Why Are Primary Care Doctors Still in Debt?

The LOUNGE - A Newsletter for Savvy Physicians

We scour the net, selecting the most pertinent articles for the busy doc so you don’t have to! Here’s what kept our focus this week…

• Without investment in primary care, physician shortages, burnout, and healthcare costs will rise.

• What happens when coffee, shaved ice, and family mix into a franchise juggernaut?

• Time your business can operate before cash runs out, based on reserves and burn rate.

• Wealthy areas accepted more housing when paired with new metro lines.

• What can the NHS teach North America about patient care?

• From judge’s bench to law firm desk, AI is rewriting legal playbooks—are we ready for the verdict?

How Doctors Tripled Their Income Going From Insurance To Cash

Dr. Mike Woo-Ming and Dr. Anne Truong debunk the myth that hospital and insurance-based medicine offers more stability than entrepreneurship.

Dr. Truong shares her firsthand experience of transitioning from an insurance-based practice (2000-2018) to a cash-based model in 2019, revealing how she overcame decreasing reimbursements, increasing denials, and inefficient billing systems. Discover how she tripled her income, streamlined her practice, and built 17 diverse income streams, including podcast sponsorships, webinars, and more, to achieve true financial freedom.

LOUNGE TALK

Dr. John Wei, a primary care physician, shares the sobering reality of carrying over $300,000 in student loan debt despite working in one of the most critical — yet least compensated — medical specialties. Drawn to primary care for its relational nature and potential PSLF eligibility, Wei entered the field knowing it would be challenging but not anticipating the financial precarity that persists even years into practice. Loan forgiveness programs like PSLF offer hope, but their fragile nature — subject to political shifts and strict compliance — leaves physicians living in financial limbo. The pandemic’s temporary loan pause showed doctors what financial breathing room could look like, making the resumption of payments even more painful. Despite government rhetoric praising primary care, systemic underinvestment, administrative hurdles, and low compensation perpetuate a cycle where altruism is exploited rather than supported. Wei argues that without protecting loan forgiveness and investing meaningfully in public health, America risks deepening physician shortages, burnout, and inequitable access to care. For him, supporting primary care isn’t just about physician well-being — it’s about ensuring a healthier future for everyone.

Tony Lamb, a former door-to-door vacuum salesman, turned his sales grit into Kona Ice, a reinvented ice cream truck experience that grew to 1,000 trucks by 2020. Seeking a year-round business, he launched Travelin’ Tom’s Coffee Truck—named after his father—which now serves coffee, lattes, and more from mobile units blasting country music. With a simple, accessible franchise model ($15K franchise fee, ~$172K truck cost, and flat annual royalties), Lamb’s companies have sold over 2,500 trucks across Kona Ice, Travelin’ Tom’s, and a new brand, Beverly Ann’s Cookie Truck. The model thrives on corporate events, schools, and festivals, with in-house financing making ownership more attainable. Lamb emphasizes celebrating life-changing stories from franchisees over top earners, underscoring his mission to give people financial freedom. Family remains central—his father still advises franchisees, his mother inspired the cookie brand, and all four of his kids have worked in the business. As the largest mobile franchise system globally, the company is on track to hit $500M in sales in 2025, with Lamb aiming to keep growth fun, grounded, and family-oriented.

For small business owners, “runway” is the number of months you can operate before running out of cash—a crucial metric often overlooked. Calculated by dividing cash reserves by monthly cash burn, runway gives you a clear picture of how much time you have to reach profitability or raise more capital. The danger lies in over-reliance on fixed expenses, which remain constant even when revenue drops, potentially wiping out runway fast. At least 30% of expenses should stay variable to preserve flexibility during downturns. Extending runway can be done by cutting or renegotiating fixed costs, stabilizing revenue through recurring income, improving payment terms with vendors, or accessing short-term capital. Even profitable businesses should monitor runway regularly, since profitability can evaporate with market shifts, rising costs, or customer churn. In short, knowing and protecting your runway is the difference between steering your business and flying blind.

Collective decision-making often gets bogged down in bureaucracy, information overload, and entrenched power dynamics—problems AI is now helping address. Hamburg, Germany, faced a housing crisis in 2016 as it prepared to house 80,000 refugees in a city already struggling with zoning disputes. Partnering with MIT Media Lab, the city used CityScope, an AI-powered urban planning tool, to aggregate data, run “what-if” simulations, visualize trade-offs, and engage a broad cross-section of residents through interactive workshops and augmented reality. The platform’s four functions—insight, prediction, transformation, and consensus—enabled citizens to understand complex data, explore alternatives, and find common ground, even among wealthier neighborhoods resistant to higher density. By shifting debates from narrow projects to shared priorities, CityScope helped Hamburg not only house refugees but distribute them in ways that fostered social cohesion and resilience. The approach has since expanded to other city planning areas and is now being exported internationally. While AI can streamline processes and democratize access to information, it can’t eliminate conflict—human leadership and respectful discourse remain essential for lasting solutions.

At the King’s Fund Digital Health Transformation event in London, the issues discussed—workforce shortages, AI uncertainty, and digital bottlenecks—were strikingly familiar to those in Canada and the US. The standout difference: the NHS has embedded patients directly into the design process for healthcare services. Leaders like Robyn Chappell of National Voices showcased initiatives where patients, caregivers, and service users are core members of care redesign teams, not just storytellers. The conference also featured Suvera, a startup co-founded by Dr. William Gao, which uses technology to engage chronic care patients, lower hospitalizations, and address language and literacy barriers in underserved communities. These parallels across countries raised a key question—why aren’t Canada, the US, and the UK sharing more solutions, given their nearly identical challenges? The event underscored that while accents may differ, the playbook for fixing healthcare could be far more collaborative and globally informed.

Artificial intelligence is rapidly embedding itself in the legal system, streamlining tasks like case research, contract review, and legal transcription. For law firms, especially smaller ones, AI can level the playing field by offering faster access to complex case law and freeing up billable hours. However, risks loom large—accuracy drops dramatically when AI replaces human transcription, and infamous incidents like fabricated legal citations show the danger of unchecked automation. Bias in training data, opaque algorithms, and lack of human oversight remain significant barriers to trust. While AI can enhance efficiency, the legal community must pair it with human judgment to safeguard fairness and compliance. Even U.S. Supreme Court leadership warns that technology cannot replace wisdom and experience. The consensus: AI will play a bigger role in law, but it must be managed with transparency, integrity, and rigorous review.

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QUICK BITES

• 4 research-backed ways to strengthen your pitch and get funding.

• What sleep sensing can tell physicians about mental health.

• 3 reasons your employees are burning out—and how to fix it.

• How AI is finally fixing the electronic health record.

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