0:00
Just like to say thanks to all of our podcast guests and all of our listeners out there. As a journalist, I've been really privileged to have some great conversations, and I'm always grateful to anyone willing to spend time with some of our work. You

0:20
Austin, welcome to off the chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Latrell. I'm the Assistant Editor of medical economics, and I'd like to thank you for joining us for joining us for our 100th episode of off the chart. Over the past 99 episodes, we've covered everything from Ai liability and burnout to the economics of private practice and student debt. We've interviewed everyone from policy leaders to frontline physicians who keep medicine running every day. To celebrate this milestone, we've brought together the editors who have helped shape off the chart into what it is today to talk about what we've learned our favorite conversations, and where we think the business of medicine is headed next. Today, I'm joined by Todd Shryock, managing editor of medical economics, Richard perish and senior editor of medical economics, and Keith Reynolds, editor of physicians practice. Thanks for being here, guys.

1:14
Great to be here. Happy to be here. Thanks for joining Austin

1:17
so on, the newest addition to our editorial staff, just joining medical economics late last year, and I was looking back the first episode of off the chart that I was really involved in was episode 48 the top risk for medical practices in 2025 with Peter Riley from HUB International. Since then, we've really taken off, and the show is now available twice a week on Monday and Thursday mornings. So as we hit 100 episodes, what does that milestone mean to you?

1:42
I'll start I would really just like to say thanks to all of our podcast guests and all of our listeners out there. As a journalist, I've been really privileged to have some great conversations, and I'm always grateful to anyone willing to spend time with some of our work, and so with the podcast being able to present some innovative thinkers, you know, physicians and other analysts across medicine and looking at a diverse range of issues. I just hope we're really providing a forum for people to listen to some new ideas. Todd, how about you?

2:17
I think it's been quite a journey. When the podcast first started, it was almost like a hobby, almost on the side, for once, one member of the staff, and now it's a more much more polished, professionally produced podcast. The you know number of listeners continues to grow, the guest list continues to grow. I think we're getting a lot of great topics, a lot of great industry experts. And I think it's it's been really impressive how far it's come. And I hope the listeners have you know, gotten good information from it.

3:01
Yeah, when, when we first started the podcast, which was back in the the plague year of 2020, it was sort of just, you know, a sort of value add to what medical economics was doing already. And I took over about episode 35 I believe, looking at it, which is when we sort of developed having a pretty regular schedule for it and stuff like that. And you know, since then, it's, it's really, really taking off, especially when you took over Austin, not to kiss your butt too hard, but you really did kick things up a notch from where it was at. But I think that really just creating another channel to get the fantastic interviews that all of us do every day. You know, we really talked to some serious luminaries and and major major officials and stuff. Looking at you Rick, with that one, it's, you know, it's just a, it's a, it's a different beast, and it's a good beast. And I think it's, you know, I think the things that we've done have been great and

4:15
continues to evolve. Absolutely looking back, what's an episode that really stuck with you, or one that you still think about? Rick, how about you go first? Yeah.

4:24
Thank you, Austin. One of the ones that really, really sticks with me was episode 43 we called it the physician's guide to running for office. I spoke with eight physicians who also are elected officials at the local, state and federal levels, and each one of the physicians who spoke with me clearly was passionate about taking care of patients, but doctors who get involved in politics really want to expand that care by having greater influence on programs and policies. And one of the things that was also very interesting, they advocated for medical training as a great way to develop the analytical. Mindset needed to consider legislation about not only healthcare, but a range of other issues and topics.

5:06
Absolutely Todd, I really enjoyed talking to Marshall Runge. He's the head of Michigan medicine. He's the head of the medical school and a bunch of other spin offs, various healthcare related things they have going up in Ann Arbor. He has a really good feel. He's an academic, but he has a very good feel for what's going on, kind of everywhere, like at the practice level as well as the government level. And he really sees very clearly kind of the big picture issues that are affecting doctors, very intelligent, very friendly. At the end of the interview, I think after I'd stopped recording, I said, Hey, I saved it for now to let you know that I'm an Ohio State guy. And he just laughed and said, That's okay. I'm from Texas. So he was a funny guy and very insightful into medicine, definitely.

6:07
And I think that episode is one that really resonated with the audience. I think that one performed really well. It's called what's broken in healthcare, and you can check that one out now, Keith, how about you nice

6:18
plug? Nice plug there. I don't know. I've got to sort of echo Rick's, Rick's choice of the physician guide to running for office, mainly because I'm still having stress nightmares about that one. That was a lot of work, but it came out. I Not to toot my own horn, but I think it came out very well, but it was mainly built on the quality of interviews that Rick had done for that with that story too. That story was just terrific. That was a great job. As for my own episodes, though, I always, always enjoyed talking to Anders over from MGMA. He always brings a good insight. As you know, he's the man on the ground for this big organization, and he's at, you know, he's got good insight into what's going on in to Washington. And, you know, I feel like over the years, we've built a pretty good rapport and stuff like that. But also, if I can get a twofer out of it, my most recent interview with Katie Russell about what to do if ice comes to your your practice. That was a pitch from Todd that I stole and I man, I recorded it faster.

7:33
That's fine. I get a nickel every time somebody listens to it.

7:38
That's all I'm getting. Is two cents. That sucks. But yeah, no, like Kate Russell's, you know, she's incredibly knowledgeable. And, you know, it was really just, you know, finger on the pulse of what's going on in the country right now, and really giving actionable tips, which, you know, not to put in too much of a pitch for p2 but like, that's what we do, is, you know, actionable tips for practice managers and stuff like that, and that's that's what we had there.

8:03
Yeah, absolutely, for me, it probably has to be AI and malpractice that accompanied our October cover story. And I really thought to answer a question that I think a lot of physicians are worried about right now. We had Sarah gurkey, David Simon and Divya Srivastava joining us, and they really pulled back the curtain on how AI is about to change liability law

8:28
on top of, though, all the like, actual, like, informative episodes we've done. I always enjoy when we do things like this, like, I think we've done ones in the past. I've sat down with Chris mazzolini, our editorial director, and I think I sat down with Rick, I think it was for our first issue of the insider, of medic Insider. And it's, like, it's always great sitting down with you guys, because, like, we're all, we all spend so much time in the the minds of this sort of thing, and it's always good to just sort of chat and and pick you all's brains and stuff like that. It's, you know, we got a good team here, if

9:04
you look at where the industry was when this podcast started compared to now, what's changed the most? I've been around the shortest out of all of us, but even in the year, I've seen a lot of change, especially around things like policy and AI. The conversation around med tech has really shifted from should we use this new technology to how can we use it safely? Todd, you've been around the longest out of any of us, so I'll start with you. What's changed the most since the podcast has started, and also just since you've started with medical economics?

9:30
I think it has to be AI. I mean, it's gone from this, like, kind of gee whiz, what's this all about to suddenly it's dominating every conference, every discussion like you can't get away from it every you know there's AI in everything, but one of the biggest issues that's coming to light, and a number of people that I've interviewed for the podcast have talked about this. Who's paying for it. Like all of these technologies are great. The promise is there. It could do wonders for patient safety. It can do wonders for reducing burnout, reducing the workload on physicians. But hey, guess what? None of this is free. All these companies with all their products they need to get paid, but we have a healthcare system that's already stretched to the limit, and really beyond with how much it costs. And so who's paying for all this? And that's a question that keeps coming up now, and the industry side, people will tell you, like, well, you know, we're working, you know, with hospitals or rural clinics or whatever, you know, to give them basically a competitive price or a discount or whatever. But even with that, I don't think that's going to be enough. Like, they're not free, and there are so many of them, you know, even if it's $100 a month per user, you know, if you have 10 different technologies, suddenly $100 a month is $1,000 a month. And I'm not sure how we're going to pay for all of this. So I think the promise is there, but we also run into equity issues, like, are we going to end up with people in urban areas with wealthy healthcare systems are going to have access to every AI tool and all the diagnostic tools and everything else, while rural areas can't afford any of it, and are literally years or decades behind in technology. So I think that's a very real question on how this is going to play out in the future. I mean, we've come a long way, but it's it's exposed a whole lot of new questions.

12:00
And Keith, what about you? What changes have you noted?

12:05
I think the biggest change is like, you got to keep in mind, we honestly our senior editor at the time, Jeff Bendix, when he started the podcast, it was mid 2020, so at the time, all practices were dealing with the same question of, how do we stay open? And like the the national feeling towards medical professionals was warm, and, you know, it's, you know, everybody, oh, they're, you know, there are heroes that sort of deal. And you got, you know, people in New York, out banging pots and pans for like, first responders and stuff like that. And then, like, very quickly after that, things, the worms started turning a little bit, and now you've got a populace that's far more suspicious, I guess, would be the way to put it, even you have an administration that's suspicious of doctors and of practices and stuff like that. So it's, you know, it's, I'd say that the biggest change has just been the the national mood over the past five years. Now it's, it's, you know, it's, it's, it's gone in a weird cycle that hopefully, you know, ends soon. And it's not, you know, it's not a constant. We have to re examine our relationship with the medical profession every five years. I doubt it. I doubt it's, I doubt it's gonna, you know, continue like this much longer. But, you know, who knows?

13:41
Rick, how about you? You know what? Todd and Keith both make some great points. There's sort of a under undercurrent, or a feeling I feel like I've been picking up on in the last couple years. And I'll point specifically to Episode 70. Was the state of private practice with Dr Paul Berg green. He was, at the time, the president of the American Independent Medical Practice Association. And more recently, in Episode 95 the case for independent practice, with Dr Paul Merrick and ceo dan Greenleaf of Dooley healthcare, they really showed two things. And the first one, I think, is that physicians who work in independent practice are really strong advocates for physician autonomy as foundational for great patient care. And that's not to say that employed physicians aren't also providing some great patient care, but I think that independent physicians are hopeful that the pendulum may be swinging a little bit in the sector, and maybe a lot that independent practice not only will continue, but maybe even grow. And in talking, you know, especially with those doctors and the CEO you know, there has been a lot of study about the effects of private equity investment and potential harmful effects on patient outcomes. But. But I think that they would be, you know, they would tell you that they've had some good experience with private equity investment that works to support independent medical practice. And I just think that maybe thinking about the way the industry has changed, and maybe looking into the crystal ball to see how it may change here in the next year or two, I think there's going to be a more nuanced view developing around policies involving private equity and healthcare. Great. And you

15:25
kind of hinted on it. 2026 the year ahead. Quick lightning round here, 30 seconds or less. What's one trend you'll be watching closely in 2026 and Rick, I'll go back to

15:35
you. This is a little bit more on the patient side, but I think as well as the physician and the provider side, hospitals, health systems, I just feel like price transparency under this administration is going to get a resurgence in 2026

15:50
Right? Todd,

15:53
AI. But a different aspect, I think it's the trust aspect, because these tools are all great when you trust it, and it's doing a great job, but I think there's a lot of holes starting to open up in the AI bubble, and I wonder it only takes one mistake by an AI tool for doctor and go, You know what? I don't trust that anymore, and then it's all over for that. So we'll see how AI and trust kind of work hand in hand here in the coming years,

16:23
definitely. Keith, how about you one, one trend that you'll be watching closely in 2026

16:29
not to piggyback off of Rick's answer to the last question, but the migration back to independent practice. We did a panel discussion not too long ago, with some really bright thinkers, and it seems like, you know, it's the consolidation has sort of hit a point where it's diminishing returns for all around and I think that there's going to be a movement back towards independent practices people. People are sick of having bosses, and we, everybody on this call, I know can agree with that, especially you. Austin,

17:14
hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack, an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at mjh life sciences.com with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

18:04
So where do we go from here? What kind of stories or themes do you want to see us dig into as off the chart continues past 100 episodes. Keith, you hosted the show before I joined. So we'll start with you.

18:16
I would like us to do more holiday episodes, which I have been pitching since the beginning, a Halloween episode, a Christmas episode. Yeah, we're going to do that at some point. But in all honesty and seriousness, though, I think that Todd, Todd keeps bringing it up, and it's absolutely the truth. It's like AI is claimed to be the the end all be all to all this, and it's not going to be. And I think that we got to keep a really close eye on on how that works, and the podcast is a great vehicle to to get that sort of record or that sort of reporting and insight from our our interviewees out to the public as you know, as it happens in real

19:04
time. Definitely,

19:06
right. Kate, about you? You know Keith a moment ago, I think, I think it was Keith had touched on some of the the panel discussion that we had had, and I've already got some ideas cooking for future panel discussions that I think will turn into beneficial programs and hopefully some more podcasts. One issue I would like to explore. I think, I think even apart from everything that we do, and frankly, some of our competitors, I just think that the situation with rural healthcare is really going to warrant some attention in coming days. And again, just the from the consumer side, the patient side, health insurance costs and medical debt are going to be factors when we talk about sustaining health care and physicians. If people can't afford to go to the doctor, our audience members are not going to get paid, not to put too fine a point on it. So I think those could be real influences in in coming days,

20:05
definitely. And Todd, how about you? I

20:08
would like to hear more from kind of frontline doctors. Like, we seem to always talk to the big picture people, but sometimes it's good to hear from from the front lines, the small picture, like, what, you know, I want to hear your day to day challenges and in and what they think the solutions are. They're the ones in the trenches. They're the ones dealing with this. What is it really going to take to fix medicine, to fix reimbursement? You know, what? What do they need to see? And what would they like to have happen in the government and just in medicine in general?

20:47
Definitely for me personally, I think I'd like to see us lean even more into the physician finance side of things, building wealth tax strategy, loan repayment and everyday decisions to keep a practice and a physician profitable. Before we wrap up, let's do another quick lightning round, one sentence of advice for practice. For practice leaders heading into 2026 Rick, we'll go back to you.

21:08
Tune in twice a week to the Off The Charts, a business of medicine podcast.

21:11
Absolutely. I like that one a lot. Todd, how about you?

21:15
You can save the world, but you might be able to save the patient in front of view. So focus on that, Keith.

21:25
Take care of your coders. They're the ones that really make all this work.

21:33
Todd, Rick and Keith, thank you all for joining me for this milestone episode, and of course, thanks to everyone who's listened and subscribed and shared the show along the way. From our first episode to 100th the goal stayed the same, and that's helping physicians thrive in the business of medicine. Here's to the next one. Hunter, thank you

21:57
again for joining us for our 100th episode of off the chart and for listening along the way. My name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you sincerely for listening and don't forget to subscribe so you don't miss the next episode. Check back on Monday and Thursday mornings for the latest conversations with healthcare experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart, wherever you get your podcasts also, if you like, the best stories from medical economics and physicians practice delivered straight to your inbox six days of the week. Subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business and medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Luttrell. Medical economics and physicians practice are both members of the MGH Life Sciences family. Thank you. Applause.