Dr. Michael Durbin bought his first practice in 1990 with about $15,000 in student debt, from a faculty mentor. A resident today can finish owing more than $500,000, and many of the practices they'd want are already owned by OSOs and DSOs. The sitting president of the American Association of Orthodontists joins host Dr. Michael Jerkins with an unusually complete view of that shift: he has been an owner, an associate, and a corporate doctor, worked alongside pediatric and general dentists, and eventually sold his practice to his son and stayed on as an associate.

From there, it gets practical. Mentorship doesn't come standard, so ask for it by name before you sign. Startups are back on the table precisely because acquisitions often aren't. A practice running two days a week is a practice worth filling, not a gap to plug with associate work elsewhere, and that's the one thing he'd do differently. The new loan caps are the open question, and the person most exposed is the resident with dental school debt and no cosigner. AI, meanwhile, is already in the building: diagnosis, treatment planning, and the front desk. The AAO's rule is "human in command," meaning the software suggests, and the doctor decides. And the part nobody puts in the sales pitch is that a tool can move work rather than remove it.

Would he buy a practice again at today's valuations? Is corporate consolidation still climbing? Why should nine states requiring an in-person exam matter to a doctor practicing in the other forty-one, and what exactly is "vocation insurance"? Tune in for an honest look at what ownership asks of you now, from someone who has tried nearly every version of it.

Dr. Gerald A. Cox and Dr. Silvia Caswell join host Dr. Ned Palmer to close out the three-part series on ultra-processed foods with the question that's been building since episode one: what does a physician actually do about it? They start in the grocery store, where Dr. Caswell offers a test simple enough to hand to any patient — and where both guests push back on treating "processed" as a single verdict. Canned beans, frozen vegetables, and whole grains all sit in that category, and all of them can be the right call for a family shopping on a budget.

From there the conversation gets practical. Kids don't buy the groceries, so counseling a child without the family rarely works. Ultra-processed food often delivers the most calories per dollar, which makes affordability a clinical question, not a side note. GLP-1s quiet food noise but don't teach anyone how to eat. The anchor is "add, don't subtract" — one piece of fruit, one can of beans, one small change a week. Then the guests widen the lens to advocacy: sidewalks and bike lanes, letters to state representatives, food industry lobbying, and the one change each of them would make if they could.

Can you eat well on a tight budget without giving up your whole Saturday to meal prep? Does a GLP-1 prescription let food quality off the hook? What do you say to the parent whose kid only eats the bright orange stuff? And what would it actually take to make the healthy choice the cheap one? Tune in for a conversation about treating food as medicine — without pretending patients live in a world that makes that easy.

Dr. Caswell's views are her own and do not reflect those of the U.S. Department of Veterans Affairs or the U.S. government.

Tim Boyle, Director of Sales and Business Development at Reva Global Medical and a former professional hockey player, joins Dr. Michael Jerkins to talk about the part of private practice nobody trains you for: the operations. His argument is that most physician-owned practices don't struggle because of medicine — they struggle because scheduling, insurance verification, prior authorizations, and claims follow-up all land on the same overloaded desk, and every task that gets dropped is revenue that quietly disappears.

Tim makes the case for medically trained virtual professionals handling the clerical and back-office work, and where the line sits between what can be offloaded and what can't. Dr. Jerkins pushes back on the operational logic with the question that actually matters: what do patients want? Not what's efficient — what makes someone trust a practice in the first ninety seconds. Both land in the same place. Patients should be greeted by a person. Trust is built at intake, and you don't get it back once it's gone.

Should physicians still be opening their own practices? Which specialties actually have the margin to make independence work? And is the front desk the last place in medicine that should ever be automated?