Your paycheck now depends on quality scores, HCC coding, and population health numbers that nobody actually trained you to hit. Most clinicians pick it up through mistakes and admin feedback, and it's quietly pushing people out of primary care.

Kenneth Botelho, who runs a Doctor of Medical Science program, argues the problem isn't clinician capability. It's that workforce development has been treated as paperwork instead of core infrastructure.

⏱️ Chapters:
0:00 Introduction
0:19 The gap nobody warned you about
1:49 Why fee-for-service is dying
3:46 What changes when your paycheck hits the dashboard
6:26 The training almost no one actually got
7:54 The skills clinicians are missing
9:41 How the fix should look
12:05 The real driver of primary care burnout
14:34 Take home messages

About this episode:
Kenneth Botelho makes the case that clinicians are struggling not because they're incapable but because medical education has not caught up with how health care now evaluates and compensates them. Primary care physicians, PAs, and nurse practitioners are asked to hit population health metrics, manage HCC risk coding, and drive screening rates for breast cancer, cervical cancer, and colonoscopies, often without structured training in why these measures exist or how to integrate them into daily practice. The conversation covers why that gap fuels moral injury and drives clinicians out of primary care, why postgraduate fellowships and structured onboarding programs are the right place to build real fluency in value-based care, and why giving clinicians a clear framework restores professional identity, a sense of control, and ultimately better patient outcomes.

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