You're staring at your 2025 P&L. Revenue flat. Expenses up 8-15% across the board. The profit margin that feeds your family is physically smaller than three years ago.

The consulting class says run a tighter ship. Cut the bagels. Code better.

That advice is a lie. You cannot efficiency your way out of a structural disadvantage.

This episode dissects the MedMerge Investment Thesis and breaks down the financial physics crushing independent medicine. A 50-person practice pays $480,000 more per year than an identical facility inside a hospital system. Same coverage. Same carrier. Same risk profile. The only difference is size.

That's not a market inefficiency. That's engineered economic pressure designed to drive consolidation.

IN THIS EPISODE:

The invisible tax: why being small costs you $480,000 annually in insurance alone
The PE trap: what really happens after the Patagonia vest shows up with a check
The four-step playbook that turns practice owners into employees
The goose and the grain silo: infrastructure aggregation without ownership surrender
Captive insurance and the float: the Warren Buffett parallel that changes everything
Pilot results: 85% reduction in Rx spend, $1.4 million returned to physicians in year one
Economic gravity: why leaving costs $1 million+ (and why you won't want to)

The thesis argues you're currently funding your own demise. Every premium check hands carriers the capital they use to build their wealth while your margins shrink.

There's a third path. Not PE. Not hospital employment. Infrastructure coordination that makes independent practices unbuyable.

LINKS

📰 Read The Rojas Report: https://therojasreport.substack.com

🔗 Connect with Dutch:

X: https://x.com/DutchRojas
LinkedIn: https://linkedin.com/in/dutchrojas

EPISODE KEYWORDS/TAGS

independent medical practice, physician independence, private equity healthcare, captive insurance, healthcare economics, practice management, MedMerge, insurance float, healthcare consolidation, physician entrepreneurs

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$480,000: The Annual Tax You Pay, But Can Get Back...