100 episodes of Off the Chart: A Business of Medicine Podcast

In the 100th episode of Off the Chart: A Business of Medicine Podcast, host Austin Littrell is joined by Todd Shryock, Richard Payerchin and Keith Reynolds — the editors from Medical Economics and Physicians Practice who helped build Off the Chart into what it is today. Together, they look back on favorite conversations, memorable guests and defining trends from the show’s first 100 episodes.

From the rise of artificial intelligence and new liability concerns to the return of independent practice, rising costs and shifting patient trust, the team discusses how medicine’s business landscape continues to evolve — and what stories they plan to chase next.

Don't miss our recent episodes on lifestyle medicine, fighting burnout, AI and malpractice law and Medway.

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Opening thanks
Richard opens with gratitude to guests and listeners who helped shape 100 episodes of Off the Chart.

0:20 – Introduction
Austin welcomes listeners to the 100th episode and introduces Todd Shryock, Richard Payerchin and Keith Reynolds.

1:17 – Looking back on the journey
Austin recalls joining the show at episode 48 and asks what the 100-episode milestone means to the team.

1:42 – Milestone reflections
Austin shares appreciation for the show’s growth and its role as a forum for fresh ideas in medicine.

2:17 – Podcast evolution
Todd Shryock on how Off the Chart grew from a side project into a polished, professional production.

3:01 – Early days and transition
Keith Reynolds describes taking over around episode 35 and credits Austin for elevating production and consistency.

4:15 – Memorable episodes
Austin asks which episodes have stuck with the editors over the years.

4:24 – Running for office
Richard Payerchin highlights Episode 43: The Physician’s Guide to Running for Office and lessons from doctors-turned-policymakers.

5:06 – What’s broken in healthcare
Todd Shryock revisits his interview with Michigan Medicine’s Marschall Runge, M.D., Ph.D., and how academic leaders see systemic challenges.

6:18 – Behind the mic
Keith recalls producing the “Running for Office” episode, his conversations with MGMA’s Anders Gilberg, and his latest chat with attorney Katie Russell, J.D.

8:03 – AI and malpractice
Austin reflects on Episode 97: AI, malpractice and the future of physician liability, and the October cover story on artificial-intelligence liability in medicine.

8:28 – Team reflections
Keith shares why editor roundtables and behind-the-scenes episodes remain his favorite part of the job.

9:04 – How medicine has changed
Austin asks how the health care landscape has shifted since the podcast began.

9:30 – AI everywhere
Todd explains how artificial intelligence went from novelty to necessity — and raises the looming question: who pays for it?

12:05 – The changing public mood
Keith discusses how public perception of physicians has evolved since the pandemic and why trust feels more fragile today.

13:41 – Independence and private practice
Richard points to episodes 70 and 95 on physician autonomy and the growing nuance around private-equity partnerships.

15:25 – Lightning round: trends for 2026
Austin asks each editor for one trend to watch in the year ahead.

15:35 – Price transparency
Richard predicts renewed momentum for transparency policy under the current administration.

15:53 – Trust in AI
Todd warns that adoption will hinge on physicians’ confidence in AI accuracy.

16:29 – Return to independence
Keith expects a migration back to physician-owned practices as consolidation stalls.

17:14 – P2 Management Minute
Keith delivers a quick interlude of practice-management advice and listener call-to-action.

18:04 – Looking ahead: the next 100
Austin asks what stories or themes should shape Off the Chart going forward.

18:16 – Keith: More creative episodes
Keith lobbies (again) for holiday specials and continued AI coverage.

19:06 – Richard: Rural healthcare and affordability
Richard calls for deeper dives into rural access, insurance costs and medical debt.

20:08 – Todd: Front-line voices
Todd wants more firsthand perspectives from practicing physicians on fixing medicine.

20:47 – Austin: Financial literacy
Austin advocates expanding coverage of physician wealth-building, taxes, and loan repayment.

21:08 – Lightning round: advice for 2026
One-sentence takeaways from each editor for practice leaders.

21:08 – Richard's advice
“Tune in twice a week to Off the Chart.”

21:15 – Todd’s advice
“You can’t save the world — start with the patient in front of you.”

21:25 – Keith’s advice
“Take care of your coders; they make everything work.”

21:33 – Closing and gratitude
Austin thanks the editorial team and listeners for helping reach the 100-episode milestone.

21:57 – Outro
Final wrap-up, subscription reminder and acknowledgments to the Medical Economics and Physicians Practice teams.