The Healthcare System Is Broken: How Doctors Build Businesses Outside It

Welcome to Unbankable, the podcast for entrepreneurs who won’t take no for an answer. I’m Alex Shvarts. Today we talk about how physicians are breaking free from traditional, insurance-driven medicine to build direct-pay practices that serve patients better. The healthcare system is broken, but smart doctors are creating alternatives that work.

My guest is Dr. Dimitri Gitelmaker, board-certified in internal and obesity medicine with fellowship training in preventive medicine and nutrition. He built a direct-pay concierge practice in South Florida focused on prevention, longevity and personalized care rather than the insurance-driven conveyor belt of traditional medicine.

On hearing ‘no’: as a physician you constantly have to find common ground and motivate people, and only about a third will readily listen. You can’t force someone past their ‘no’; you build trust over time. There’s a saying that doctors make terrible businesspeople because they’re trained to be too nice, and medical school teaches almost no business, while dental school includes far more.

His breaking point: he became medical director at a Medicare Advantage company and saw that the model pays a lump sum per patient, which incentivizes spending as little as possible on each person to keep the rest. He walked away and started his own practice with the goal of spending real time with patients and treating everyone like family.

On the concierge model and pricing: every doctor has to decide their price point and give people a reason to pay. He moved from hourly to membership and program-based pricing, weight loss, peptides, and a new longevity program stacking hyperbarics, red light, IVs and peptides, keeping the menu simple with about three tiers rather than nickel-and-diming. His sales philosophy, from the book To Sell Is Human: never upsell, ‘upserve’; give people more value (like including IVs) and they’ll happily pay the premium. You’re either selling a brand or you’re on sale, and people treat a ‘deal’ very differently from a premium brand.

On funding the practice: he bootstrapped. He had savings from years as a traveling hospitalist plus severance, rented one room from a friend for about $1,000, and his wife, a nurse, handled credentialing and paperwork. He started while still receiving severance and grew through aggressive marketing, always iterating and watching every dollar. I noted FundKite funds many medical and dental practices that can’t get bank money, so we know the space, but Dr. Gitelmaker’s route was self-funding.

His advice for doctors who want to go independent but lack business knowledge: you can learn it. Get a library card or a Kindle and read about leadership, marketing, and sales, it’s a few dollars versus a half-million-dollar degree. Everyone is selling something; a doctor convincing a patient to quit smoking is selling a better lifestyle. Business is just another skill doctors, who are good at research, can learn.

On the peptide craze: it’s real but complicated. Some peptides are FDA-approved, some are gray, some are banned, and many people get them from unreliable ‘gym bro’ sources. He cautioned heavily about sourcing and noted most peptides are manufactured in a few overseas labs. The takeaway for patients: be careful where products come from, and don’t launch a peptide company just because it’s trendy.

On scaling concierge medicine, I pushed back that it’s hard to scale because patients come for him specifically, and you can’t clone yourself; the theory of constraints applies. He agreed the bottleneck is real but described his plan: build a brand and trust (that’s why he gives away content on Instagram), then add tiers, online lab ordering and at-home blood draws, and longevity services that don’t all require his personal time. The lesson from Palo Alto and the book 10x Is Easier Than 2x: you scale by delegating and using systems, not by working more hours.

On staff: he’s had very little turnover by hiring people who fit the practice, and his hardest hire was a good practice manager. He has deliberately turned away physicians, PAs and nurse practitioners so far, because the brand promise is that you see a doctor; he doesn’t want to dilute that level of care.

On obesity and internal medicine: combining them is valuable today. He trained at Harvard for obesity boards as the GLP-1 era began, and uses those medications sparingly, emphasizing that lasting results require lifestyle change, you have to master the fundamentals before the fancy add-ons.

On longevity medicine: it’s niche but growing, and at minimum it gives people hope and a better mindset, which affects health. But the goal is quality years, being a fully functioning, productive human, not just living to 100. I added that patients should ask their doctors why, research, and not just accept what they’re told.

On value versus ‘free’ insurance care: coming from the Soviet Union, he knows how hard it is to convince people programmed under socialized medicine to pay, and he warned that incentivizing physicians as paperwork-pushers paid a fixed amount removes the incentive to do a good job. Doctors should be compensated well enough not to worry about money, an idea as old as Maimonides and Hippocrates.

On purpose and money: everyone has to pick a number for what ‘enough’ means, and it changes over time. He once took a year off traveling Asia after investing well in the 2008 crash, but now, as an immigrant with a family, his work is about giving them a better life. His purpose is helping people, and he gets the privilege of doing that daily and being paid well for it.

On regulation and the future: he’s optimistic that AI will transform medicine. Doctors increasingly use evidence-based tools like Open Evidence, trained on top journals, that return answers based only on published research, compressing months of literature review into instant, reliable guidance. We’re entering an era where the abundance of information is finally accessible and usable.

On the criticism that concierge medicine is just healthcare for the wealthy: he doesn’t entirely disagree, most of his patients are high-net-worth individuals optimizing performance, but he also does pro bono work and sees patients he doesn’t charge. His advice for burnt-out physicians who want their own practice: take a hard look at yourself, because not everyone is built to be a founder, and founder hours are real. Like me, he joked he’s the CEO at night and an employee for his team during the day. We closed agreeing that success, 20 years out, is defined by family and how your children turn out, not by money.