Christopher Garofalo, MD – Walking Away from Employment: A Practice Owner's Playbook

Dr. Christopher Garofalo joins Dr. Michael Jerkins for a wide-ranging conversation about a transformation few in medicine are tracking closely—the slow disappearance of the physician-owned practices, and what it means for the doctors and patients left in its wake. As a family physician, longtime private practice owner, and advocate inside organized medicine, Dr. Garofalo has watched the ownership model erode from the inside, and has a clear-eyed view of how policy, private equity, and the insurance industry have reshaped what it means to practice independently. Dr. Garofalo walks through the levers physicians rarely realize they can pull: how simply showing up in advocacy circles translates into tangible wins like prior authorization reform, why direct primary care is quietly rebuilding a relationship between doctor and patient that insurance long ago broke, and how policies restricting physician ownership of hospitals and surgery centers have quietly tilted the field toward consolidation. The episode also takes on the harder structural questions underneath the trend lines: What happens to access and cost when monopolies and vertical integration replace independent practices? Why has the dental profession protected ownership while medicine surrendered it? And could AI tools and new financing models finally make private practice viable again for the next generation of doctors? Throughout the conversation, one truth anchors the discussion: practice ownership is not nostalgia—it is infrastructure. Restoring it is how physicians regain autonomy, how patients regain access, and how medicine regains the room to be practiced the way it was always meant to be practiced.