A surgeon reads his father’s CT scan, spots a massive liver tumor, and has to deliver the worst possible news himself. That moment helped shape Dr. David Jackowski’s lifelong drive, but it didn’t lead where most people would expect. It eventually helped turn an orthopedic surgeon into a founder and CEO who thinks as much about incentives, systems, and outcomes as he does about the operating room. 

We walk through David’s early life in New York, where a teacher-mom demanded academic precision and a business-owner dad taught him to “buy” stocks from the newspaper, track performance, and learn taxes the hard way. From there, he moves at full speed through medicine, crosses paths with Mayo Clinic training, and explains why he switched from general surgery toward orthopedics, drawn by variety, complexity, and a different kind of problem solving. 

Then the conversation turns into the real work: leaving a world-class institution, writing a business plan for value-based care, and moving to Phoenix to build what became the Core Institute and later Hopco. We get specific about standardization, evidence-based practice, service line management, payer negotiations, and why trust matters more than pitch decks. We also unpack private equity in healthcare from an operator’s perspective: growth capital versus control, why some physician models fail, and what it takes to scale across states without losing the culture. 

Finally, we dig into digital health, AI, data warehousing, and the hard truth that tools do not create ROI, workflows do. If you care about orthopedic practice sustainability, value-based care, private practice, healthcare innovation, or physician leadership, this one is for you. Subscribe, share with a colleague, and leave a review with the biggest idea you’re taking into your week.

A kid in Spain watches his family’s world collapse, loses his father to cancer at age five, then loses the uncle who adopted him nine months later. Years later, that same kid becomes an immigrant in rural North Carolina, cleans tanning beds to pay his way forward, builds a business, and eventually leads Zimmer Biomet, the world’s largest orthopedic company in the world. We talk with Ivan Tornos about the turning points that shaped him and the mindset that kept him moving: refusing victimhood, practicing grit, and choosing problem solving when life gets brutal.

We get tactical about leadership and career growth in healthcare and medtech. Ivan breaks down why an MBA can help with skills like strategy and finance but won’t magically teach leadership, and why failure is often the real training. He also shares one of the clearest frameworks for advancement: mentors show you the way, sponsors clear the way. If you’ve ever wondered how people land “too big, too soon” roles and survive them, this conversation explains the difference.

Then we zoom into Zimmer Biomet’s reality: post-merger complexity, FDA warning letters, compliance pressure, culture friction, and what it takes to regain trust while catching up on innovation. Ivan lays out a customer-first approach across patients, physicians, providers, and payers, plus how robotics, ambulatory surgery centers, efficiency, and AI-driven data could reduce waste in musculoskeletal care without pushing surgeons out of the operating room.

If you care about orthopedic surgery, medical device innovation, healthcare costs, or modern leadership under pressure, hit play, then subscribe, share this with a colleague, and leave a review with the biggest idea you’re taking from the conversation.

Same-day hip replacement used to sound like a bad idea someone would regret out loud. Then Dr. Richard Berger did it anyway and backed it up with results. Sitting with him in Chicago, we walk through the real story behind outpatient joint replacement: how an engineer’s obsession with motion became a surgeon’s obsession with systems, and why the biggest breakthroughs weren’t flashy gadgets but hard, unglamorous protocol changes that made patients feel better faster.

We talk minimally invasive hip surgery, the early four-hour cases, and the moment patients started asking the uncomfortable question: “Why am I still in the hospital?” From there, Berger breaks down what had to change to make same-day discharge safe and repeatable, including anesthesia choices, medication strategy, physical therapy alignment, admissions messaging, and the grind of personally shepherding patients until the entire machine caught up. We also get into the backlash, the threats, and what it actually costs to challenge medical convention when incentives and egos are on the line.

Then we shift into the business of medicine: building a word-of-mouth practice, adopting a concierge-style model, and the pivotal decision to drop Medicare after running the numbers. Berger shares how he builds a high-touch team using hospitality standards, why he resists replacing humans with automation, and how leadership, grace, and “extreme ownership” create loyalty in the OR and the office.

If you care about hip replacement, knee replacement, outpatient surgery, practice building, or redefining work-life balance for physicians, hit subscribe, share this with a colleague, and leave us a review with your biggest takeaway.

Infection after joint replacement is one of the few problems in orthopedics where the stakes can go from “recover and rehab” to “fight for your life” in a matter of weeks. We sit down with Chris Hughes and Eric Stookey, two longtime orthopedics operators who built OsteoRemedies by doing what most companies would not: going all-in on joint infection (PJI) and infection management while everyone else treated it like a side project.

We talk candidly about the entrepreneurship leap in healthcare and medical devices, including the lonely early days of shipping product, assembling conference booths, and learning that a napkin plan only survives through execution. Chris and Eric break down how they protect culture as they scale, why they “check titles at the door,” and how “micro leadership” means removing obstacles so teams can move fast without getting micromanaged. We also get into the messy truth of innovation: FDA and 510(k) hurdles, changing goalposts, multi-year gaps in launches, and why acquisitions can restore the cadence of innovation when organic pathways slow down.

Then we go straight at the market forces shaping orthopedic infection care right now: antibiotic spacers, local antibiotic delivery beads, debridement tools, wash solutions, and the rising debate over one-stage vs two-stage revision. Their core argument is simple: if the standard of care shifts, a patient-first company cannot cling to a single product category. It has to build an infection management portfolio that follows the clinical need.

If you care about PJI, orthopedic infection prevention, medical device startups, or leadership that holds up under pressure, subscribe, share this with a colleague, and leave a review. What part of the infection story do you think the industry still avoids talking about?