Hey Hospitalogists,

A few months ago, I sat down with Scott Becker (yes, that Becker, of Becker's Healthcare) and going in, I'll admit I felt the size gap. He's built one of the most recognized names in healthcare media over 3 decades. I'm a few years into this thing.

But Scott flipped the script on me almost immediately: healthcare media isn't zero-sum, and he spent the next hour proving it. We got into the M&M scoreboard approach to doubling down on what's working, the internal fight to make short-form content the norm (spoiler: the data won), and why your entire career might come down to 10-20 relationships instead of 10s of thousands of subscribers.

He also didn't pull punches on the supply-and-demand crisis at the center of U.S. healthcare, a take that manages to annoy both sides of the aisle equally.

Grab a coffee; this is worth the read.

P.S. Meet me for happy hour at Vizient Connections Summit. Apply to RSVP here.

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THE HOSPITALOGY AI RETREAT

There's no greater clown fiesta in healthcare right now than the discourse around "AI transformation." Spoiler: most of it doesn't help the people who are actually running health systems.

So I'm doing something about it: 100 senior execs, 2 days at a golf resort and spa in Phoenix, curated roundtables, and off-record conversations you won't find on a trade show floor.

Plus, it's 100% free to attend, and we'll cover your hotel and airfare thanks to our amazing brand partners.

The Hospitalogy AI Retreat is for health system leaders who have to make real calls on AI when it comes to governance, RCM, clinical ops and more.

Think of it like last year's retreat, but (slightly) bigger, and way, way better. Hope to see you there.

Apply to attend.

BLAKE’S BREAKDOWN

The Becker's Blueprint: What 30 Years in Healthcare Media Actually Teaches You About Building Something

I'll be upfront about something: I walked into this conversation a little unsure what I'd get. Scott Becker is, by any reasonable definition, a competitor. He built one of the most recognized names in healthcare media over three decades. I'm a few years into a newsletter and a podcast. The asymmetry was obvious.

But Scott reframed it in the first two minutes. "We view the world as an abundant place," he said. "It's not a zero-sum game, or it shouldn't be." And then he spent the next hour proving it.

What followed was one of the more useful conversations I've had on this podcast. Not because Scott was dropping novel frameworks, but because he kept identifying the same instinct underneath wildly different decisions. Whether he was talking about which legal niche to pursue, which media vertical to double down on, or which people to invest in, the logic was always the same: watch where the returns are actually coming from, and chase that.

Listen to the podcast here.

The myth of the origin story

The Becker's narrative gets cleaned up in the retelling. Smart founder sees the surgery center wave coming, plants his flag early, builds an empire. That's the version that gets cited. It's not quite right.

Scott tested three areas simultaneously: surgery centers, disease management, and cardiovascular. The surgery center business returned 4x as much client work as the others, so that's where he went. "People say to me, ‘My God, you were so bright to choose surgery centers.' I did nothing of the sort."

What I found genuinely useful here was the M&M scoreboard metaphor. If you've got three initiatives running in parallel and the red one is lapping the field, the instinct some entrepreneurs have is to pour energy into the lagging ones. There must be more upside there, right? Scott's entire operating philosophy runs the opposite direction: kill the red one, eat the red one, be the red one. Double down on what's already working.

He'd apply this same logic again when Becker's expanded into orthopedics and hospitals. They went into both. Hospitals and health systems ended up being 90% of the business. "In hindsight, it's easy to understand: hospitals and health systems is just a huge market." We’re talking 20K orthopedic physicians versus 5,300 hospitals averaging $100–200M in annual spend. The math isn't subtle. But Scott is the first to admit he didn't see it coming. He just noticed it happening and reacted faster than most would.

I pushed back a little here. "That's the mark of a successful petri dish," I told him. The process itself is the genius, even if no individual decision was. He deflected. But I'll stand by it.

The short-form war nobody talks about

This was the part of the conversation I wasn't expecting, and it's the part I keep thinking about.

We take it as obvious today that healthcare executives want short, scannable, quickly consumable content. Six-item roundups. Quick hits. Headlines they can absorb in 10 minutes over coffee. Becker's built a dominant position on exactly that format.

What Scott described was the internal fight to get there, and it was genuinely brutal. Thinking back 20 years ago, journalists came out of school wanting to write the definitive piece. One article a week, deeply reported, George Will-esque. And Scott, a lawyer running an editorial team with zero journalism background, was telling them: no, you're writing 6 things today, and they're going to be short.

"It was literally a war," he said. "I used to say I never want to raise kids alone again, never want to run a journalism team again."

What turned it wasn't an editorial mandate; it was data. Becker's tracked readership obsessively. Long strategy pieces: 50 clicks. Short-form roundup items: 200 clicks, 300 clicks. The audience was voting in real time, and eventually the numbers were impossible to argue with. He'd show the feedback to editors. Actual comments from actual CFOs saying: I love this format. I get a sense of what's going on in 10 minutes.

The deeper point here, and this connects to something I think about constantly with Hospitalogy, is that being online means you get graded every single day. You can think you're brilliant. The click data will tell you otherwise. Scott figured out feedback loops as a competitive advantage before that was a thing anyone was talking about.

Thought leadership is distribution, not creation

One of the sharper frameworks Scott laid out: the product itself is not the point.

"Writing an article itself is useless. Fine, but relatively useless." What matters is what you do with it. Specifically, whether you use it as a reason to get in front of the 20, 30, 50 people who actually matter to your practice or business.

I think this is widely misunderstood, especially in professional services. Firms celebrate the output. Someone wrote a white paper. We launched a podcast. We got published in Modern Healthcare. The implicit assumption is that publishing equals reach, and reach equals relationships.

Scott's version is more direct: the white paper is an excuse to email your best clients. The podcast appearance is credibility collateral you distribute. The newsletter isn't for everyone; it's for the handful of people you actually need to stay in front of. "I need the 50 people that are my regular clients or contacts to see it. That's who I need to see it."

This reframe matters a lot for anyone building a professional practice around content. The question isn't "how many people read this?" It's "did the right people read this, and did it start a conversation?"

The 10-to-20 rule

We spent some time here on a point that sounds small but I think is actually one of the most underrated insights in the conversation.

Scott's claim: your real career is built on 10 to 20 relationships. Not thousands of followers, not a massive distribution list. A handful of people who opened doors, made introductions, became loyal customers, pushed you to grow. He mentioned Greg Koonsman, VMG's founder, as one of Becker's early advertisers and a relationship that compounded significantly over time. (Small world: VMG is where I came up, so that landed differently for me than it might for other listeners.)

He travels to see a health system CEO even when it loses money because that person has been so supportive of Becker's over the years. Not because there's a deal on the table. Because the relationship matters intrinsically, and because that kind of loyalty is rare enough to honor.

The practical implication: most people optimize for scale when they should be optimizing for depth. A thousand passive subscribers will not move your career. Five people who genuinely believe in what you're building will.

On healthcare: the supply problem nobody wants to name

Scott had some sharp healthcare takes in the back half of our conversation, and I want to give them space because I think he's directionally right in ways that are uncomfortable for people on both sides of the policy debate.

His core thesis: the central crisis in US healthcare is a supply-and-demand imbalance, and almost all the political energy is going to the wrong problem. "It's the supply and demand, stupid" (the Carville callback was deliberate).

The left pushes coverage for all. Scott says he agrees with the goal, he wants coverage for everybody, but coverage without fixing supply "is like me writing a check I can't cash." You can insure everyone and still have 200,000 fewer primary care physicians than the system needs. The math doesn't close.

On the right, free market arguments hit a different wall: we're already 50%+ government-funded, and the experiment of turning Medicare Advantage over to large commercial payers has, in his telling, been "a massive disaster." More spending per enrollee, worse access, massive system-level inflation. He's not hedging here.

What struck me is how cleanly this cuts against the dominant narratives on both sides. The solution isn't a payment model. Fee-for-service has its abuse vectors; capitation has its own. The solution is more physicians, more advanced practitioners, more triage capacity, and neither party is running on that.

His example of the PA-staffed urgent care in Florida that dispensed prescriptions on-site for $15 extra (no pharmacy wait, no prior auth loop, just triage working as designed) is the kind of signal that gets lost in the larger coverage debate. The system can work when capacity exists to route people appropriately. The specialty shortage is where the real fragility lives.

Building the team that eventually replaces you

The last thread I want to pull is the founder evolution framework Scott laid out, because I think it maps onto something I'm living right now with Hospitalogy.

Stage one: doing everything yourself. Stage two: doing it with people, but you're still the ceiling. Stage three: you've hired and retained people who can do every individual job better than you ever could.

He used an agentic AI analogy I genuinely wasn't expecting: "You're not responsible for every single input. Now other people are driving the inputs and outputs and you're not the limiting step." That's the goal. That's what Jess Cole and the broader Becker's team represent. Scott does what Scott does (speaks, podcasts, writes, shows up), and the business runs on the people who've made individual functions their own.

The hiring corollary is worth noting: his warning against managers getting gun-shy after a bad hire is real. Every hire is a gamble. You don't know what you have until you've worked with someone. The worst outcome is a risk-averse manager who stops making bets because of one miss — because you can't grow if your team stops swinging.

Following what the data is already telling you

Since our conversation, Scott’s book, Building Great Businesses: Create Momentum, Overcome Setbacks, Scale with Confidence, has been released. And if the conversation was any preview, it's less about prescriptive frameworks and more about motivation and recognizing patterns you already know are true. "I'm probably not teaching you anything new," Scott said at one point. "But there are things you could categorize from your experience, like: yeah, that resonates. I should double down on that thought."

That's a decent summary of the whole conversation, honestly.

What I took away: the instinct to double down isn't about confidence in your original thesis. It's about following what the data is already telling you. Scott has built his entire career around that one move, applied repeatedly across niches, products, and people.

The hardest part isn't seeing the signal. It's having the discipline to act on it when every other instinct says to spread the risk.copy

ON YOUR RADAR 

• Read: Becker’s Health IT explains the healthcare AI PR wars.

• Resource: Retrospective HCC recapture is losing ground. Regard’s Lens finds net-new, defensible diagnoses in outpatient data. One health system found $18.2M in net-new HCC revenue. Request your free HCC gap analysis.*

• Breakdown: J.P. Morgan dropped its mid-year healthcare investment banking outlook, and the TL;DR: capital is flowing, and it's flowing toward a very specific set of themes.

• Event: Meet me for happy hour at Vizient Connections Summit. I’m getting a group together for drinks on Sept 23 at The Venetian. If you’re going to the summit, you won’t even need to leave the hotel. If you touch workforce transformation, this is for you! Apply to RSVP here.

*This resource is brought to you by one of my brand partners who help make this newsletter possible!

Thanks for the read! Let me know what you thought by replying back to this email.

— Blake