On/Offcall: The Money Trap Leading to Physician Burnout

Welcome back to On/Offcall!

“If you actually understood how the money works, then a physician would be much less easily manipulated.” — Dr. Eric Bricker on Offcall.

This week, we put out a post discussing one of the structural barriers that’s causing too many brilliant physicians to burn out: lack of understanding about money.

After interviewing over 35 physicians for the How I Doctor podcast, one theme that’s become crystal clear is that we, as physicians, are never taught how money actually flows in healthcare both on a macro level – i.e. How insurance and reimbursement frameworks actually work – and on a personal one – i.e. What are the different employment models and how do they impact my practice and wealth potential (h/t Dr. Scott McCusker). Case in point: Physician employment attorney Michael Johnson shared with us that his firm does 200 1-hr virtual lectures for med schools, residency, and fellowship programs each year, and many times this is the ONLY training on physician contracts and negotiation they ever receive in school. Wooph. “This is total nonsense and needs to change. Physicians deserve better,” he said. 🤯

This lack of knowledge leaves physicians woefully unprepared to enter the workforce and is a big motivation behind Offcall (also check out Dr. Jared Dashevsky and Dr. Paul Tran’s work on the topic). We suspect mismatched financial expectations about things like salary and money are also contributing to burnout. For example, many physicians, and particularly women (h/t Dr. Resa Lewiss), don’t recognize that you can negotiate your first employment contract.

We’ll continue to share additional resources, data sets, and podcasts about the financial side of practicing in the coming weeks. Tell us: What’s one financial topic/skill you’d like us to tackle? Reply back or let us know in the comments.

What Happens When a Pediatrician Takes On Congress: Meet Dr. Annie Andrews

This week’s How I Doctor guest is a pediatric hospitalist, mother of three, who’s now running for Lindsey Graham’s Senate seat in South Carolina.

Welcome to the show, Dr. Annie Andrews! Our co-founder Dr. Graham Walker talked with Annie about why she made the jump from politics after the Parkland school shooting and what it’s really like for women physicians to speak up, lead, and run for office. A troubling theme emerged from the conversation: For years, Annie experienced sexism in how women physicians get treated, and she’s finding the same double standard in politics. "If I bring my kids to a campaign event, it's like, what, she couldn't find childcare? If a man brings their kids, it’s like — oh my gosh, that’s amazing.”

This mirrors the experience Graham recently shared about analyzing the comments on his How I Doctorinterview with Dr. Tiffany Moon (“oh my god, it's a trash heap dumpster fire.”). It’s also one of the reasons we’re releasing gender pay gap data and will continue to discuss the barriers that exist for women in medicine.

During the episode, they unpack:
👉 Why Dr. Andrews made the jump from medicine to politics.
👉 Why physicians must be at the table when systemic change is on the line.
👉 The dangerous rise of anti-vax rhetoric and misinformation.
👉 And the double standards women in medicine still face.

Listen to the full episode
(You can learn more about Dr. Andrew’s campaign here).

P.S. Know someone who would benefit from joining us? Help us grow our tent by forwarding this newsletter to your physician colleagues and subscribing here.

Most Talked About On Offcall

From Burnout to Building Something New: My Journey to Becoming a Physician Entrepreneur

Hot off the press from Dr. Joshua Guttman: “I spent close to a year recovering and regrouping from burnout. Getting into something totally new has brought my energy back.”

Physician Builders Spotlight: William Cherniak

New spotlight drop! Meet Dr. William Cherniak, founder and CEO of Rocket Doctor. Learn his secrets to entrepreneurship (and how he’s using AI tools!).

New Data Reveals Job Satisfaction for Men vs. Women Physicians By Specialty

How does job satisfaction differ between men and women physicians – and how does that differ based upon medical speciality? See our new data.

Independent Physician Spotlight: Demetrio Aguila

New feature! We put out a call to celebrate independent physicians, and we’re featuring a different doctor who’s decided to go (or remain!) independent to restore their autonomy and provide better patient care. This week, meet Demetrio Aguila, who’s the founder and medical director of his own practice Total Pain Solutions. You can connect further with Demetrio on LinkedIn.

1. Demetrio, give us a little background on you and your practice. Our surgical practice is focused on permanent surgical solutions for chronic pain. About 50% of our practice is the resolution of postherpetic neuralgia, of which there are roughly 200,000 new cases in the U.S. annually. Our goal is simple — restore hope to the hopeless by offering permanent fixes for which the temporary band-aids of the past have been ineffective. I am a diplomate of the American Board of Plastic Surgery and the American Board of Otolaryngology, and I am the only surgeon in Nebraska, Iowa, Colorado, and South Dakota to offer micro-invasive carpal tunnel surgery with real-time ultrasound guidance, allowing patients to return to work the same day, without restrictions. I’m the CEO and President of Healing Hands of Nebraska and the founder of Healing Hands of America, the 501(c)3 non-profit that runs the revolutionary M25 Program offering patients innovative options for specialty care while avoiding crushing medical debt.

2. What do you see as the biggest challenges to physicians going (or staying) independent? How are you addressing these challenges? The biggest challenge to going independent is debt. By the end of the training, with over a million dollars in debt, many physicians feel boxed in, unable to do anything other than take the big paycheck, and the golden handcuffs, that are offered by the big hospital systems, a deal that is married to the administrative horrors of the health insurance system as well. These physicians find themselves trapped in a system that promotes profit over care and burnout over well-being. The biggest challenge for physicians who want to stay independent is restoring the doctor-patient relationship through direct care. Direct care is the way of the future, and ironically, is also “traditional” medicine in the truest sense. Hospitals treat us as expendable widget-makers, with those who are willing to work silently on the assembly line being the least bothersome. I once had a hospital CEO tell me that “physicians are a necessary evil in the delivery of healthcare.” Shedding the shackles of fear that hold us back and giving ourselves permission to determine our value, independent of what the hospital administration or insurance industry tell us, is the key to maintaining independence.

3. What are the biggest benefits for going independent? Independent practice is how we are able to maintain autonomy. The only committee that has to approve any changes in the practice is the one that I see in the mirror every morning, and if we can’t agree, then we’ve got a bigger problem! Independent practices are more adaptable and flexible, able to meet the needs of the patient in real-time. Subsidiarity is the greatest benefit to the patients. The best person to solve the problem is the one closest to the problem, with minimal (if any) interference from third parties, particularly those who have never met the patient. The result of this intimate doctor-patient relationship in direct care is a significant reduction in overhead costs, and the savings can be passed on to the patient. The employed physician model is the classic “one size fits none” approach, and only serves the shareholders, not the patients or the caregivers who are in the trenches with the patients.

4. What's your advice to anyone who's thinking about making the leap or deciding what path to take straight out of training? Do it! If you’re in training, you’ve been living a modest lifestyle (I hope!). If you want to have the freedom to build or join a practice that is of your choosing (and not one that has been thrust upon you out of financial necessity), then continue to live as a resident until you’ve built up a big enough nest egg to be comfortable with the financial risks associated with stepping out on your own. This means driving your beater and living in a small house until your debt is paid off early. Cash is king, and if you’re not beholden to those debtors, then you won’t feel the need to bow before the altar of an employed position in order to feed yourself and your family.

5. Are there any resources you can recommend to help physicians who are considering this path? The first resource I would recommend is Dave Ramsey’s Financial Peace University. If you want independence, then you need to know how to make your money work for you rather than you working for your money. Secondly, I would recommend the Free Market Medical Association, dedicated to transparency, independence, and fairness in the practice of medicine. Thirdly, I would recommend resources like Freedom Healthworks led by Christopher Habig that specializes in helping physicians transition to direct care, with a concrete pathway to independence that works for the physician AND the patient.

6. How can other physicians who are inspired support you? Check out the M25 Program, the mechanism by which patients can receive specialty care without incurring crushing medical debt. Your tax-deductible donation will make it possible for patients who are willing to invest in themselves through community service to access the care that they need without going bankrupt. Secondly, check out our YouTube channel to learn more about the surgical solutions we offer to treat patients with chronic pain and spread the word. If you’re a surgeon and you’re interested in learning more about how to treat these patients, please reach out to us. And finally, and most importantly, if you’re the type to pray, then I would ask you to pray on behalf of our practice, our patients, and our families.

This excerpt has been shortened, read the full article here. Know someone else who should be featured? Reply or tag them and their company in the comments!

Best Things to Read This Week

Patient Complaints & Industry Payments for Physicians (JAMA Network)
From Dr. Yong Hyun Park, Dr. Zhuo Tony Su, and Henry John Domenico: Do physicians with more unsolicited patient complaints also have a greater likelihood of accepting general payments from industry?

A shared vision and roadmap for AI in primary care (AAFP and Rock Health)
Primary care is at a breaking point, but here’s how AI can lead to a breakthrough. Commentary from Dr. Kameron Matthews here, and more work on this topic from Dr. Jackie Gerhart, Joseph Betancourt, and Eric Schneider here.

Endoscopist deskilling risk after exposure to AI (The Lancet)
How do endoscopists who regularly use AI perform colonoscopies compared to when AI is not in use? New study, plus commentary from Dr. Bryan Vartabedian here.

How this physician group built scale without selling out (Becker’s Healthcare) Here’s how Articularis Healthcare Group built a model to keep community rheumatologists independent while giving them the scale and resources to thrive.

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.

✅ Thanks for your leadership, John Whythe
AMA CEO John Whythe wrote about why we need to embrace AI but also have oversight, transparency, and clinician leadership. Read it here.

💯 What a role model, Mark Richman 
Dr. Mark Richman shared why he gives his patients his phone number directly and how that’s led to more trust. Read more here.

💡Important listen, Francis Mei Harden
Former ENT surgeon Dr. Francis Mei Harden opened up to Dr. Antonio Webb about her decision to leave medicine – and why it might have saved her life. Listen here.

🫡 Thanks for sharing, Andrew Ibrahim
Dr. Andrew Ibrahim reflected on his experience trying to coordinate and schedule an appointment for a family member, and why this is still one of the biggest challenges to fix in healthcare. Read it here.

📝Great work, John Hernandez
John Hernandez published a paper in Nature Medicine introducing a Personal Health Large Language Model for sleep and fitness coaching. Read it here.

❗Fascinating work, Kameron Black
Dr. Kameron Black published new work in NEJM AI on the topic of how AI agents can assist with real-world clinical task completion. Read more here.

💯 💯 So true, Harsh Moolani
Dr. Harsh Moolani posted openly about the massive need to improve salary transparency in medicine and for more reliable data. Thank you! Read it here.

👀 See you soon, Sachin Jain
Dr. Sachin Jain will serve as the Keynote Speaker at the 2025 Changing Care Together Summit hosted by Nexus Health Systems next month in Houston. Learn more here!

💞 Inspiring, Tori Marsh
Tori Marsh posted about her fight with Cigna to cover a new drug to treat her husband’s rare and aggressive bile duct cancer, and after the community rallied together, Cigna approved coverage! See part 1 and part 2 here. Inspiring!!

🚀 Congratulations, Edward Yap!
Dr. Edward Yap is starting a new position as Physician Researcher at The Permanente Medical Group, Inc. Well done! Celebrate him here.

🎉 More congratulations, Alae Kawam
Dr. Alae Kawam is starting a new position as Pathology Fellow at Mount Sinai Health System! Learn more here.

🥳 Also congratulations, Roger Kerzner
Dr. Roger Kerzner is starting a new position as Medical Director at Heartbeat Health. Congratulate him here!

🎉🥳 Still more congrats are in order, Siavash Sarlati
Dr. Siavash Sarlati is starting a new position as Chief Medical Officer at Sparrow! Congratulate him here.

Be Sure to Sign Up for Offcall!

At Offcall, we believe physicians deserve to be heard, valued, and treated fairly. Everything we do is driven by our commitment to empowering doctors with accurate, reliable, and trustworthy data — to advocate confidently for themselves and ensure their compensation truly reflects their worth.

Learn more and sign up here

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