Out of Patients with Matthew Zachary

Hosted by Matthew Zachary Worldwide

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526

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Nov 2026

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About the show

Matthew Zachary is the healthcare policy love child of Jon Stewart, Howard Stern, Thomas Paine, Ralph Nader, and Jerry Seinfeld. He has 19 years of receipts to prove it. Editorially independent. Answerable to no one. What started as The Stupid Cancer Show in 2007 became Out of Patients. The first online health podcast in America, predating the medium itself. Zachary survived brain cancer at 21, built the young adult cancer movement from scratch, and spent two decades channeling patient rage into something the system never saw coming. Now he is marching into Washington. Out of Patients goes where the comfortable shows will not. Politics. Healthcare policy. Economics. Institutional accountability. Consumer protection. The forces shaping what 330 million Americans can access, afford, and survive. Battle-scarred patients. Exhausted caregivers. Rare insiders brave enough to name what is killing us. And the occasional elected official about to find out what an organized patient constituency actually looks like. This is the show that started the conversation America is still not ready to finish. ]]>

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60 recent

November 10, 202640 min

[BEST OF OOP] Dr. MaryAnn Wilbur

Dr. MaryAnn Wilbur spent years doing exactly what medicine tells ambitious people to do. She got the grades, survived medical school, finished residency and fellowship, and became a gynecologic oncologist caring for people with cancer. Then the system began asking her to practice medicine in ways she believed compromised patient care, while treating human beings like “volume” and “throughput” and stripping away the resources physicians need to do their jobs. Eventually, the consequences became personal. MaryAnn found herself confronting something far darker than burnout: moral injury, suicidal thoughts, and the realization that being Dr. Wilbur had swallowed the rest of MaryAnn Wilbur. She ultimately walked away from clinical medicine and began figuring out who she was outside the profession that had defined most of her adult life. In this conversation, we get into physician suicide, hospital economics, 15 minute cancer appointments, the pressure physicians face inside large healthcare institutions, and why blaming Epic for physician burnout misses the giant flaming dumpster behind it. MaryAnn talks about the moment she knew she needed an “escape plan,” the shame physicians can face when they leave medicine, and what happens when the person trying to protect you from the healthcare system also works for the healthcare system. We also talk about what came next. MaryAnn coauthored The Doctor Is No Longer In, joined the work of Medicine Forward and the Clinician Burnout Foundation, and became involved with the documentary Suck It Up Buttercup. Her work now focuses on exposing the structural forces driving clinicians out of medicine and helping build something better for the people who care for patients and the patients counting on them. And because this is Out of Patients, we somehow find our way to formaldehyde, Shawshank Redemption, the “This Is Fine” dog, Wonder Woman, Douglas Adams, Broadcast News, ER, Erin Brockovich, and my temporary inability to distinguish Lynda Carter from Linda Hamilton. MaryAnn describes herself as “passionate and irreverent.” That tracks. RELATED LINKS MaryAnn Wilbur on LinkedIn The Doctor Is No Longer In: Conversations With U.S. Physicians Suck It Up Buttercup Film Clinician Burnout Foundation FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

November 3, 202642 min

[BEST OF OOP] Farla Efros

Farla Efros is a senior retail executive and former CEO who built and sold companies before facing her own breast cancer diagnosis. She brings that same operational mindset into a healthcare system that expects patients to manage complexity while they are at their most vulnerable. She was on a client call in Spain when the diagnosis came through. A clear mammogram had missed it. An MRI caught it. Within hours, she was ordering binders, building a plan, and structuring her treatment like a turnaround strategy. Every appointment became a meeting. Every doctor faced an agenda with dozens of questions. She paid out of pocket for PET scans that were denied and hired a third party firm to validate her treatment path when her own doctors resisted outside input. The conversation tracks what happens when a high-functioning executive enters a system built on delay, denial, and fragmentation. Efros describes negotiating for tests, managing physician relationships, and assembling an “executive board” of advisors across conventional and alternative care. She calls the experience “the worst client I ever had,” exposing how administrative burden shifts onto patients and families. The tension sits between what worked for her and what is inaccessible to most. Her approach requires confidence, time, and fluency in navigating power. The system rewards that behavior while quietly failing patients who cannot replicate it. Insurance coverage still left her paying out of pocket. Doctors pushed standard protocols over precision medicine. Survivorship offered little support once treatment ended. This episode examines how cancer care operates as a series of incentives rather than a coordinated system, and why patients are forced to become operators just to get through it. RELATED LINKS Farla Efros Farla Efros on LinkedIn F*ck Cancer F*ck Cancer on Amazon Accenture CTOAM FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

October 27, 202645 min

[BEST OF OOP] Katy Talento

In 2008, Katy Talento walked away from Capitol Hill and into a Catholic convent. Within a year, she walked out. Within another decade, she sat inside the White House shaping health policy. Somewhere in between, she got labeled “infertile” after a single cycle of testing and spent years believing it. That label stuck. The pain that came before it never got investigated. Doctors offered birth control and moved on. No one asked why her body was struggling. No one followed the thread. Talento built her career inside the very systems she now critiques. She worked on federal health policy, global disease programs, and later advised the Trump administration on healthcare reform. She helped advance price transparency rules in a system where hospitals can still list 457 different prices for the same service. Then she left. Now she builds employer health plans that bypass insurers, PBMs, and traditional networks. Her approach replaces insurance contracts with direct payment, nurse navigators, and cost sharing models that promise simplicity but raise hard questions about risk and protection. This conversation sits in that tension. Talento describes a healthcare system shaped by layered incentives, where insurers, hospitals, and intermediaries profit from complexity. She argues that employers hold the leverage to disrupt it. The host pushes on what happens when patients fall outside those structures, when contracts disappear, and when community based models fail. The episode moves through infertility, misdiagnosis, insurance design, and the mechanics of employer sponsored care. It tracks how policy decisions made in Washington ripple into exam rooms, billing departments, and family lives. It also confronts a harder truth. Even insiders who understand the system can still get caught in it. RELATED LINKS AllBetter Health Katy Talento Them Before Us An Arm and a Leg Relentless Health Value FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

October 20, 202652 min

[BEST OF OOP] Ben Unger

In a wooded campground cabin in the early 2000s, 19 year old Ben Unger stood in the doorway and watched 20 naked men form a circle around a crying teenager. A counselor held up two tangerines and shouted, “These are your balls.” The exercise claimed to cure same sex attraction by forcing young men to “reclaim” their masculinity from overbearing mothers. Phones had been confiscated. Parents had paid thousands of dollars. Religion supplied the script. Pseudoscience supplied the props. Ben had grown up in an Orthodox Jewish community in Brooklyn and later studied in Israel to become a rabbi. When he admitted he felt attracted to men, rabbis told him to eat 7 figs a day, immerse in a ritual bath 5 times daily, or marry a woman and trust that “if there’s friction, it works.” At 19, he entered conversion therapy through an organization called Jews Offering New Alternatives to Homosexuality, known as JONAH. He left with depression, religious trauma, and 6 months of silence toward the mother he had been taught to blame. Years later, represented by the Southern Poverty Law Center, Ben helped sue JONAH for consumer fraud in a landmark New Jersey case. The argument centered on evidence, not theology. Sexual orientation cannot be changed. The jury deliberated for 3 hours and ruled against the organization. The verdict helped reshape how states regulate conversion therapy and protect minors from psychological harm disguised as treatment. Today, Ben runs Buff Personal Training in New York City, a gym built on autonomy, mental health, and self respect. His story traces the arc from institutional control to self authorship. The conversation examines religion, LGBTQ rights, conversion therapy, consumer protection law, and the lasting cost of being told your identity is a disorder. RELATED LINKS Ben Unger on LinkedIn Ben Unger on Instagram BUF Personal Training Southern Poverty Law Center JONAH FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

October 13, 202641 min

[BEST OF OOP] Jessica J. Federer

Jessica Federer built her career inside the rooms where science, money, and power collide. As the first female Chief Digital Officer at Bayer, she helped steer a 120,000 person global company through the rise of digital medicine while confronting a harder truth: women were excluded from U.S. clinical trials until 1993. In this conversation, she explains how decades of “first in man” research shaped drug development, why women experience side effects at nearly 2x the rate of men, and how guidance on sex based differences did not arrive from the FDA until December 2025. She shares what it means to sit on a Yale Institutional Review Board, why clinical trial stipends over $3,000 get taxed, and why she believes participants deserve tax credits instead. From GLP 1 profits to $40,000,000 women’s health funds that barely move the needle, this episode names the gaps and the opportunity hiding inside them. RELATED LINKS Jessica Federer on LinkedIn Jessica Federer on Instagram Yale School of Public Health Health of Women Investor Summit FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

October 6, 202647 min

[BEST OF OOP] Eugene Manley, Jr., PhD

Dr Eugene Manley grew up in Detroit in the 1980s cycling through emergency rooms 20 to 30 times a year with asthma and anaphylaxis while hospital staff talked past his family and buried them in paperwork they could not decode. He responded by earning a BS in mechanical engineering an MS in biomedical engineering and a PhD in molecular biology cell biology and biochemistry. Along the way he tore his ACL training for a jiu jitsu black belt worked 86 straight days in a lab during his doctorate and learned how academic and clinical systems punish people who refuse to shrink. In this episode Manley walks through a recent post surgery ordeal at Mount Sinai Queens where staff falsified records attempted an illegal discharge and nearly sent him home on the wrong blood thinner. He explains how medical racism shows up in charts staffing and decision making and why measurable equity fails without accountability. Listeners hear how his STEMM and Cancer Health Equity Foundation builds pipelines for underrepresented students challenges clinical trial design and teaches patients how to protect themselves when institutions lie. RELATED LINKS Eugene Manley Jr STEMM and Cancer Health Equity Foundation Village Voice LUNGevity Foundation FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

September 29, 202640 min

[BEST OF OOP] Jenny Opalinski

Jenny Opalinski has spent more than a decade inside hospitals where people lose the ability to speak, breathe, swallow, and sometimes survive. A medical speech language pathologist by training, she worked in ICU, neuro rehab, and long term acute care settings, including a Level 1 trauma center, where she watched clinicians absorb 10 to 15 traumatic events in a single shift and then get told to move the crash cart faster next time. That lived reality pushed her to co found The Wellness Shift, an advocacy and education platform focused on healthcare worker burnout, suicide, and assault. In this conversation, Opalinski walks through the moment that changed everything for her: standing in a hospital hallway listening to a family wail after a failed code, followed by a debrief that addressed logistics and ignored grief entirely. She also explains how that work led to Humanity Rx, her podcast about the human cost of medicine, and Dragon’s Breath: Calming Tricks for Big Feelings, a children’s book that translates evidence based breathing and regulation strategies into language kids can actually use. The episode covers moral injury, time scarcity, false wellness, respiratory muscle training, and why empathy keeps getting treated as an optional expense instead of clinical infrastructure. RELATED LINKS Jenny Opalinski on LinkedIn Humanity Rx Podcast FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

September 22, 202647 min

Fitz Happens: The Marvelous Fitz Koehler

Fitz Koehler is a fitness expert, race announcer, author, and breast cancer survivor whose career spans decades of helping people move, train, and live healthier lives. After earning a master’s degree in exercise and sport sciences, she built the Fitzness brand, launched the Morning Mile school fitness program, and became one of the country’s most recognizable voices at endurance events before cancer abruptly shifted the conversation. She spent 15 months enduring chemotherapy, surgery, and radiation after discovering breast cancer shortly after receiving a clean mammogram. She kept traveling, announcing races, and working through treatment while watching the body she had spent a lifetime building become weaker by the week. Instead of asking why cancer happened, she focused on the only things she believed remained under her control: movement, nutrition, sleep, and mental health. The conversation explores where personal agency ends and biology takes over. Koehler argues that exercise is not about chasing perfection or preventing every diagnosis. It is about building physical reserve before illness arrives and preserving strength, mobility, and independence during treatment. She rejects wellness snake oil, fad supplements, and miracle cures in favor of practical habits rooted in exercise science and lived experience. The discussion also confronts a harder truth. Koehler did everything “right” and still developed cancer. That tension becomes the center of the episode. Fitness cannot eliminate randomness, but it can influence how people experience treatment, recover from surgery, and reclaim their lives afterward. The conversation moves beyond motivation and into survivorship, exercise oncology, cancer rehabilitation, evidence-based nutrition, and the limits of individual control inside a healthcare system that often tells patients what they should do without showing them how to do it. Along the way, the conversation wanders through kickboxing, Cinnabon, Jean-Claude Van Damme, chocolate-covered Cheetos, Jerry Seinfeld playing during chemotherapy stretches, and why the simplest advice is often the hardest to follow. Beneath the humor sits a larger argument: preparing the body for hardship is not about living forever. It is about living better when life inevitably gets difficult. RELATED LINKS Fitz Koehler ⁠ Fitzness ⁠ The Morning Mile ⁠ You. Supercharged! ⁠ My Noisy Cancer Comeback ⁠ Your Healthy Cancer Comeback ⁠ UF Health Cancer Center ⁠ American College of Sports Medicine Exercise Is Medicine ⁠ FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

September 8, 202641 min

SurgeON: Dr. Jeremy Heffner

Jeremy Heffner, MD, FACS is a board-certified trauma surgeon, former Chair of Surgery at Lima Memorial Health System, and cofounder of Surgery Unified, one of the largest physician-led communities in surgery. His perspective carries weight because he has spent decades inside operating rooms, hospital leadership, physician culture, and the growing collision between medicine and corporate healthcare. He grew up in a blue-collar Ohio family of firefighters, railroad workers, police officers, and tradespeople. Medicine represented something rare: a career that combined service, stability, and purpose. He pursued engineering, earned his medical degree, completed trauma surgery fellowship training at the University of Michigan, and entered a profession that taught physicians to sacrifice themselves for patients. Then the rules changed. This conversation traces the gap between the medicine physicians were trained to practice and the healthcare industry that emerged around them. Administrative burden expanded. Insurance companies gained influence over treatment decisions. Prior authorization became routine. Hospital systems consolidated. Physicians retained responsibility for outcomes while losing authority over the conditions required to achieve them. Heffner describes watching colleagues struggle with burnout, moral injury, PTSD, and growing frustration with a system that increasingly inserts business incentives between clinicians and patients. He explains why younger physicians are entering medicine with a level of visibility that previous generations never had. They see the paperwork, the denials, the loss of autonomy, and the personal cost before they ever finish training. The discussion moves beyond physician dissatisfaction and into the broader consequences for patients. When insurers delay care, hospitals absorb costs, clinicians absorb stress, and patients absorb uncertainty. The financial incentives remain intact while trust erodes across every level of the healthcare system. At its core, this episode examines what happens when a profession built around service finds itself operating inside an industry built around extraction. The result affects physicians, nurses, caregivers, and every patient forced to navigate the consequences. RELATED LINKS Jeremy Heffner ⁠ Surgery Unified ⁠ SurgeOn ⁠ University of Michigan Department of Surgery ⁠ KevinMD ⁠ Suck It Up Buttercup ⁠ FEEDBACK Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.com See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .

September 3, 202618 min

[HIATUS] The Cancer Mavericks EP8: The Inequity of Cure: Who Gets to Matter

In 1971 , the National Cancer Act transformed cancer into a national research priority. More than 50 years later, the next frontier is no longer defined solely by scientific discovery, but by how quickly knowledge, lived experience, and patient voices can reshape healthcare itself. The concluding chapter of The Cancer Mavericks: A History of Survivorship explores how the cancer advocacy movement continues to evolve in an era of digital communities, social media, precision medicine, and grassroots activism. Building on the work of pioneers such as Mary Lasker , Rose Kushner , and the generations of survivors who followed, today’s advocates are expanding the movement beyond awareness to demand health equity, trusted information, patient-centered research, and meaningful representation in healthcare decision-making. The episode examines how technology has transformed advocacy from local support groups into global communities capable of organizing in real time. Researchers, policymakers, nonprofit leaders, and survivors reflect on the growing influence of digital storytelling, online education, and peer-to-peer networks that connect patients across diagnoses, generations, and geographic boundaries. At the same time, they acknowledge new responsibilities: ensuring accurate medical information, combating misinformation, protecting trust, and keeping patients at the center of innovation. The story also looks ahead to the next generation of advocates. Young leaders are applying lessons learned from decades of cancer activism while drawing inspiration from broader movements for social justice, public health, and community organizing. Their work reflects a simple but enduring truth: meaningful change rarely begins inside institutions. It begins when ordinary people refuse to accept that the system cannot improve. Cancer survivorship has never been a finished story. Every generation inherits the progress achieved by those who came before while confronting challenges uniquely its own. The future of survivorship will be shaped not only by scientific breakthroughs, but by those willing to listen, organize, educate, and ensure that every patient’s voice helps define what comes next. RELATED LINKS National Cancer Institute ⁠ Cancer Moonshot ⁠ Centers for Disease Control and Prevention | Division of Cancer Prevention and Control ⁠ HopeLab ⁠ Tigerlily Foundation ⁠ Stupid Cancer ⁠ FEEDBACK Like this episode? Rate and review The Cancer Mavericks: A History of Survivorship on your favorite podcast platform. For more information, visit CancerMavericks.com . Please send any questions to podcasts@matthewzachary.com . See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info .