At the heart of this revolution is Keith Smith, M.D. , an anesthesiologist and co-founder of the Surgery Center of Oklahoma. His model has become a beacon for patients and an inspiration for physicians, proving that health care can be both affordable and high quality—if physicians are willing to step outside of the traditional third-party payer system.

I had the privilege of speaking with Smith for the Medical Economics podcast Physicians Taking Back Medicine. For me, the conversation was not only professionally inspiring but also deeply personal. As a family physician, I’ve referred my own patients across the country to Oklahoma for surgeries they could not afford locally.

One of my patients without health insurance was quoted $20,000 at a local hospital for a life-saving surgery—so expensive he needed to sell his Harley-Davidson motorcycle to pay for it. Instead, he flew to Oklahoma, where he underwent surgery for under $5,000 (including travel and lodging), and returned home with his dignity, health, and savings intact.

That kind of story raises the obvious question: Why isn’t this model being replicated everywhere?

Music Credits
Medical Education by Art Media – stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using AI tools.

Patient Frustrations and Introduction to Keith Smith, M.D. (00:00:14) Overview of patient struggles with the healthcare system and introduction to Keith Smith, M.D., and the Surgery Center of Oklahoma.

Smith’s Background and Motivation (00:00:54) Smith’s early career, government payment frustrations, and decision to leave traditional hospital practice.

Founding the Surgery Center of Oklahoma (00:01:40) How Smith built his reputation, gathered colleagues, and started the surgery center to protect patients financially and medically.

Early 90s Healthcare Problems and Free Market Motivation (00:02:27) Declining quality of care, financial abuse by hospitals, and the decision to create a fair, market-driven alternative.

All-Inclusive Cash Pricing Model (00:04:02) Explanation of the center’s cash pricing, initial patient stories, and dramatic cost differences compared to hospitals.

Building the Price List and Industry Pushback (00:05:27) Development of a public price list, industry backlash, and the center’s role as a champion for affordable care.

Posting Prices Online and Market Impact (00:06:35) Decision to post prices online in 2009, attracting patients nationwide, and sparking a price war in healthcare.

Growth and Influence of the Surgery Center (00:07:42) Expansion to a larger facility, multi-specialty services, and inspiring other centers to adopt transparent pricing.

Patient Success Story and Website Usability (00:08:39) A patient’s experience using the website, cost savings, and positive outcomes compared to traditional hospitals.

Surgeon Compensation and Hospital Billing Disparities (00:09:55) Discussion of the vast difference between hospital charges and actual surgeon payments.

Market Creation and Price Matching (00:10:09) How public pricing led to market competition, price matching by hospitals, and the creation of a healthcare marketplace.

Eliminating Middlemen and Keeping Prices Low (00:12:19) How removing hospital profit motives keeps surgery prices reasonable and benefits both patients and physicians.

Barriers for Surgeons Adopting the Model (00:12:38) Challenges and fears preventing more surgeons from leaving the traditional system for a free market approach.

Entrepreneurship and Payment Systems for Physicians (00:13:11) The need for confidence, entrepreneurship, and understanding payment logistics for physicians considering this model.

Atlas Billing Company and Free Market Medical Association (00:14:32) How Smith’s billing company and association help other physicians transition to cash-based or hybrid models.

Headwinds and Examples of Success (00:15:46) Real obstacles, government resistance, and examples of other centers successfully adopting the model.

Advice for Physicians Considering the Model (00:18:23) Practical steps for doctors: starting small, finding leadership, and considering relocation to more receptive areas.

Overcoming Inertia and Finding Opportunities (00:20:29) Discussion of geographic and systemic barriers, and strategies for launching a physician-owned center.

Risks of Insurance Contracts and Going Independent (00:22:14) Risks of working with insurance companies, benefits of independence, and advice to leave government payments.

Economic Principles and Physician Value (00:23:44) Understanding value from an economic perspective and the importance of seeing value through the patient’s eyes.

The Free Market Model as a Positive Alternative (00:25:03) The benefits of the free market approach for physicians and patients, and encouragement to explore the model.

Closing Remarks (00:25:54) Host’s closing comments and invitation to future episodes.