The Practice Profit System

How many times does the company that employs you have to change hands before you stop calling it security? For Liz Lyster, it was three sales and a bankruptcy. She started at Cigna in 1994, when it still ran its own hospital locations in Los Angeles, and watched the model eat itself: the office was paid to keep patients out of the hospital, and the hospital was paid to put them in. Then the company was sold. Then sold again, and again. In 2000, seven months pregnant, she showed up to a crowd at the front door and a building locked for bankruptcy. The nurses handed her a few IUDs on the way out because nobody knew what would happen to them.

Liz grew up with two academic physicians for parents, so money and business were never discussed at the dinner table, and she opened her first practice with no money skills at all. I tell every doctor I work with that there is no shame in that, because the system is built to keep you from learning it. Liz and I agree that a business class in medical school is just the class people skip. What she would teach instead is independence: the real pros and cons of being employed and what you want your career to look like twenty years out. Full disclosure, Liz is a Mavrix client. We met at a dinner table on the BHRT Training Academy cruise, and she tells me straight that what she felt back then was closer to resignation. We get into what changed, and why she now lets long-time patients graduate when they won't renew at her new prices. Then we go somewhere harder: how she has had to rebuild her leadership after losing her husband, and a lesson I've been teaching lately about how most of us hire out of our own woundedness.

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About the Guest:

Dr. Liz Lyster is a board-certified OB/GYN and hormone specialist who has spent more than 30 years getting women in midlife real answers. The daughter of two Argentine physicians who trained at the Mayo Clinic, she graduated with honors from Cornell University, earned her medical degree at UC Irvine, trained in OB/GYN in East Los Angeles, and holds a master's in community health education from UCLA.

After years as an employed physician and then running her own insurance-based practice in Southern California, she now runs a cash-based midlife hormone practice and lives in Reno, Nevada. She hosts Hotness, the podcast where hormones, confidence, and desire come back online, and has written several books, including Dr. Liz's Easy Guide to Menopause, Go for GREAT, and Sacred Libido. She celebrated her 50th birthday by climbing Kilimanjaro and dances Argentine tango.

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Social Handles:

Download Dr. Liz's Guide to Midlife for free at drlizmd.com/hotness

Follow Dr. Liz for midlife hormone real talk at @drlizlyster

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Frank Shallenberger loved emergency medicine. It was fast, it was clear, and you could save a life. Then the ER started filling up with people who'd had a rash for six months, so he crossed the street, hung up a shingle, and opened a family practice. Six months in, he went to the hospital administrator with a problem. He was giving patients the right medications for hypertension and arthritis, and nobody was actually getting better. The administrator went through his cases with him every week for a couple of months and came back with the answer that changed Frank's career: you're doing everything right. Frank responded that if this is doing it right, then something is missing.

What he found was a study group run by Linus Pauling. Before each evening meeting, the physicians would spend the morning wandering the stacks of a university library basement, pulling periodicals going back to the 1800s and bringing whatever looked interesting to the group. No internet, no Amazon, just yellow legal pads and a librarian who made copies. A few years later, as program director for a meeting of the Orthomolecular Medical Society, Frank booked a speaker named Charlie Farr, who was infusing an oxidant into patients at a time when everyone in the room believed oxidants were the problem. That talk, and Paracelsus's old line that the dose makes the poison, set the direction for the next 40 years. It also got him into trouble with the state of California, which is how he ended up in Nevada in 1991.

The part I wanted every doctor listening to hear is what his practice looks like now. Frank runs a 15,000-square-foot clinic with three nurse practitioners, a naturopath, nurses, and an IV room, and every new patient is tested before Frank walks into the room. He's 80, he still loves the work, and he told me that if he ever retires, it'll be because of the red tape. We also got into the business side: what ozone sessions go for in big and small markets, why they're sold as a series, and where to get trained. I've been to Frank's big conference and his smaller Reno trainings, and most of the functional medicine doctors I work with have been through them.

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About the Guest:

Frank Shallenberger, MD, HMD, ABAAM, has been practicing medicine since 1973 and leads The Nevada Center for Alternative & Anti-Aging Medicine in Carson City, Nevada. He trained at the University of Maryland in one of the country's first shock trauma units, spent close to a decade in emergency medicine, completed a surgical residency in California, and then opened a family practice. His search for why patients weren't improving led him into Linus Pauling's orthomolecular study group in the San Francisco Bay Area, and later to Nevada, where he has been licensed by both the allopathic and homeopathic medical boards since 1991.

Frank is one of the early pioneers of ozone therapy in the United States, a field he began researching in the 1980s. He helped form the American Academy of Ozone Therapy, which certifies physicians, dentists, and veterinarians, and he teaches its medical track. His clinic spans about 15,000 square feet and includes an IV infusion room and in-house testing for mitochondrial and endothelial function, including a computerized oxygen and carbon dioxide analysis system he developed about 25 years ago. He is the author of Bursting with Energy.

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Learn about ozone therapy certification for physicians, dentists, and veterinarians at the American Academy of Ozone Therapy: aaot.us

Request an appointment at Frank's Carson City clinic at antiagingmedicine.com

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The health insurance industry spent 2025 telling everyone it had just lived through its worst year in over a decade. Read the filings and what you find are write-downs. Nobody wrote a check. On Out of the System I walk through what the first half of 2026 actually looks like from the payer side, where premiums were repriced and claims were paid out at a smaller share of every dollar collected. Three orthopedic surgeons sat down with me in Los Angeles this week and every one of them opened with the same question about their reimbursement. This is the arithmetic behind that question, and what I think doctors should do with it.

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About the Host:

Matthew Gillogly is the host of Out of the System and the founder and CEO of the Mavrix Profit System. He is not a doctor, and he treats that as the advantage. While physicians were learning anatomy, he was learning business anatomy, and he brought it into medicine as an operator. He ran three clinics in North Carolina under a management arrangement built by the letter of the law, where the doctor owned the practice and made every clinical call and his company carried the business side, and those clinics became the number one provider of men's sexual health solutions in their market before he sold them.

He built Mavrix to hand that playbook to physicians who want out of insurance-dependent care, and he and his team have worked with hundreds of doctors on cash and direct-pay models. Much of that work happens in the room: Dominion Path Days, where a physician spends a day with him and leaves with a full review of the business. He spends the rest of his time making the same argument he makes here, that the system is not broken, it is working exactly as it was designed to work, and the people it works worst for are the ones who trained the longest.

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Mark Ayzenberg finished his fellowship in 2019 believing the era of owning your own practice was over. He is proof it is not, and in his telling, none looked like turning points at the time.

He joined a group that sold to private equity, ending the promised partnership and leaving him a perpetual associate. He moved to a hospital-owned group and hit another wall: he could not do regenerative medicine at the quality the science demands. One practice ran a kit that produced platelet-poor plasma and called it platelet-rich. When he pushed back, the hospital said a board-certified surgeon had used it before him. Mark is generous: good surgeons doing what they were trained for — the problem was structural. They make their money in the operating room, so nothing keeping a patient out of it gets funded.

The science was never his bottleneck. He had learned quality regen from Dr. Don Buford, his ethical north star, and found himself steering seventy-year-olds toward a knee replacement instead of letting them decide whether to pay out of pocket — and did not see it. Then he heard a question at a conference: would you offer your mother regen if insurance were not an issue, and what right you have to decide for a paying patient. He quotes it almost daily now. In short: the insurance box versus the science box — insurance coverage is reasonable, the science box is bigger.

From there it is an exit story — messy and human. He signed with Mavrix at the Business of Orthobiologics before he had a location, negotiated one day a week, and ran his first regen day from a sublet room in a friend's practice in May 2024. By November he had taken over a closed urgent care, priced like a quarter-sized space. His former scheduler showed up and painted walls before there was work for her. She runs the office now. One employee became five in under a year. The non-compete fight was ugly: Pennsylvania's ban did not cover his contract; his verdict: you do not have to be right, just need clout. He paid for the slower, more ethical route and is glad.

What he built with the freedom is the tell. New patients get forty-five minutes to an hour and he feels rushed. There is Fiji and Pellegrino in the waiting room and a coffee menu called Iron Mountain Summit Sips. He asks every patient the same question — pain or function — because a mechanical problem needs a mechanical fix, and avoids unnecessary surgery. Ask what saddens him most about medicine and it is not reimbursement or paperwork. It is that doctors have stopped telling children this is a good path. He knew he wanted this at five years old.

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About the Guest:

Mark Ayzenberg, MD, FAAOS is a double board-certified, fellowship-trained orthopedic surgeon and founder of Iron Mountain Orthopaedic Institute in Huntingdon Valley, Pennsylvania. He studied at the University of Pennsylvania, led his class at Geisinger Commonwealth School of Medicine, did residency at Einstein Healthcare Network, and fellowshipped in sports medicine, arthroscopy and reconstructive surgery at the Southern California Orthopedic Institute.

His subspecialty is minimally invasive shoulder, knee, hip and ankle surgery, plus shoulder arthroplasty, revision work, and trauma. Two lines sum up his approach: "I don't treat pictures, I treat you," and "less pills, less shots, less surgery whenever possible." Surgery pairs with orthobiologics: PRP, bone marrow concentrate, MLS laser and shockwave therapy. Anyone treated leaves with his cell phone number.

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Social Handles:

Website: ⁠ironmountainortho.com⁠

Instagram: ⁠@ironmountainortho⁠

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There are three things I believe wrecked healthcare in this country, and I have gone after two of them before: an Affordable Care Act that handed insurers the room to consolidate, and agencies that stopped acting like regulators. The third one is the one I take on here. Venture capital and private equity buying hospitals, buying practices, and inserting themselves between a doctor and a patient.

I start with the Stark Laws, because the history is the whole argument. In the late 1980s it became illegal to compensate a physician on revenue and performance the way you compensate a salesperson, after a stretch where drug and device companies were paying doctors a cut of what they recommended. Those laws never went away. They just stopped being enforced, and RVUs rebuilt the same incentive with a name nobody objects to. Then I tell you about a friend's wife in Arizona, walking fifteen blocks with me on a November evening with a slight limp, telling me over dinner that she had a hip replacement scheduled for right after Christmas. No MRI. No ultrasound. No x-ray. Ten minutes with the doctor. I am not a doctor and I am not going to diagnose anyone from a dinner table. I am going to ask why that surgery had to happen before the year closed.

From there I get into what physician surveys and the outcome research keep reporting about private-equity-owned facilities, the pattern nurses and their unions have been describing for years, and the reckoning I am starting to hear in whisper conversations at conferences. The roll-up strategy was supposed to buy leverage over the payers. The payers have worked out that they control the purse strings, and that a lower reimbursement rate turns a struggling hospital into a bargain. Then we get to the part that actually matters, which is you. You are the one holding the bag. You are the one taking the reputation hit for the seven minutes you are allowed to spend, because the patient has no idea there is a metric behind it. Private equity in hotels is fine. Private equity in golf courses is fine. In a room where somebody is frightened and in pain, it is a category error, and the word patient exists precisely because that person is not a customer.

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About the Host:

Matthew Gillogly is the host of Out of the System and the founder and CEO of the Mavrix Profit System. He is not a doctor, and he treats that as the advantage. While physicians were learning anatomy, he was learning business anatomy, and he brought it into medicine as an operator. He ran three clinics in North Carolina under a management arrangement built by the letter of the law, where the doctor owned the practice and made every clinical call and his company carried the business side, and those clinics became the number one provider of men's sexual health solutions in their market before he sold them.

He built Mavrix to hand that playbook to physicians who want out of insurance-dependent care, and he and his team have worked with hundreds of doctors on cash and direct-pay models. He spends most of his time making the same argument he makes here: the system is not broken, it is working exactly as it was designed to work, and the people it works worst for are the ones who trained the longest.

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Schedule a Discovery Call at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠MavrixProfitSystem.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ 

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