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?

A doctor signs on for one clinic and later learns the employer can reassign them across town, legally, because of one clause they skimmed. Jillian Vestal, who specializes in doctor contracts, joins Dr. Michael Jerkins to break down the terms that quietly decide where you work, when you work, and where you're allowed to go next.

She starts with the phrase that appears in nearly every agreement and protects almost nothing: "at the discretion of the employer." It can hand over your location, your schedule, your call, and even your pay. Jillian separates a real salary review, where both sides revisit the number against survey data, from a vague clause that just lets the employer decide. She also dismantles the fear that hiring an attorney turns the negotiation combative, and the belief that a doctor can read the contract themselves. The work isn't reading the words; it's catching how provisions cross-reference and cancel each other out.

On money, she demystifies MGMA: why employers depend on it to justify pay as fair market value, and how an internal cap like a 60th percentile ceiling can be more conservative than the market supports. Her reframe is that "I want more" goes nowhere, while differentiation moves offers, whether that's bilingual ability, niche training, or a skill that opens a service line. She also flags that anesthesiology has climbed the most over four years, and that pay is rising while productivity expectations largely aren't.

Should doctor non-competes exist at all? Should doctors be using AI to review and negotiate their contracts? Are doctors negotiating the right pieces of their contract?

One theme anchors the conversation: the parts of a contract that shape a doctor's life the most are rarely the parts they negotiate. Verbal promises don't survive a dispute; the MGMA median isn't the right target for a new attending, and the first contract is the cheapest one to get right.

Attorney Advertising: Prior results don't guarantee similar outcomes. Information provided is not legal advice and doesn't create an attorney-client relationship.

Dr. Gerald A. Cox and registered dietitian Anafer Barrera join host Dr. Ned Palmer for the second installment of the three-part series, moving the conversation about ultra-processed foods out of the abstract and into the exam room. The question is no longer just what's wrong with the modern food supply. It's how clinicians can actually talk about it with patients in a way that helps rather than shames.

Dr. Cox and Anafer make the case that every nutrition conversation starts with tone. Before a single recommendation lands, patients need to feel heard rather than blamed, because food is rarely just fuel. It's routine, reward, emotion, and sometimes an addiction-like pull. The two walk through the NOVA classification that gives "ultra-processed" its precise meaning, from minimally processed foods all the way to the soft drinks, instant noodles, and cured meats drawing the most scrutiny. They dig into the mounting evidence tying these foods to cognitive decline and dementia, whether the risk is dose-dependent, and why food itself can become a source of anxiety when nutrition advice tips into fear.

The conversation also takes on the harder, more practical questions. What does this look like in a high-volume clinic with ten minutes per patient? The guests trade the checklist for a single opening question: how important is diet to you, and what's your biggest barrier? They champion an "add, don't just subtract" approach, one that asks patients to eat enough earlier in the day, build in variety, drink water when a craving might be thirst, and stop treating counseling as a list of foods to give up. They also widen the lens to the systems patients live inside, where cheap, marketed, convenient food is the default. Along the way they point to a local program that doubles SNAP dollars at the farmer's market and the case for subsidizing real food over industrial staples.

Throughout, one idea anchors the discussion: the goal isn't moderation or willpower. It's diversity, addition, and empathy. Meet patients where they are, treat food as a tool for support rather than a moral battleground, and the whole conversation shifts from blame to nourishment, from restriction to expansion, from individual failing to structural understanding.

Casey Wiley joins Dr. Michael Jerkins to unpack the biggest shift in medical school financing in decades: the July 2026 elimination of Grad PLUS loans under the One Big Beautiful Bill Act. For roughly twenty years, students could borrow up to the full cost of attendance. Now federal borrowing is capped at $50,000 a year—and for many trainees, that opens a funding gap of $25,000, $70,000, or more.

Casey, the mind behind the Med School Money Guy channel, walks through what actually changed and who it hits first. He explains the confusing line between "legacy" and "new" borrowers, the aggregate and lifetime caps that can quietly run out mid-degree, and the rise of private loans as the new gap-filler—along with everything students give up when they leave the federal system, from income-driven repayment to PSLF. He makes the case that credit score has become a gatekeeper to a medical career, with 10–15% of first-years unable to qualify for the loans they now depend on.

The conversation also takes on the harder questions. Who gets squeezed out when funding depends on creditworthiness and co-signers—and what does that mean for a physician pipeline already trying to reach rural, lower-income, and first-generation students? Is tuition-free medical school a real fix or a fundraising fantasy? And amid the caution, where's the good news? Casey points to the new RAP repayment plan as the bill's genuine silver lining: congressionally durable, interest-subsidized, and structured to keep balances from ballooning during residency.

Throughout, one theme anchors the discussion: the rules are changing faster than the advice can keep up. Understanding them now—before June application deadlines and August panic—is the difference between a manageable plan and a career-altering scramble.

Dr. Gerald Cox joins Dr. Palmer for a revealing conversation about a shift most clinicians were never trained to see—how the food on our shelves stopped being food and became a product, deliberately designed to be difficult to stop eating. As a preventive medicine specialist focused on reversing cardiometabolic disease, with roots in obesity, lifestyle, and internal medicine, Dr. Cox brings both the science and a personal story: his own adolescence as an overweight kid who thought he was simply making bad choices, before realizing the choices themselves had been engineered.

Dr. Cox walks through the machinery hiding behind familiar labels. He explains how "flavor engineering" blends taste, aroma, color, and texture to defeat moderation, and why a "healthy" protein bar can carry a paragraph of unfamiliar ingredients. He traces how tobacco companies—under public-health pressure in the 1980s—bought their way into the food supply, bringing Oreos, Kool-Aid, Lunchables, and their marketing playbooks with them. And he connects high-fat, high-salt, low-fiber formulations to the brain's dopamine and reward pathways, explaining why "bet you can't have just one" was never a joke.

The episode also takes on the harder questions underneath the trend lines. When food behavior is shaped by biochemistry and industry design, how should clinicians respond—with blame, or with grace and tools like the Yale Food Addiction Scale? What does the latest research from the Lancet and the American Journal of Public Health reveal about engineering techniques and their public-health cost? And with "Make America Healthy Again" messaging, the FDA's "natural" loophole, and food dyes all moving into the political mainstream, could this be a once-in-a-generation opening for real reform?

Throughout, one truth anchors the discussion: this isn't a story about willpower—it's about environment. Understanding how the modern food supply was built is the first step toward meeting patients with compassion, and toward giving them back some control over what ends up on their plate.

Dr. Christopher Garofalo joins Dr. Michael Jerkins for a wide-ranging conversation about a transformation few in medicine are tracking closely—the slow disappearance of the physician-owned practices, and what it means for the doctors and patients left in its wake. As a family physician, longtime private practice owner, and advocate inside organized medicine, Dr. Garofalo has watched the ownership model erode from the inside, and has a clear-eyed view of how policy, private equity, and the insurance industry have reshaped what it means to practice independently.

Dr. Garofalo walks through the levers physicians rarely realize they can pull: how simply showing up in advocacy circles translates into tangible wins like prior authorization reform, why direct primary care is quietly rebuilding a relationship between doctor and patient that insurance long ago broke, and how policies restricting physician ownership of hospitals and surgery centers have quietly tilted the field toward consolidation.

The episode also takes on the harder structural questions underneath the trend lines: What happens to access and cost when monopolies and vertical integration replace independent practices? Why has the dental profession protected ownership while medicine surrendered it? And could AI tools and new financing models finally make private practice viable again for the next generation of doctors?

Throughout the conversation, one truth anchors the discussion: practice ownership is not nostalgia—it is infrastructure. Restoring it is how physicians regain autonomy, how patients regain access, and how medicine regains the room to be practiced the way it was always meant to be practiced.