Show Notes
Attendings often tell stories about residency "back in the day" - more autonomy, more responsibility, more independence. But was training really better, or has the entire system changed? In this episode of Cut & Tell, plastic surgery resident Dr. Liz Malphrus explores why modern residents often report feeling less prepared for independent practice despite performing similar case volumes to previous generations. From duty-hour debates and supervision requirements to RVU-based compensation and the growing pressure for clinical productivity, she examines the structural forces reshaping surgical education. This isn't a conversation about whether residency is easier or harder. It's about understanding how the training environment has changed, and what that means for autonomy, burnout, and the future of medical education. Topics discussed: Why case numbers don't tell the whole story Resident autonomy and surgical confidence The impact of RVU-based compensation on teaching Academic medicine's productivity pressures Why more residents pursue fellowship training The relationship between autonomy and burnout How surgical education has evolved over the past two decades What attendings and residents can learn from each other
Cut & Tell is a podcast exploring the realities of surgical training, medicine, and life beyond the operating room. Subscribe for new episodes and visit the Hippocratic Collective for more conversations about the culture of medicine.
More from Cut & Tell
What do interviewers actually remember about you? It isn’t your answers. In this episode, plastic surgeon Dr. Liz Malphrus goes past the standard “be yourself” advice and shares what worked on the plastic surgery interview trail. She covers the wild rooms, including Operation, paper-folding tests, and a question that should never have been asked. She also explains how she prepared, which questions to ask and which to avoid, why the coordinator and the resident room matter, and how to handle the social event. Plus, a preview of a new recurring segment: First Job M&M. Host: Liz Malphrus, MD Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md IG: @dr.malphrus Produced By: The Hippocratic Collective Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.
What if doctors ran medicine the way lawyers run law? Lawyers, accountants and dentists have kept control of their professions, while physicians have lost control of both who owns them and who pays them. Liz looks at corporate practice of medicine laws that exist on paper but not in practice, the ERISA provision that shields insurers from liability for denials that harm patients, and vertical integration from UnitedHealth/Optum. She then lays out what physicians can do to win back professional sovereignty. Referenced: Paul Starr, The Social Transformation of American Medicine; Zhu et al, "A doctrine in name only," NEJM (2023) Host: Liz Malphrus, MD Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md IG: @dr.malphrus Produced By: The Hippocratic Collective Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.
What happens when you become the surgeon, pay off the loans, and still feel empty? On Cut & Tell’s first guest episode, Dr. Mel Thacker (ENT, surgeon coach, and host of Surgeons with Purpose) joins me to talk about her new memoir, Scrubbing In. It covers her path from childhood neglect to surgery, the arrival fallacy, and the panic attacks in the OR that finally forced her to face it all. We also get into how insurance incentives quietly shape clinical decisions, why Mel walked away from private practice, why residency needs coaching, and how she built a part-time locums career on her own terms. 📚 Referenced: Scrubbing In: A Surgeon’s Journey from Self-Doubt to Wholeness by Dr. Mel Thacker; “When Incentives Become Instinct” (Hippocratic Collective); The Infinite Game by Simon Sinek Enjoyed this episode? Rate, review, and subscribe, and find more shows at hippocratic-collective.com. Host: Liz Malphrus, MD Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md IG: @dr.malphrus Produced By: The Hippocratic Collective Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.
Administrative bloat, skyrocketing CEO pay, hospital mergers, rural closures. These aren't separate problems. They're symptoms of one syndrome: financialization. In this episode, Liz breaks down how hospitals and practices went from places that care for people to assets that exist to generate returns, and why nonprofit hospitals now behave almost exactly like for-profits. We cover the vocabulary that gets thrown around in boardrooms (marketization, corporatization, privatization), the administrator arms race between hospitals and insurers, what hospital CEOs are actually paid to optimize for, and how consolidation drives up prices without improving quality. Then we get to what doctors can do about it, from unionization to clinician leadership requirements to cutting out the insurance middleman. It's Goodhart's Law on a massive scale: when growth and revenue are the targets, healthcare stops being the point. 📚 Referenced: Bruch, Roy & Grogan, "The Financialization of Health in the United States," New England Journal of Medicine (2024) Blumenthal & Galvin, "The Vocabulary of Our Discontent," JAMA "Money has become the mission," The Lancet (2025)
What happens when a well-intentioned healthcare metric gets turned into a target? Nothing good — and Liz has the receipts. Before medical school, she spent two and a half years as study director for a major National Academies report on healthcare measurement. Then she went to residency, and everything she believed fell apart. This episode walks through the VA wait-time scandal, MIPS, and the Hospital Readmission Reduction Program — three cautionary tales about what happens when you attach incentives to healthcare data, and why Goodhart's Law keeps winning. 📚 Referenced: Vital Signs: Core Metrics for Health and Healthcare Progress (National Academies of Sciences, Engineering, and Medicine) Host: Liz Malphrus, MD Connect with Liz: https://www.hippocratic-collective.com/members/liz-malphrus-md IG: @dr.malphrus Produced By: The Hippocratic Collective Subscribe to @hippocraticcollective on Youtube for all of the other shows and content the Hippocratic Collective has to offer.