Out of Network Podcast

In this episode of Out of Network, Dr. Ryon Parker sits down with Dr. Joshua Goldman (Board-Certified Plastic & Reconstructive Surgeon, co-founder of Vegas Plastic Surgery Institute) to discuss the challenges of modern healthcare, physician burnout, and why so many are moving away from traditional insurance models.

You’ll learn:

✅ How burnout is caused by the administrative burdens of insurance
✅ The broken system that limits time doctors can spend with patients
✅ Why concierge medicine is growing as a solution to care delivery issues
✅ The surgery outcomes that set realistic expectations and prevent patient frustration
✅ Why volume-based models are hurting both physicians and patients
✅ The shift in expectations when it comes to patient care
✅ How healthcare is often about balancing time with quality outcomes

Timestamps

 00:00 – Intro: Dr. Joshua Goldman + Vegas Plastic Surgery Institute
 03:33 – What craniofacial + microsurgery means
 10:47 – What elite surgical training selects for
 19:10 – Leaving academia to build a new model
 21:33 – Why insurance-based care breaks (admin + overhead)
 25:10 – Denials and recoupments: getting paid, then losing it
 27:21 – The “third model” (concierge feel without cash-only)
 33:30 – Concierge-level experience standards
 35:10 – Expectation-setting and why volume kills quality
 40:08 – Patient selection: when to say no
 01:01:37 – Closing takeaways: access and “time to care” 

Connect with Out of Network:
 🌐 Website: https://www.outofnetworkpod.com/
 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/
 ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast
 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts:
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Parker Medical: https://parkermedical.org/
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/
Seth Premiere Medical: https://sethmedical.com/

Dr. Goldman → https://vegaspsi.com/meet-dr-joshua-goldman/
https://www.instagram.com/goldstandardplasticsurgery/

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🎙 About Out of Network
 Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

#OutOfNetwork #Healthcare #PlasticSurgery #MedicalBurnout #ConciergeMedicine #ReconstructiveSurgery #MedicalCare #PhysicianBurnout #HealthcareSystem

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In this episode of Out of Network, Dr. Ryon Parker sits down with Attorney Adam Garth (healthcare defense attorney) for a behind-the-scenes look at how malpractice cases, board complaints, documentation, AI notes, and telemedicine risk actually play out - and why it’s driving physicians out of certain markets.

You’ll learn:

✅ Why doctors are “under assault” in some jurisdictions - and why they leave
✅ The real cost of a lawsuit: 2–3 years with a cloud over your head
✅ How concierge medicine can reduce risk by giving you time to practice and document well
✅ AI scribing: powerful, but risky if you don’t verify (because the chart becomes evidence)
✅ Why many board complaints aren’t malpractice - they’re billing/respect/front desk issues (and still consume hours and legal fees)
✅ Telemedicine’s blind spot when you can’t put hands on the patient
✅ The simplest legal advice in medicine: “Document, whatever you’re doing.”

Timestamps
00:02 – Who Adam Garth is (healthcare defense attorney)
03:10 – Why physicians are leaving certain jurisdictions
04:37 – The “2–3 year cloud” of malpractice cases
08:34 – Concierge medicine: less volume, more time, lower risk
11:41 – AI scribing: advantage vs liability (verify your notes)
23:45 – Board investigations and what triggers them
24:10 – “Billing / respect” complaints and why they waste time
27:17 – Telemedicine risk when you can’t examine hands-on
47:14 – The best free legal advice for physicians

Connect with Out of Network:
 🌐 Website: https://www.outofnetworkpod.com/
📱 Instagram: https://www.instagram.com/outofnetworkpodcast/
▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast
🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts:
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Parker Medical: https://parkermedical.org/
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/
Seth Premiere Medical: https://sethmedical.com/

Adam Garth → https://www.linkedin.com/in/adam-garth-86b00b36/

Enjoyed the Episode?
If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.

🎙 About Out of Network
Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Modern pediatrics is breaking parents and burning out doctors - and most families have no idea why it feels so rushed, confusing, and lonely.

In this episode of Out of Network, Dr. Rishi Seth sits down with Dr. Lisa Hayes (founder of Hayes Pediatric) for a no-fluff conversation about what changes when pediatric care is built around families instead of throughput.

You’ll hear:

• A behind-the-scenes look at why many pediatric visits feel like a blur (10 to 15 minutes is the reality in a lot of practices)
•  What concierge / direct pediatric care actually looks like in real life
•  Why Dr. Hayes does home visits within 48 hours of newborn discharge and continues home visits until 2 months
•  The baby “products” parents waste money on (and the ones that don’t belong in the crib)
•  What’s normal vs not normal in the first months, including crying and sleep
•  Why sleep training is not one-size-fits-all and how she frames it without guilt
•  How she handles vaccine anxiety in a world where parents are drowning in noise and fear
•  What made her leave traditional pediatrics and build a model she would want for her own family

Timestamps

00:50 – What “pediatrics designed around families” actually means
03:49 – What it looks like to join Hayes Pediatric
04:17 – Home visits within 48 hours after discharge
05:18 – The baby product trap parents don’t need
06:50 – The crib setup mistake families don’t realize is risky
09:10 – Crying peaks around 6 weeks and what parents should know
10:30 – Sleep training: when to start and why it’s not one method for everyone
24:53 – The part that breaks doctors: “Did I listen long enough?”
25:00 – The reality: 10 to 15 minutes per child
41:10 – Why you can’t counsel vaccine questions in 15 minutes
42:10 – CDC vs AAP confusion and what parents actually need

Connect with Out of Network:
 🌐 Website: https://www.outofnetworkpod.com/
 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/
 ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast
 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts:
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Parker Medical: https://parkermedical.org/
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/
Seth Premiere Medical: https://sethmedical.com/

Dr. Lisa Hayes → https://www.instagram.com/hayespediatrics/

Enjoyed the Episode?
If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.

🎙 About Out of Network
 Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Psychedelics are everywhere right now - and most physicians still feel uneasy even saying the words out loud.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth have a no-hype conversation about psychedelics in medicine: ketamine, psilocybin, MDMA, and what these therapies could mean for patients with refractory depression, anxiety, and PTSD who feel like they’ve run out of options.

You’ll hear:

• A real clinical case where a patient had tried “everything,” including multiple meds and therapy, and still wasn’t okay
• Why Dr. Seth is skeptical (FDA approval, data quality, who these therapies are NOT for)
• Dr. Parker’s decision to refer to a guided retreat option after clinical trials weren’t available
• A personal story from Dr. Parker that adds a completely different layer to the conversation
• Ketamine’s role today (anesthesia, pediatrics, refractory pain) and why “ketamine clinics” raise real questions

Timestamps

00:00 – Why psychedelics in medicine makes doctors uncomfortable
01:26 – Clinical scenario: “nothing is working” for severe depression/anxiety
03:44 – The lineup: ketamine, MDMA, LSD, psilocybin
04:07 – Skepticism: “not FDA approved,” limited robust data
05:23 – A Colorado retreat enters the conversation
09:20 – The hard part: tapering off meds safely, risks, close follow-up
10:10 – Outcome: “first time I feel better” after the retreat
13:16 – Who psychedelics are NOT for (bipolar/psychotic disorders risk)
14:07 – What the research hints at (and what we still don’t know)
16:20 – Dr. Parker shares his personal experience and why this topic matters
28:40 – Ketamine: what it’s used for, what’s legit, what’s questionable
34:21 – Takeaways: hope, ambiguity, and why this deserves a real conversation

Connect with Out of Network:
 🌐 Website: https://www.outofnetworkpod.com/
 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/
 ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast
 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts:
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Parker Medical: https://parkermedical.org/
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/
Seth Premiere Medical: https://sethmedical.com/

Enjoyed the Episode?
If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.

🎙 About Out of Network
 Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive deep into the explosive world of GLP-1 medications—exploring the realities of semaglutide, tirzepatide, Ozempic, Wegovy, and Zepbound. With a projected $200 billion market by 2029, these drugs have transformed weight management, but they've also created chaos in the healthcare landscape. From med spa injections to proper medical supervision, this conversation sheds light on what safe GLP-1 treatment should actually look like.

What You'll Learn

• The difference between proper medical weight loss programs and dangerous "syringe-in-a-fridge" clinics
• Why tirzepatide (Mounjaro/Zepbound) outperforms semaglutide (Ozempic) in most patients
• Real strategies for patients who plateau or don't respond to GLP-1 medications
• Insurance coverage realities and the new $50/month Medicare pricing
• Serious side effects to watch for, including pancreatitis and gallbladder issues

Timestamps

• 00:00 – Introduction: The $200 billion GLP-1 economy
• 03:15 – Wild West of GLP-1 prescribing: Med spas and strip mall clinics
• 10:42 – Proper patient screening and medical supervision
• 24:30 – Insurance coverage, pricing, and access issues
• 32:00 – Tirzepatide vs. Semaglutide: Which is better?
• 42:55 – The future of GLP-1s and closing thoughts

Connect with Out of Network:
 🌐 Website: https://www.outofnetworkpod.com/
 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/
 ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast
 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts:
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Parker Medical: https://parkermedical.org/
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/
Seth Premiere Medical: https://sethmedical.com/

Enjoyed the Episode?
If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.

🎙 About Out of Network
 Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into AI's rapid integration into healthcare—exploring how artificial intelligence is transforming medical documentation, diagnostics, and patient care. With a mix of personal experiences, honest concerns, and evidence-based insights, this conversation sheds light on both the promise and perils of AI in medicine, and how physicians can harness its power without losing the clinical skills that make them effective doctors.

What You'll Learn

• How AI scribes are changing medical documentation (and why one doctor got "see Brad Pitt movies" as a treatment recommendation)
• The risk of "de-skilling" physicians when AI handles too much of the diagnostic process
• Why AI chatbots for patient triage could be dangerous—and when they might be helpful
• How AI bias can reinforce physician mistakes and create dangerous feedback loops

Timestamps

00:00 – Introduction: AI's rapid rise in healthcare
03:15 – AI scribes: Making doctors better or lazier?
10:42 – The de-skilling concern: Are we training lazy physicians?
16:00 – AI liability and the Brad Pitt diagnosis story
21:30 – Patient self-diagnosis with AI: Benefits and dangers
24:30 – Why concierge practices should resist AI automation
27:20 – Closing thoughts: AI oversight and physician responsibility

Connect with Out of Network
Website: https://www.outofnetworkpod.com/
Instagram: https://www.instagram.com/outofnetworkpodcast/
YouTube: https://www.youtube.com/@OutofNetworkPodcast
TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts
Parker Medical - Las Vegas, NV → https://bit.ly/parkermedical
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiere
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into the overwhelming world of wellness trends—exploring what's helpful, what's harmless, and what patients should avoid. From IV vitamin drips and NAD injections to hyperbaric chambers and supplement claims, they break down the science (or lack thereof) behind popular wellness treatments. With honest physician perspectives and real patient stories, this conversation sheds light on how to navigate wellness confusion while maintaining trust in evidence-based medicine.

What You'll Learn

• How to approach patients who've received conflicting wellness advice from other providers
• The real science behind popular treatments like IV vitamins, NAD, and hyperbaric oxygen therapy
• Why the wellness industry thrives on aging fears and how to address patient concerns compassionately
• Red flags to watch for in wellness claims and when treatments cross into dangerous territory

Timestamps
00:00 – Introduction to wellness world confusion
01:12 – Navigating conflicting advice from different providers
08:09 – IV vitamins and NAD: separating hype from science
11:50 – Hyperbaric oxygen therapy: medical vs. wellness applications
15:15 – The supplement industry and "nutraceuticals"
16:43 – Why people seek wellness solutions: aging, fear, and social media
25:32 – Dangerous wellness trends: chiropractic overreach and chronic conditions
30:40 – The importance of staying in your lane as healthcare providers
33:37 – Final thoughts on evidence-based wellness

Connect with Out of Network
Website: https://www.outofnetworkpod.com/
Instagram: https://www.instagram.com/outofnetworkpodcast/
YouTube: https://www.youtube.com/@OutofNetworkPodcast
TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts
Parker Medical - Las Vegas, NV → https://bit.ly/parkermedical
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiere
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth explore the world of telemedicine and reveal how it's revolutionizing healthcare access in rural America. Dr. Seth shares his firsthand experience as a telehealth hospitalist—running emergency codes from hundreds of miles away, managing critical patients over a screen, and keeping small-town hospitals alive. From a patient with "3 out of 10" chest pain who turned out to have a life-threatening heart attack, to the technology and expertise required to provide remote care, this conversation uncovers the hidden infrastructure that's changing medicine as we know it.

What You'll Learn

• How telehealth hospitalists manage critical emergencies remotely—including running codes over a screen
• The reality of rural hospitals where there may be no doctor on-site at all
• The dramatic story of catching a full-blown STEMI (heart attack) from 100 miles away
• Why telemedicine requires 5+ years of clinical experience before going remote
• The technology behind telehealth carts and remote patient monitoring
• How small-town hospitals stay open thanks to telehealth coverage
• State licensing requirements and the Interstate Medical Licensure Compact
• Best practices for using telemedicine in outpatient and concierge settings
• The future of AI integration in telehealth

Timestamps

00:00 – Introduction: What if there's no doctor in the building?
01:00 – Dr. Seth's journey into telehealth hospitalist work
02:30 – What are critical access hospitals and why do they matter?
04:00 – The technology: Telehealth carts, stethoscopes, and zoom capabilities
07:00 – Why rural hospitals are the lifeblood of small-town America
08:00 – The gray patient: Catching a life-threatening STEMI remotely
10:30 – Why experience matters more than technology in telehealth
14:00 – The business model keeping rural hospitals financially viable
18:00 – State licensing requirements and legal considerations
21:00 – How Dr. Parker uses telemedicine in his concierge practice
24:00 – Documentation requirements and billing for telehealth visits
26:00 – The future of telehealth and AI integration
28:00 – Final thoughts: Why telemedicine is revolutionary for rural America

Connect with Out of Network
Website: https://www.outofnetworkpod.com/
Instagram: https://www.instagram.com/outofnetworkpodcast/
YouTube: https://www.youtube.com/@OutofNetworkPodcast
TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts
Parker Medical - Las Vegas, NV → https://bit.ly/parkermedical
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiere
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into the FDA's recent removal of the black box warning on hormone replacement therapy—exploring the realities of what this change actually means for women's health. With a mix of bold truths, real stories, and evidence-based insights, this conversation sheds light on the complex nuances behind HRT, the original Women's Health Initiative study, and why headlines rarely match the science.

What You'll Learn

• Why the FDA removed the black box warning and what it actually means (spoiler: it's not a universal green light)
• The real story behind the Women's Health Initiative study and why Premarin vs. bioidentical hormones matters
• How to navigate HRT decisions based on age, symptoms, and individual risk factors

Timestamps
00:00 – Introduction
01:15 – FDA removes black box warning: What does it really mean?
03:28 – The concerning conflicts of interest behind the decision
07:25 – Breaking down the Women's Health Initiative study
12:00 – Estrogen types: Premarin vs. bioidentical hormones
16:00 – The age factor: Why timing matters in HRT
24:00 – Real patient case: Factor V Leiden and HRT complications
30:47 – Key takeaways for patients and physicians

Resources & Links Mentioned
Women's Health Initiative Study > https://www.nhlbi.nih.gov/science/womens-health-initiative-whi

Connect with Out of Network
Website: https://www.outofnetworkpod.com/
Instagram: https://www.instagram.com/outofnetworkpodcast/
YouTube: https://www.youtube.com/@OutofNetworkPodcast
TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts
Parker Medical - Las Vegas, NV → https://bit.ly/parkermedical
Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/
Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiere
Dr. Rishi Seth → https://www.instagram.com/drrishiseth/

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this candid episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth step away from discussing broken healthcare systems to share the raw, unfiltered lessons from their medical journey. From the struggles of foreign medical school to the challenges of starting a practice, they explore the wins, mistakes, doubts, debt, and grind that shaped them as physicians, husbands, fathers, and business owners.

What You'll Learn

• Why comparison truly is the thief of joy in medical practice
• The reality of starting a concierge practice with limited capital and massive student debt
• How attending a Caribbean medical school (Ross University) actually made them better doctors
• The importance of taking notes during residency rotations and learning from attendings
• Real talk about practice startup costs, renovation delays, and staffing challenges

Timestamps

00:00 – Introduction: The journey no one tells you about
03:15 – Starting humble: Learning not to compare yourself to others
10:42 – Ross University experience: Would they do it again?
24:30 – Residency lessons: What they wish they'd done differently
42:55 – Practice building mistakes and wins

Connect with Out of Network

Website: https://www.outofnetworkpod.com/
Instagram: https://www.instagram.com/outofnetworkpodcast/
YouTube: https://www.youtube.com/@OutofNetworkPodcast
TikTok: https://www.tiktok.com/@outofnetworkpodcast

Connect with the Hosts

Parker Medical - Las Vegas, NV → https://bit.ly/parkermedical

Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/

Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiere

Dr. Rishi Seth → https://www.instagram.com/drrishiseth/

Enjoyed the Episode?
If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.