The Doctor's Lounge

Licensing Loopholes, Wage Pressures, and the Fight for Physician Standards

• Rojas Media • Season 1 • Episode 11

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🎯 Why Listen

North Carolina approved a bill letting some international medical grads practice without U.S. residency. Smart fix for shortages—or a back door for cheaper labor that risks quality? We break down patient impact, wages, malpractice, and what it means for the profession. Plus: Vinay Prasad’s surprise return to the FDA, catastrophic insurance, and why prices stay opaque.


👥 Co-Hosts

  • Dutch Rojas – Founder, Bliksem Health
  • Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
  • Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
  • Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
  • Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur


📌 Episode Overview

  • NC Bill 67: Why hospitals pushed it; how it bypasses standard vetting.
  • Licensure’s false security—and the “Dr. Death” lesson.
  • Will cheaper labor deter U.S. trainees and suppress wages?
  • Malpractice/insurance: who absorbs the risk?
  • Commoditizing clinicians: PR, checklists, and EHR clicks over care.
  • Quick hits: Prasad’s FDA comeback and how the ACA erased catastrophic plans.


đź’¬ Notable Quotes

  • “This is an employer-driven bill. Hospitals need cogs, not clinicians.” – Dan Choi
  • “Licensure can give a false sense of security.” – Anish Koka
  • “Import cheaper labor and U.S. grads will walk.” – Sanat Dixit
  • “Killing catastrophic plans killed price signals.” – Anthony DiGiorgio


📚 What You’ll Learn

  • How IMG parity reshapes the pipeline—and who wins.
  • Why incentives, not slogans, drive workforce behavior.
  • The hospital risk calculus: compliance vs. clinical judgment.
  • Lobbying’s role in workforce policy.
  • How restoring catastrophic coverage could revive real markets.


⏱ The Episode (Timestamps)

  • 00:00–07:30 NC Bill 67—IMGs sans U.S. residency
  • 07:30–13:00 Licensure gaps & Dr. Death
  • 13:00–22:30 Wages, “STEM coolies,” incentives
  • 22:30–29:30 NP scope, hospital demand, commoditization
  • 29:30–34:45 Professional standards & patient trust
  • 34:45–41:00 Lobbying power and politics
  • 41:00–48:00 Vinay Prasad, FDA, biotech pushback
  • 48:00–54:00 Catastrophic insurance & ACA effects
  • 54:00–End Price transparency, DTE contracts, fixing incentives

đź”— Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X