Scott Becker doesn’t waste time.
He runs one of the most-listened-to healthcare podcasts in the country, and he earned that audience the old-fashioned way.
He pays attention. He reads the signals. He asks real questions and lets the answers land.
I’ve had a lot of conversations on many stages. The Beckers’ conversation is one I look forward to every time, because Scott comes prepared, and he doesn’t need you to soften anything.
This week, we covered a lot of ground.
We talked about where the system’s incentives produce exactly the outcomes they were designed to produce, and why I think the answer is always payment first, everything else downstream.
We talked about the physician-owned hospital ban, why repealing it is the honest answer to the rural health crisis, and why I keep saying it until someone in Congress actually acts.
We talked about site-neutral payments. Same procedure, same complexity, same outcome. Same payment. It shouldn’t be a radical idea.
We talked about what’s going right, too. And I mean it when I say things are moving. I’ve been in San Francisco, Seattle, New York, Wisconsin, and Dallas, all in recent months.
I’m having the same conversation everywhere. Physicians who sold 5 to 7 years ago are out of their non-competes, and they are not going back to employed medicine.
The trajectory is real. I haven’t felt this way in years!
Scott asked me about leadership. What separates the executives who produce from those who substitute process for accountability? I gave him the honest answer. The ones I respect simplify relentlessly. They don’t confuse complicated for unsolvable. They take the first step without waiting for consensus.
I told him I think I’m finally at a place, having turned 50 this year, where I can look back at 25+ years of building ASCs, working in practices, consulting for rural hospitals, academic centers, physician-owned hospitals, and say: I think I understand the problem now. Not perfectly. But well enough to build something real.
That’s what I’m trying to do.
Scott was generous, as always. He told his audience he agrees with me about 95% of the time. I’ll take it.
The episode is out now. If you want to hear the unfiltered version of where I think independent medicine is going, and what it’s going to take to get there, listen.
It’s worth your time.
-Rojas out.
