Ep. 230 Out of Network and in Control with Dr. Sarah Bryczkowski

Episode Summary

What happens when a surgeon decides she's done being underpaid and undervalued — and refuses to sell her practice to private equity? She goes out of network. That's exactly what Dr. Sarah Bryczkowski did, and in this episode she walks us through every step of how she made it work.

Dr. Bryczkowski is a robotic general surgeon in Somerset County, New Jersey and a partner at Somerset Surgical Specialists. After making partner in a private practice and realizing she was barely covering overhead as an in-network surgeon, she convinced her partners to take the leap out of network. Since September of last year, they've been operating entirely out-of-network — and they've never looked back.

This episode breaks down a model that most physicians have heard about but don't fully understand. Sarah demystifies the billing process, explains what the No Surprises Act actually means for surgeons and patients, and talks honestly about the financial risks, the leap of faith, and what it finally feels like to get paid what you're worth.

What You'll Learn in This Episode

What "out of network" actually means — and why insurance companies don't want you to understand it
How the No Surprises Act changed the game (for better and for worse)
What balanced billing really is — and how it's used to scare patients away from out-of-network doctors
How Independent Dispute Resolution (IDR) works and why surgeons are winning
The billing workflow: from consult to arbitration (and why you won't see money for 3–6 months)
How Dr. Bryczkowski convinced her skeptical partners to make the switch
The partnership track reality — why making partner isn't always what you expect
What the first year in an out-of-network practice actually looks like financially
The metrics to watch so you're not flying blind on income
Who this model is and isn't right for
How to find a billing company and legal team you can trust

Key Quotes

"I'm doing quality surgery. I wanted to find a way to get paid what I'm worth for what I do — and the employed model didn't fit."

"Balanced billing is a term insurance companies use to scare people away."

"Even if I wasn't making money, I wouldn't want to be told what to do. It's worth it."

"I don't have people problems, I have checklist problems."

"You're sucking wind now, but as long as you've got the metrics, you know you're gonna be okay."

"It's a journey of faith and challenge and courage — but it's so worth it."

Resources Mentioned

Somerset Surgical Specialists — somersetsurgical.com
The No Surprises Act (2021)
Independent Dispute Resolution (IDR) process
Online directories for in-network/out-of-network physician lookup

About Dr. Sarah Bryczkowski

Dr. Sarah Bryczkowski is a robotic general surgeon and partner at Somerset Surgical Specialists in Somerset County, New Jersey. She trained at Hackensack University Medical Center, where she was first exposed to the out-of-network practice model. After several years in both employed and in-network private practice settings, she led her practice group to transition out of network — without selling to private equity. She specializes in complex robotic surgery including component separations, hiatal hernia repairs, and fundoplications.