Dr. Farzad Mostashari is the former National Coordinator for Health IT, the CEO and co-founder of Aledade, and a longtime champion for independent primary care. He’s spent his career trying to answer one question: how do we fix American healthcare by paying doctors to prevent illness—not just treat it? In this episode of How I Doctor, Dr. Graham Walker sits down with Farzad to unpack the financial forces behind physician burnout, the byzantine mess of incentives driving consolidation, and why empowering small, independent practices could be the key to turning it all around.

They talk about how value-based care is finally beginning to deliver real results, with independent practices earning more through shared savings than through fee-for-service billing. Farzad breaks down the math behind a billion-dollar primary care group, what it really means to have leverage with payers, and how doctors can reclaim both their autonomy and financial upside. Whether you’re an early-career physician wondering what path to take—or a veteran feeling stuck inside a system you didn’t design—this conversation offers a clear-eyed look at what’s broken and what’s finally working.

What You’ll Learn in This Episode:

• Why the Payment Model Is the Root Problem – How the current system rewards volume over outcomes, and what happens when that finally changes.
• The Hidden Power of Primary Care – Why independent doctors can drive massive savings—and how a 100-physician practice can become a billion-dollar enterprise.
• Who Built the Machine—and Why It’s So Hard to Escape – A candid look at the patchwork of well-intentioned policies that now trap physicians in burnout.
• The Business Case for Independence – How some practices are now earning more in one check than in an entire year of fee-for-service billing.
• Control, Respect, and the Right to Say No – Why owning your schedule matters as much as your paycheck—and how it connects to professional satisfaction.
• Rebuilding a Career on Your Terms – What it takes to go independent today, and why the future might finally be tipping in favor of small, physician-led care.

This conversation is for anyone who’s ever wondered: What happens when being a doctor isn’t enough — and what else might be possible?

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