In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners are joined by a very special guest, Lara's husband, Robert Pinate, a nurse consultant with over 30 years in UK emergency medicine.

Rob helps emergency departments rethink outdated workflows and improve patient flow. The conversation dives into how the NHS actually works from its funding model and workforce of to the freedom clinicians feel when billing isn't part of the equation. Rob breaks down the rapid assessment and treatment model he champions, the culture shock of implementing America's Epic EHR in a system that doesn't bill, and what it's like walking into struggling hospitals that feel like they've regressed.

The trio explores the sobering parallels between the NHS's decline after years of austerity and the growing cracks in the U.S. system, from Medicare cuts to frontline burnout. But it's not all doom. Rob shares where he's seeing improvement and makes the case that sometimes all it takes is pulling the right people off the floor, handing them a blank sheet of paper, and asking: how can we do this better?

What happens when a Canadian finance guy with zero healthcare experience decides to take on one of the most broken systems in the world? You get Alex Barrett, co-founder and CEO of Meroka, and a genuinely different perspective on why independent medicine is dying and what can actually be done about it.

In this episode, Drs. Lara Zibners and Adam Brown sit down with Alex to unpack the real force behind healthcare consolidation, and it's not the "silver tsunami" you keep hearing about. CMS reimbursement rates have been essentially flat since 2002 while costs have surged, making the business model of running an independent practice quietly unsustainable for thousands of physicians across the country.

Alex shares how Meroka is building a third exit path for retiring physicians, one that keeps practices out of private equity hands and transfers ownership to the staff who actually do the work. But the conversation goes deeper: Why does the only OB delivering babies in a 100-mile radius in rural West Virginia still have no negotiating power? Why are non-compete clauses one of the biggest hidden barriers to independent medicine? And is the system so broken it simply can't be fixed?

Spoiler: Alex doesn't think so.

Listen now.

Dr. Adam Brown and Dr. Lara Zibners are back for Season 2 of Unstable Vitals, and they're wasting no time. After catching up on life, including Laura's Arctic Circle dog sledding adventure, Adam's new London life, Calla Lily's first Big Pharma partnership, and a spirited rant about Yorkshire pudding, the duo lays out their ambitious plan for the season ahead.

This episode introduces the "Five P's" framework that will guide Season 2: Politicians/Policymakers, People (patients), Providers, Payers, and Producers. They argue that fixing America's broken healthcare system requires engaging all five groups, and they plan to do exactly that through conversations with health tech founders, clinical innovators, device executives, regulators, and investors.

From the cost of estrogen gel in Europe vs. the U.S. to why walking to the grocery store might be better healthcare policy than anything coming out of Washington, this season promises to be equal parts hilarious and eye-opening.

Topics covered:

• The "Five P's" of healthcare: the season's guiding framework
• Public transportation, walkability, and downstream population health
• Lifestyle medicine and transatlantic perspectives on healthcare costs
• A preview of Season 2 guests and episodes
• What Adam and Lara have been up to since last season

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