Sajeel R.Khan, M.D, FAANS.

Asstt. Professor Dept. Of Neurosurgery, Marshall University SOM,Marshall Health,Cabell Huntington Hospital. Adult and Pediatric Scoliosis.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Open the arachnoidea to the mighty canyon. Deep down is the river beyond which lies the realm of dreams. Take my hand to travel to the realm of dreams.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@DrDiGiorgio 😀. Nice analogy

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@DutchRojas Doctors please fwd to all friends to comment and steer the policy towards common sensical cost cutting strategies.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@olsonplanner Fantastic piece. Surgeons pay attention.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@anish_koka @HeathVeuleman Every physician should read it and this should be mandatory resident teaching during training.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@realdocspeaks Agreed . 100 %

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@DutchRojas @physicianhosp 100% in agreement. In fact this should be part of residency training.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@RMengerMD @AANSNeuro @washingtonpost Amen brother.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@DrDiGiorgio I agree. Somebody’s job depends on it and it’s at the expense of my mental health.😀

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@DutchRojas I hope they adjusted for the expensive medical school education and prevailing medico legal environment.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@nntaleb True words

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@CanesDavid He is a hype creator and thats what he is doing here. Tesla share value depends on this hype. The moment the hype is gone, tesla shares will nose dive now that the cars are not hot cakes any more.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Whole heartedly support all the assertions. High time physicians pay attention to market place and learn the business of medicine. It is equally important both for doctors and their patients. Current ecosystem is not healthy.

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

People often ask me why, as an employed physician, I spend so much of my energy advocating for policies that protect independent private practice.

All doctors, employed or not, need a thriving private practice ecosystem with solo practices, group practices, specialty-specific models, ASCs, hybrid structures, and cash-friendly care. The persistence of that ecosystem forces hospitals to treat physicians as partners rather than disposable RVU generators.

This is why policies that protect private practice matter for all physicians even those who never plan to leave employment.

Things like site of service differential, 340B distortions, certificate of need laws, Stark Law, and tax advantages put independent private practice at a disadvantage over large consolidated systems. They make private practice harder to sustain and by doing so, they make life worse for doctors and patients alike.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Needs to be addressed asap. Doctors are not providers.

[Natalie morgan @SpineNeuro]

Makes sense. When docs owned their own practices & hospitals (god forbid), they poured their hearts and souls into it.

Now that soul crushing govt regulation (ACA most recently) has reduced us to mere providers who get less respect, our younger colleagues are saying hell no.

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Physicians need to organize. All associations need to wake up and lead the charge.

[Dutch Rojas @DutchRojas]

𝐈𝐧 𝟐𝟎𝟏𝟎, 𝟕𝟓% 𝐨𝐟 𝐩𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬 𝐰𝐨𝐫𝐤𝐞𝐝 𝐢𝐧 𝐩𝐫𝐢𝐯𝐚𝐭𝐞 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞.
𝐓𝐨𝐝𝐚𝐲, 𝐥𝐞𝐬𝐬 𝐭𝐡𝐚𝐧 𝟐𝟓%.

Only 12% of independent practices have zero outside capital partner. No private equity. No health system joint venture.

218,000 physicians who used to own their labor now work for someone else.

This isn't good for employers.
It isn't good for patients.
It isn't good for physician supply.

But it's incredibly good for the systems doing the acquiring.

Read more below...

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Truth, the whole truth and nothing but the truth.👏 . Only full clean and competitive health landscape with reasonable tort reform will bring down the prices.

[Mark Cuban @mcuban]

😭😭😭

Who exactly is going to cut their prices ? Independent physicians can barely pay their bills. DPC is already a bargain. Hospitals are going to get rid of facility fees or walk away from keeping 340b margins and passing that to the patient ? No.

Big PBMs are going to stop charging fees ? No. Big insurers are going to stop gaming vertical integration transfers ? No

Break up the big insurance companies first. Make them divest each vertical , PBMs, Providers, ASOs , Digital They are the ATT1984 of 2026.

Break them up.

They have become Too Big To Care

[Mark Cuban @mcuban]

😭😭😭

Who exactly is going to cut their prices ? Independent physicians can barely pay their bills. DPC is already a bargain. Hospitals are going to get rid of facility fees or walk away from keeping 340b margins and passing that to the patient ? No.

Big PBMs are going to stop charging fees ? No. Big insurers are going to stop gaming vertical integration transfers ? No

Break up the big insurance companies first. Make them divest each vertical , PBMs, Providers, ASOs , Digital They are the ATT1984 of 2026.

Break them up.

They have become Too Big To Care

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Patients and physicians: Help yourselves
Call both senators and your MOC and tell them you want the reversal of the ban on physician owned hospitals to remain in year end bill

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

@HeathVeuleman Amen to that.

[Uzma Samadani @DrSamadani]

Earlier intervention for a disc herniation leads to a better outcome! Can some tell @UHC @aetna @bcbs https://t.co/X6iMP5ImoV @NeurosurgeryCNS

[Sajeel R.Khan, M.D, FAANS. @sajeelk]

Great post and immensely beneficial

[Tyler Olson, EA @olsonplanner]

Compensation Red Flags

1. RVU thresholds that don’t match reality

If the required RVUs are above MGMA 75th percentile for your specialty, the job may be impossible to hit.

Many hospitals quietly bury unrealistic production expectations.

2. “Guaranteed salary” that actually isn’t

Some contracts call it a guarantee but allow the employer to claw back deficits if your production doesn’t support it.

3. Uncapped deductions from collections

If you’re on a collections model, they must define what counts as overhead.

Vague language leads to surprise charges and lower take-home pay.

Call, Schedule, and Duties

4. Call coverage not in writing

If they “promise” light call but don’t document it, assume the opposite.

Protect yourself with specific limits and compensation if it increases.

5. Vague “other duties as assigned”
This phrase can be abused. It’s better to define what is in scope and what requires separate negotiation or pay.

6. No protected time for admin, teaching, or research

If you’ll be expected to do any of these, make sure the contract grants time for it.

Otherwise, it becomes unpaid overtime.

Noncompete and Restrictions

7. Noncompete radius over 10 miles or lasting more than 1 year

Some states restrict noncompetes.

But where they’re allowed, employers often push boundaries.

Overly broad = risk

8. Noncompete activates even if THEY terminate you

Huge red flag.

At minimum, you should be exempt if the employer ends the relationship without cause.

9. Restrictive moonlighting or outside income rules

If they block locums, consulting, or telehealth with no reasonable justification, that’s a financial chokehold.

Malpractice & Liability

10. No clear tail coverage responsibility

Many physicians get burned here.

If they require claims-made coverage but make YOU pay for tail, that’s a 5-figure hit when you leave.

11. Low malpractice limits

If limits don’t match state norms, you’re exposed.

Termination Clauses

12. One-sided termination rights

If the employer can terminate without cause on 30 days’ notice but you must give 180, that’s imbalance.

Should be symmetrical or close.

13. Vague “for cause” definitions

If they can fire you “for cause” for subjective or undefined reasons, you’re at risk of losing tail coverage, bonuses, or buyouts.

Partnership Track Issues

14. “Partnership track” with no terms spelled out

If it’s not defined, it’s not real.

You want: timeline, buy-in formula, expected salary post-partnership, governance rights.

15. Buy-in based on future valuation
That’s a setup. You shouldn’t pay for growth you didn’t participate in.

Benefits & Operational Issues

16. No transparency on staffing

If they won’t commit to MA/APP support ratios, risk of burnout is not small.

17. CME, licensure, board fees not covered

These are basic in competitive contracts.

18. No relocation clawback protection

If relocation money must be repaid even when THEY terminate you, that’s predatory.