Épisodes

  • S2E6 Who Got The Raise? 76 Years of Physician Pay Reveal What Healthcare Really Values. The New Healthcare by Dr Adama

    S2E6 Who Got The Raise? 76 Years of Physician Pay Reveal What Healthcare Really Values. The New Healthcare by Dr Adama
    Oct 31 2026
    Who Got The Raise? 76 Years of Physician Pay Reveal What Healthcare Really Values The New Healthcare | Hosted by Dr. Adama Diarra, DO, FACP, DABOM Why does a cardiologist earn nearly twice as much as an internist? Why has neurology experienced relatively little inflation-adjusted income growth over the past 76 years? And what does physician compensation reveal about the priorities of the American healthcare system? In this solo episode of The New Healthcare, Dr. Adama Diarra examines physician compensation from 1949 to 2025 using historical data from the U.S. Department of Commerce and contemporary wage estimates from the Bureau of Labor Statistics. The findings offer a revealing look at how physician compensation has evolved—and raise important questions about the value assigned to clinical reasoning, longitudinal care, procedures, and physician-patient relationships. Physician Compensation: 1949 vs. 2025 Using inflation-adjusted historical physician income and modern wage estimates, the episode compares five specialties: Specialty 1949 income (2025 dollars) 2025 income Change Cardiology $210,900 $496,010 +135% Family medicine / General practice $119,500 $244,180 +104% General surgery* $240,300 $414,010 +72% Internal medicine $170,900 $256,560 +50% Neurology* $222,900 $248,560 +12% These are approximate historical comparisons, not strictly equivalent compensation measures. The 1949 data represent mean net income for independent physicians, while the 2025 figures represent median employee wages. Neurology was grouped with psychiatry in 1949, and the modern surgical figure uses a broader occupational category. Key Topics Discussed 1. How procedures became more valuable than clinical reasoning Historically, medicine compensated physicians for their expertise, judgment, and services. Over time, medical technology created opportunities for new procedures, especially in fields such as cardiology. The episode explores how the expansion of interventional procedures may have contributed to rising compensation in some specialties, while predominantly cognitive specialties experienced comparatively slower growth. 2. Medicare's Physician Fee Schedule and the RUC A central discussion examines how physician services are valued and reimbursed. How CMS establishes Medicare physician payments using relative value units (RVUs). The role of the AMA's Relative Value Scale Update Committee (RUC). How specialty societies influence the valuation of clinical services. Why evaluation and management services may be undervalued compared with procedures. How Medicare payment structures influence private insurance reimbursement. The discussion raises an important question: Does the reimbursement system adequately recognize the time, expertise, and complexity involved in cognitive medical care? 3. Physician employment versus independent practice In 1949, independent practice ownership was common. Today, physician employment has become a dominant model. This shift has changed the relationship between clinical productivity, professional autonomy, business ownership, and physician compensation. Dr. Diarra considers what physicians may have gained through employment—and what they may have surrendered in control over their schedules, patient relationships, and the economics of their work. 4. Physician compensation and workforce shortages Specialty reimbursement differences may influence medical students' career choices, particularly when combined with educational debt, training requirements, working conditions, and professional expectations. The episode examines the potential consequences for primary care access, specialty availability, and the sustainability of cognitive medicine. 5. Can independent practice offer a different future? Drawing on his experience in concierge and membership-based primary care, Dr. Diarra discusses how alternative payment models can create opportunities to prioritize longitudinal relationships, preventive care, clinical judgment, and adequate time with patients. The larger question is not simply how much physicians earn, but how payment models shape the medicine physicians are able to practice. Questions for Physicians Are we adequately compensating physicians for clinical reasoning and complex decision-making? Have procedural reimbursement structures contributed to workforce imbalances? Should Medicare place greater value on time-intensive cognitive services? Does physician employment improve or limit professional autonomy? Can direct primary care, concierge medicine, and other alternative models help restore the value of the physician-patient relationship? References and Further Reading Historical compensation data U.S. Department of Commerce. Income of Physicians, 1929–49. Survey of Current Business, July 1951. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Physicians and Surgeons. May 2025 wage estimates. U.S. Bureau of Labor Statistics. Consumer Price Index, 1949–2025. ...
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    22 min
  • S2E5 Leaving Corporate Medicine to Rethink Menopause Care, with Dr. Christina Enzmann

    S2E5 Leaving Corporate Medicine to Rethink Menopause Care, with Dr. Christina Enzmann
    Oct 24 2026
    Why do so many women in midlife feel terrible when their labs come back "normal"? Dr. Christina Enzmann is a board-certified OB-GYN and Menopause Society Certified Practitioner who trained in Germany and the US. After going through perimenopause herself, she added functional medicine to her practice, left corporate medicine, and now runs her own hybrid practice: an online functional medicine practice plus insurance-based gynecology two mornings a week. Dr. Adama and Dr. Enzmann discuss: Why she sees the menopause transition as a neuroendocrine and metabolic event, not only a hormonal one The midlife woman who exercises hard, eats too little, and is told she's fine How clinicians can help in a short visit: blood sugar, stress, and simple explanations Lifestyle first: vegetables and fiber, coffee, alcohol, sleep, and how much protein is enough The functional tests she uses and why Her approach to hormone therapy, starting with progesterone in perimenopause What the WHI study did and didn't show about blood clots and breast cancer risk Timestamps 01:01 Welcome 01:27 From Germany to US gynecology and menopause care 05:09 Leaving corporate medicine 07:11 Building an online functional medicine practice 10:48 What perimenopause looks like in the clinic 16:34 Helping patients when labs look normal 22:46 Lifestyle changes before testing 25:57 How much protein midlife women need 28:45 Her functional testing approach 37:47 Her approach to hormone therapy 42:25 Blood clots, breast cancer, and the WHI study 44:04 How to reach Dr. Enzmann Connect with Dr. Enzmann Website, blog and newsletter: drchristinaenzmann.com Email: contact@drchristinaenzmann.com Connect with The New Healthcare Episode summaries: thenew-healthcare.com/subscribe Be a guest: thenew-healthcare.com/be-a-guest This episode is for education only and is not medical advice. Talk with your own clinician about your care.
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    46 min
  • S2E4 A Mother Sold Her Land to Pay a Hospital Bill — Then Stopped Feeding Her Other Child with Athena Hall, MD

    S2E4 A Mother Sold Her Land to Pay a Hospital Bill — Then Stopped Feeding Her Other Child with Athena Hall, MD
    Sep 1 2026
    A mother in Rwanda sold her family's land and livestock to save one of her children — and had to stop feeding another to do it. That's the story that changed how Dr. Athena Hall thinks about healthcare. A pediatric hospitalist and urgent care physician, Athena spent a year in Rwanda during a global health fellowship, watching a "gold standard" Western medical model create hospital-acquired infections, financial ruin, and impossible choices for the families it was meant to help. She's carried that lesson home ever since — because the same broken math shows up here too: two-thirds of U.S. bankruptcies are tied to medical debt, and the specialty that actually saves the system money, primary care, is the one getting squeezed hardest. In this conversation, Athena and Adama dig into why healthcare's foundation — not just its policies — is misaligned with why people go into medicine in the first place. They talk about Alaska's Nuka System of Care and what happens when communities take back control of their own health systems, the power dynamics between doctors and patients, and why Athena thinks fixing any of this requires what she calls "cathedral thinking" — building something we may not live to see finished. It's a conversation about incentives, power, and what it actually takes to redesign a system from the inside — one relationship at a time. Adama Diarra, DO, FACP, DipABOM
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    50 min
  • S2E3 The Muscle Group Nobody Talks About — Until It Stops Working

    S2E3 The Muscle Group Nobody Talks About — Until It Stops Working
    Aug 17 2026
    Episode Description Pelvic floor health affects everyone — but it's rarely discussed until something goes wrong. In this episode, Dr. Adama Diarra sits down with Dr. Isabel Hoyven Cisneros to break down what the pelvic floor actually does, why it matters for men and women alike, and why so many common symptoms go unaddressed simply because patients don't know to ask about them. Dr. Cisneros walks through the "five S's" of pelvic floor function, what a healthy pelvic floor looks like versus a dysfunctional one, and the surprisingly wide range of conditions tied back to this single muscle group — from incontinence and prolapse to pelvic tension, diastasis recti, and sexual dysfunction. She also shares the screening questions every clinician should be asking, the tools reshaping pelvic floor therapy today, and real patient outcomes that show just how transformative this often-overlooked area of care can be. This episode is a practical primer for physicians who want to recognize pelvic floor dysfunction in their patients — and a reminder that whole-person care means asking the questions patients don't always know to bring up themselves. Key Topics Why pelvic floor dysfunction goes unrecognized in everyday clinical visits The five S's: what the pelvic floor actually does What a healthy pelvic floor looks like vs. common signs of dysfunction Pelvic floor issues in men — an overlooked and undertreated area Pelvic floor tension: the lesser-known counterpart to weakness Diastasis recti, prolapse, and pressure management Sexual dysfunction and pain as pelvic floor symptoms, not standalone issues Screening questions physicians can start using today Innovative tools shaping the future of pelvic floor therapy
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    42 min
  • S2E2 "You Don't Need a Bestseller — You Need Authority": How Physicians Can Actually Write a Book

    S2E2 "You Don't Need a Bestseller — You Need Authority": How Physicians Can Actually Write a Book
    Aug 3 2026
    Season 2 Episode 2 "You Don't Need a Bestseller — You Need Authority": How Physicians Can Actually Write a Book with Rick Lite from Trust Pub Episode Description Most physicians have a book in them — and most never write it. In this episode, Rick Light, founder of TrustPub, breaks down why that gap exists and how to close it without blowing up your schedule or your identity as a clinician first. Rick walks through the real process of going from idea to published book: how to pick a topic that actually stands out in an oversaturated medical publishing space, the most common mistakes physicians make when they try to do it alone, and where AI fits into modern book writing — including how the publishing industry is actually responding to AI-assisted content. We also get into traditional vs. self-publishing, realistic timelines, and what a full-service publishing process looks like when you don't have time to become a part-time author. If you've been sitting on a book idea because you don't know where to start — or because you assumed it would take over your life — this episode is your starting point. Key Topics Why writing a book multiplies a physician's influence beyond the exam room The most common mistakes physicians make when writing their first book Choosing a topic that stands out in a crowded medical publishing market Step-by-step: what the writing-to-publishing process actually looks like TrustPub's full-service model for authors with no time to spare Realistic project timelines and expectation-setting AI in book writing: where it helps, where the industry draws the line Traditional publishing vs. self-publishing — which fits your goals Chapters 00:00 Introduction and Podcast Purpose 00:23 Guest Introduction: Rick Light and Background 01:20 The Mission of TrustPub and Helping Professionals Publish 02:21 Why Physicians Should Write Books to Expand Influence 03:05 Common Mistakes Physicians Make When Writing Books 04:20 The Process of Writing and Publishing a Book 07:01 TrustPub's Full-Service Publishing Process 09:42 Project Timelines and Managing Expectations 11:37 Choosing Topics and Identifying Market Gaps 13:07 Using AI in Book Writing: Opportunities and Concerns 16:40 Industry Perspectives on AI-Generated Content 19:10 Future of AI in Publishing and Ethical Considerations 21:14 How to Get Started with Your Book Project 22:02 Contact and Final Advice from Rick Light Resources TrustPub — https://trustpub.com IngramSpark — https://www.ingramspark.com KDP (Kindle Direct Publishing) — https://kdp.amazon.com Guest Links Website — https://trustpub.com Sound Bites "A book multiplies a physician's influence beyond the exam room." "Books can establish authority, build trust, and explain complex topics." "You don't need to aim for a bestseller — focus on your expertise." Adama Diarra, DO, FACP, DipABOM
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    23 min
  • S2E1 The Secret Fishing Hole: The 100-Year Legal Blueprint for Cash Medicine No One Told You About — with Jim Eischen, Esq.

    S2E1 The Secret Fishing Hole: The 100-Year Legal Blueprint for Cash Medicine No One Told You About — with Jim Eischen, Esq.
    Jul 6 2026
    Episode Description Most physicians building concierge or membership-based practices are operating without a map. They've been told to opt out of Medicare, keep their fees low, and pick a tribe — DPC, concierge, hybrid — without ever understanding that a compliant, tax-advantaged, bulletproof model for cash medicine has existed in federal law since 1913. No one told them about it. That changes today. In this episode, Dr. Adama Diarra sits down with James Eischen, Esq., founder of Eischen Law Office and one of the foremost legal authorities on concierge and membership-based medicine in the United States. With nearly four decades of legal experience and 17 years spent exclusively in this space, Jim breaks down what the major practice models — DPC, concierge, executive health, lifestyle and longevity — actually are under the law, why the names don't mean what you think they mean, and why the confusion in this space is not an accident. Jim explains the legal and historical framework that has protected annual and routine exam-based subscription medicine since 1965, why you almost certainly do not need to opt out of Medicare to run a cash practice, how to structure your patient agreement so that your patients can unlock FSA and HSA benefits from day one, and why pricing yourself too low may be quietly undermining your practice before it gets off the ground. This episode also covers the history most physicians have never heard — the corporate, political, and racial roots of why this model was kept hidden from most of the medical profession, and why the cost of that ignorance has been borne not just by physicians, but by the patients and communities they serve. If you have ever asked yourself whether you can charge a membership fee and still bill insurance, whether you need to opt out of Medicare, or what your patient agreement actually needs to say — this conversation is the one you have been waiting for. Dr Adama Diarra, DO, FACP, DipABOM
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    1 h et 9 min
  • S1E22 Why Four Doctors Quit the Machine — And What It Actually Cost Them.

    S1E22 Why Four Doctors Quit the Machine — And What It Actually Cost Them.
    Jun 22 2026
    After months of conversations with physicians building independent practices — a concierge doctor who makes house calls, a DPC physician who traded a 2,000-patient panel for one capped at 300, an internal medicine doctor in Bend offering 60-minute first visits, and a cancer survivor running a holistic practice out of a converted space — Dr. Adama Diarra noticed the same four themes surfacing again and again. In this solo recap episode, Dr. Diarra pulls those threads together into one conversation: autonomy as a deliberate trade-off rather than an escape fantasy, AI as a tool to sharpen clinical judgment rather than replace it, the patient relationship as the actual product of medicine, and the constant temptation to let your brand outrun your care. Along the way: how an extra 45 minutes of autonomy helped one doctor catch a missed aortic aneurysm, why "physically ill" is how one physician described her old inbox, and why none of the doctors featured on this show built a following before they built trustworthy care. A practical, story-driven episode for any physician, NP, or PA weighing what independence actually costs — and what it's actually for.
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    27 min
  • S1E21 The New Healthcare-Your Brain on Hypnosis: Pain, Prediction, and the Science of State Change with James Harrison

    S1E21 The New Healthcare-Your Brain on Hypnosis: Pain, Prediction, and the Science of State Change with James Harrison
    Jun 15 2026
    The New Healthcare | In this episode, Dr. Adama Diarra sits down with James Harrison, certified clinical hypnotist and author of Mental Foraging, to explore what clinical hypnosis actually is — and what it isn't. James strips away the pop-culture myths and grounds the conversation in contemporary neuroscience: predictive processing, allostasis, mirror neurons, and the stability-plasticity problem. The two discuss how hypnosis works as a guided state change that can help patients access their own capacity for pain modulation, habit updating, and emotional reconsolidation. Practical territory covered includes chronic pain, IBS, fibromyalgia, smoking cessation, and sleep — along with clear guidance on which patients are good referral candidates and which aren't. James also shares simple, in-office techniques any clinician can use to begin shifting a patient's relationship to their pain signal — right in the exam room. For physicians looking to expand their integrative referral network, this episode offers both the neuroscience rationale and the clinical roadmap to do it thoughtfully.
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    1 h