Most of the time in my work as a financial planner, my job is to help fellow physicians think long-game so they can craft a sustainable career and life they love. Today is different. We are going to focus on the short game and introduce a financial concept I call the “Courage Fund.” If you are hoping to create a more flexible career, and you cannot wait years to develop …
Unlocking career flexibility with a Courage Fund
Independent physicians, particularly in rural communities, have spent years navigating a steady stream of financial cuts, rising costs, and policy instability. Over time, these pressures have forced difficult decisions: scaling back services, reducing staff, and in too many cases, closing care centers altogether.
While there has been modest, temporary relief through adjustments in the Physician Fee Schedule (PFS), it has not been enough to reverse the broader trend. Many practices remain …
How Medicare reimbursement hurts independent physicians
Before treating a patient, you review their history, run diagnostics, and verify every detail. Have you done the same before trusting your financial advisor with your wealth?
Most medical professionals do not know if their advisor is truly acting in their best interest, or what they are really paying in fees, conflicts of interest, and hidden incentives.
I spent years working with financial advisors managing $20 million to more than $3 billion …
15 financial advisor questions for medical professionals
Policy changes eventually become operating decisions
Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk?
That question matters, but it is not the only operator question. Medicare practice expense and related Physician Fee Schedule changes also affect the billing-service decision. If the practice outsources billing, the policy change does not …
How Medicare changes affect medical billing contracts
There were many tax code changes in the One Big Beautiful Bill Act (OBBBA) when it was signed into law in 2025. Many of these changes affected taxpayers at different income levels, and with so many changes, it can be a challenge to know which items can best benefit physicians and their families. One of the provisions in OBBBA was an update to the SALT deduction, a change that can …
SALT deduction for physicians: the $500,000 magic number
A new federal Health Care Advisory Committee has been announced to guide policy for Medicare, Medicaid, and other major health programs. Its mission is ambitious: improve outcomes, modernize care, and address the growing burden of chronic disease.
But there is a glaring omission. Not one independent, private practice physician, someone who manages chronic illness in the community every day, is represented. That is striking because at least one-quarter of all physicians …
Independent physicians are missing from health care policy
Nobody in my residency program would have predicted I’d end up in venture capital. Certainly not me.
I immigrated to the United States from India with a straightforward plan: become the best physician-scientist I could and build a career in academic medicine. For the first chapter of my professional life, that’s exactly what I did. I trained in internal medicine, published over 100 peer-reviewed papers including in the New England Journal …
Physicians in venture capital see what others miss
The extra 90 days is not a rounding error
A 90-day credentialing timeline and a 180-day credentialing timeline can sound like two versions of the same problem. They are not. The second version can mean another quarter of rent, software, malpractice coverage, staff time, loan payments, marketing spend, and owner compensation before the practice can bill a major payer.
For a typical primary care startup, 90 additional days of fixed costs can …
3 reasons credentialing delays push past 90 days
I used to think health care finance was mostly about numbers. Then I worked inside the financial operations of a health care organization and realized how much patient care depends on systems most people never see. One experience has stayed with me ever since.
A claim for care that had already been provided was sitting in a billing backlog, approaching the payer’s filing deadline. The treatment had been completed. The staff …
Missed claims filing deadlines threaten patient care
A cash symptom can have several causes
A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still sitting unpaid. The first conclusion is usually simple. Billing is the problem.
Sometimes that is true. More often, the word “billing” is covering several different problems that require different fixes. A slow front desk, a coding issue, payer delays, denial …
Accounts receivable days hide four billing problems
A generation ago, most physicians barely considered the possibility of suddenly losing a job.
The profession was not perfectly stable, of course. Doctors still burned out, practices failed, partnerships fractured, and hospitals behaved badly from time to time. But for many physicians there remained an underlying assumption that competence and hard work created a reasonably durable professional life. If you trained well, treated patients properly, maintained your reputation, and kept your …
How to navigate physician job loss in the first week
Credentialing mistakes are expensive before they are visible
Credentialing problems usually look administrative until the revenue gap appears. A new practice may be open, staffed, leased, insured, and ready for patients, but one missing payer panel can cut off a revenue stream for a quarter or more.
The timeline is not small. Payer enrollment commonly takes 90 to 180 days. For a practice carrying rent, software, payroll, malpractice coverage, phones, internet, marketing, …
5 questions to ask before you choose a credentialing service
Consider a pediatrician and his wife, a cardiologist. Together they earn over $700,000 per year. They have $200,000 sitting in a savings account earning 4 percent. They own a $750,000 house and lease a luxury sedan. They pay a financial advisor 1 percent annually to manage their retirement accounts, mostly because a colleague recommended him. Neither has ever heard of an expense ratio. When a friend suggests they open a …
Why your doctor invests like a vaccine skeptic
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Every physician remembers the first time they ran a code. The adrenaline. The organized chaos. The moment you reach for the crash cart and trust, without thinking, that everything inside it is where it should be, that the medications aren’t expired, and that the equipment has been checked.
But here’s what most physicians don’t think about: Who’s making sure that crash cart is actually compliant? Who’s tracking whether every piece of …
The crash cart that taught me physician-led investing
Efforts to expand diversity in education and the workforce, through affirmative action, Diversity, Equity, and Inclusion (DEI) initiatives, and policies such as the Rooney Rule, are grounded in a clear objective: to broaden access for groups historically excluded from opportunity. In many settings, these efforts have succeeded. A substantial body of evidence shows that such policies increase representation at the point of entry, particularly in selective institutions and competitive professional …
Measuring the real success of modern diversity initiatives
Suppose you were offered the following two work opportunities. Which would you choose?
Career A: an acceptable opportunity that pays slightly more than your current job; you’re guaranteed never to make less than you do today.
Career B: a dream opportunity that sings to your soul but comes with no guarantees. While you may make much more than you do today, you could also potentially take a six-figure pay cut.
In other words, …
Physician career choices come down to risk tolerance
Clinical training does not teach operational survival
Clinical training prepares physicians for clinical decisions. It rarely prepares them for the operational decisions that determine whether an independent practice survives the first three years.
A new practice owner may understand diagnosis, treatment, documentation, and patient communication, yet still be unready for payer enrollment, days to get paid, denial management, lease math, compliance deadlines, electronic health record (EHR) tradeoffs, and vendor evaluation. These decisions …
Independent medical practice runs on operations
In one health care organization, a provider was reviewed and cleared through routine payment integrity processes. Months later, that same provider became the subject of a fraud investigation, based on patterns that had been present all along. Both reviews were technically correct within their scope. But together, they revealed something more concerning: The system itself was not aligned. Health care organizations invest heavily in payment integrity (PI) and special investigations …
Why health care fraud detection requires payment integrity alignment
Most health care startups don’t fail because the technology is bad. They fail because of mistakes that happen long before the product ever reaches a clinical setting. After seven years of evaluating health care companies as a physician-scientist turned venture investor (and making over 20 investments across digital health, biotech, medical devices, and therapeutics), I’ve started to see the same patterns repeat.
These aren’t obscure business school failures. They’re patterns that …
5 patterns behind health care startups that fail
A few months ago, a well-connected investor sent me a deal for a surgical device with a proprietary safety feature. U.S. Food and Drug Administration (FDA)-cleared. Strong intellectual property. Thousands of units sold. Multiple institutional backers across several rounds. The investor who referred it had taken a company to a NASDAQ initial public offering and was putting in his own money.
On paper, this was exactly the kind of deal most …
Health care investing insights from a venture capital pro
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