Physicians Taking Back Medicine

Dermatologist Jon Ward, M.D., grew up in the Florida Panhandle. Disillusioned after just one year as an employed physician, he returned home and opened his own practice. Over the next two decades, he expanded that solo practice into a 32-location organization operating across four states, with a particular focus on providing skin cancer care in rural communities.

With that success, Ward could have done almost anything: retire early, travel the world or buy a fleet of sports cars. Instead, he decided to help buy a rural hospital.

Read more at MedicalEconomics.com.

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

0:00 Cold open: could physician ownership save rural hospitals?
1:01 Meet Jon Ward, M.D.: 32 locations, four states and one rural hospital
2:05 Why he bought a hospital instead of retiring
2:41 HealthMark Regional closes, and the deal that came back around
4:44 A 1990 for-profit hospital and the reputation it left behind
5:31 The Stark law, the whole hospital exception and what changed in 2010
7:45 The thinking behind the ban on physician ownership
8:54 The workaround: own the building, not the operating entity
9:42 Raising $3.7 million from colleagues, plus promissory-note loans
11:06 USDA and Treasury financing, and a $7 million first year
12:34 Finding the profit center: why the operating rooms came first
13:41 Charity care, EMTALA and Medicaid payments that arrive a year late
15:17 Medicaid cuts, $50 billion for rural health and a $4.6 million award
16:39 Cash pay at a rural hospital: what a spine surgery actually costs
18:41 Why price transparency means little without insurer rate transparency
20:51 Service lines today: imaging, mammography and a mobile lung screening unit
23:04 $5 million to open the last wing, and codes as a barrier to entry
23:59 Winning back a community that had written the hospital off
25:33 The ask: bring back physician ownership, starting with rural
27:46 Advice for residents weighing corporate medicine against ownership
28:25 The business education no one gets in residency
31:10 One practice to 32 locations: the non-metro strategy
32:39 Model the pro forma, and don't buy the MRI in year one
34:01 Six months of payroll he wasn't sure he could make
35:00 Outro

For more than a decade, physicians have cited $77 per month as the average price of a direct primary care (DPC) membership. A new national survey suggests that benchmark is now substantially out of date, as well as showing a few other unexpected findings.

The 2024 survey was commissioned by the Direct Primary Care Alliance (DPCA) and led by Kenneth Qiu, M.D., a family physician who launched his Richmond, Virginia, DPC practice directly out of residency. The survey received 465 physician responses, representing approximately 13% of the estimated 3,600 DPC practices in the United States.

While not a definitive census of every DPC practice, the DPCA survey offers one of the largest recent datasets describing how physicians are designing and operating their practices.

Find five findings that surprised even Qiu and his fellow survey committee members at medicaleconomics.com/view/five-surprising-findings-about-the-state-of-direct-primary-care

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

0:00 Cold open: what does a direct primary care membership actually cost, and what counts as a full panel?
0:57 Meet Kenneth Qiu, M.D.; Emily O'Rourke, M.D.; and Kelsey Smith, M.D.
1:46 Why the alliance ran the survey: testing word-of-mouth benchmarks against real numbers.
2:22 How the survey was designed, vetted and distributed across the DPC community.
3:16 Why 465 responses makes for a representative sample.
4:03 The response rate, the leading states and the Medicaid expansion pattern.
4:57 Women made up 67% of respondents, and why the model may appeal to them.
5:31 Specialty mix, and why nearly a quarter of respondents were osteopathic physicians.
7:03 An average owner age of 46, and Qiu on the "peak of despair."
8:13 The full-panel surprise: a sizable group calls 100 to 300 patients full.
8:43 O'Rourke on staying a micropractice by choice, not by default.
9:31 Panels that run from under 50 to more than 1,000.
10:10 Smith on why 1,000 patients turned out to be an overshoot.
11:00 What "full" really means, and O'Rourke's satiety analogy.
12:01 Staffing: more than 30% of respondents run with no staff at all.
12:40 Why O'Rourke outsources instead of hiring.
13:45 The case for a right-hand person, and Smith's 19-year medical assistant.
15:30 Pricing: the $77 benchmark gives way to $98.46 per month.
16:02 The "$50 or you're greedy" myth, and raising prices to match inflation.
16:49 How price splits by region, rural versus urban and panel size.
18:10 Qiu on why older rural practices price lowest.
19:08 Practice age against price point, and the newer practices charging more.
20:10 Pressure to raise prices, and Smith's move off age-based tiers.
21:02 The tiering breakdown: 76.4% tiered, 15% flat, the rest on family pricing.
21:31 Qiu on switching to family pricing to bring in whole households.
22:45 "If you've seen one DPC, you've seen one DPC."
23:39 Better questions than "how much should I charge?"
24:43 Where to read the survey, and sign-off.

What do you do when a hospital decides to replace your independent physician group with a corporate staffing company? For this group of physicians, the answer was simple: fight back.

In the fall of 2025, Eugene Emergency Physicians (EEP) learned that after more than 35 years of serving the community, its emergency medicine contract would be awarded to an out-of-state corporate medical group. Recognizing that this action contradicted Oregon's corporate practice of medicine laws, EEP took action. They organized colleagues, contacted legislators and engaged the media. When those efforts failed, the group took legal action, filing an emergency injunction.

Read more: https://www.medicaleconomics.com/view/a-hospital-tried-to-replace-them-these-oregon-physicians-fought-back-and-won

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

0:00 Cold open: do physicians still have power in corporate medicine?

1:02 Meet Bianca Jacobs and Dan McGee of Eugene Emergency Physicians.

1:45 PeaceHealth closes University District Hospital over the group's warnings.

2:42 What the closure cost: lost beds and Oregon's capacity crisis.

4:20 PeaceHealth puts the contract out for bid and picks ApolloMD.

5:07 Scapegoated for emergency department wait times.

6:57 Senate Bill 951 and the "friendly physician" loophole.

8:28 The group closes ranks and signs a 90-day pledge.

11:17 More than 450 medical staff push back; physicians vote no confidence.

12:57 Nurses follow, and the fight goes to the governor, legislators and the media.

14:08 A law with no teeth: no one could enforce it.

15:57 Running out of time as job offers pile up.

17:27 The only path left is the courtroom.

18:13 Assembling the legal team and the injunction request.

19:44 Dramatic hearings and three plaintiffs, including an 8-year-old patient.

21:50 Bracing for a personal attack on cross-examination.

22:28 The "scab" posts and the judge who stopped the questioning.

27:32 Holes punched in the bid-scoring process.

27:54 PeaceHealth returns to the table and ApolloMD walks away.

28:42 No legal fees recovered, and AAEM's backing.

29:00 A call to medical societies and the advocacy playbook.

30:41 The locums leverage and refusing to roll over.

32:10 Closing advice and sign-off.

What if the most important thing you do as a physician happens outside the exam room?

Free N. Hess, D.O., a board-certified pediatrician and pediatric emergency physician, reached this epiphany early in her career when she realized that many of the children she was treating didn't need to be there at all.

"Moving from an inner-city hospital to a rural area opened my eyes to how many injuries and illnesses could be prevented by more community resources and better education," Hess said.

That insight didn't just change how she practiced. It changed her sense of responsibility.

"I wanted to do more than educate one-on-one in the emergency room. I wanted a larger platform."

Hess took action, starting the website Pedi-Mom, launching a podcast, and branching into social media. Now a national expert on child safety, Hess speaks at medical conferences, regularly consults with families, schools, and manufacturing companies, and was even interviewed for the BBC documentary "Childhood 2.0." And her work is making a difference.

Read more at MedicalEconomics.com.

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

0:17 — Dr. Free Hess introduces herself and her background in pediatric emergency medicine
1:18 — From the Bronx to rural Florida: How the move changed her perspective on preventable injuries
4:33 — Frustration with one-on-one education in the ER and the decision to build a larger platform
4:49 — Launching Pedi-Mom, the podcast, and expanding to social media including TikTok
6:09 — Safe sleep: Explaining the difference between bed sharing and room sharing, and why "co-sleeping" is a problematic term
8:18 — Why safe sleep generates so much backlash, and working with parent advocates who have lost children
11:15 — Expanding into speaking, documentaries, and consulting on child safety and online predators
12:03 — Why physicians need to be on social media and how to get started
13:25 — Practical advice for overcoming the fear of criticism and imperfection online
16:16 — Discussion of a viral post on teenage pregnancy and the broader threat of child sexual exploitation
20:11 — How advocacy opens doors: BBC's "Childhood 2.0" documentary and collaborating with outside influencers
21:22 — The scope of child sexual abuse and how social media and AI have expanded predators' reach
23:15 — Explaining sextortion: How it works, why teen boys are the primary target, and the link to suicide
25:01 — Advice for parents and physicians on protecting kids online
25:44 — The sextortion story that changed everything: A mother's message and a Department of Homeland Security arrest
28:18 — Saving parent thank-you messages as motivation, and the impact of getting just one physician online
30:19 — Advice for physicians on reaching out to peers when things go wrong on social media
33:22 — Closing thoughts on why the benefits outweigh the risks of speaking out

New Mexico has faced its share of health care challenges in recent years, but perhaps none has been more urgent than the loss of physicians, many of whom cite the state’s extreme malpractice climate as a major reason for leaving. 

“Between 2017 and 2024, between 200 and 300 physicians left the state as a net negative,” says Aaron Snyder, M.D., a board-certified emergency physician practicing in Albuquerque. “It’s the only state in the country that actually had a net loss during that period.”

Snyder, who has been fighting for malpractice reform since arriving in New Mexico in 2021, believes the medical-legal risk of practicing there bears much of the blame. Indeed, surgical oncologist Amani AJ Jambhekar, M.D., says she left the state for mainly that reason.

“It wasn’t that I was personally worried I would be sued,” Jambhekar says. “It was the downstream impact of the malpractice environment on the ability to recruit collaborating plastic surgeons and provide the care our patients need.” In the two years that she practiced in the state, Jambhekar says that she didn’t see a single plastic surgeon move into her community.

Jambhekar advocated for malpractice reform by writing op-eds, sharing information on social media and visiting legislators before ultimately deciding to leave the state.

“As a surgeon who treats patients with breast cancer, I had patients driving more than 250 miles to get comprehensive reconstructive care. The environment was very, very challenging because of these limitations.”

Read more at MedicalEconomics.com.

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

0:16 — Introduction: Aaron Snyder, M.D., on New Mexico's net physician loss from 2017 to 2024

0:37 — Amani AJ Jambhekar, M.D., on the plastic surgery access crisis and why breast cancer patients were driving 250 miles for reconstructive care

3:15 — History of New Mexico's Medical Malpractice Act and the structure of the Patient Compensation Fund

5:00 — The 2021 legislative overhaul: raised caps, uncapped punitive damages, and lumping independent practices in with hospital systems

7:52 — Personal financial exposure under New Mexico's limited asset protections

8:03 — Punitive damages attached to 92% of malpractice cases and the forced-settlement dynamic

9:42 — A $412 million nuclear verdict in a urology case accelerates the physician exodus

10:00 — A husband-and-wife primary care team closes after two decades and relocates to Missouri; insurers exit the state

15:00 — Emergency physicians absorbing primary care volume; a jaundiced patient's story prompts real-time legislator outreach in the ER

16:27 — QR codes for constituent contact, rallying major health systems, and the emergence of HB 99

18:26 — What HB 99 actually does: caps on punitive damages, raised evidentiary standard, and post-discovery sequencing

20:00 — Jambhekar on leaving New Mexico, feeling relieved, and the state as a cautionary tale for Virginia

22:54 — Jambhekar on missing her New Mexico patients; the outsider trial bar's structural grip on an unpaid legislature

25:00 — Resident retention rates, incentive gaps, and what it would take for Jambhekar to return; Snyder on how advocacy became an antidote to physician burnout

30:00 — Closing from host Rebekah Bernard, M.D.

30:40 — End

Physicians don’t show up to legislative hearings expecting applause. In fact, most arrive knowing the vote may already be decided. They come anyway — on their own time, at their own expense, often canceling clinics or trading call shifts — because patient safety is worth two or three minutes at a microphone.

What they don’t expect is to be personally attacked for telling the truth.

Yet that is exactly what happened during a recent Florida legislative hearing on a bill that would allow psychiatric mental health nurse practitioners to practice independently, without oversight by a psychiatrist. After calm, evidence-based testimony from multiple physicians outlining differences in training, patient safety risks and noncompliance with existing law, the bill sponsor closed not by rebutting the data — but by attacking the physicians themselves.

They were described as “arrogant,” “obnoxious” and “greedy.” The sponsor claimed doctors were profiting off nurse practitioners, earning thousands of dollars per month per clinician, joking that physicians could use the money to “buy a plane and go to The Bahamas.”

It was not a debate over policy. It was political theater — and physicians were cast as villains for refusing to play along.

Read more at MedicalEconomics.com.

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

0:00 – Florida legislator’s closing remarks attacking physician testimony

0:24 – Episode introduction: Physicians speak out against unsupervised psychiatric nurse practitioner legislation

1:38 – Dr. Vicki Norton’s committee testimony on training differences and patient safety

4:23 – Interview with Dr. Norton: Reaction to lawmaker’s comments

7:22 – Introduction of Dr. Ankush Bansal

7:57 – Dr. Bansal’s testimony on physician education, ethics, and access to care

9:58 – Dr. Bansal reacts to sponsor’s personal attacks

13:32 – Introduction of Dr. Mays DeBose (South Carolina advocacy effort)

13:57 – Dr. DeBose on physician image, humility, and legislative communication

15:11 – South Carolina “turf war” characterization

15:43 – Dr. DeBose describes committee hearing experience

16:02 – Dr. Phil Schaefer testifies on lack of data

16:18 – Legislator comments about AI replacing radiologists

16:42 – Dr. Schaefer responds to AI comment

18:27 – Florida bill sponsor closing remarks (“It’s going to be cool”)

19:06 – Dr. Schaefer on legislators’ understanding of medicine

19:46 – Call to physician advocacy

20:34 – Dr. Norton on overcoming personal attacks and getting involved

22:48 – Dr. Bansal’s advice for physicians interested in advocacy

23:43 – Dr. Schaefer on why physicians struggle to engage politically

24:33 – Dr. DeBose on supporting organized medicine

26:05 – Dr. DeBose on collective voice and combating learned helplessness

28:20 – Final encouragement to join local and state medical societies

29:02 – Closing remarks from host Dr. Rebecca Bernard

“Please stand, raise your right hand, and repeat after me: I pledge not to use the word provider when referring to physicians and further, to encourage my colleagues to do so. You may be seated.”

So began rheumatologist Dr. Robert McLean’s inaugural address as 2019 President of the American College of Physicians — and with it, his mission to eliminate the “P-word,” provider, as a term for physicians.

“People stood, smiled, I got some claps, and several came up afterward to thank me,” McLean recalls. “It kind of became my moniker. For the rest of the year, at every committee meeting, I would start with the ‘No Provider Pledge. If somebody slipped up and used the word provider, they had to throw a dollar in the kitty.’”

Six years later, McLean is still widely recognized among recent ACP physician leaders as the standard-bearer against the term. “At a recent AMA meeting, when the word ‘provider’ slipped into speeches by CMS Director Dr. Oz and AMA CEO Dr. Whyte, people sitting nearby would turn around and look at me and shake their heads,” he said. McLean notes that the AMA and other major physician organizations have longstanding policy opposing use of the term.

While some may argue that fighting a word isn’t worth the effort, McLean and others believe replacing physician with provider represents far more than semantics. It reflects a deeper erosion of professional identity, clarity, and trust in American medicine.

Read more at MedicalEconomics.com.

Music Credits
Medical Education by Art Media - stock.adobe.com

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

Introduction to the "Provider" Problem (00:00:13) Overview of the episode’s focus on the term "provider" and its impact on physicians’ roles and identity.

The "No Provider Pledge" and Its Reception (00:00:36) Dr. McLean introduces the "No Provider Pledge" and describes physicians’ reactions to it.

Origins and Spread of the Term "Provider" (00:02:34) Historical background of the term, its use by insurance companies, and its effect on healthcare roles.

Confusion in Clinical Titles and Patient Perception (00:04:06) How patients are confused by titles, and the implications for care and professional identity.

Declining Standards in Nurse Practitioner Education (00:06:18) Concerns about the quality and rigor of nurse practitioner training and its consequences.

Legislative Changes and Nurse Practitioner Autonomy (00:07:36) Dr. McLean’s advocacy experience and the evolution of laws allowing nurse practitioners more independence.

Differences in Training: Physicians vs. Non-Physicians (00:10:10) Discussion of the rigorous, standardized training for physicians compared to other practitioners.

Personal Sacrifice and Physician Burnout (00:13:07) Dr. Alaba shares the personal costs of becoming a physician and the emotional impact of being called "provider."

Corporate Medicine and Physician Demoralization (00:15:14) How corporate healthcare, loss of autonomy, and generic titles contribute to physician burnout and suicide.

Propaganda and the Visual Blurring of Roles (00:17:12) Analysis of social media posts that visually equate physicians and non-physicians, reinforcing the "provider" label.

Physician Reactions to Lack of Recognition (00:18:22) Doctors’ emotional responses to being grouped with non-physicians and the importance of proper recognition.

Strategies to Reclaim Physician Identity (00:19:33) Dr. McLean discusses ways to push back against the "provider" term and reclaim professional identity.

Relational vs. Transactional Care (00:21:22) Emphasis on the unique physician-patient relationship and the dangers of commoditizing healthcare.

Market Forces and Commoditization of Medicine (00:22:32) Discussion of how insurance and private equity treat healthcare as a commodity, harming the profession.

Comparison to Legal Profession and Final Thoughts (00:23:25) Comparison to law, concluding with a call for physicians to reclaim their identity and resist being called "providers."