In this week’s episode of Life of Flow, Dutch Rojas joins us for a candid conversation about why independent physicians are being systematically pushed out of American healthcare. Drawing on decades spent building surgery centers, working inside insurance and policy structures, and watching consolidation unfold firsthand, Dutch explains why the system is not broken, but functioning exactly as designed. We talk through CMS priorities, hospital lobbying, and the growing gap between how medicine is practiced and how physicians are trained to work.
🎧 This episode continues our ongoing conversation about physician autonomy, institutional power, and what it feels like to practice medicine inside systems that control decision-making, reimbursement, and voice.
05:40 The moment consolidation became impossible to ignore
08:09 CMS priorities and why hospitals come first
11:58 How payment structures work against independent doctors
13:42 Why physicians lack political leverage
21:46 What it feels like to practice without autonomy
22:24 The fear of speaking out inside institutional medicine
22:41 Why autonomy is the number one complaint from physicians
31:12 Certificate of need laws and blocked physician ownership
40:12 Signs consolidation may be slowing and what comes next
Who Should Listen
This episode is for physicians navigating hospital employment, private practice, or consolidation pressures, as well as healthcare operators and investors trying to understand how policy, incentives, and institutional power shape modern medical practice.
About Dutch Rojas
Dutch Rojas is a healthcare entrepreneur who has spent over two decades building, operating, and exiting physician-focused businesses. He is the founder of MedMerge, co-founder of PhyCap Fund, and serves on the board of Physician Led Healthcare for America. Dutch invented surgery futures and options and built and sold ambulatory surgery centers and surgical practices. His exits include Sano Surgery and Everyone Health.
Dutch is the creator of The Rojas Report, a reader-supported Substack publication focused on exposing the hidden power structures in American healthcare, and host of The Physicians Edge podcast. His forthcoming book, Too Big To Care: How Nonprofit Health Systems Hijacked Healthcare, launches in early 2026. He is a Marine veteran.
Connect with Dutch
📰 Substack: dutchrojas.substack.com
💼 LinkedIn: Dutch Rojas
🐦 X: @DutchRojas
Follow Life of Flow
📲 Instagram: @LifeofFlowPodcast
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💼 LinkedIn: Life of Flow Podcast
🐦 X: @VascularPodcast
If this episode clarified how consolidation, policy, and institutional incentives affect physician autonomy, consider sharing it with someone navigating the same pressures. A quick review also helps others find conversations like this.
