Board-certified orthopedic surgeon. Solo private-practice hand surgeon (NJ/NY). Breaking down physician pay, Medicare, insurers & policy. Not medical advice.
Fort Lee, NJ
Joined October 2026
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Employed docs: find the without-cause clause in your contract. Mine had one.
It lets them end your job with no reason. Typical notice is 90 days, and some contracts let them send you home early.
Ask one thing before you sign: do you still get paid for the whole notice period?
Source: AAFP, Navigating Physician Employment Contracts (2021). Typical without-cause notice: 90 days. Some contracts let the employer move up the end date, even to immediate. AAFP says get pay and benefits for the full notice period. Not legal advice. aafp.org/fpm/2021/0900/p17.p…
6 House cosponsors from both parties. It cleared its subcommittee by voice vote in June.
H.R. 9396 would make commercial insurers publish how often they deny prior auths, how many denials get overturned on appeal, and how often AI made the call.
Doctors, residents, med students: ask your House member to cosponsor. Template below.
Template letter (fill in and send through your rep's website contact form):
Dear Representative [name],
I am a [physician / resident / medical student] in [city, state]. Please cosponsor H.R. 9396, the Prior Authorization Accountability Act.
Prior auth denials delay care, and patients can't see how often their plan says no. This bill makes commercial plans publish approval and denial rates, appeal results, decision times, and how often software or AI made the call. It is bipartisan.
Sincerely,
[Name, credentials]
[City, state]
Find your rep: house.gov/representatives/fi…
Most states set a deadline for insurers to pay a clean claim, with interest owed if they're late. New Jersey: 30 days electronic, 40 paper, 12% a year.
Look up your state's prompt-pay law, then check your remits.
Practice owners: has your billing company ever flagged a missing interest payment?
Source: N.J.A.C. 11:22-1.5 and NJ DOBI Bulletin 24-17. State prompt-pay laws cover state-regulated plans, not self-funded employer plans.
law.cornell.edu/regulations/…
nj.gov/dobi/bulletins/blt24_…
The C-arm in my office is a used mini. Those run $30 to 50K.
A stationary unit costs about double and needs a tech on salary. Same reimbursement.
When you can't raise your fees, every equipment purchase is an overhead decision.
When I left my employed job, I didn't need tail coverage. My malpractice was occurrence, not claims-made.
Residents and fellows: ask which one you're getting before you sign. Tail can run 1.5 to 2 times a year's premium.
Always ask for occurrence on your contract.
Sources: tail cost and who pays (Davidson, Key Physician Contract Issues): amwa-doc.org/wp-content/uplo…
Epstein Becker Green on tail coverage: ebglaw.com/health-law-adviso…
Own your practice and you don't have a job. You have a hobby that pays you.
2 years in. Still feels that way.
Thinking about buying into a surgery center? Read the exit terms before the buy-in price.
What happens to your shares when you leave matters more than the first year's distributions.
ASC owners: what do you wish you'd checked first?
Hospital systems are on track for their busiest year of deals since the pandemic started.
Doctors? Since 2010 we've been blocked from opening new physician-owned hospitals that bill Medicare. The hospital lobby wants to keep it that way.
Who exactly is that rule protecting?
Sources: Kaufman Hall Q3 2026 M&A report kaufmanhall.com/news/ma-acti… and AHA position on physician-owned hospitals aha.org/advocacy/advocacy-is…
My books close twice a day without me. An AI agent files every receipt into QuickBooks.
I just review it. Minutes, not weekends. @grok
Owners: what are you still doing by hand?
65 House cosponsors. Zero in the Senate.
The Patients First Act would tie doctors' Medicare updates to inflation, the way hospitals already get. Adjusted for practice costs, Medicare physician pay is down about a third since 2001.
House: H.R. 9693. Senate: S. 5672. Doctors, residents, med students: ask your House member and both senators to sign on. Template below. Takes 5 minutes.
Template letter:
Dear [Senator / Representative] [name],
I am a [physician / resident / medical student] in [city, state]. Please cosponsor the Patients First Act ([S. 5672 in the Senate / H.R. 9693 in the House]).
Medicare physician pay has not kept up with inflation for years. This bill ties updates to inflation and fixes the budget rules behind the cuts.
When Medicare pay falls behind, independent practices close or sell, and patients lose options.
The bill is bipartisan. Please add your name.
[Optional: one sentence about your own practice or training]
Sincerely,
[Name, credentials]
[City, state]
Find your senators: senate.gov/senators/senators…
Find your House member: house.gov/representatives/fi…
Bills: congress.gov/bill/119th-cong… and congress.gov/bill/119th-cong…
When private equity buys a practice, the plan is to sell it again in a few years.
So the doctors who sold aren't partners anymore. They're inventory.
I own mine. Nobody can sell me to a fund.
Residents: I matched my employed pay in my first year of owning my practice.
Bank loan to start. Took call at local hospitals and ran Google ads to get patients.
Nobody teaches that part in residency.
BlackRock is buying a $2.8 billion majority stake in about 150 of Humana's senior primary care clinics.
Seniors walking in don't know Wall Street and their insurer own the practice.
Humana press release, Oct 13, 2026: policy.humana.com/news-and-r…