Off the Chart: A Business of Medicine Podcast

Health care hiring is in a strange place. Clinical job applications jumped 10% at the start of 2026, yet the gap between open positions and actual hires keeps widening, a sign that getting candidates in the door is only half the battle. In this episode, Medical Economics Managing Editor Todd Shryock speaks with Trent Cotton, head of talent insights at iCIMS, about what the data reveals and what physician practices can do with it. Cotton explains why so many candidates drop out between the application and the offer, how smaller practices can out-recruit enterprise hospital systems by competing on candidate experience and why pay transparency in a job posting keeps the hiring funnel clean. He also digs into the friction that drives applicants away, the two factors that most influence whether staff stay and where AI genuinely belongs in hiring, from automated scheduling to the conversations that should always stay human.Music Credits:Steady State of Mind by Yigit Atilla - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:26 | Sponsor message Copic medical liability insurance.0:26 – 0:57 | Cold open Cotton frames the question driving the episode: how do practices fast-track top talent from hello to hire?0:57 – 1:39 | Introduction Austin Littrell introduces the episode and guest, previewing what the latest data reveals about health care hiring and how physician practices can compete for talent.1:39 – 3:14 | What's behind the surge in clinical applications Todd Shryock opens the conversation, and Cotton explains the January jump in clinical applications, tying it to post-pandemic turnover leveling off and clinicians looking for better compensation.3:14 – 4:35 | Why hires lag behind openings Clinical openings are up far more than actual hires. Cotton points to a steep drop-off after the application, the gap between recruiter and hiring-manager interviews and the bureaucracy of offer approvals, with the fastest-moving practices winning.4:35 – 5:57 | How a small practice out-recruits a hospital system Cotton's answer is candidate experience. He argues smaller practices win by making hiring feel personal and frictionless, citing survey data that 60% of candidates abandon applications that are too long, opaque on pay or unclear on qualifications.5:57 – 8:17 | Compensation and the case for pay transparency Cotton says the data doesn't show practices have regained leverage on pay, and makes the case for listing compensation in the posting: it keeps the top of the funnel clean and avoids wasting everyone's time, even as he acknowledges why some employers hesitate to post pay.8:17 – 10:55 | The non-clinical side Non-clinical applications are outpacing both openings and hires. Cotton attributes the slow pace to the same screening and scheduling bottlenecks, and urges understaffed practices to build a pipeline now, re-engaging strong past applicants before the candidate pool tightens.10:55 – 11:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.11:47 – 13:44 | Removing friction from hiring Cotton defines friction as any point where candidates drop off, and explains how AI-driven skills matching and job simulations are reshaping the process, including a notable shift among Gen Z candidates who now prefer assessments to compete on skills rather than résumés.13:44 – 14:46 | What drives retention Retention comes down to two things, Cotton says: hiring for genuine skill fit and giving employees a visible career path, especially in high-volume and entry-level roles where people often leave simply because they can't see a future internally.14:46 – 16:33 | Where AI belongs in hiring Asked whether a hands-on practice has an edge over a hospital using AI, Cotton, a self-described AI advocate, says it depends entirely on where it's applied. He keeps the hiring-manager interview, the deeper recruiter conversation and the offer human, and automates much of the rest.16:33 – 17:28 | The next 12 to 18 months Cotton points to growing concern about a shrinking candidate supply, and says recruiters are already getting creative, partnering with local universities to build talent pipelines and shape curriculum.17:28 – 18:43 | Final advice and close Cotton's parting advice: map your candidate journey, decide what only a human can do and what can be automated, then share that roadmap with applicants for transparency. Todd Shryock thanks Cotton.18:43 – End | Outro Austin Littrell thanks the guest and wraps the episode.

Selling a medical practice is one of the most consequential financial decisions a physician will ever make, and many start the process far later than they should. In this episode, Medical Economics Managing Editor Todd Shryock speaks with Kevin Baker, director of business development at Emergency Care Partners, about how practice owners can prepare for a sale or succession years before they actually need to. Baker breaks down the most common mistakes sellers make, the factors that drive a practice's valuation, the financial and legal documents to have in order before approaching a buyer and how selling to a hospital system, a private equity-backed strategic partner or a junior partner each changes the outcome. He also digs into the parts of a transaction physicians tend to underestimate: the tax implications of deal structure, the emotional weight of handing off a practice that represents their life's work and how to protect staff and clinical quality through the transition.Music Credits:Jazz Warm Lo-Fi by Nadezhda Pilitskaia - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:23 | Sponsor message Copic medical liability insurance.0:23 – 0:46 | Cold open Baker sets up the episode's central message: good decisions are rarely made under pressure, and failing to prepare is preparing to fail.0:46 – 1:39 | Introduction Austin Littrell introduces the episode and guest, previewing how physicians can prepare to sell their practice and plan for succession long before they actually need to.1:39 – 3:49 | The biggest mistakes sellers make Todd Shryock opens the conversation, and Baker points to four recurring errors: not lining up experienced advisors early, waiting too long to prepare, keeping financials that satisfy the IRS but not a buyer and fixating on the headline price instead of deal structure.3:49 – 6:08 | How far in advance to start Baker argues the best transactions are intentional and begin years ahead, framed around one question: what would need to be true for the practice to thrive if you stepped away in three to five years?6:08 – 8:04 | What drives valuation Value comes down to financial performance, risk profile and growth potential. Baker explains how EBITDA anchors the starting point and which risks can drag a number down, from hospital subsidy reliance and locums dependence to ED contract renewals and payer mix.8:04 – 10:21 | Getting your documents in order Before approaching a buyer, Baker says practices should understand the tax implications of their legal entity structure, clean up the cap table, document partner buyout arrangements and begin assembling a data room of vendor contracts and payer agreements.10:21 – 13:22 | Hospital, strategic buyer or your partners Baker compares the three paths: partner buyouts that pay out slowly and modestly, hospital deals that often open with teaser compensation before dropping to productivity-based pay and strategic acquirers who can pay more by realizing synergies and offering equity.13:22 – 16:14 | Staff, patients and the identity transition Baker addresses the emotional side physicians tend to underestimate, urging sellers to define what success means beyond the closing table and to be wary of any buyer who doesn't put clinical quality and staff first.16:14 – 17:05 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.17:05 – 19:24 | How open to be with your staff Discretion matters early in the process. Baker suggests routing buyer requests through a third-party CPA or advisor where possible, and having a candid one-on-one with a key operations or finance leader when documents and data are needed.19:24 – 22:40 | Tax implications and deal structure With a "consult your tax advisor" disclaimer, Baker walks through the value of taking equity in the acquiring company, the difference between ordinary income and long-term capital gains treatment and the net present value advantage of receiving several years of earnings up front.22:40 – 24:19 | Staying on part time after a sale For physicians who want to keep practicing, Baker's advice is to communicate it upfront, make sure there are enough physicians on the schedule to absorb the hours and understand how moving from full time to part time affects benefits.24:19 – 25:22 | Final advice and close Baker's closing message: start the conversations now, since signing an NDA opens the door to information without committing you to a deal. Todd Shryock thanks Baker.25:22 – End | Outro Austin Littrell thanks the guest and wraps the episode.

Artificial intelligence (AI) is already driving workforce decisions at major companies, and health care practices, large and small, are not immune. In this episode, Christopher Mayer, J.D., a specialist in employment law with the firm Frier Levitt, explains how generative AI is being used to guide layoff decisions, why practice leaders can never simply accept what an AI tool recommends, and what the legal exposure looks like when AI-influenced reductions in force create disparate impact across protected categories. Mayer also addresses the near-total absence of federal AI regulation in the employment space, why the first jury trials over AI-driven layoffs could be damaging for employers, and where litigation is likely to land next. The conversation then turns to physician non-compete agreements.Music Credits:Warm Hands by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:33 | Sponsor message Copic Insurance.0:33 – 0:52 | Cold open Mayer delivers the episode's central warning: you can't blindly accept what an AI tool tells you to do — you have to protect yourself from liability.0:52 – 1:37 | Introduction Austin Littrell introduces the episode and previews the conversation with Mayer.1:37 – 5:07 | How AI is reshaping workforce decisions Mayer describes two converging forces: employers using generative AI to drive layoff decisions, and AI disrupting entire job categories across industries. He notes that health care is relatively protected from AI job displacement given its patient-facing nature — but not entirely immune, citing Verizon and Amazon as examples of AI-driven workforce reductions.5:07 – 7:19 | AI-related layoffs in health care so far Mayer says major AI-driven health care layoffs have been limited, pointing to Revere Health in Utah — which eliminated nearly 200 jobs, roughly 7% of its workforce, largely targeting medical coders. He explains why small practices are unlikely to trigger WARN Act requirements and why their layoffs tend to stay out of the headlines.7:19 – 9:14 | How small practices are already using AI Mayer observes that small practice owners are often early AI adopters, using it for administrative and research tasks — not as a replacement for clinical judgment, but as a practical tool for running a lean operation.9:14 – 14:01 | The HR and employment law intersection with AI Mayer explains the core compliance risk when AI influences a reduction in force: disparate impact across protected categories. He walks through the Age Discrimination in Employment Act requirements for group layoffs, why employers must build an employee census before proceeding, and why you can never simply accept what an AI tool tells you to do.14:01 – 16:30 | Age, discrimination and the employee census Mayer clarifies how employers can know employee ages for compliance purposes, explains what an employee census looks like in practice and describes how small practices can conduct their own disparate impact analysis before proceeding with a reduction.16:30 – 18:25 | Federal AI regulation: largely absent Mayer says meaningful federal AI regulation in the employment space doesn't yet exist. The current administration is broadly pro-AI and not focused on regulating it. California has moved at the state level, but the federal picture remains thin.18:25 – 22:14 | Predicting the first AI employment lawsuits Mayer forecasts that challenges to AI-driven layoffs are inevitable — and that juries will likely be unsympathetic to employers who appear to have used AI as cover for discriminatory intent. He flags AI bias in tools like Grok as an early warning sign of what's coming.22:14 – 23:04 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.23:04 – 28:08 | The non-compete landscape for physicians Mayer traces the FTC's failed attempt at a federal non-compete ban, explains why state law now governs entirely, and walks through the spectrum: California's outright ban, Pennsylvania's new one-year cap and termination carve-out for physicians, and states like New Jersey and New York where enforceability depends heavily on geographic scope, duration and the judge.28:08 – 31:06 | What physicians should do when presented with a non-compete Mayer's advice: don't sign without consulting an attorney. He also raises a nuance most physicians overlook — that a new employer's legal team can review an existing non-compete and potentially provide indemnification if the physician is sued by a former employer.31:06 – 31:51 | The one thing physicians must never do Mayer warns that deceiving either a former or new employer about a non-compete — or hiding its existence — is the fastest way to create serious legal exposure.31:51 – 32:49 | A message to primary care physicians Mayer closes with a note of optimism: don't be fearful of AI. For physicians in particular, he expects it will supplement care rather than replace it — and that over time it will be viewed as more positive than the current fear suggests.32:49 – 34:10 | Outro Payerchin closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.