The Root Cause - Business of Medicine Podcast

Erik has known this week's guest for more than a decade — they started a cardiology program at the same Riverside County hospital, reconnected at a Metagenics clinic in Orange County, and watched each other leave the system.

Dr. Sanjay Bhojraj is a board-certified interventional cardiologist and one of the few cardiologists in the country certified by the Institute for Functional Medicine, where he now teaches. He is the founder of Well12 and the Integrative Heart Institute, hosts The Curious Cardiologist podcast, and writes on heart health for CNBC.

He was pushed into medicine — an Indian kid in small-town Indiana whose parents were both family doctors, with job offers waiting before he'd chosen a specialty. He was pulled out of it by a Saturday on call with eight back-to-back heart attacks, two friends his age who had their own, and the realization that at fifty he was a few years from being the patient. "It's not work-life balance," he says. "It's life-work balance."

In this episode

• Growing up in his parents' practice, where patients sometimes paid in tomatoes — and what that taught him about the doctor-patient relationship
• The jagged line: why every career outside medicine expects pivots, and why medicine sets the next forty years on day one
• Med school at $8,000 a year, and how that freedom shaped every decision after
• The frog in the water: four more clicks on top of four hundred, e-prescribing security keys, and turning over your own exam rooms
• "We know you're going to stay" — how a physician's commitment to patients gets used against them
• The dog in the open crate: doctors who don't realize they can leave
• Five percent of a physician's horsepower is more business acumen than most entrepreneurs have — the missing piece is tolerance for failure
• ReoPro, a bailout drug, and the meeting where administrators asked for 30% less of it
• Why every hospital CEO should have practiced for ten years, and why physicians should be paid to sit in the meetings they currently attend for free
• Davin's own years as a CMIO and CMO, and the executives who said doctors "don't understand business"
• Three or four soft landing zones: med-tech consulting, fractional CMO work, a failed med spa, and Well12
• Well12 — 20 to 40 people a month, blood pressure normalizing within two weeks, a woman who thought she had Alzheimer's
• The HEART framework: hormones, energy, autonomic nervous system, rest and repair, toxins and triggers — and the question that clears a million-dollar chest-pain workup: "Did you feel safe as a child?"
• The book in progress, the grand rounds invitation back at his own fellowship, and being a bridge between conventional and integrative cardiology
• Where medicine goes: personalization, proteomics, and "you are 7.3 years from type 2 diabetes — here is the one lever"

About Dr. Sanjay Bhojraj

Sanjay D. Bhojraj, MD, FACC, FMCP-M is a board-certified interventional cardiologist and IFM-certified functional medicine physician. After more than twenty years in conventional cardiology in Southern California, he founded Well12, a twelve-week cardiometabolic program, and the Integrative Heart Institute, a virtual practice built around his HEART framework. He is an educator for the Institute for Functional Medicine, faculty for A4M, host of The Curious Cardiologist podcast, and a CNBC contributor.

Links

• Integrative Heart Institute
• Well12
• The Curious Cardiologist — his own podcast
• @doctorsanjaymd on Instagram

Erik and Davin have had physicians, recruiters and founders on this show. This week they have the first chiropractor — who also holds a PhD, a Harvard postdoc, and a master's from Harvard Medical School.

Dr. Datis Kharrazian is a clinical research scientist, Associate Clinical Professor of Preventive Medicine at Loma Linda University School of Medicine, and the founder of the Kharrazian Institute. His books Why Do I Still Have Thyroid Symptoms? and Why Isn't My Brain Working? reframed how a generation of clinicians approaches thyroid and brain care.

Ask him what drove all of it and he doesn't say curiosity. His family left Iran in 1979. His mother was severely ill for most of his childhood — psychiatric admissions, electroconvulsive therapy, drug after drug, no response — until a chiropractor working with nutrition made a difference nobody else had. Decades later he would learn she had neurological autoimmunity: antibodies to her own serotonin and dopamine. "I don't think I was just curious," he says. "I think I was just a scared kid that never stopped being scared, and was just trying to figure out how to help someone who wasn't getting help."

The business conversation is unusually concrete. He ran a small practice three days a week, scheduled six hours for a new patient, and priced a filter at the front door.

In this episode

• Leaving Iran in 1979, and a childhood spent watching the healthcare system fail his mother
• Finding Jeffrey Bland's literature reviews as a student — checking out five years of them and flow-charting every one to learn how he was thinking
• Taking over Harry Eidenier's blood chemistry seminar series in his mid-twenties: "You're a kid, what are you doing here?"
• Brain dissection at Bastyr — twelve brains, three weeks, pulling pathways apart "like string cheese"
• The PhD in Aristo Vojdani's lab: how chemicals can change the configuration of albumin, create a new antigen, and cross-link to neurological autoantibodies
• Harvard as a research fellow, then a master's in clinical investigation — going back to school because he felt intimidated when someone cited a study he couldn't evaluate
• The practice model, in numbers: a $1,500 case review (raised from $500, because $500 didn't filter), a $5,000 exam and workup including four hours in the chart, and $500/hour follow-ups — three clinic days a week
• Why 10–15% of case reviews get sent somewhere else first: chronic patients who gave up on medicine and still have undiagnosed disease
• The expectations conversation — "the minute I'd hear cure or reverse, I'd have to have that discussion" — and the Parkinson's patient who was furious about it
• Home runs are 10–15% of a practice. Erik's breakdown of the rest, and why nobody tells new practitioners this before they burn out
• Time as a clinical skill: reading how long a patient actually needs, and refusing to charge when he ran late
• Practitioner bias — "whatever helped them is what they think everyone has"
• Filming his own patients for two years, including the partial responders and the failures: "It wasn't theoretical anymore"
• Why the seminar junkies never grow, and what he tells master-class teachers to do instead
• Cash practice reality: "if you're not top dog, you're irrelevant"
• An introvert who taught almost every weekend for fifteen years — and hid at lunch
• Where he thinks it all goes: individualized medicine, or no career

About Dr. Datis Kharrazian

Datis Kharrazian, PhD, DHSc, DC, MS, MMSc, FACN is a Harvard Medical School–trained clinical research scientist and Associate Clinical Professor of Preventive Medicine at Loma Linda University School of Medicine, where his research centers on autoimmune molecular mimicry and environmentally induced immune reactivity. He is a Fellow of the American College of Nutrition and of the Royal Society of Medicine, and a two-time Researcher of the Year of the International Association of Functional Neurology. Through the Kharrazian Institute he has trained more than 5,000 clinicians across some thirty countries.

Links

• The Kharrazian Institute
• Dr. K News
• Why Do I Still Have Thyroid Symptoms?
• Solving the Puzzle with Dr. Datis Kharrazian — his own podcast

Erik and Davin have had a lot of physicians on this show. This week they have someone who talks to physicians all day long — from the other side of the table.

Teona Ducre is a physician recruiter with Pinnacle Health Group, specializing in concierge, direct primary care, and membership practices. She screens seven to ten doctors a day across primary care, urology, rheumatology, and gastroenterology, and works markets from Texas and Kansas to Chicago, California, and the UAE.

Ask a physician what their practice is worth and you'll usually hear about the build-out, the equipment, the years. Teona's answer is much shorter: your patient panel. Almost nothing else counts.

She didn't arrive here through healthcare. She was a journalist, then spent eleven years in education. Then, on April Fool's Day 2016, at 41 and a single mother of two teenagers, she was diagnosed with stage 3 pancreatic cancer — when the five-year survival rate was seven percent. The advocacy work she took up afterward put her in rooms full of physicians, and a recruiting firm owner noticed. Ten years out, she screens candidates for compassion and connection as hard as she screens for clinical skill, because she has been on the other side of that exam room.

In this episode

• Journalism, then eleven years teaching, then a stage 3 diagnosis — and how advocacy turned into a recruiting career
• What being the patient permanently changed about how she screens physicians
• The numbers behind the shift: concierge and DPC practices grew more than 80% between 2018 and 2023, with physicians entering the model up nearly as much. "This isn't a niche market anymore."
• Why employers — airlines, big-box retail, car dealerships — are now buying direct primary care for their staff
• Specialty direct care on the rise: the Chicago endocrinologist who flipped to a membership model and kept about 70% of his panel
• The compensation conversation nobody has in medical school: RVUs vs. income guarantee vs. straight salary, and the answer she hears most ("I have no idea what you're talking about")
• The 1,800–2,000 patient panel rule of thumb for converting to concierge — and when it still works with less
• How to vet a management company: track record, panel-growth forecast, a specific marketing plan, territory, and the 10–12% vs. 15–20% fee question
• Davin on his own exit from a health system — the sabbatical year, and why a physical office mattered more than he expected
• Succession planning from day one, and the question that reframes it: would you buy your own practice today?
• What a valuation actually looks at — subscription rate times panel, 7–10% expected attrition, real estate in, furniture and equipment essentially out
• What she's seeing from private equity in functional and integrative medicine, and why more fellows are heading into private practice
• Longevity medicine abroad — her UAE client, and the thought she had in Portugal after treatment

About Teona Ducre

Physician recruiter with Pinnacle Health Group, the Atlanta-based national search firm, focused on concierge, direct primary care, and membership practices. A ten-year survivor of stage 3 pancreatic cancer and an advocate with the Pancreatic Cancer Action Network, she came to healthcare recruiting by way of journalism and more than a decade in education. She writes an ongoing LinkedIn series on the business of concierge medicine and direct primary care.

Links

• Teona Ducre on LinkedIn — her concierge and DPC series
• Pinnacle Health Group

Season 2 opens with a conversation Erik and Davin have wanted to have for a long time.

Dr. Richard Horowitz is a board-certified internist, the creator of the 16-point MSIDS model, and the New York Times bestselling author of Why Can't I Get Better? — the book patients call "the Lyme Bible." Over 41 years he treated more than 13,000 patients with chronic Lyme and tick-borne disease. In November 2025 he closed his clinical practice, and more than twenty advocacy organizations jointly honored him with a Lifetime Achievement Award.

But this isn't a victory lap. It's the story of what it actually cost.

Early in his career, Horowitz did what a well-meaning doctor does: he brought the insurance companies in to look at what he was finding. They told him he'd "spent $70,000 on a disease that doesn't exist." The medical boards investigated him. The panels threw him out. He lost 2,000 patients in one stroke and remortgaged his house to keep the doors open. His wife told him she'd understand if he wanted to stop.

He didn't stop. In this episode he explains why — and the answer turns out to be less about stubbornness than about a two-hour-a-day meditation practice he started in medical school, precisely because he knew he'd need it.

In this episode

• Bringing the HMOs in to validate his findings — and what happened instead
• Losing 2,000 patients, remortgaging the house, and deciding whether to keep going
• Why he's never been successfully sued in 41 years, and what his documentation had to do with it
• Meditating two hours a day through medical school — and a Jewish physician's path into a Tibetan Buddhist practice
• How the MSIDS model was discovered by listening to patients, one unexplained finding at a time
• Dapsone combination therapy, now backed by eleven peer-reviewed papers
• The Alzheimer's case: reversing p-tau 217, the most sensitive biomarker, in a live patient with chronic Lyme
• Why Ending Chronic Illness argues all 16 MSIDS factors apply well beyond Lyme — including cancer
• What he'd tell a physician who is certain they're seeing something their specialty says isn't there

About Dr. Richard Horowitz

Founding member and past president-elect of ILADS. Served on the HHS Tick-Borne Disease Working Group and co-chaired its co-infection subcommittee, which delivered recommendations to Congress. Founder of the MSIDS Foundation. Author of Why Can't I Get Better?, How Can I Get Better?, and Ending Chronic Illness (Simon & Schuster, October 2026).

Links

• cangetbetter.com — books and consulting
• MSIDS Foundation
• Medical Detective — his Substack

Twenty episodes in, brother doctors Erik and Davin Lundquist step out from the interviewer's chair to reflect on Season One of The Root Cause Business of Medicine and tee up Season Two. The Lundquist brothers — Erik a longtime functional-medicine physician, Davin newer to the path — talk candidly about launching the show as self-described novices, figuring it out episode by episode, and why shipping something imperfect beat waiting for polish.

Looking back across the first 20 episodes, they revisit standout moments: Chris Magryta's work securing local funding to feed underserved pediatric patients; a physician's pivot from high-end concierge care to building a direct-primary-care company that helped catalyze the membership movement; and one-liners that stuck — "ready, fire, aim," the two-stakeholder simplicity of cash-pay care, and Tieraona Low Dog's "knee to knee" patient connection. They credit guests like Jeffrey Bland and Jill Carnahan for pairing rigorous science with genuine human healing.

Most tangibly, the brothers share how the show reshaped their own practice — layering a membership model over insurance-based care, tightening compliance, and refining their niche and branding. They close with what's ahead: all 20 episodes rolling out as videos (~2/week on YouTube) and Season Two's topic-driven episodes. For clinicians weighing a move toward integrative, membership-based care, it's both a recap and an invitation.

In the most tech-forward episode yet, brother doctors Erik and Davin Lundquist sit down with Travis Garland — co-founder and COO of My Compliance Citadel and a two-decade healthcare-operations veteran (United Healthcare, UF Health, and earlier work that earned an award for redesigning Florida's foster-care system) — to map the collision of AI, innovation, and compliance in medicine.

Travis breaks down a distinction most clinicians miss: a GPT prompt simply answers, while an AI agent makes decisions and acts autonomously — sometimes spawning other agents. He explains why prompts are only ~50–60% reliable ("a pinky swear with a robot"), how one rogue agent erased a company's entire production database, and why the deploying practice, not the developer, is who regulators hold accountable. My Compliance Citadel acts as a fortress around that risk: a runtime layer that intercepts agent actions and renders one of three verdicts — pass, pause, or prevent — logging everything to a tamper-proof audit chain. Erik stress-tests it against two real scenarios: pasting patient labs into open ChatGPT, and using AI to comb an EMR for high-risk patients.

For clinicians, students, and small-practice owners excited about AI but wary of HIPAA and PHI exposure, it's a grounded primer on innovating boldly without betting the license.

Brothers, and Doctors Erik and Davin Ludnquist sit down with health reporter Jess Craig to unpack what "cash-based care" actually means — and why it's quietly tripled over the past several years. Drawing on her reporting at Straight Arrow News and her decade in infectious disease epidemiology, Jess maps the landscape: direct primary care (now 11% of family physicians, up from 3% in four years), cash-based specialty and surgical centers like the Surgery Center of Oklahoma, longevity-focused practices, and the rapidly growing world of direct-to-employer contracting (40% of large companies and 20% of small ones now negotiate directly with health providers).

The conversation moves through the structural forces driving the shift — flat insurance reimbursement against rising overhead, the stakeholder problem of insurers and PBMs sitting between patient and physician, and what Jess in her recent reporting calls the demoralization of America's doctors. They wrestle with the inherent scaling tension in cash-based care, how AI is more likely to be deployed to maximize insurance margins before it relieves physician burden, and what international models (Kenya, Canada, global health insurance) can teach Americans about price transparency and personal responsibility. Jess closes with a journalist's challenge: keep questioning, follow the evidence, and resist letting health policy collapse into political tribalism.

For physicians evaluating a model change, employers reconsidering benefits, and anyone trying to understand why so many doctors are walking away from the insurance-based system.

Dr. Erik Lundquist and Dr. Davin Lundquist sit down with JJ Virgin for a candid playbook on what it actually takes to build a brand, marketing engine, and scalable practice in integrative and functional medicine. JJ walks through her Trusted Authority Triangle — Trust (built through vulnerability and showing humanity), Authority (built through absolutes and contrarian beliefs you'll defend, not credentials alone), and Proof (the patient transformation stories no one can copy) — with YOU at the center, because the best part of building a business is who you become in the process.

She reframes imposter syndrome as evidence you're stepping into a bigger game, makes the case that "people seek experts, not generalists," and offers concrete tactics: a signature talk that doubles as lead-magnet content for YouTube, podcast, and social; capturing email lists everywhere you speak (since 50% of prospects buy within 18 months — but only 3% buy now); collaborating with 5–10 aligned partners who share your patient avatar; and optimizing for both SEO and AEO (AI-engine optimization) so AI assistants surface you to the patients you're meant to serve.

The conversation closes on the bigger shift — moving from transactional fee-for-service to transformational programs, why AI is actually creating more demand for trusted human authorities, and JJ's mantra: "You shouldn't have to sacrifice your life to save others."

For practitioners ready to stop trading time for money and build a sustainable, mission-aligned practice.

Dr. Samir Qamar — one of the original founders of the Direct Primary Care movement and creator of MedLion, MedWand, and AstroDoc, joins Brothers, Dr. Erik Lundquist and Dr. Davin Lundquist, for a wide-ranging conversation shaped by a childhood spent across four continents with a UN-diplomat father. Samir traces his arc from Ross   University to England's socialized NHS to Penn Medicine-Lancaster General, where as an intern he cold-called MDVIP from his scrubs after  discovering concierge medicine. His first post-residency role was House Physician for Pebble Beach Resorts; that seeded MedLion, the nation's  largest DPC network across 27 states, which in turn led to the MedWand — a handheld telemedicine device that lets remote clinicians capture real  physical-exam data.

His current obsession is AstroDoc and its AI health agent Astrid ("A System To Reinforce Infinite Doctors"), designed to be for billions of patients what Samir became for his own parents when they were sick. The conversation digs into healthcare versus sick care, why AI will change the physician's role without replacing it, the ethics of non-clinicians building medical AI, and Samir's view that the next generation of doctors will function as coaches and cheerleaders — not gatekeepers of knowledge.
For physicians weighing DPC, founders building health AI, or anyone thinking about how the doctor-patient relationship evolves in an era of voice-enabled, multilingual, clinician-led tooling.

In this episode, Doctors and Brothers Erik and Davin Lundquist sit down with Erik Goldman, the co-founder and editor of Holistic Primary Care, a publication that has spent 25 years bridging conventional and integrative medicine for over 60,000 physicians. Goldman shares his journey from covering dermatology news to becoming New York bureau chief at International Medical News Group, where he realized mainstream medicine was almost entirely focused on end-stage disease with little attention to prevention or whole-person health. That realization led him and Publisher Meg Sinclair to launch HPC in 2000.

The conversation dives deep into the structural forces shaping healthcare — the rise of managed care and HMOs in the 90s, how the "gatekeeper" model distracted primary care from its healing mission, and why insurance-based reimbursement remains the biggest barrier to integrative medicine adoption. Goldman draws on his experience  producing the Heal Thy Practice conferences (2009-2016) to share what made practitioners successful: confronting their psychology around money, breaking out of professional silos, and being willing to take risks even when the path isn't clear.

Looking forward, Goldman argues the tipping point won't come from government but from Fortune 500 employers demanding better care models from insurers. He calls for the field's "different tribes" — naturopaths, MDs, nurses, chiropractors — to present a unified front and position integrative medicine as the core of healthcare, not a side dish. Essential listening for any clinician navigating the business side of integrative practice.