The Hidden Economy Around Physicians (And How to Use It Instead of Getting Used By It)

 

For those of you who are new here, my name is Brad. I’m a practicing physician, I own a multi-million dollar primary care practice, and I spend a lot of my time helping other doctors start or scale their own practices. Today I want to pull the curtain back on something nobody warned me about in med school: the hidden economy that forms around founder physicians and employed physicians the moment you start to succeed.

If you haven’t gone down this road yet, I think you’re going to be surprised. There is an entire underground economy built around you, the physician. And once you see it, you can’t unsee it. More importantly, once you understand it, you can stop being the mark and start being the strategist.

Let me be honest about how I got here. When I started my practice, I assumed the hardest part would be seeing patients and building the thing from nothing. And yeah, that’s brutally hard. Finding amazing talent might be the single hardest part of running any business, physician or not. But there’s another challenge nobody prepares you for, and it’s not a clinical one. It’s the fact that as soon as you become a successful practice owner, you become the most wanted customer in the room.

Why everyone suddenly wants a piece of you

Here’s the thing about an owner-occupied medical clinic: it almost never fails. Put it on a spectrum. On one end you’ve got someone opening a restaurant, which is one of the riskiest business bets out there. On the other end you’ve got a doctor who owns their own clinic. Banks know this. Lenders know this. Vendors know this. Your business is about as close to a sure thing as exists in the small business world.

So what happens? Everyone wants a piece of the person who has money coming in, whose endorsement carries weight, and whose trust means something. As you grow and scale, you will be shocked at the sheer volume of businesses lining up to pitch you. It becomes a constant. And I’m not telling you this to make you jaded or cynical. I’m telling you so that you simply know this underground world exists, because knowing it is the first step to using it to your advantage.

Rule one: everyone has a business model

The single most useful mental shift I ever made was this. Whenever someone pitches me something, I stop and ask: how does this person, this group, this company actually make money? What is the business model here?

Medical societies, conferences, Facebook groups, online communities, the guy buying you lunch, all of them have a business model. And here’s what I want to be crystal clear about: making money is not inherently wrong. This isn’t a video about villains. I have personally paid a lot of money to consultants, and it was some of the best money I ever spent. The right consultant skipped me five years of painful trial and error and handed me expertise on day one. That’s a beautiful thing.

It’s the same reason people buy established businesses instead of starting from scratch. Could you go out and start a competing burger chain with four locations from zero? Sure, technically. But do you have any idea how hard it is to build a brand and grow from nothing? It’s insane. So paying for a shortcut, paying for expertise, paying for an established platform, none of that is bad. The point isn’t to assume bad intent. The point is to understand the incentive, because once you understand the incentive, everything gets a lot clearer.

A perfect case study: the laser pitch

Let me give you a real example. For a while I kept taking meetings with medical device reps pitching me things like aesthetic lasers and vaginal rejuvenation machines. Here’s the funny part: my clinic was about 80% male at the time. So why on earth was I sitting through those meetings? I actually made a whole separate video about that. But let’s talk about their incentive, because it’s a masterclass in a layered business model.

First, they sell you the laser. That’s the obvious part. But then they offer to finance it for you, so now they’re not just making the purchase price, they’re making interest on top of it. Then, oh by the way, you’ve got to buy the warranty from them too. And if you don’t buy the warranty, good luck when the thing breaks, because these machines do break down over time.

And then there’s the real kicker: consumables. Every single time you turn the machine on, you’re either paying them a royalty or you’re burning through a proprietary part that has to be replaced. That’s the consumable. So they make money on the sale, on the financing, on the interest, on the warranty, and then forever on the consumables every time you flip the switch. It is a genuinely beautiful business model, and the pitch is always the same: “Doc, you only have to see two patients a month and this thing pays for itself.”

And you know what? That might be true. It might genuinely benefit patients. It might be a great addition to the right practice. But that salesperson walking in wearing a Rolex is making a lot of money off that sale. So the real question you have to ask is: is this actually in my best interest if I don’t have the patient panel to support it? I’m not saying any of it is sleazy. I’m saying know what their incentive is before you sign.

The one paragraph that could cost you your practice

Here’s an example that’s a lot more serious than a laser you’ll never use. At one point I was about to sign up with an ACO. For those who don’t know, an ACO is basically a structure built around Medicare quality metrics. You hit your targets on blood pressure control, pap smears, mammograms, bone density screenings, all these measures, and Medicare rewards you for taking good care of complex patients. That’s the gist of it.

This particular ACO company had private equity behind them. And I did what almost nobody does: I actually read the entire contract. Fifty pages. And buried in that fifty-page document was a single paragraph about a right of first refusal.

That’s it. One paragraph. On the surface they were making their money off the ACO arrangement, which is fine. But that little clause said that if I ever sold my practice in the future, they had the first right of refusal, which effectively meant I’d be obligated to sell to them. Think about what that is. They spend tens of millions of dollars building this ACO, they pay reps to come out, pitch me, and buy me lunch, and in exchange for the “reward” of hitting Medicare metrics, they quietly take a claim on the future ownership of my practice.

Always ask: why would a company spend tens of millions of dollars building this thing? What’s the real return for them? Sometimes the answer is a slice of ownership in your business that you didn’t even realize you were handing over. I’m not saying it’s evil. If they make money, I make money, and the patient benefits, great. But the incentive there was ownership of my practice, and thank goodness I read the fine print and passed.

So let me say this as plainly as I can: if you joined an ACO and you did not read the fine print, there’s a real chance a clause like that is in there. Go read it. If you ever sell, you may be contractually bound to sell to them. (For what it’s worth, I did later join a different ACO that didn’t have that clause at all, and they were fantastic. So this isn’t a knock on the entire model. It’s a knock on not reading your contract.)

Rule two: free is almost never free

Doctors love free stuff. Free dinners, free webinars, free consulting, free software, free everything. And I get it. But you have to understand what you’re actually trading.

When you join a “free” Facebook community and you type in your cell phone number and email address to get in, understand that your information has real value. A lot of these groups and survey companies are selling your data to brokers. It’s the same story with those physician survey companies. Half the time you don’t even qualify for the survey, and the reason is that they don’t actually care about the survey. They care about your phone number, your address, your specialty, where you practice, and who your colleagues are. That personal information gets sold to data brokers for something like ten to fifteen bucks a pop.

You can go online right now, find these data brokers, and buy the list yourself. Ever wonder why, the moment you open a practice, you suddenly start drowning in emails from remote patient monitoring companies and chronic care management vendors? It’s not a coincidence. They bought your info from a data broker. Free was never free. You paid with your data, and your data is worth a lot of money.

Rule three: communities have incentives too

This one gets personal, and I’ll own my part in it. For those of you I’ve consulted with, you’ve heard me mention that there’s a huge private practice community on Facebook. I got kicked out of it. Here’s how it went down: people started recognizing me. “Wait, are you Brad, the Investing Doc?” And right around the time I started my own subreddit, r/PrivatePracticeDocs, I got permanently booted. I’ve tried to rejoin. I’ve tried to reach out. I’ve been ghosted every single time.

And you know what? I actually get it. She has her own group. I had what looked like a competing group forming on Reddit. That’s a conflict of interest from her point of view. But the lesson stands: communities have incentives too. They’re sponsored, they’re moderated, and there are business interests woven through all of them.

Here’s an even clearer example. There’s another online physician community, a big one, something like 90,000 physicians in it. About six months ago I reached out and asked, “Hey, I’ve got this MSO, is it okay if I post about it?” They said no. And I respected that. At least I asked. It’s a conflict of interest, because I’d be selling something to their members. Totally fair.

So then I asked, “Okay, what if I sponsor a post? I’ll pay you three, five, eight thousand dollars for a single post that says Brad’s here, he’s an independent doc, that’s it.” And the reply was: no. They didn’t want a one-time payment. They said they’d prefer equity or recurring revenue. They want ownership in what you’re building, or they want a recurring monthly check.

And honestly? Respect. Genuinely. If you’ve built a community of physicians so valuable that you can turn down eight grand and hold out for equity or recurring revenue, good for you. That’s a serious business. It also tells you something: that community must be making an absolutely insane amount of money. You can be mad about it, or you can learn from it.

Even the people you respect have a business model

I want to be really careful here, because this next point tends to get people fired up. Take someone like the White Coat Investor. Enormous respect for him and for what that platform has built. But be clear-eyed about how a lot of these platforms work. When you get a physician mortgage or a disability policy through a referral link, the referrer often gets paid, sometimes over a thousand dollars, for sending you their way.

Ever wonder why so many physician influencers are constantly telling you that you need to sign up for a disability policy right now? Part of the reason is that they earn a significant commission when you do. And here’s the crucial part: both things can be true at the same time. You absolutely should have a disability policy. I’m a huge believer in it. I’ve even been in conversations with a company about potentially offering one to my own audience, precisely because I believe in it so strongly. So the person recommending it can be genuinely right and be making a great commission. Those aren’t contradictions.

I’m not bringing any of this up to accuse anyone of fraud or shady behavior. These are legitimate businesses making legitimate money, sometimes millions of dollars, by serving physicians. These platforms aren’t hobbies. They’re out there to make a profit, and that doesn’t make them bad. It just means you should know the incentive behind the advice you’re getting.

How to actually use this to your advantage

Okay, so the whole world is trying to sell you something. What do you do with that? Here’s how you flip it.

Learn to say no. If a meeting doesn’t align with your vision for where your practice is going, say no. It’s a complete waste of your time. As you grow, your time and your attention become genuinely valuable assets, arguably your most valuable assets. There’s a line I think about from Ryan Serhant, the real estate guy. He basically said, look at your day as being worth a million bucks, then divide that by your time. Fifteen minutes is worth X. Now ask: is this meeting worth that amount? Build your own version of that equation however you like. The underlying point is that your time as a physician and an entrepreneur is extremely valuable, and saying no to worthless meetings is how you protect it.

Say yes strategically. Saying no to time-wasters frees you up to say yes to the things that actually build you. “Yeah, I’ll pay $3,000 to come on your podcast.” “Yeah, I’ll do that, because it grows my brand.” Start thinking intentionally about what your brand is, how you’re going to market, and how you’re going to network. That’s how leaders and entrepreneurs think. Is some of this game a little sleazy? That’s for you to decide, and yes, there’s absolutely a sleazy way to play it. But at the end of the day, it’s a business, and the people running these physician communities and platforms aren’t doing it as a hobby. They’re doing it to profit, and there’s nothing wrong with that.

Understand that people don’t want your business, they want your value. When someone comes to you, they usually want one of two things: your audience or whatever value you create. Maybe you’re the best hand surgeon in the world and they want access to your skill. Maybe you’ve built an audience and they want in front of it. If you’re an employed physician being offered ownership in a group, flip the question around: what value can you bring to that group to earn more equity, more income, more of whatever you’re after? Your value is the leverage.

The lines you never cross

Now, some opportunities aren’t just bad deals, they’re illegal, and this is where I need you to pay close attention. I have been pitched more questionable things than I can count. So let me be blunt.

If anyone ever offers you a referral fee, turn it down immediately. You cannot pay for, or accept payment for, patient referrals. I’ve lost count of how many times someone has pitched me, “Hey, for every sleep study you send us, we’ll send you a $35 gift card.” Brother, that’s a one-way ticket to jail. How did that even get past your lawyer? Never accept a kickback or a referral fee. You will get in serious trouble, full stop.

Be equally careful with opportunities that seem too good to be true, especially the “medical director” roles where you’re really just being paid to rubber-stamp everything. That’s not mailbox money, that’s liability. I was briefly a medical director of an infusion suite, and let me tell you, it was real work. I was in there constantly, reviewing every single note, because I had to. It wasn’t easy money and it wasn’t passive. If you take one of those roles and you don’t cross every T and dot every I, you can land in a world of trouble. Be careful with anything that doesn’t align with your long-term vision and sounds too good to be true, because it usually is.

The real lesson: build your own ecosystem

If you take one thing from all of this, take this: build your own ecosystem. Build your own brand. Be intentional about it.

I’m sitting here thinking about this for my own channel, Investing Doc, right now. Let’s be real, this has been a hobby up until this point. But the more work I put into it, the more I realize I should start treating it like a business. What brand do I want to identify as? Do I lock in real colors and fonts and an identity? Do I build a proper website and platform? I think the answer, finally, is yes. And that goes for you too. Build your own website, your own platform, your own community, whatever it is, but do it on purpose, with your eyes open to the incentives all around you.

Remember how this whole thing started for me. They wouldn’t let me into that private practice Facebook group, so fine, I built my own. That physician community turned down my eight grand because they wanted equity or recurring revenue, so good for them, and also, that just tells me what’s possible when you own the platform instead of renting space on someone else’s. You can be mad about the rejection, or you can go create your own thing. I’m not angry about any of it and I’m not taking the rejection personally. I’m just peeling the cover back so you know what you’re walking into.

Because you will have to start pitching your own ideas. You’ll have to throw things out into the world, and a lot of them won’t land. Some people will tell you you’re crazy. Some will tell you it’s stupid. Most will just ghost you. That’s the game.

And here’s the payoff of your attention when you point it in the right direction. Recently I finally started taking Instagram Reels seriously, just throwing them up. The most recent one I actually put effort into has something like 70,000 views. That’s insane brand recognition, and it took me about five minutes to make. That’s the power of building your own thing.

So stop believing every sales pitch. Walk into every meeting with a healthy dose of “what’s in it for them?” I promise you’ll come out the other side a much healthier, sharper entrepreneur, one who can focus and hone in on what actually matters: what do you stand for, what value do you create, and what is genuinely worth your time at this point in your career.

Nobody taught me about this underground economy in med school. I thought people just wanted to buy me a chicken sandwich for lunch. Turns out a lot of the time, they’re paying for your time, your data, your audience, or a piece of your future. Nothing inherently wrong with any of it, as long as you see it clearly.

Thank you all so much for following along. I’m building out my own community and I’d love to have you in it. If you’ve got questions, I’m here for you. See you on the next one.

 

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