Your Doctor Wants to Quit: Conversations to Fix Our Broken Health Care System

In this episode I interview Dr. Nathan Hammel, a board-certified orthopedic surgeon with fellowship training in orthopedic oncology - and now he does utilization review for insurance companies.

I've spent my career in primary care fighting denials. He's worked on both sides of the desk — submitting his own prior authorizations and evaluating appeals of other doctors' denied insurance claims. That's what made me want to talk to him.

If you're a patient, this is a look behind a process that usually happens invisibly. Why the delay happens. What's actually being evaluated. Why your doctor sometimes can't get you the test they already know you need — and what you can do about it. We also talk about why an MRI can cost $230 in cash and thousands through insurance, and why knowing that in advance changes how people choose their care.

If you're a physician, Dr. Hammel explains what reviewers look for and where strong requests fall apart, which is useful whether or not you land where he does. He argues utilization review grew out of how fee-for-service incentives shape behavior across the profession. I push back — most of what my practice fights over is medications, imaging, and labs, none of which we profit from ordering. We also get into what's happened to Medicare reimbursement since 1999, the squeeze on independent practice, and what consolidation elsewhere in health care suggests about where medicine is headed.

What comes through is that he'd rather this system didn't exist. He closes with a proposal: an audit-based model that would exempt physicians with strong guideline compliance from prior authorization altogether — and shrink the industry he works in.

In this episode, Dr. Joy Evers sits down with Ada Andruszkiewicz, co-founder and COO of Talkie AI, a voice AI platform built specifically for medical practices. Although Ada is not a physician, her eight-plus years in digital health give her a rare vantage point on how AI has evolved — from clunky rule-based systems to today's large language models — and where it still falls short.

Together, Joy and Ada explore the promise of AI as an administrative partner, the hazards of hallucination and "AI wanting to please," the legal and ethical questions surrounding AI diagnosis, and the parts of medicine that may never be automated. Because medicine is both an art and a science — and while AI can offer a powerful assist with the science, the art still belongs to the humans at the bedside.

Kicking off season 2, Dr. Joy interviews Kal Vepuri, CEO and founder of Hero. They explore the intricate landscape of modern healthcare. Kal shares his personal journey, and they discuss insights on systemic obstacles, the transformative potential of technology (including AI), and the enduring importance of empathy and human touch in medicine.

The Season 2 trailer of the "Your Doctor Wants to Quit" podcast, hosted by Dr. Joy, sets the stage for a compelling series that delves into the challenges and transformations within the health care system. Dr. Joy emphasizes that despite the podcast's title, the focus is on addressing the systemic issues rather than quitting. The season promises raw conversations about the integration of technology and humanism in health care, the impact of AI on medical practices, and stories from frontline providers. Dr. Joy also shares a personal story of overcoming illness, which has reignited her passion for healthcare reform. The trailer invites listeners to engage in these critical discussions and contribute ideas for improving health care in America.

In the episode Dr. Joy interviews Dr. Dan Meltzer, an Emergency Physician who now works for a health insurance company. Dr. Meltzer is the Executive Medical Director for Regence Blue Shield of Idaho, a not-for-profit health insurance company serving more than 370,000 people. The discussion delves into Dr. Meltzer's unique career path, the challenges of integrating the business of medicine with the practice of medicine, and the importance of physician leadership in health care organizations in general, including health insurance companies. Dr. Meltzer shares insights on the evolving landscape of health care, the impact of health insurance on medical practice, and the ethical considerations in balancing patient care with necessary business functions to ensure viability of the health care system as a whole.

In this episode, Dr. Mo Alo, a board-certified cardiologist, discusses the challenges he faces in his quest to combat the tsunami of medical misinformation on social media. Dr. Joy and Dr. Alo also discuss evidence-based practice and the recent government press conference held on Tylenol and Autism. The conversation highlights the complexity of medical research and the responsibility of healthcare professionals to provide accurate, politically neutral information to the public.

This conversation explores the personal journeys of eleven emergency physicians, highlighting the trust and responsibility inherent in their roles. It delves into defining moments that inspire these professionals, the challenges they face, and the importance of teamwork and community in emergency care. The speakers share personal experiences and insights, emphasizing the need for empathy, community support, and the significance of maintaining a balance between professional responsibilities and personal well-being. They also provide valuable advice for those considering a career in emergency medicine, highlighting the rewarding aspects of the field despite its challenges.

In this conversation, Dr. Joy and the founders of Airway discuss the importance of storytelling in medicine, the challenges faced by healthcare professionals, and the need for vulnerability and connection in the medical field. They explore how Airway serves as a platform for physicians to share their experiences, process trauma, and build trust with patients. The discussion highlights the significance of empathy, the impact of burnout, and the future of healthcare advocacy.

For more information on Airway, or for instructions on how to submit your story to Airway, please visit their website: airwaystories.com

For recent coverage of Airway in the media, see the recent NY Times article by journalist Lisa Miller, Real Doctors of New York Spill Their Guts - link below:

https://www.nytimes.com/2025/06/24/well/real-doctors-of-new-york-spill-their-guts.html

In this episode, Dr. Joy engages with Dr. James Howard, an emergency physician turned primary care doctor (and big wave chaser!) They explore the role of emergency medical services in health care delivery, and innovations that could leverage EMS to improve access. They discuss Dr. Howard's unique journey from emergency medicine to primary care, the ethical dilemmas faced by healthcare professionals, and the importance of person-centered care. The conversation highlights the need for more flexible reimbursement models to facilitate innovation. They also discuss precision medicine.

In this conversation, Dr. Joy engages with Dr. Alyssa Burnham and Dr. Michael Turner to explore the intersection of naturopathic and conventional medicine. They discuss their unique training paths, the challenges of balancing medical careers with family life, and the importance of understanding each other's perspectives in healthcare. The conversation highlights the role of naturopathic doctors in the healthcare system, the challenges they face, and the need for greater integration and accessibility of integrative care. They also emphasize the importance of preventive medicine and advocate for changes in healthcare policy to improve patient access to diverse medical practices.