The Preventive Medicine Podcast podcast

Episode 78 – The Business of Getting People Better: Private Practice, Preventive MSK Care, and What No One Tells Young Physicians | Brad Sorosky, MD

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Brad Sorosky, MD

What does it actually take to build a private practice from scratch — and keep it alive?

In this episode, Dr. Sharma sits down with a physician who has done exactly that. A Northwestern-trained physiatrist and fellowship-trained spine and sports medicine specialist, today’s guest founded Desert Spine and Sports Physicians and has led it as CEO since its inception — earning Top Doc recognition in Phoenix every year since 2009.

The conversation goes deep on the philosophy behind function-first MSK care, the operational realities of private practice ownership, and why the current healthcare system is structurally built against the kind of preventive, patient-centered medicine both physicians believe in. This isn’t a polished origin story — it’s an honest, unfiltered look at the business of medicine, the ethics of care delivery, and what it takes to build something that lasts.

If you’re a physician thinking about private practice, a patient trying to understand why the system feels broken, or simply someone who wants to know how to actually get and stay healthy — this episode is for you.

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Show Notes

What Preventive Medicine Actually Means — How today’s guest defines preventive medicine in the context of spine and MSK care, and why the word gets misused in modern healthcare.

Function-First Philosophy — The origin of Desert Spine’s approach to MSK care centered on restoring and maintaining function rather than chasing symptom relief. What shaped this perspective and why it diverges from conventional practice.

Starting a Practice from Scratch — The decision to build rather than join. What the early operational phase actually looked like, which systems and decisions made the biggest difference in getting to sustainability, and what most physicians underestimate going in.

Why Private Practices Fail in Years 1–5 — The most common reasons practices don’t survive their first few years: financial miscalculation, operational blind spots, physician burnout, and loss of clinical identity under business pressure.

How Reimbursement Models Work Against Prevention — A frank breakdown of how current fee-for-service and value-based payment structures disincentivize the kind of care that actually keeps patients healthy long-term.

Navigating the Insurance Landscape — The practical reality of getting paid as a private practice. Credentialing, contracting, billing infrastructure, and how to build a system that doesn’t hemorrhage revenue.

When Patient Care and Business Reality Conflict — Real talk on the moments every practice owner faces: when doing right by the patient costs the practice money. How to build systems and a culture that protect clinical quality even under financial pressure.

Two-Minute Health Advice — If someone walks up and asks how to get healthy, what does a Top Doc physiatrist actually tell them?

Honest Advice for Physicians Considering Private Practice — What today’s guest wishes someone had told them. What the business schools don’t cover, what the idealism misses, and what the rewards actually look like on the other side.

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