Saving the Independent Practice: How One Company Is Trying to Stop Healthcare's Consolidation Crisis

The Safety Net You've Never Heard Of: Inside America's FQHCs with Dr. Rui Ariyapala

What if there were a network of clinics quietly delivering full-suite care — primary care, dental, behavioral health, pharmacy, prenatal, mobile units — to anyone who walks in, regardless of their ability to pay? Spoiler: there is, and most Americans have no idea it exists. Adam and Lara sit down with Dr. Rui Ariyapala, Associate Chief Medical Officer at Piedmont Health Services and a public health physician trained across New Zealand, the UK, and the US, to unpack the Federally Qualified Health Center model, a 55-year-old experiment in keeping vulnerable patients out of the ED and inside coordinated, value-based care. Along the way: why a father walked out of his child's cancer diagnosis, how $4,500 of NHS coverage stacks up against $26,000 a year in US premiums and what it actually takes to move a system built on sick-care toward real prevention. Plus: Gary the Word Bird, Ginger Spice at the London Zoo, and a proposal hidden inside an escape room. A conversation about the parts of US healthcare that are working and the upstream shifts that could fix the parts that aren't.

The Women's Health Funding Gap: Why Nobody Opposes It but Nothing Gets Done with Kathryn Schubert

Endometriosis affects as many women as diabetes. Diabetes research gets $1 billion a year from NIH. Endometriosis gets $28 million. That kind of gap doesn't exist because people are against women's health research, it exists because it hasn't been made a priority. In this episode, Dr. Adam Brown and Dr. Lara Zibners sit down with Kathryn Schubert, President & CEO of the Society for Women's Health Research, to unpack why the women's health funding gap persists, how policy actually gets shaped behind the scenes in Washington, and what it's going to take to close the gap for good. Kathryn shares her journey from Capitol Hill scheduler to registered lobbyist to leading one of the longest-standing organizations fighting for women's health equity. Along the way, we get into the real role lobbyists play in healthcare policy (it's not what you think), how advocates tailor their message to move lawmakers on both sides of the aisle, the history of excluding women from clinical trials — and the assumptions that made it seem reasonable at the time, navigating women's health advocacy in a politically charged environment, and why the private sector is finally waking up to women's health as a market opportunity. This conversation will change how you think about where health policy comes from and who's actually moving it forward. Follow Unstable Vitals: LinkedIn [https://www.linkedin.com/company/theunstablevitals] Instagram [https://www.instagram.com/theunstablevitals/] Youtube [https://www.youtube.com/@UnstableVitals]

Ringworm, MRSA & Broken Buckles: The PPE Problem Nobody's Talking About w/ Justin McKay

You put on a lead apron and assume it's keeping you safe. But what if it's carrying MRSA, ringworm, and nearly 10 times the bacteria of a gas station pump handle? Even worse, what if nobody's required to clean it? Justin McKay, founder of RadCare Services, joins Dr. Adam Brown and Dr. Lara Zibners to share how a ringworm infection, a torn-up apron on his first day in the OR, and a year of quietly studying hospitals across the country led him to build something the healthcare industry didn't even know it needed: a full-service lead apron cleaning, repair, and compliance program. In this episode, we dig into the disgusting (and dangerous) reality of radiation protection garments in U.S. hospitals from blood and fecal-stained aprons going right back on the rack, to a culture study that found MRSA on the majority of aprons tested. Justin shares the moment a skeptical surgical director called his pitch "snake oil," so he tested her busiest surgeon's apron on the spot. The results were jaw-dropping. We also talk about the uphill battle of building a business around a problem no one is required to fix, why financial incentives in healthcare make or break innovation, and what gives Justin hope for the future of medicine. In this episode: * Why hospital lead aprons are virtually unregulated for cleanliness in the U.S. * The ATP test that proved aprons are nearly 10x dirtier than gas pump handles * How a 2017 lawsuit tied defective PPE to cancer deaths among OR staff * The founder's journey: quitting a VP of sales job, two years without a paycheck, and bootstrapping a new business Follow Unstable Vitals: LinkedIn [https://www.linkedin.com/company/theunstablevitals] Instagram [https://www.instagram.com/theunstablevitals/] Youtube [https://www.youtube.com/@UnstableVitals]

The NHS Up Close: Emergency Care and Lessons from Across the Pond With Robert Pinate

In this episode of Unstable Vitals, Dr. Adam Brown and Dr. Lara Zibners are joined by a very special guest, Lara's husband, Robert Pinate, a nurse consultant with over 30 years in UK emergency medicine. Rob helps emergency departments rethink outdated workflows and improve patient flow. The conversation dives into how the NHS actually works from its funding model and workforce of to the freedom clinicians feel when billing isn't part of the equation. Rob breaks down the rapid assessment and treatment model he champions, the culture shock of implementing America's Epic EHR in a system that doesn't bill, and what it's like walking into struggling hospitals that feel like they've regressed. The trio explores the sobering parallels between the NHS's decline after years of austerity and the growing cracks in the U.S. system, from Medicare cuts to frontline burnout. But it's not all doom. Rob shares where he's seeing improvement and makes the case that sometimes all it takes is pulling the right people off the floor, handing them a blank sheet of paper, and asking: how can we do this better?

Saving the Independent Practice: How One Company Is Trying to Stop Healthcare's Consolidation Crisis

What happens when a Canadian finance guy with zero healthcare experience decides to take on one of the most broken systems in the world? You get Alex Barrett, co-founder and CEO of Meroka, and a genuinely different perspective on why independent medicine is dying and what can actually be done about it. In this episode, Drs. Lara Zibners and Adam Brown sit down with Alex to unpack the real force behind healthcare consolidation, and it's not the "silver tsunami" you keep hearing about. CMS reimbursement rates have been essentially flat since 2002 while costs have surged, making the business model of running an independent practice quietly unsustainable for thousands of physicians across the country. Alex shares how Meroka is building a third exit path for retiring physicians, one that keeps practices out of private equity hands and transfers ownership to the staff who actually do the work. But the conversation goes deeper: Why does the only OB delivering babies in a 100-mile radius in rural West Virginia still have no negotiating power? Why are non-compete clauses one of the biggest hidden barriers to independent medicine? And is the system so broken it simply can't be fixed? Spoiler: Alex doesn't think so. Listen now.