Problems with RVU-based reimbursement

Medicine is full of people doing the right thing inside systems that reward the wrong work.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Shikha Jain, a hematologist-oncologist, professor, and founder of Women in Medicine, to discuss why some of the most essential work in medicine happens after hours, off the clock, and without recognition - especially for women physicians.

Shikha makes a clear case for why physician distress isn’t a resilience problem, a time-management issue, or a pipeline failure. It’s a systems problem. From RVU-based compensation models that ignore invisible labor, to unpaid committee work that never counts toward promotion, to insurance barriers that put doctors in the crosshairs while profits flow elsewhere, she explains how modern healthcare quietly extracts more from physicians while valuing them less.

Together, Graham and Shikha explore how gender expectations shape leadership, why women physicians are “voluntold” into uncompensated work, and how stereotypes around empathy and agreeableness create double standards that follow doctors from the clinic to the boardroom.

The conversation closes with practical guidance for change: how physicians can set boundaries without guilt, how institutions can measure the work that actually matters, and how male allies can show up in ways that help rather than harm.

This episode isn’t about blaming individuals. It’s about fixing the system so doctors can keep doing the work that brought them to medicine in the first place.

What You’ll Learn

1. Why physician burnout is a structural failure, not a personal one
2. How RVU-based compensation undervalues real clinical and cognitive work
3. The hidden, uncompensated labor disproportionately carried by women physicians
4. Practical ways physicians and allies can drive meaningful change

Learn More About Shikha & Women in Medicine

1. Dr. Shikha Jain: https://shikhajainmd.com
2. Women in Medicine: https://www.wimedicine.org
3. Women in Medicine Summit September 24-26, 2026: https://www.wimedicine.org/summit
4. Oncology Overdrive Podcast: https://oncologyoverdrive.com

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