Out of Network Podcast

In this episode of Out of Network, Dr. Ryon Parker sits down with Dr. Joshua Goldman (Board-Certified Plastic & Reconstructive Surgeon, co-founder of Vegas Plastic Surgery Institute) to discuss the challenges of modern healthcare, physician burnout, and why so many are moving away from traditional insurance models.You’ll learn:✅ How burnout is caused by the administrative burdens of insurance✅ The broken system that limits time doctors can spend with patients✅ Why concierge medicine is growing as a solution to care delivery issues✅ The surgery outcomes that set realistic expectations and prevent patient frustration✅ Why volume-based models are hurting both physicians and patients✅ The shift in expectations when it comes to patient care✅ How healthcare is often about balancing time with quality outcomesTimestamps 00:00 – Intro: Dr. Joshua Goldman + Vegas Plastic Surgery Institute 03:33 – What craniofacial + microsurgery means 10:47 – What elite surgical training selects for 19:10 – Leaving academia to build a new model 21:33 – Why insurance-based care breaks (admin + overhead) 25:10 – Denials and recoupments: getting paid, then losing it 27:21 – The “third model” (concierge feel without cash-only) 33:30 – Concierge-level experience standards 35:10 – Expectation-setting and why volume kills quality 40:08 – Patient selection: when to say no 01:01:37 – Closing takeaways: access and “time to care” Connect with Out of Network: 🌐 Website: https://www.outofnetworkpod.com/ 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/ ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the Hosts:Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Parker Medical: https://parkermedical.org/Dr. Rishi Seth → https://www.instagram.com/drrishiseth/Seth Premiere Medical: https://sethmedical.com/Dr. Goldman → https://vegaspsi.com/meet-dr-joshua-goldman/https://www.instagram.com/goldstandardplasticsurgery/Enjoyed the Episode?If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.🎙 About Out of Network Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.#OutOfNetwork #Healthcare #PlasticSurgery #MedicalBurnout #ConciergeMedicine #ReconstructiveSurgery #MedicalCare #PhysicianBurnout #HealthcareSystemEnjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker sits down with Attorney Adam Garth (healthcare defense attorney) for a behind-the-scenes look at how malpractice cases, board complaints, documentation, AI notes, and telemedicine risk actually play out - and why it’s driving physicians out of certain markets.You’ll learn:✅ Why doctors are “under assault” in some jurisdictions - and why they leave✅ The real cost of a lawsuit: 2–3 years with a cloud over your head✅ How concierge medicine can reduce risk by giving you time to practice and document well✅ AI scribing: powerful, but risky if you don’t verify (because the chart becomes evidence)✅ Why many board complaints aren’t malpractice - they’re billing/respect/front desk issues (and still consume hours and legal fees)✅ Telemedicine’s blind spot when you can’t put hands on the patient✅ The simplest legal advice in medicine: “Document, whatever you’re doing.”Timestamps00:02 – Who Adam Garth is (healthcare defense attorney)03:10 – Why physicians are leaving certain jurisdictions04:37 – The “2–3 year cloud” of malpractice cases08:34 – Concierge medicine: less volume, more time, lower risk11:41 – AI scribing: advantage vs liability (verify your notes)23:45 – Board investigations and what triggers them24:10 – “Billing / respect” complaints and why they waste time27:17 – Telemedicine risk when you can’t examine hands-on47:14 – The best free legal advice for physiciansConnect with Out of Network: 🌐 Website: https://www.outofnetworkpod.com/ 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/ ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the Hosts:Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Parker Medical: https://parkermedical.org/Dr. Rishi Seth → https://www.instagram.com/drrishiseth/Seth Premiere Medical: https://sethmedical.com/Adam Garth → https://www.linkedin.com/in/adam-garth-86b00b36/Enjoyed the Episode?If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.🎙 About Out of Network Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Modern pediatrics is breaking parents and burning out doctors - and most families have no idea why it feels so rushed, confusing, and lonely.In this episode of Out of Network, Dr. Rishi Seth sits down with Dr. Lisa Hayes (founder of Hayes Pediatric) for a no-fluff conversation about what changes when pediatric care is built around families instead of throughput.You’ll hear:A behind-the-scenes look at why many pediatric visits feel like a blur (10 to 15 minutes is the reality in a lot of practices) What concierge / direct pediatric care actually looks like in real life Why Dr. Hayes does home visits within 48 hours of newborn discharge and continues home visits until 2 months The baby “products” parents waste money on (and the ones that don’t belong in the crib) What’s normal vs not normal in the first months, including crying and sleep Why sleep training is not one-size-fits-all and how she frames it without guilt How she handles vaccine anxiety in a world where parents are drowning in noise and fear What made her leave traditional pediatrics and build a model she would want for her own familyTimestamps00:50 – What “pediatrics designed around families” actually means03:49 – What it looks like to join Hayes Pediatric04:17 – Home visits within 48 hours after discharge05:18 – The baby product trap parents don’t need06:50 – The crib setup mistake families don’t realize is risky09:10 – Crying peaks around 6 weeks and what parents should know10:30 – Sleep training: when to start and why it’s not one method for everyone24:53 – The part that breaks doctors: “Did I listen long enough?”25:00 – The reality: 10 to 15 minutes per child41:10 – Why you can’t counsel vaccine questions in 15 minutes42:10 – CDC vs AAP confusion and what parents actually needConnect with Out of Network: 🌐 Website: https://www.outofnetworkpod.com/ 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/ ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the Hosts:Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Parker Medical: https://parkermedical.org/Dr. Rishi Seth → https://www.instagram.com/drrishiseth/Seth Premiere Medical: https://sethmedical.com/Dr. Lisa Hayes → https://www.instagram.com/hayespediatrics/Enjoyed the Episode?If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.🎙 About Out of Network Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

Psychedelics are everywhere right now - and most physicians still feel uneasy even saying the words out loud.In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth have a no-hype conversation about psychedelics in medicine: ketamine, psilocybin, MDMA, and what these therapies could mean for patients with refractory depression, anxiety, and PTSD who feel like they’ve run out of options.You’ll hear:A real clinical case where a patient had tried “everything,” including multiple meds and therapy, and still wasn’t okayWhy Dr. Seth is skeptical (FDA approval, data quality, who these therapies are NOT for)Dr. Parker’s decision to refer to a guided retreat option after clinical trials weren’t availableA personal story from Dr. Parker that adds a completely different layer to the conversationKetamine’s role today (anesthesia, pediatrics, refractory pain) and why “ketamine clinics” raise real questionsTimestamps00:00 – Why psychedelics in medicine makes doctors uncomfortable01:26 – Clinical scenario: “nothing is working” for severe depression/anxiety03:44 – The lineup: ketamine, MDMA, LSD, psilocybin04:07 – Skepticism: “not FDA approved,” limited robust data05:23 – A Colorado retreat enters the conversation09:20 – The hard part: tapering off meds safely, risks, close follow-up10:10 – Outcome: “first time I feel better” after the retreat13:16 – Who psychedelics are NOT for (bipolar/psychotic disorders risk)14:07 – What the research hints at (and what we still don’t know)16:20 – Dr. Parker shares his personal experience and why this topic matters28:40 – Ketamine: what it’s used for, what’s legit, what’s questionable34:21 – Takeaways: hope, ambiguity, and why this deserves a real conversationConnect with Out of Network: 🌐 Website: https://www.outofnetworkpod.com/ 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/ ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the Hosts:Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Parker Medical: https://parkermedical.org/Dr. Rishi Seth → https://www.instagram.com/drrishiseth/Seth Premiere Medical: https://sethmedical.com/Enjoyed the Episode?If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.🎙 About Out of Network Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive deep into the explosive world of GLP-1 medications—exploring the realities of semaglutide, tirzepatide, Ozempic, Wegovy, and Zepbound. With a projected $200 billion market by 2029, these drugs have transformed weight management, but they've also created chaos in the healthcare landscape. From med spa injections to proper medical supervision, this conversation sheds light on what safe GLP-1 treatment should actually look like.What You'll LearnThe difference between proper medical weight loss programs and dangerous "syringe-in-a-fridge" clinicsWhy tirzepatide (Mounjaro/Zepbound) outperforms semaglutide (Ozempic) in most patientsReal strategies for patients who plateau or don't respond to GLP-1 medicationsInsurance coverage realities and the new $50/month Medicare pricingSerious side effects to watch for, including pancreatitis and gallbladder issuesTimestamps00:00 – Introduction: The $200 billion GLP-1 economy03:15 – Wild West of GLP-1 prescribing: Med spas and strip mall clinics10:42 – Proper patient screening and medical supervision24:30 – Insurance coverage, pricing, and access issues32:00 – Tirzepatide vs. Semaglutide: Which is better?42:55 – The future of GLP-1s and closing thoughtsConnect with Out of Network: 🌐 Website: https://www.outofnetworkpod.com/ 📱 Instagram: https://www.instagram.com/outofnetworkpodcast/ ▶️ YouTube: https://www.youtube.com/@OutofNetworkPodcast 🎵 TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the Hosts:Dr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Parker Medical: https://parkermedical.org/Dr. Rishi Seth → https://www.instagram.com/drrishiseth/Seth Premiere Medical: https://sethmedical.com/Enjoyed the Episode?If this conversation resonated with you, please like, comment, and subscribe. Share it with someone who cares about the future of healthcare.🎙 About Out of Network Out of Network is a bold, physician-led podcast hosted by Dr. Ryon Parker and Dr. Rishi Seth. Each week, they challenge the broken healthcare system and explore how medicine can be reimagined—through patient-first care, prevention, and real human stories.Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into AI's rapid integration into healthcare—exploring how artificial intelligence is transforming medical documentation, diagnostics, and patient care. With a mix of personal experiences, honest concerns, and evidence-based insights, this conversation sheds light on both the promise and perils of AI in medicine, and how physicians can harness its power without losing the clinical skills that make them effective doctors.What You'll LearnHow AI scribes are changing medical documentation (and why one doctor got "see Brad Pitt movies" as a treatment recommendation)The risk of "de-skilling" physicians when AI handles too much of the diagnostic processWhy AI chatbots for patient triage could be dangerous—and when they might be helpfulHow AI bias can reinforce physician mistakes and create dangerous feedback loopsTimestamps00:00 – Introduction: AI's rapid rise in healthcare03:15 – AI scribes: Making doctors better or lazier?10:42 – The de-skilling concern: Are we training lazy physicians?16:00 – AI liability and the Brad Pitt diagnosis story21:30 – Patient self-diagnosis with AI: Benefits and dangers24:30 – Why concierge practices should resist AI automation27:20 – Closing thoughts: AI oversight and physician responsibilityConnect with Out of NetworkWebsite: https://www.outofnetworkpod.com/Instagram: https://www.instagram.com/outofnetworkpodcast/YouTube: https://www.youtube.com/@OutofNetworkPodcastTikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the HostsParker Medical - Las Vegas, NV → https://bit.ly/parkermedicalDr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiereDr. Rishi Seth → https://www.instagram.com/drrishiseth/Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into the overwhelming world of wellness trends—exploring what's helpful, what's harmless, and what patients should avoid. From IV vitamin drips and NAD injections to hyperbaric chambers and supplement claims, they break down the science (or lack thereof) behind popular wellness treatments. With honest physician perspectives and real patient stories, this conversation sheds light on how to navigate wellness confusion while maintaining trust in evidence-based medicine.What You'll LearnHow to approach patients who've received conflicting wellness advice from other providersThe real science behind popular treatments like IV vitamins, NAD, and hyperbaric oxygen therapyWhy the wellness industry thrives on aging fears and how to address patient concerns compassionatelyRed flags to watch for in wellness claims and when treatments cross into dangerous territoryTimestamps00:00 – Introduction to wellness world confusion01:12 – Navigating conflicting advice from different providers08:09 – IV vitamins and NAD: separating hype from science11:50 – Hyperbaric oxygen therapy: medical vs. wellness applications15:15 – The supplement industry and "nutraceuticals"16:43 – Why people seek wellness solutions: aging, fear, and social media25:32 – Dangerous wellness trends: chiropractic overreach and chronic conditions30:40 – The importance of staying in your lane as healthcare providers33:37 – Final thoughts on evidence-based wellnessConnect with Out of NetworkWebsite: https://www.outofnetworkpod.com/Instagram: https://www.instagram.com/outofnetworkpodcast/YouTube: https://www.youtube.com/@OutofNetworkPodcastTikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the HostsParker Medical - Las Vegas, NV → https://bit.ly/parkermedicalDr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiereDr. Rishi Seth → https://www.instagram.com/drrishiseth/Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth explore the world of telemedicine and reveal how it's revolutionizing healthcare access in rural America. Dr. Seth shares his firsthand experience as a telehealth hospitalist—running emergency codes from hundreds of miles away, managing critical patients over a screen, and keeping small-town hospitals alive. From a patient with "3 out of 10" chest pain who turned out to have a life-threatening heart attack, to the technology and expertise required to provide remote care, this conversation uncovers the hidden infrastructure that's changing medicine as we know it.What You'll LearnHow telehealth hospitalists manage critical emergencies remotely—including running codes over a screenThe reality of rural hospitals where there may be no doctor on-site at allThe dramatic story of catching a full-blown STEMI (heart attack) from 100 miles awayWhy telemedicine requires 5+ years of clinical experience before going remoteThe technology behind telehealth carts and remote patient monitoringHow small-town hospitals stay open thanks to telehealth coverageState licensing requirements and the Interstate Medical Licensure CompactBest practices for using telemedicine in outpatient and concierge settingsThe future of AI integration in telehealthTimestamps00:00 – Introduction: What if there's no doctor in the building?01:00 – Dr. Seth's journey into telehealth hospitalist work02:30 – What are critical access hospitals and why do they matter?04:00 – The technology: Telehealth carts, stethoscopes, and zoom capabilities07:00 – Why rural hospitals are the lifeblood of small-town America08:00 – The gray patient: Catching a life-threatening STEMI remotely10:30 – Why experience matters more than technology in telehealth14:00 – The business model keeping rural hospitals financially viable18:00 – State licensing requirements and legal considerations21:00 – How Dr. Parker uses telemedicine in his concierge practice24:00 – Documentation requirements and billing for telehealth visits26:00 – The future of telehealth and AI integration28:00 – Final thoughts: Why telemedicine is revolutionary for rural AmericaConnect with Out of NetworkWebsite: https://www.outofnetworkpod.com/Instagram: https://www.instagram.com/outofnetworkpodcast/YouTube: https://www.youtube.com/@OutofNetworkPodcastTikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the HostsParker Medical - Las Vegas, NV → https://bit.ly/parkermedicalDr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiereDr. Rishi Seth → https://www.instagram.com/drrishiseth/Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth dive into the FDA's recent removal of the black box warning on hormone replacement therapy—exploring the realities of what this change actually means for women's health. With a mix of bold truths, real stories, and evidence-based insights, this conversation sheds light on the complex nuances behind HRT, the original Women's Health Initiative study, and why headlines rarely match the science.What You'll LearnWhy the FDA removed the black box warning and what it actually means (spoiler: it's not a universal green light)The real story behind the Women's Health Initiative study and why Premarin vs. bioidentical hormones mattersHow to navigate HRT decisions based on age, symptoms, and individual risk factorsTimestamps00:00 – Introduction01:15 – FDA removes black box warning: What does it really mean?03:28 – The concerning conflicts of interest behind the decision07:25 – Breaking down the Women's Health Initiative study12:00 – Estrogen types: Premarin vs. bioidentical hormones16:00 – The age factor: Why timing matters in HRT24:00 – Real patient case: Factor V Leiden and HRT complications30:47 – Key takeaways for patients and physiciansResources & Links MentionedWomen's Health Initiative Study > https://www.nhlbi.nih.gov/science/womens-health-initiative-whiConnect with Out of NetworkWebsite: https://www.outofnetworkpod.com/ Instagram: https://www.instagram.com/outofnetworkpodcast/ YouTube: https://www.youtube.com/@OutofNetworkPodcast TikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the HostsParker Medical - Las Vegas, NV → https://bit.ly/parkermedicalDr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiereDr. Rishi Seth → https://www.instagram.com/drrishiseth/Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.

In this candid episode of Out of Network, Dr. Ryon Parker and Dr. Rishi Seth step away from discussing broken healthcare systems to share the raw, unfiltered lessons from their medical journey. From the struggles of foreign medical school to the challenges of starting a practice, they explore the wins, mistakes, doubts, debt, and grind that shaped them as physicians, husbands, fathers, and business owners.What You'll LearnWhy comparison truly is the thief of joy in medical practiceThe reality of starting a concierge practice with limited capital and massive student debtHow attending a Caribbean medical school (Ross University) actually made them better doctorsThe importance of taking notes during residency rotations and learning from attendingsReal talk about practice startup costs, renovation delays, and staffing challengesTimestamps00:00 – Introduction: The journey no one tells you about03:15 – Starting humble: Learning not to compare yourself to others10:42 – Ross University experience: Would they do it again?24:30 – Residency lessons: What they wish they'd done differently42:55 – Practice building mistakes and winsConnect with Out of NetworkWebsite: https://www.outofnetworkpod.com/Instagram: https://www.instagram.com/outofnetworkpodcast/YouTube: https://www.youtube.com/@OutofNetworkPodcastTikTok: https://www.tiktok.com/@outofnetworkpodcastConnect with the HostsParker Medical - Las Vegas, NV → https://bit.ly/parkermedicalDr. Ryon Parker → https://www.instagram.com/dr.ryonparker/Seth Premiere Medical - Tampa, FL → https://bit.ly/sethpremiereDr. Rishi Seth → https://www.instagram.com/drrishiseth/Enjoyed the Episode?If you liked this conversation, please subscribe, leave us a review, and share this podcast with a friend—it helps more people discover a new vision for healthcare.