Unstable Vitals

What happens when a Canadian finance guy with zero healthcare experience decides to take on one of the most broken systems in the world? You get Alex Barrett, co-founder and CEO of Meroka, and a genuinely different perspective on why independent medicine is dying and what can actually be done about it.

In this episode, Drs. Lara Zibners and Adam Brown sit down with Alex to unpack the real force behind healthcare consolidation, and it's not the "silver tsunami" you keep hearing about. CMS reimbursement rates have been essentially flat since 2002 while costs have surged, making the business model of running an independent practice quietly unsustainable for thousands of physicians across the country.

Alex shares how Meroka is building a third exit path for retiring physicians, one that keeps practices out of private equity hands and transfers ownership to the staff who actually do the work. But the conversation goes deeper: Why does the only OB delivering babies in a 100-mile radius in rural West Virginia still have no negotiating power? Why are non-compete clauses one of the biggest hidden barriers to independent medicine? And is the system so broken it simply can't be fixed?

Spoiler: Alex doesn't think so.

Listen now.

Dr. Adam Brown and Dr. Lara Zibners are back for Season 2 of Unstable Vitals, and they're wasting no time. After catching up on life, including Laura's Arctic Circle dog sledding adventure, Adam's new London life, Calla Lily's first Big Pharma partnership, and a spirited rant about Yorkshire pudding, the duo lays out their ambitious plan for the season ahead.

This episode introduces the "Five P's" framework that will guide Season 2: Politicians/Policymakers, People (patients), Providers, Payers, and Producers. They argue that fixing America's broken healthcare system requires engaging all five groups, and they plan to do exactly that through conversations with health tech founders, clinical innovators, device executives, regulators, and investors.

From the cost of estrogen gel in Europe vs. the U.S. to why walking to the grocery store might be better healthcare policy than anything coming out of Washington, this season promises to be equal parts hilarious and eye-opening.

Topics covered:

• The "Five P's" of healthcare: the season's guiding framework
• Public transportation, walkability, and downstream population health
• Lifestyle medicine and transatlantic perspectives on healthcare costs
• A preview of Season 2 guests and episodes
• What Adam and Lara have been up to since last season

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In this special year-end episode of Unstable Vitals, Dr. Lara Zibners and Dr. Adam Brown reunite for their funniest, most unfiltered conversation yet. From GLP-1 mania to AI hype, from the workforce crisis to the seismic impacts of the 2025 election, Lara and Adam break down the five biggest healthcare stories of the year, with the honesty and occasional oversharing you’ve come to expect.

Along the way, they revisit their favorite moments from Season 1, reflect on personal wins, and look ahead to what excites and terrifies them most about 2026. 

They also talk negotiations, vaccine misinformation, reproductive rights, and why you should always travel with spare underwear.

Lara and Adam close out 2025 exactly the way they started it: unstable, opinionated, and determined to make healthcare a little less chaotic, one candid conversation at a time.

In this episode of Unstable Vitals, we sit down with Mac Deford, former local government attorney, community advocate, and congressional candidate from South Carolina. From his time in the Coast Guard to his work in behavioral health and affordable housing, Mac has seen firsthand how policy decisions ripple through people’s lives.

We talk about what inspired him to run for Congress, the realities of healthcare and housing access in South Carolina, and why public service still matters, even when the system feels a little… unstable.

In this episode of Unstable Vitals, Dr. Lara Zibners and Dr. Adam Brown welcome Alison Fragale, organizational psychologist, professor, and author of Likeable Badass, to talk about the science of respect, influence, and why women in leadership still face steep uphill battles.

From trading nail files for shoes to unpacking why “likeable” and “badass” aren’t opposites, this conversation dives into how gender bias shapes pay, leadership, and culture, and what can be done to change it.

Alison breaks down the psychology behind earning respect and why bias isn’t just a “men vs. women” problem. Lara and Adam bring it home with real-world reflections on mentorship and what it means to balance warmth and authority in a system that often rewards the opposite.

Smart psychology, unfiltered honesty, and a little bit of chaos the Unstable Vitals way.

In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with orthopedic surgeon, researcher, and author Dr. Jocelyn Wittstein. Together, they dig into an often-overlooked area of medicine: bone and joint health as the foundation for long-term wellness.

Dr. Wittstein shares insights from her new book, The Complete Bone and Joint Health Plan, exploring why osteoporosis and arthritis are more than “aging problems” — they’re critical, preventable drivers of disability that ripple into cardiovascular health, cognitive decline, and overall quality of life. The conversation covers:

• Why mobility is medicine and how preventing fractures protects independence.
• The evidence (and myths) behind supplements like glucosamine, collagen, and more.
• How proactive, cross-specialty care (from hormone therapy to strength training) can reduce complications and extend healthy years.
• Dr. Wittstein’s journey as one of the 6% of women in orthopedics, and how her perspective shapes both her practice and her advocacy for women’s health.

Blending humor, real-life stories, and evidence-based strategies, this episode shines a light on the connection between musculoskeletal health and the stability of our entire healthcare system.

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners welcome Dr. Steven Farmer, former senior leader at the Center for Medicare and Medicaid Innovation (and Adam’s husband).

Between playful banter and sharp commentary, the trio dives into the serious business of healthcare regulation: why the U.S. system remains unaffordable, how payment models shape medical practice, and what it really takes to shift toward value-based care. From international adventures to bundled payments, Dr. Farmer shares his unique journey through medicine, policy, and innovation—sprinkled with equal parts humor and frustration.

If you’ve ever wondered how regulation, incentives, and a little bit of “gaming the system” affect the care you receive, this is the episode for you.

Trigger warning: This episode contains discussion of physician mental health  and suicide. If this topic is distressing, please consider listening with support nearby or using local mental health resources.

In this episode of Unstable Vitals, hosts Dr. Adam Brown and Dr. Lara Zibners sit down with Dr. Stefanie Simmons, Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation, for an urgent, unfiltered conversation about the mental health crisis in medicine. Timed for National Physician Suicide Awareness Day (September 17), the episode explores why clinicians—especially emergency and critical care providers—face elevated rates of burnout, depression, and suicide; the systemic barriers that keep clinicians from seeking help; and concrete policy and operational changes that can begin to “heal the healers.”

Dr. Simmons explains the Foundation’s work that’s shifting culture and protections for clinicians. The hosts bring personal stories from residency and frontline care to highlight how stigma, intrusive application questions, and unsafe workplace systems drive clinicians away from care. This episode is essential listening for physicians, nurses, hospital leaders, policy makers, and anyone who cares about the future of the healthcare workforce.

Subscribe to Unstable Vitals, share this episode to raise awareness, and consider supporting clinician wellbeing efforts in your organization.

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners dive into one of the biggest challenges in healthcare today: misaligned incentives. Should our system prioritize profit or patients? How do payment models, public policy, and personal responsibility collide to shape health outcomes?

From fee-for-service vs. value-based care to the impact of public transportation, food policy, and behavioral nudges, Adam and Lara unpack the hidden forces driving both innovation and inequity in modern medicine. Along the way, they share personal stories, debate policy trade-offs, and explore how we can make healthy choices easier, care more accessible, and incentives better aligned, without sacrificing innovation.

If you’ve ever wondered why our healthcare system feels broken (and what it would take to fix it) this episode is for you.

🎧 Listen now to hear:

• Why profit-driven incentives often work against patient health
• How public health policies intersect with economic growth
• The promise and pitfalls of value-based care
• Behavioral nudges  and making healthy choices easier
• Why doctors need to understand the business of healthcare

Listen to Part 1 before diving into Part 2.

Why is the U.S. healthcare system so expensive, yet so ineffective? In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners dive deep into the tangled web of patients, profits, and misaligned incentives driving instability in American healthcare.

From skyrocketing medical school debt and low primary care reimbursements to insurance company profits and hospital billing practices, Adam and Lara expose the financial forces shaping how (and if) patients receive care. They compare the U.S. system to models in the U.K. and Europe, exploring why Americans pay more but live shorter, less healthy lives.

This episode tackles big questions, like:

• Why do we prioritize treating illness over preventing it?
• How do insurance companies profit while patients struggle with medical bills?
• What does “health” actually mean and who gets to decide?
• Can we fix a system where profit often outweighs patient care?

If you’ve ever wondered why navigating healthcare feels so complicated, or why the U.S. spends more per person on healthcare than any other developed nation but ranks lower in life expectancy, this conversation is a must-listen.