What happens when you become the surgeon, pay off the loans, and still feel empty?

On Cut & Tell’s first guest episode, Dr. Mel Thacker (ENT, surgeon coach, and host of Surgeons with Purpose) joins me to talk about her new memoir, Scrubbing In. It covers her path from childhood neglect to surgery, the arrival fallacy, and the panic attacks in the OR that finally forced her to face it all.

We also get into how insurance incentives quietly shape clinical decisions, why Mel walked away from private practice, why residency needs coaching, and how she built a part-time locums career on her own terms.

📚 Referenced: Scrubbing In: A Surgeon’s Journey from Self-Doubt to Wholeness by Dr. Mel Thacker; “When Incentives Become Instinct” (Hippocratic Collective); The Infinite Game by Simon Sinek

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Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

Administrative bloat, skyrocketing CEO pay, hospital mergers, rural closures. These aren't separate problems. They're symptoms of one syndrome: financialization.

In this episode, Liz breaks down how hospitals and practices went from places that care for people to assets that exist to generate returns, and why nonprofit hospitals now behave almost exactly like for-profits. We cover the vocabulary that gets thrown around in boardrooms (marketization, corporatization, privatization), the administrator arms race between hospitals and insurers, what hospital CEOs are actually paid to optimize for, and how consolidation drives up prices without improving quality. Then we get to what doctors can do about it, from unionization to clinician leadership requirements to cutting out the insurance middleman.

It's Goodhart's Law on a massive scale: when growth and revenue are the targets, healthcare stops being the point.

📚 Referenced:

• Bruch, Roy & Grogan, "The Financialization of Health in the United States," New England Journal of Medicine (2024)
• Blumenthal & Galvin, "The Vocabulary of Our Discontent," JAMA
• "Money has become the mission," The Lancet (2025)

⏱️ Timestamps

00:00 Welcome to Cut & Tell

00:19 From the administrator boom to a bigger problem

02:22 Financialization as a syndrome

04:56 Defining financialization

07:30 Marketization: the 1980s shift

12:52 Corporatization and consolidation

14:14 Why nonprofits act like for-profits

15:15 Privatization and Medicare Advantage

16:38 Money has become the mission

21:02 The administrator boom, by the numbers

24:45 The US vs. Canada and the VA

27:51 The hospital–insurer arms race

29:59 Executive pay

33:20 CEO-to-employee pay ratios

36:05 What CEOs are actually paid for

39:08 Mergers, prices, and hospital closures

44:30 The administrative accountability gap

46:30 Recap

48:00 What doctors can do about it

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#HealthPolicy #Healthcare #HospitalCEO #Financialization #PhysicianLife #MedicalPodcast #CutAndTell #DoctorsOfInstagram

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.

What happens when a well-intentioned healthcare metric gets turned into a target? Nothing good — and Liz has the receipts. Before medical school, she spent two and a half years as study director for a major National Academies report on healthcare measurement. Then she went to residency, and everything she believed fell apart. This episode walks through the VA wait-time scandal, MIPS, and the Hospital Readmission Reduction Program — three cautionary tales about what happens when you attach incentives to healthcare data, and why Goodhart's Law keeps winning.

📚 Referenced: Vital Signs: Core Metrics for Health and Healthcare Progress (National Academies of Sciences, Engineering, and Medicine)

Host: Liz Malphrus, MD

Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md

IG: @dr.malphrus

Produced By: The Hippocratic Collective

Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.