In this solo, podcast‑style monologue, host Matthew Cologli (also introduced as Matthew Gallaudet) reads excerpts from his book Out of the System and deconstructs the systemic forces that keep U.S. physicians locked into low‑pay, high‑burnout employment. He frames the problem as three foundational “lies” taught during medical training: (1) that long hours and relentless hard work guarantee success; (2) that massive student‑loan debt is an inevitable part of the journey; and (3) that deep specialization is the path to respect and income. Cologli argues each lie is a deliberate conditioning tool designed to produce exhausted, indebted, and territorially isolated “medical employees.” He then exposes how the health‑insurance industry exploits these conditions, detailing the artificial 10 % profit cap created by the Affordable Care Act, the unlimited profit avenues of pharmacy‑benefit managers, and the resulting $449 billion profit surge. The host critiques volume‑based compensation (RVUs, production bonuses) and the myth that seeing more patients equals virtue, showing how it erodes patient care and drives physicians toward “Taco Bell wages.” He contrasts this with cash‑price models that can be dramatically cheaper for patients, illustrating with personal MRI cost examples. Throughout, Cologli emphasizes the hidden obedience curriculum embedded in medical education, the competitive silos it creates, and the punitive mechanisms (license threats, board reports) that silence dissent. The episode ends with a call to action: reclaim autonomy, pursue patient‑centered practice, and explore his book and the Mavericks Profit System for guidance.
Chapters
Lie number 1 is long hours and hard work are the key to success, which is complete and utter BS. Okay? If working 14 to 16 hour days, sleeping 4 hours a night, and sacrificing everything else in your life was the formula for success, my friend, my brothers, the union plumbers would be multi-billionaires. The residency model you endured was literally created by a cocaine addict at Johns Hopkins who worked insane hours because he was constantly high. It's not a joke. It's history. You can Google it and check it out. Okay? They buried you in impossible hours, not to make you a better doctor, but to Make you too exhausted to question the system they were building around you. You didn't build your clinic to feel like an employee in your own business. I'm Matthew Cologli, and on Out of the System hosted by Doctor Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable, patient-centered practices and doing it their way. I want to talk to you about the lie you've been living. If you're a provider, doctor, NP, naturopath. And you are new to this podcast, or this is the first time, you'll notice this is a slightly different format. It's just me, a little bit shorter form. And what I'm doing in these is I'm reading you excerpts from my latest book called Out of the System. And today I want to talk to you about the lie. I want to talk to you about the lie that you've been living. And what you have to realize is the first step to freedom is recognizing your chains. Now, this lie that you've been living, it's not the small kind of lie that makes you uncomfortable, like the kind of one that makes you uncomfortable when you think about it. It's the soul-crushing, life-destroying, legacy-obliterating kind of lie that has turned you, one of the most educated, skilled, and dedicated professionals in society, into a glorified employee working for the equivalent of Taco Bell wages. Now, when was the last time you felt genuinely excited to go to work? When did you last feel like you were practicing medicine the way you dreamed about in medical school? And when did you last make a treatment decision purely based on what was best for the patient without a single thought about what some insurance company bureaucrat might approve? If you're struggling to remember, you're not alone and it's not your fault. You've been systematically programmed, indoctrinated, and trapped in a system designed to extract maximum profit from your medical license while keeping you just comfortable enough that you won't question it. They've created the perfect storm, and just enough money to survive, just enough debt to keep you working, just enough fear to keep you compliant, and just enough busywork to ensure you never have time to see what you're really doing. Welcome to the lie you've been living. And what they do is they call this, I call this the white coat indoctrination. And let's start at the beginning. Let's start with your medical training. What you thought was preparation for a noble career was actually an elaborate conditioning process designed to create the perfect medical employee. If you study how predators groom their victims, you'll find disturbing parallels to how the medical system has shaped you. And from day one, they taught you 3 fundamental lies. Lie number one is long hours and hard work are the key to success. Which is complete and utter BS. Okay? If working 14 to 16-hour days, sleeping 4 hours a night, and sacrificing everything else in your life was the formula for success, my friend, my brothers, the union plumbers would be multi-billionaires. The residency model you endured was literally created by a cocaine addict at Johns Hopkins who worked insane hours because he was constantly high. It's not a joke. It's history. You can Google it and check it out. Okay? They buried you in impossible hours not to make you a better doctor, but to make you too exhausted question and system they were building around you. Here's the second lie. Massive debt is just part of the journey. They expect you to go into debt up to your eyeballs. Quarter of a million, half a million, sometimes more. Why? Because debt is the perfect chain. If you owe $300,000 and you're making $250,000 a year, you can't stop working. You can't take risks. You can't tell them to go to hell when they treat you like garbage. They don't pay you $4 million a year because then you could pay everything off and have options. They pay you just enough, not enough to thrive, but enough to survive. survive and service your debt. Here's lie number 3: specialization is the path to respect and income. Here's what they— why they really want you to specialize. Silos. When you become hyper-specialized, you lose sight of the bigger picture. You become territorial, competitive with other doctors instead of collaborative. You focus so narrowly on your tiny slice of medicine that you never step back to see the massive machinery extracting wealth. From your expertise. The entire indoctrination process was designed to create the perfect medical employee, exhausted, indebted, territorially isolated, and completely dependent on the system for survival. Now, there's a $449 billion secret that exists, and this number should make your blood boil. Since the Affordable Care Act has been in effect, you health insurance companies have generated over $350 billion in Profits. UnitedHealthcare alone is valued among the top 15 largest corporations in America alongside Tesla, Amazon, and Nvidia. How did they get there? The ACA created an artificial cap on insurance company profits. They can't make more than 10% profit on health insurance premiums. Sounds reasonable, right? Okay. Wrong. It's the most brilliant scam in business history. And here's the math. If you make $100 million in revenue, your maximum profit is $10 million. But if you make $1 billion in revenue, your maximum profit is $100 million. Why do you think the CEOs focus on driving up revenue, which means driving up healthcare costs? The result? American families now spend an average of $16,500 out of pocket after paying their premiums. Healthcare costs in America are 3 to 4 times higher than in any other industrialized nation, and we have worse outcomes. But here's the real kicker. The 10% cap only applies to health insurance. These companies figured out how to make unlimited profits through things like pharmacy benefit managers, which control drug pricing. And this is why medication costs 3 to 4 times more in America than anywhere else. Every single payer in this system is making money off your medical license except you. The pharmaceutical companies are immune from lawsuits. The hospital bills you for your services. The insurance companies control what you can prescribe and charge. The lawyers circle like Vultures. And who gets sued when something goes wrong? You do. Who gets paid last? You do. Who has their license threatened if they speak out? You do. And there's this unspoken contract. When you took that first job out of residency, you thought you were signing an employee agreement. What you actually signed was an unspoken contract that traded your autonomy for the illusion of security. You will not make medical decisions. You're really just choosing from a pre-approved menu created by insurance company bureaucrats. Want to do what's actually best for the patient? Not gonna happen. Okay? That's not covered. Wanna skip the next 6 months of ineffectual treatments you know won't work? Not possible. You have to fail the approved protocols first. Your work. You will work yourself to exhaustion. If you're not seeing 40 to 60 patients a day, you're not a good doctor. If you're not completely burned out, you're not working hard enough. They've convinced you, literally convinced you, that volume equals virtue, that running from room to room like a hamster on a wheel Is somehow noble. You will remain financially dependent. They structure your compensation to keep you needing them. Relative value units, otherwise known as RVUs, and production bonuses, which by the way is all commissioned sales, just dresses up medical terminology. Then there's the false gospel of volume. And let me destroy one of the biggest lies they've sold you: that seeing more patients is the key to success. The average doctor spends seven to nine minutes with each patient. You cannot possibly gather enough information. information to make that accurate diagnosis in that time, and you know it. You know this. But the system doesn't care about your accurate diagnosis. It cares about billable encounters. This model isn't designed for patient care. It's designed for insurance company profits. Patients are frustrated as hell. More frustrated than you are. They wait weeks for appointments, sit in waiting rooms for hours, then get rushed through 7-minute encounters where they can't ask real questions. But here's what they don't want you to know. Patients will gladly pay you directly for quality time and attention. They're already spending that $16,500 out of pocket anyway. The difference is when they pay you direct, they get real value. They get real answers. When they pay the insurance company, they get bureaucracy. So this creates a financial, financial reality check. You ready for some math that'll make you sick? Dr. Don Buford recently calculated that orthopedic surgeons are getting paid approximately $28 per hour for ACL reconstructive surgery. When you factor And all the time involved, pre-op appointments, surgery prep, the procedure itself, 60 to 90 days of post-operative care. $20 an hour for orthopedic surgery performed by someone with 8 years of medical training. Current trends suggest that will drop to $24 per hour soon. That means orthopedic surgeons will soon be paid less than someone working at Taco Bell. Now, how is that possible? Because the insurance companies don't value you. They're a necessary— you are a necessary evil to them. And if they could replace you with AI, they would. Every dollar they don't pay you goes to their shareholders, their executive bonuses, and their political lobbying. Insurance dependency myth is out there. Here's another lie they tell you. You need insurance to financially survive, which is garbage. I'll give you a personal example. 5 years ago, I needed an MRI for a prostate issue. With quote unquote good insurance, my out-of-pocket cost was $850. 3 years later, I needed an MRI for my back. When they asked about insurance, I said I'd pay cash. The price? $350. Same facility, same machine, less than half price. This happens constantly. The cash price is almost always lower because there's no administrative overhead, no claims processing, no negotiations between multiple bureaucracies. What we call health insurance in this country isn't insurance at all. It's a system where people pay monthly premiums hoping the insurance companies won't bankrupt them when they get sick. That's not insurance. That's extortion with better marketing. Then there's the hidden script. Every aspect of your training follows a hidden script designed to control you. Work harder, not smarter. They tie your compensation to RBUs, commission sales, with a medical name. The more you work, the more burned out you become, the less time you have to realize how badly you're being exploited. Compete, don't collaborate. Medical training deliberately creates competitive, isolated professionals to prevent them from working together to recognize and resist the system exploiting them. They want you to stay in debt. Every startup involves more debt. Medical school, residency survival, all of it. The debt keeps you working for their system because you can't afford to leave and follow the protocol. Questions on the standard of care, you'll be labeled a heretic, reported to medical boards, and potentially lose your license. Then there's the obedience curriculum. Everything about your medical education was designed to teach you to follow orders, not think independently. They reward you for having the right answers from textbooks, not for questioning whether those answers actually served the patient. Real science is about questioning, hypothesizing, and testing. But if you question standard protocols as a practicing physician, they threaten your license. If you speak out about what you've observed, they can censor you. Look at what happened during COVID to doctors who questioned quote unquote official protocols or prescribed alternative treatments. Many had their license threatened. Their social media deleted, their reputations attacked, regardless of whether their approaches were helping patients. Look, this isn't about science or patient care. The current system is not about that. It's about control. Let's be really clear about this. The system cannot tolerate doctors who think independently because independent thinking leads to independent action. Think on it. Check out our other podcasts on Out of the System where we go into longer form, where we talk with people and doctors and leaders throughout the industry and the world who've decided to leave their systems and build something bigger. I'm Matthew Gallaudet. I'm your host. And check out our new book, Out of the System. You can buy it on Amazon and on our site as well. It's a doctor's guide, provider's guide for reclaiming your purpose, your power, and your passion. We'll talk to you soon. Thank you. If this episode got you thinking differently, hit follow and share it with someone stuck in the system. Please leave a review. It helps us grow. Want more? Visit MavericksProfitSystem.com to schedule your free discovery call and explore how far your business can go.
