Most physicians dream of independence but dread the isolation and heavy lift of running a solo practice. What if there were a way to share infrastructure, lighten the load, and still maintain your autonomy?

In this episode, Dr. Disha Spath sits down with special interviewer Dr. Dan Sooriabalan and guest Dr. Natalie Gentile to explore how managed services organizations (MSOs) can strengthen direct primary care practices. From sharing cross-coverage to negotiating employer contracts, she shares how she and her partner built a collaborative model that supports physicians while keeping patient care personal.

This conversation is packed with lessons on leadership, partnership, and building something bigger than yourself!

Key Topics Covered:

1. The Hidden Price of 401K

• Breaking down what a managed services organization is and why it matters for direct primary care.

2. From Vaccine Clinics to Direct Primary Care Collaboration

• How grassroots community efforts during the pandemic sparked the creation of Pittsburgh’s first DPC-focused MSO.

3. Shared Pain Points, Shared Solutions

• Cross-coverage, marketing, vaccine acquisition, mentorship—how an MSO makes solo practice less lonely.

4. The Business Side of Medicine

• Legal guardrails, employer contracts, and the financial realities of keeping physician ownership at the center.

5. Scaling Without Selling Out

• Why Natalie and her co-founder built their MSO without private equity—and how they’re keeping it mission-driven.

6. Not a One-Size-Fits All

• Why MSOs aren’t one-size-fits-all and what to consider before starting one in your own region.

Listener Takeaways:

• MSOs (Managed Services Organizations) give DPC doctors shared infrastructure—like marketing, cross-coverage, and legal support—without sacrificing independence.
• Collaboration often starts with small, local initiatives (like community vaccine clinics) before scaling into sustainable models.
• Legal and financial guardrails are essential to keep physicians—not private equity—at the center of ownership.
• Quarterly case reviews, mentorship, and camaraderie help prevent isolation and burnout in solo practice.

Resources Mentioned:

• Gentile Family DPC
• Maintenance Phase Podcast
• Atlas.md
• Direct Care Physicians of Pittsburgh
• Rebel Wellness

Connect with Us:

Host: Dr. Disha Spath, The Frugal Physician
Guest: Dr. Natalie Gentile, Gentile Family DPC

This episode is brought to you by:

Earned Wealth: Earned's unique Doctor Wealth Playbook includes tax planning, investing, insurance, career advisory, and more. It’s a holistic approach from advisors who get the financial pressures of your profession. And for a limited time, Frugal Physician listeners can visit Earned.com/Frugal for exclusive access to this comprehensive planning at a discounted rate.

Most of us assume our 401k plans are free because we never see a bill. But hidden fees—record keeping, custodial, administration, and advisory costs—can silently erode your retirement savings over time.

In this episode, Dr. Disha Spath sits down with forensic 401k consultant Paul Sippel to uncover how these costs work, why they’re so hard to detect, and practical steps you can take to protect your wealth.

If you’re a physician, business owner, or employee relying on your 401k for retirement, this conversation is a must-listen!

Key Topics Covered:

1. The Hidden Price of 401K

• Why most employees (and even physicians) don’t realize how much retirement fees are costing them

2. Decoding the Fee Structure

• Custodial, record keeping, administration and advisory charges explained by Paul

3. So Who Really Pays the Bill?

• How physicians often carry a bigger share of plan costs than their staff.

4. Defining a “reasonable” costs

• Benchmarks to know if your plan fees are fair or quietly draining your bank account.

5. Beware of the Transparency Trap

• Why statements rarely show the true expense and how the industry profits from the confusion

6. Proven Strategies to Lower the Fees

• From negotiating employer-level billing to exploring self-directed brokerage accounts.

Listener Takeaways:

• If you’ve never seen a bill for your 401k, that doesn’t mean it’s free—the fees are just hidden.
• Even “small” percentages in fees can compound into massive retirement losses over time.
• Physicians are often subsidizing their staff’s 401k costs without realizing it.
• Shifting fees to the employer level creates more fairness and bigger savings potential.
• You have the tools to uncover and reduce your 401k fees—knowledge equals real money saved.

Resources Mentioned:

• Chatgpt
• Department of Labor’s www.efast.dol.gov
• FreeERISA

Connect with Us:

Host: Dr. Disha Spath, The Frugal Physician
Guest: Paul Sippel, 401k Forensic Consultant