular, Off the Chart hosts Keith Reynolds and Austin Littrell race to clean the studio before a holiday party — and along the way, revisit some of the most important conversations of the year.

Listeners hear from Anders Gilberg of MGMA on what 2026 health care policy could actually bring for physician payment, prior authorization and value-based care. Deepika Srivastava breaks down how artificial intelligence is reshaping malpractice risk and what physicians need to do now to protect themselves. David Tawes of the HHS Office of Inspector General offers a clear warning on skin substitutes and sketchy offers targeting primary care. The episode also revisits leadership lessons from Dave Gans, practical branding advice from Scott Bartnick, and a quick victory lap from the show’s 100th episode.

It’s part year-in-review, part behind-the-scenes chaos and fully grounded in the real issues physicians are heading into the new year with — teamwork, boundaries and absolutely no confetti.

Happy holidays from the crew at Off the Chart: A Business of Medicine Podcast!

Music Credits:
Joyful Christmas Adventure by TheRatu - stock.adobe.com
Various Holiday Songs by Elizabeth Klucher Reynolds

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00–3:49
Cold open chaos: last-minute studio cleanup, holiday banter and rules about boxes, soundboards and “fast, ugly cleaning.”

3:49–4:39
The temptation to turn cleanup into a clip show — and why this year actually matters.

4:39–8:21
MGMA policy outlook: Anders Gilberg on what health care policy could realistically look like in 2026, from physician payment reform to prior authorization and value-based care tensions.

8:21–10:45
Back to cleaning: aging, disco lights, mystery cables and why some boxes must never be opened.

10:45–12:24
Artificial intelligence and malpractice risk: Deepika Srivastava on informed consent, documentation, AI scribes and why physicians remain ultimately responsible.

12:24–15:07
Mops, closets, confetti debates and the hidden costs of sticky floors.

15:07–16:27
Compliance warning for primary care: HHS Office of Inspector General’s David Tawes on skin substitutes, red flags and when “too good to be true” really is.

16:27–17:08
Banner hanging, tape as the “EHR of the party world” and clinical perfectionism.

17:08–18:08
Milestone moment: a quick victory lap from the Off the Chart 100th episode lightning round.

18:08–19:08
Holiday music, near-confetti incidents and metaphors for practice management debt.

19:08–20:33
Leadership and retention: Dave Gans on why taking care of staff directly improves efficiency and practice performance.

20:33–21:06
Mic stand mishaps and festive elbows.

21:06–22:11
Physician personal branding: Scott Bartnick on reviews, local reputation and why doctors don’t need national brands to stand out.

22:11–23:36
Final checks: chairs set, snacks staged, disco light defeated.

23:36–25:14
Wrap-up, holiday thanks, subscription reminders and a firm no-confetti policy.
26 min
December 22, 2025 S1 Ep112: Why leading physicians will move to concierge medicine in 2026 with Greg Grant of Specialdocs
Today’s episode is brought to you by Specialdocs Consultants, and our topic today is the growing popularity of concierge medicine. As physician burnout, payer pressures, and patient expectations reach new inflection points, many doctors are rethinking how they practice medicine.

For this episode, Medical Economics Content Vice President Chris Mazzolini sat down with Greg Grant, the Chief Operating Officer of Specialdocs Consultants to explore why 2026 may be a pivotal year for physicians considering the transition to membership-based care. From financial models and patient demand to technology and lifestyle balance, Greg uncovers what’s driving the next wave of concierge medicine and what it could mean for your future in practice.

Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

(00:00:00)
Overview of physician administrative burden, episode introduction, and the focus on concierge medicine trends.

Macro trends shaping concierge medicine (00:01:32)
Discussion of macro trends: physician burnout, patient expectations, and the mainstreaming of concierge medicine.

Economic pressures and growth trajectory (00:04:06)
Impact of inflation, payer pressures, physician shortages and economic data on the growth of concierge medicine.

Physician specialties adopting concierge models (00:07:48)
Analysis of which specialties (primary care, cardiology, endocrinology, geriatrics, pediatrics, OB/GYN) are moving into concierge medicine.

Patient willingness to pay and changing expectations (00:11:22)
Exploration of patient attitudes toward paying for personalized care and the rise of health optimization trends.

Structure of modern concierge practices (00:14:45)
Details on practice structure: panel size, visit length, communication, care coordination, and work-life balance.

Integration with hospital systems (00:18:57)
Challenges and models for integrating concierge medicine within hospital systems and health networks.

Specialdocs’ unique approach (00:22:03)
What differentiates Specialdocs in the concierge medicine space and their support model for physicians.

Physician burnout and post-conversion experiences (00:26:24)
Physician stress and burnout before conversion, and improvements after transitioning to concierge medicine.

Hospitality mindset in concierge medicine (00:29:08)
How hospitality principles enhance patient experience and satisfaction in concierge practices.

Transition timeline and readiness signs (00:32:08)
Typical timeline for converting to concierge medicine and indicators that a physician is ready for the change.

Financial realities and misconceptions (00:35:31)
Common misconceptions about the economics of concierge medicine and financial outlook for 2026.

Advice for hesitant physicians (00:38:11)
Guidance for physicians considering the transition and reassurance about the mainstream status of concierge medicine.

Future outlook and excitement (00:40:14)
Predictions for the future growth of concierge and direct primary care, and reasons for optimism.

Closing remarks (00:42:41)
Final thanks, episode wrap-up, and information on subscribing and future episodes.
45 min
December 18, 2025 S1 Ep111: The physician engagement crisis, with Bill Heller of CHG Healthcare
Most physicians say they’re satisfied with their jobs — but far fewer say they feel engaged at work. That disconnect is at the center of CHG Healthcare’s 2025 Physician Sentiment Survey, which draws on responses from more than 900 physicians nationwide.

In this episode of Off the Chart, Medical Economics Assistant Editor Austin Littrell speaks with Bill Heller, chief operating officer at CHG Healthcare, about what’s driving low engagement despite relatively high satisfaction. They break down the survey’s findings on trust in leadership, communication gaps, administrative burden, economic pressure and why engagement plays such a critical role in retention.

Heller also discusses what highly engaged physicians say makes the biggest difference in their day-to-day work, why involvement in decision-making, including around technology and artificial intelligence (AI), matters more than ever, and what health care leaders can do now to improve engagement without major new spending.

Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Why physician engagement is one of the most powerful retention tools health systems have.

0:16 — Intro
Austin Littrell introduces CHG Healthcare’s 2025 Physician Sentiment Survey and its core findings.

1:31 — Satisfaction vs. engagement
Why 75% job satisfaction doesn’t prevent turnover when only 18% of physicians feel engaged.

2:55 — What highly engaged physicians report differently
Transparency, open communication and trust in leadership stand out.

3:09 — How leaders build trust day to day
Visibility, explaining the “why,” frequent check-ins, and closing feedback loops.

5:40 — Trust gaps between physicians and executives
Why physicians trust direct supervisors far more than executive leadership.

7:46 — Net Promoter Score and physician loyalty
What a negative NPS says about physician advocacy and organizational risk.

10:56 — Physicians want a voice — but feel excluded
Why most doctors want input into decisions and how leaders can meaningfully involve them.

13:10 — When physician input becomes performative
Why late-stage consultation undermines trust and better decision-making.

15:13 — P2 Management Minute
Keith Reynolds on practical, real-world workflow and engagement ideas.

16:02 — Moonlighting, job changes and economic uncertainty
How engagement dramatically lowers the likelihood physicians will leave.

19:16 — Financial stress and physician decision-making
Why economic uncertainty affects physicians more than leaders may assume.

21:16 — Administrative burden and documentation pressure
What engaged physicians say helps make daily pressures more manageable.

24:44 — Artificial intelligence: hope and concern
Why physicians want AI to reduce burden — not simply increase patient volume.

27:01 — The message physicians want leaders to hear
Visibility, listening, well-being and time for patient care.

27:50 — What leaders may be underestimating
Why small changes can produce meaningful gains in engagement.

29:13 — Outro
Final thanks, credits and where to find future episodes.
31 min
December 15, 2025 S1 Ep110: Vaccine skepticism, with Paul Offit, M.D.
Vaccine conversations have changed. Sure, there have always been skeptics, but since the COVID-19 pandemic — and especially since Robert F. Kennedy, Jr., has headed Health and Human Services (HHS) — debates have only intensified.

For physicians, what used to be occasional questions in the exam room have become daily conversations that are more emotional, more complex and more consequential for public health.

Paul Offit, M.D., one of the nation’s leading vaccine experts, joins the show to talk about the state of vaccine and public health skepticism we’re in — and what it means for physicians.

Offit explains why confidence in vaccines has slipped, how federal advisory processes have become more politicized and why rising outbreaks of measles, pertussis and other preventable diseases are a warning sign of things to come.

He discusses how misinformation shows up in the exam room, what’s worked for him when talking with hesitant patients and what physicians should keep in mind as they navigate these increasingly complex conversations.

This interview was conducted in preparation for Medical Economics November-December cover story, "Medicine under attack: How physicians can help their patients navigate the disinformation age."

Read more: https://www.medicaleconomics.com/view/medicine-under-attack-how-physicians-can-help-their-patients-navigate-the-disinformation-age

Music Credits:
After Hours by Yigit Atilla - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Cold open
Dr. Offit on public health being “under siege.”

0:21 — Intro
Austin sets up the episode on vaccine skepticism and the rise of patient uncertainty.

1:18 — Where trust in science stands now
Offit describes the erosion of confidence in medicine and the rise of “make-your-own-truth” thinking.

2:06 — Vaccine skepticism before and after COVID
How distrust long predates the pandemic — and why mandated vaccines have always faced pushback.

2:38 — Vaccines as “victims of their own success”
Why younger parents must rely on faith, not firsthand memory of disease.

4:22 — Do people need to see disease return to believe in vaccines?
The Maurice Hilleman story and why outbreaks often precede attitude shifts.

6:37 — The politicization of immunization
Why Offit says vaccine science has collided with politics in unprecedented ways.

8:05 — What’s happened to ACIP
Offit’s concerns about expertise, bias, and the breakdown of federal vaccine guidance.

10:04 — Following ACIP’s recent votes
Why Offit saw “anti-science” decisions in 2025 influenza and hepatitis B deliberations.

12:20 — Debating unproven harm vs. studying real risk
How flawed research diverts attention, funding, and global vaccine support.

14:28 — P2 Management Minute
Keith Reynolds with practical, daily practice-improvement insights.

15:19 — Global ripple effects of U.S. vaccine misinformation
How America’s internal debates are shaping vaccine attitudes overseas.

16:26 — Communication strategies for frontline clinicians
How physicians can respond when patients bring vaccine misinformation into the exam room.

19:10 — How vaccines continue to be monitored
Why post-approval surveillance is essential — and how rare events are detected.

19:35 — Where COVID vaccine communication went wrong
Offit on “warp speed,” emergency-use confusion, breakthrough infections, and lost public trust.

21:30 — Will young scientists avoid vaccine research?
How funding cuts and political hostility may shift innovation overseas.

24:07 — States stepping in with their own guidance
Fragmented recommendations and the risks for states that do nothing.

25:08 — Surveillance breakdown and rising outbreaks
Why the U.S. is undercounting measles, flu, and pertussis — and the consequences of “see no evil” policies.

27:32 — Responding to conflict-of-interest accusations
Offit addresses claims about patent profits and ACIP voting.

29:11 — What changes things now?
Why Offit says the turning point will come from parents, not politicians.

30:41 — Closing with Richard Payerchin
Final thoughts and thanks.

31:01 — Outro
Austin wraps with credits and where to find future episodes.
33 min

About Off the Chart: A Business of Medicine Podcast

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Off the Chart: A Business of Medicine Podcast features lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. New episodes release every Monday and Thursday morning. Brought to you by Medical Economics and Physicians Practice.