I’ve been inside the machine.
I know why it breaks
James Riviezzo
I’ve spent two decades in healthcare operations—including owning and operating a fast-growing primary care practice inside a major hospital system—understanding what drives physician burnout and why patient selection matters more than patient volume.
I helped private practices open with optimism. And I helped practices close when the math stopped working and the physician hit the wall.
I’ve worked across payers, ACOs, primary care and specialty practices, building systems that improve retention, simplify workflows, and reduce operational friction.
But I kept seeing the same problem: operational improvements can’t fix a fundamentally broken patient mix.
Now I help physicians build Direct Primary Care practices that actually deliver freedom by applying clinical judgment to patient selection—and avoiding the mistakes that you can’t undo.
✉️ Email: james@first100patients.com
📞 Call: 480-518-3134