The Five-Day Weekend: Retirement Planning and Practice Legacy for Pediatricians

In this Pediatric Lounge episode, hosts discuss Nicholas Children’s upcoming postgraduate pediatrics CME conference and then interview repeat guest Dr. Neil Bevin of RBK Pediatrics about physician retirement. Bevin describes planning a year ahead to transition administrative responsibilities, defining financial independence based on cost of living, and how taxes affect retirement withdrawals. He highlights common mistakes such as underfunding retirement in peak earning years, failing to adapt practice models as pediatrics shifts toward chronic disease management, and retaining control too long, which can damage practice value and legacy. He explains RBK’s move from a defined benefit plan to a 401(k) and Roth options, notes limited retirement participation among younger employees, and discusses private equity’s impact on job security and pensions. Bevin shares his semi-retired “five-day weekend” schedule, stresses planning hobbies and purpose, recommends saving early (including 529 plans), and emphasizes leaving unhealthy practices, avoiding divorce, and using keyman insurance in small practices.

00:00 Podcast Intro and CME Plug
00:50 Snowy Weekend Banter
01:27 Meet Dr Neil Bevin
02:07 Planning the Exit
04:42 Financial Independence Basics
06:17 How Much Is Enough
07:17 Common Retirement Mistakes
10:42 Practice Legacy and Adaptation
16:33 Giving Up Control
18:46 Retirement Mindset and Hobbies
21:42 401k and Roth Basics
23:30 Pensions and Private Equity Risks
26:29 The Five Day Weekend
27:36 Fair Scheduling Mindset
28:11 Flexibility Beats Absolutes
28:20 529 Plans For Kids
30:21 Inflation Crushing Doctors
32:36 Law Pay Versus Pediatrics
35:07 Private Equity Job Risk
38:26 Starting A Practice Today
39:30 Mortgage And Refi Strategy
42:42 Retirement Advice By Age
45:11 Keyman Insurance Matters
46:43 Practice Culture Horror Story
49:11 Wrap Up And Credits

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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

Expanding Bluebird Kids Health: Access, Value-Based Pediatrics, and Payment Advocacy

Host Dr. Her Bravo welcomes Dr. Shannon Fox Levine and talk about her move into Bluebird Kids Health, which is expanding Palm Beach Pediatrics’ value-based, technology-forward model to new de novo sites in Florida to address pediatric care deserts for Medicaid populations, including new offices in Jacksonville and Broward County, and the use of a partnered mobile clinic. They discuss keeping Athena Health, hiring and training new clinicians, and interest in ambient AI to reduce documentation burden and improve patient relationships. Levine outlines Florida AAP concerns, including school vaccine mandate changes, Medicaid payment advocacy (including Medicare parity via incentives), and a pilot workflow to diagnose autism in primary care using tools like RITA-T and CARS-2 with appropriate reimbursement. She also describes her national AAP payer advocacy role, addressing issues like downcoding, EOB monitoring, and use of a price transparency tool, emphasizing sustainable payment to reduce burnout and maintain access.

00:00 Podcast Intro and CME
00:55 Meet Shannon Levine
01:46 Bluebird Kids Expansion
03:35 Tech and Mobile Clinics
06:55 Ambient AI for Notes
11:27 Training New Clinicians
14:13 Florida Advocacy Updates
16:37 Autism Diagnosis Pilot
20:11 Medicaid Contracts and Pay
22:31 Value Based Care Future
23:14 Florida MPIP Basics
24:08 Incentives Versus Quality
25:39 Risk Models And Proformas
28:11 Care Coordinators In Action
31:10 Stop Loss And Carve Outs
32:54 Metrics And Vaccine Denominators
35:35 AAP Payer Advocacy Workflow
40:11 Price Transparency Tool
42:26 Negotiating With Payers
45:11 Burnout And Closing Thoughts

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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

Artificial Intelligence in Medical Education: Opportunities, Risks, and Guardrails

In this episode of The Pediatric Lounge, the hosts welcome back Dr. Rani Gareige, director of medical education and designated institutional official at Nicklaus Children’s Hospital and a clinical professor at Florida International University, to discuss artificial intelligence in medical education now and in the future. They preview Nicklaus Children’s Hospital’s 61st annual postgraduate pediatrics CME conference in Fort Lauderdale (Hilton Marina Resort, March 20–22), highlighting sessions on IBD, short stature, dermatology, psychological screening, AI in practice management, social media communication, genetic testing/personalized medicine, and Florida’s new requirement for EKG screening to clear athletes starting ninth grade.

The conversation covers common AI tools learners use (ChatGPT, Claude, OpenEvidence) and institutional concerns about HIPAA/PHI, including blocking public tools and using a secure in-house system (“Ask Nick”) and closed or constrained approaches (e.g., tools that search only approved sources or documents provided, such as Google Notebook).

They explore concerns about de-skilling and when to introduce AI in training, faculty development needs, and a precepting framework (DEFT-AI: Diagnosis, Evidence, Feedback, Teaching, and Recommendations for AI use) to assess clinical reasoning. The episode also discusses AI for simulated patient interactions (bad news delivery, motivational interviewing), ambient AI scribing pilots, clinician responsibility to review notes, and AI-driven coding that may reduce undercoding and administrative burden. The discussion concludes that AI will not replace physicians, but clinicians who use AI wisely may replace those who do not, stressing the importance of policies, ethics, transparency, and maintaining empathy and the art of medicine.

00:00 Podcast Intro and Guest
02:25 CME Conference Details
03:13 Hot Topics and New Laws
04:44 EKG Screening Program
07:42 AI Tools in Training
11:42 IRB and Data Privacy
14:39 Meeting Minutes Automation
16:48 Closed Models for Clinicians
19:13 AI Hallucinations and References
24:16 Deskilling and Timing AI
30:11 Teaching Frameworks for AI
32:46 Back to Evidence Basics
33:40 Questioning the Evidence
34:48 AI and Human Empathy
37:45 AI as Clinical Assistant
41:01 Recertification in the AI Era
46:32 Ethics and Prompting
50:40 AI Scribing and Guardrails
54:35 Coding and Care Gaps
57:15 Future of Medical Education
01:01:13 Virtual Trials and Wrap-Up
01:0

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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

The Misery of the Vaccine Business: The Real Economics of Pediatric Vaccination

In this episode of The Pediatric Lounge, the hosts reflect on the PMI conference in New Orleans and discuss how U.S. pediatricians are portrayed as “bad guys” because of vaccines, leading into a conversation with Dr. Gail Schoenfeld about the “misery of the vaccine business.” Schoenfeld describes her participation in a white paper on the real economics of pediatric vaccination, motivated in part by feeling insulted by claims that pediatricians profit from vaccines, and explains she tried to educate the authors on vaccine financing and delivery costs. The discussion details the extensive, time-intensive workflow and infrastructure required to store, track, administer, and document vaccines, including staffing time, inventory reconciliation between VFC and commercial stock, compliance tasks, refrigeration and monitoring systems, generators, maintenance, insurance, space costs, and after-hours emergencies. They address vaccine “wastage” such as broken vials, patient refusal after preparation, expiration, documentation errors that prevent billing, and demand shifts (including Schoenfeld’s experience wasting 70 Moderna COVID doses at $133 each). The group argues that fixed reimbursement set by insurers and Medicaid often fails to cover true costs, making vaccination a money-losing service for pediatric practices; they cite examples including Medicare valuing vaccine administration code 90460 at $24 and Virginia’s Medicaid not paying 90460 and restricting VFC reimbursement to a limited admin fee, resulting in losses per vaccine, with a Mississippi example of $11 payment. They discuss why adult practices often refer vaccination to pharmacies and note pediatricians cannot easily do so. The conversation expands to broader issues with Medicaid underfunding, VFC compliance burdens and liability, quality incentive programs (HEDIS/NCQA) and how incentives can be perceived as conflicts of interest despite being framed as deferred or conditional payment, and how vaccine mandates and distrust after COVID have reduced routine vaccination uptake. Schoenfeld shares past work running community COVID vaccine clinics and contrasts inefficiencies seen elsewhere. The episode ends with reflections on pediatricians being underpaid despite providing essential preventive care, Schoenfeld’s commitment to serving a largely Medicaid population in the Hamptons, and her upcoming presentation on cost center/call center reports at a future conference, followed by standard podcast outro and disclaimer.

00:00 Welcome Back + PMI New Orleans Takeaways (Why Pediatricians

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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

Back to Where It All Begins: The Journey of Dr. Jason Haua

In this episode of The Pediatric Lounge podcast, hosts George and Jason introduce Dr. Jason Haua, who shares his unique career story of moving from leading a large, successful independent practice back to solo practice, focusing on mental health and autism. Dr. Haua discusses the importance of finding joy and fulfillment in medical practice, the challenges and benefits of running a smaller practice, and his reasons for stepping away from a larger organizational structure. The conversation explores the intricacies of managing a solo practice, dealing with insurance and administrative challenges, and the importance of maintaining a positive work culture. Dr. Haua also shares insights on legacy planning, practice efficiency, and the evolving landscape of pediatric care.

00:00 Introduction to The Pediatric Lounge
01:00 Meet Dr. Jason Haua: A Journey Back to Solo Practice
01:42 The Philosophy of Returning to Solo Practice
03:24 Building and Managing a Successful Practice
07:17 Challenges and Rewards of Mental Health Focus
08:30 Operational Efficiency in a Small Practice
16:10 Transitioning from Large Group to Solo Practice
20:36 The Role of Technology and Personal Touch
39:46 Future Plans and Legacy
41:44 Balancing Work and Personal Life
42:44 Challenges of Starting a Medical Practice
44:43 Financial Struggles in Pediatrics
46:27 The Cost of Medical Equipment and Supplies
48:21 Navigating Insurance and Billing Issues
01:13:07 The Role of Optimism in Professional and Personal Life
01:15:31 Conclusion and Final Thoughts

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SOCIAL Media Pages ===============================
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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

The Pediatric Lounge: Advocating for Pediatric Care and Independent Practices

In this episode of The Pediatric Lounge podcast, the hosts discuss various topics relevant to pediatric care and independent practices. They highlight an upcoming event in New Orleans where pediatric practice leaders will gather to discuss their field. Special guest and pediatrician, Brian Birch from Idaho, shares his concerns about the future of pediatrics and his efforts at the state level, including the establishment of a pediatric council to address changes in Medicaid payments. The episode delves into the implications of legislative changes, the role of pediatric councils in payer relations, and the challenges of maintaining a medical home. The conversation also touches on the importance of independent practices, sharing mistakes, and the value of community support through groups like SOPA. The episode ends with a look ahead to upcoming conferences and talks aimed at fostering leadership and best practices in pediatrics.

00:00 Introduction to The Pediatric Lounge
00:32 Preparing for the PMI Conference
00:51 Guest Introduction: Brian Birch
01:45 Challenges in Idaho's Medicaid Program
05:08 National Medicaid Concerns
10:36 The Role of Pediatric Councils
14:19 The Importance of Practice Management
18:01 Engaging Young Pediatricians
33:50 Upcoming Events and Conferences
39:14 Conclusion and Farewell

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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

In this episode of The Pediatric Lounge, Dr. Rogu and Dr. Bravo welcome Chip Hart from PCC to discuss practical paths to fairer insurance reimbursement in pediatrics. They delve into the complexities of pediatric payment structures, including disparities in payments based on practice ownership and the impact of insurance models. The conversation also explores broader healthcare issues, including the economic implications of preventive care, the federal government's role in ensuring equitable healthcare, and potential solutions to make pediatric practices financially sustainable.

Highlighting successful practices that have thrived, the discussion underscores the importance of vision, business acumen, and an abundance mindset in pediatrics.

Additionally, the episode emphasizes the significance of the upcoming PMI (Pediatric Management Institute) conference, noting that it offers valuable opportunities for learning, networking, and professional growth. It is mentioned that PMI is fully sold out for in-person attendance but provides a streaming option, with speakers like Sandy Chung and Sue Kressley participating. Special attention is given to a T1D Mastermind Class at PMI with world-renowned pediatrician Dr. Kimber Simmons, showcasing the event as a pivotal occasion for anyone in the pediatric field.

00:00 Welcome to The Pediatric Lounge
00:32 Introducing Chip Hart and Today's Topic
01:02 Understanding Insurance Payments in Pediatrics
02:08 Private Equity and Practice Ownership
03:04 Medicaid and Payment Disparities
05:01 The Single Payer Model Debate
06:34 Value-Based Care in Pediatrics
07:55 Challenges in Preventive Care Funding
10:29 The Role of Managed Medicaid
14:02 Investment in Early Life Healthcare
19:41 Universal Coverage and Moral Hazards
20:14 Historical Context of Healthcare Policies
26:28 The Importance of Preventive Care
31:40 Public Schooling and Healthcare Parallels
40:27 Revisiting the Original Question
41:50 The Economics of Pediatric Care
42:53 Challenges with Insurance and Cash Payments
45:04 The Vaccine Debate and Physician Responsibility
47:29 Incentivizing Preventive Care
49:00 The Importance of Cash Systems in Healthcare
51:33 The New MSMS Codes and Payment Issues
01:01:39 Success Stories in Pediatric Practices
01:08:51 Upcoming PMI Conference and Final Thoughts

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SOCIAL Media Pages ===============================
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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

The Journey of Independent Pediatric Practice with Dr. Brian Birch

In this episode of The Pediatric Lounge, hosts George and Herbie welcome back Dr. Brian Birch to discuss his two years of experience running an independent pediatric practice. They explore the successes and challenges of starting the practice, the key technologies that have supported its operation, and the culture and values driving its mission. The conversation covers the use of AI ambient scribes, patient communication tools, and the importance of maintaining relationships with patients. Dr. Birch also shares insights into leadership, team building, and the complexities of vaccine hesitancy in a changing healthcare landscape.

00:00 Introduction to the Pediatric Lounge
00:24 Welcoming Dr. Brian Birch
00:39 Independent Practice Journey
01:19 Practice Operations and Team Structure
03:10 Technology in Practice
03:29 AI and Digital Scribes
18:12 Challenges and Solutions in Practice Management
24:31 Building a Positive Culture
29:25 The Courage to Prune for Growth
30:46 Enterprise First Mindset
31:55 Client Relationships and Non-Negotiables
32:52 Navigating Vaccine Hesitancy
36:41 Building Trust with Patients
46:36 Challenges in Pediatric Practice
47:13 Advocacy and Future Plans
51:54 Networking and Community Support
53:14 Conclusion and Farewell

Support the show

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SOCIAL Media Pages ===============================
📝 - Substack
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The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between.

The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.