Physician shortages, board certification, medical monopolies, residency bottlenecks, telemedicine policy, and healthcare regulation- recorded at the time of the conversation, this episode with Dr. Paul Teirstein examines why parts of U.S. healthcare may be structurally broken by design.

In this episode of Analyzing Healthcare, the conversation with Dr. Paul Teirstein of Scripps Health explores one of the most provocative questions in U.S. healthcare: how much of the system’s dysfunction is accidental, and how much is self-inflicted. Drawing from his experience as a practicing cardiologist and founder of a competing physician certification board, Dr. Teirstein explains why many doctors view maintenance of board certification as an expensive, burdensome monopoly rather than a meaningful measure of quality. The discussion also expands into physician shortages, residency funding, medical education bottlenecks, telemedicine restrictions, and how monopolistic structures across healthcare can drive higher costs, worse access, and unnecessary frustration for clinicians and patients alike.

What You’ll Learn
• ✅Why many physicians are pushing back on maintenance of board certification
• ✅ How the American Board of Internal Medicine became a gatekeeper in medicine
• ✅ Why Dr. Paul Teirstein launched the National Board of Physicians and Surgeons
• ✅ How certification requirements may contribute to burnout and early retirement
• ✅ Why physician shortages stem from broader structural and funding challenges
• ✅ How telemedicine restrictions continue to limit access to care
• ✅ Why monopolies in healthcare often drive higher costs and weaker service
• ✅ Why continuing medical education may matter more than repetitive testing
• ✅ How policy and regulation continue to shape physician supply in the U.S.

Timestamps
• (00:04) Introduction to Dr. Paul Teirstein and Scripps Health
• (01:43) Why Dr. Teirstein challenged the American Board of Internal Medicine
• (03:12) How board certification became a de facto requirement to practice
• (05:28) Revenue growth, maintenance requirements, and physician frustration
• (07:12) Why Dr. Teirstein started the National Board of Physicians and Surgeons
• (09:25) Payers, hospitals, and the barriers to alternative certification
• (11:37) What initial certification gets right—and where ongoing requirements fail
• (15:37) How AI and OpenAI’s ChatGPT expose weaknesses in board testing
• (18:52) Is maintenance certification a real quality measure—or just a tax?
• (20:32) Physician shortages, burnout, and unnecessary administrative burden
• (22:27) Medical schools, residencies, and the supply bottleneck
• (26:57) Why residency funding remains central to physician supply
• (31:41) Telemedicine, regulation, and access to care
• (36:07) The broader problem of monopoly power in healthcare

Key Takeaways
• 💎 Board certification requirements have become a major pain point for many physicians.
• 💎 CME may do more to keep doctors current than repetitive testing.
• 💎 Physician shortages stem from broader structural barriers, including residency limits.
• 💎 Telemedicine can expand access, but policy hurdles remain.
• 💎 Healthcare monopolies often drive higher costs and poorer service.
• 💎 Reducing administrative burden could improve physician retention and care access.

Resource Links
Guest: Dr. Paul Teirstein – Cardiologist, Scripps Health
Host: Roy Bejarano, CEO & Co-founder at SCALE Healthcare
Podcast: Analyzing Healthcare by SCALE Community
SCALE Community: https://www.scale-community.com

Guest Bio
Dr. Paul Teirstein is a Chief of Cardiology at Scripps Health in San Diego, where he leads within the cardiology division and performs minimally invasive heart procedures including coronary stents and transcatheter valve interventions. In addition to patient care, training, and research, he is also the founder of the National Board of Physicians and Surgeons, created in response to growing physician frustration with the maintenance of certification processes. His work sits at the intersection of clinical excellence, medical policy, and physician advocacy.

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