Dr. Karen Horton was a few years into practice, and six months pregnant with twins, when a legal letter arrived: her senior colleague was leaving. She had 48 hours to buy her out or walk away with no practice, no staff, and no patients.

In this episode of First Job M&M, San Francisco plastic surgeon Dr. Karen Horton walks through what went wrong in her first job: new consults that vanished from her schedule, a website that went dark, and an office stripped of its furniture and art. She also explains how she came out of it with the team she still works with today, and why it turned out to be the best decision she ever made. If you're heading toward your first job, this episode covers what to look for in a contract, why you need your own lawyer and banker before a crisis, and how to know your way out before you sign. 📚 Referenced: Unreasonable Hospitality by Will Guidara; Someone Has to Be the Most Expensive, Why Not Make It You? by Andrew Griffiths

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Guest: Karen Horton, MD

learn more: https://www.drkarenhorton.com/

IG: @drkarenhorton

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Why hasn’t showing patients prices made healthcare cheaper? For more than a decade, policymakers bet that price transparency would let patients shop around and push costs down. Liz looks at what actually happened, from the ACA’s vague “standard charges” language to chargemasters, hospital price tools, and the No Surprises Act. She also shares what she’s learned setting prices as a first-year aesthetic surgeon, including why cheaper can look worse to patients. Her conclusion: if we want real transparency, it has to come from health insurers.

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What do interviewers actually remember about you? It isn’t your answers. In this episode, plastic surgeon Dr. Liz Malphrus goes past the standard “be yourself” advice and shares what worked on the plastic surgery interview trail. She covers the wild rooms, including Operation, paper-folding tests, and a question that should never have been asked. She also explains how she prepared, which questions to ask and which to avoid, why the coordinator and the resident room matter, and how to handle the social event. Plus, a preview of a new recurring segment: First Job M&M.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What if doctors ran medicine the way lawyers run law? Lawyers, accountants and dentists have kept control of their professions, while physicians have lost control of both who owns them and who pays them. Liz looks at corporate practice of medicine laws that exist on paper but not in practice, the ERISA provision that shields insurers from liability for denials that harm patients, and vertical integration from UnitedHealth/Optum. She then lays out what physicians can do to win back professional sovereignty.

Referenced: Paul Starr, The Social Transformation of American Medicine;

Zhu et al, "A doctrine in name only," NEJM (2023)

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What happens when you become the surgeon, pay off the loans, and still feel empty?

On Cut & Tell’s first guest episode, Dr. Mel Thacker (ENT, surgeon coach, and host of Surgeons with Purpose) joins me to talk about her new memoir, Scrubbing In. It covers her path from childhood neglect to surgery, the arrival fallacy, and the panic attacks in the OR that finally forced her to face it all.

We also get into how insurance incentives quietly shape clinical decisions, why Mel walked away from private practice, why residency needs coaching, and how she built a part-time locums career on her own terms.

📚 Referenced: Scrubbing In: A Surgeon’s Journey from Self-Doubt to Wholeness by Dr. Mel Thacker; “When Incentives Become Instinct” (Hippocratic Collective); The Infinite Game by Simon Sinek

Enjoyed this episode? Rate, review, and subscribe, and find more shows at hippocratic-collective.com.

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Administrative bloat, skyrocketing CEO pay, hospital mergers, rural closures. These aren't separate problems. They're symptoms of one syndrome: financialization.

In this episode, Liz breaks down how hospitals and practices went from places that care for people to assets that exist to generate returns, and why nonprofit hospitals now behave almost exactly like for-profits. We cover the vocabulary that gets thrown around in boardrooms (marketization, corporatization, privatization), the administrator arms race between hospitals and insurers, what hospital CEOs are actually paid to optimize for, and how consolidation drives up prices without improving quality. Then we get to what doctors can do about it, from unionization to clinician leadership requirements to cutting out the insurance middleman.

It's Goodhart's Law on a massive scale: when growth and revenue are the targets, healthcare stops being the point.

📚 Referenced:

• Bruch, Roy & Grogan, "The Financialization of Health in the United States," New England Journal of Medicine (2024)
• Blumenthal & Galvin, "The Vocabulary of Our Discontent," JAMA
• "Money has become the mission," The Lancet (2025)

⏱️ Timestamps

00:00 Welcome to Cut & Tell

00:19 From the administrator boom to a bigger problem

02:22 Financialization as a syndrome

04:56 Defining financialization

07:30 Marketization: the 1980s shift

12:52 Corporatization and consolidation

14:14 Why nonprofits act like for-profits

15:15 Privatization and Medicare Advantage

16:38 Money has become the mission

21:02 The administrator boom, by the numbers

24:45 The US vs. Canada and the VA

27:51 The hospital–insurer arms race

29:59 Executive pay

33:20 CEO-to-employee pay ratios

36:05 What CEOs are actually paid for

39:08 Mergers, prices, and hospital closures

44:30 The administrative accountability gap

46:30 Recap

48:00 What doctors can do about it

If you enjoyed this episode, please subscribe, rate us five stars, and leave a review. Better yet, send it to someone who should be outraged, or at least better informed. Check out more shows and content at hippocratic-collective.com.

#HealthPolicy #Healthcare #HospitalCEO #Financialization #PhysicianLife #MedicalPodcast #CutAndTell #DoctorsOfInstagram

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What happens when a well-intentioned healthcare metric gets turned into a target? Nothing good — and Liz has the receipts. Before medical school, she spent two and a half years as study director for a major National Academies report on healthcare measurement. Then she went to residency, and everything she believed fell apart. This episode walks through the VA wait-time scandal, MIPS, and the Hospital Readmission Reduction Program — three cautionary tales about what happens when you attach incentives to healthcare data, and why Goodhart's Law keeps winning.

📚 Referenced: Vital Signs: Core Metrics for Health and Healthcare Progress (National Academies of Sciences, Engineering, and Medicine)

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Would you send someone you love to a hospital owned by private equity? Dr. Liz Malphrus breaks down exactly how private equity works, why it's poured billions into healthcare since 2018, and what the data says about the cost, safety, and physician burnout that follow. Plus: the exact questions to ask before taking a private-equity-backed job.

Referenced: BMJ systematic review on PE and healthcare quality/cost; JAMA analysis of Medicare claims on PE hospital acquisitions and patient safety; physician satisfaction and autonomy survey data.Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.