The Doctor's Lounge

Side Table: Who Really Decides What Doctors Get Paid? Inside the RUC


Listen Later

Send us a text

🎯 Why Listen

Ever wonder who actually decides how much doctors earn for surgeries, visits, or procedures? This episode takes you inside the mysterious but powerful Relative Value Scale Update Committee (RUC) — the body that determines physician payments for Medicare and beyond. If you care about fairness in healthcare, innovation, or why a complex surgery can pay the same as a routine one, this conversation is for you.


👥 Co-Hosts

  • Dutch Rojas – Founder, Bliksem Health
  • Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
  • Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
  • Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
  • Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur


📌 Episode Overview

In this special “Side Table” edition, the Doctors Lounge digs into the RVU Update Committee (RUC) — the physician-led but AMA-controlled group that sets values for CPT codes, essentially determining how doctors get paid. The hosts explore:

  • How the RUC works and who sits on it
  • Why budget neutrality forces specialties to fight for value
  • The unintended consequences of central planning, including stifling innovation
  • The fairness debate between primary care and high-intensity procedural specialties
  • Why physicians themselves are both defenders and critics of the system


đź’¬ Notable Quotes

  • “The RUC is essentially central planning — every doctor gets paid the same for the same code, no matter the experience.”
  • “Becoming better at your procedure can actually punish you — the faster and safer you get, the less you’re paid.”
  • “It’s a system that preserves order, but at the expense of innovation and sometimes fairness.”


📚 What You’ll Learn

  • What the RUC is and how it shapes U.S. physician payment
  • The mechanics of how CPT codes are valued
  • Why Medicare’s budget neutrality keeps physician fees locked in zero-sum battles
  • How new technologies like robotics and advanced ablation are undervalued
  • Why primary care vs. specialty debates rarely get settled at the RUC table
  • The pros and cons of a physician-run payment-setting system


⏱ The Episode (Timestamps)

  • [00:00] What is the RUC and why it matters
  • [02:00] The history: from “reasonable and customary” to RVUs
  • [05:00] Who sits on the RUC and how they’re chosen
  • [07:00] Central planning vs. innovation — robotic surgery as a case study
  • [10:00] How physician surveys shape payment values
  • [15:00] Specialty vs. primary care debates
  • [20:00] Why new procedures often get undervalued
  • [23:00] Should the RUC be reformed… or blown up?

đź”— Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

...more
View all episodesView all episodes
Download on the App Store

The Doctor's LoungeBy Rojas Media

  • 5
  • 5
  • 5
  • 5
  • 5

5

33 ratings


More shows like The Doctor's Lounge

View all
The Ben Shapiro Show by The Daily Wire

The Ben Shapiro Show

154,078 Listeners

WSJ Your Money Briefing by The Wall Street Journal

WSJ Your Money Briefing

1,724 Listeners

The Knowledge Project by Shane Parrish

The Knowledge Project

2,679 Listeners

The Jordan B. Peterson Podcast by Dr. Jordan B. Peterson

The Jordan B. Peterson Podcast

33,281 Listeners

White Coat Investor Podcast by Dr. Jim Dahle of the White Coat Investor

White Coat Investor Podcast

2,445 Listeners

Hidden Forces by Demetri Kofinas

Hidden Forces

1,439 Listeners

National Review's Radio Free California Podcast by National Review

National Review's Radio Free California Podcast

699 Listeners

Uncommon Knowledge by Hoover Institution

Uncommon Knowledge

2,020 Listeners

The Peter Attia Drive by Peter Attia, MD

The Peter Attia Drive

9,193 Listeners

All-In with Chamath, Jason, Sacks & Friedberg by All-In Podcast, LLC

All-In with Chamath, Jason, Sacks & Friedberg

9,957 Listeners

Barron's Streetwise by Barron's

Barron's Streetwise

1,560 Listeners

PBD Podcast by PBD Podcast

PBD Podcast

4,250 Listeners

Capital Record by National Review

Capital Record

446 Listeners

Morning Wire by The Daily Wire

Morning Wire

26,638 Listeners

The Morgan Housel Podcast by Morgan Housel

The Morgan Housel Podcast

985 Listeners