As a practicing pain management physician in good standing in California, I’ve observed how accusations against physicians are actively encouraged, while meaningful accountability for false or exaggerated claims is largely ignored. This creates a system that rewards a “throw mud until something sticks” strategy for financial gain by patients, insurers, and other parties. This is precisely why I wrote the book Legal Mind in Medicine to highlight the legal aspect of medicine in general and pain medicine in particular. As Chairman of the National Campaign to Protect People in Pain (NCP3), I regularly hear from both patients and colleagues who are deeply frustrated with this broken system. The problem exists nationwide but is especially severe in California.
Even when a physician successfully defeats an allegation, the media rarely closes the loop. Accusations are publicized freely, but exonerations receive little attention. This leaves the public assuming “there must be a reason” for the accusation, causing lasting reputational damage with no real consequences for the accuser. As a result, it is common to see good physicians leaving California to practice elsewhere in search of a more peaceful environment.
In my previous article at KevinMD, I painted a stark picture: high taxes that erode take-home pay combined with an aggressive California Medical Board that leaves physicians constantly looking over their shoulder. The result? A growing physician shortage as doctors question whether staying in California still makes sense. A couple of weeks later, I followed up with the crushing daily reality of administrative burden of prior authorizations, endless EHR clicks, and bureaucratic hurdles that turn medicine into a paperwork grind and fuel severe burnout. Many of us nodded in recognition reading both pieces, as they hit close to home.
But there’s a third, often unspoken piece of this puzzle that makes the exhaustion feel almost inevitable: California’s lopsided legal system, which stacks the deck against physicians even when they’ve done nothing wrong.
Take medical malpractice for example. Under the American Rule, each side pays its own attorney fees. That means even when a doctor wins, which majority do, they still absorb the massive cost of defense, often several hundred thousand dollars in legal bills, lost time, and emotional toll. Insurance helps, but it doesn’t make you whole. Lose, and the financial exposure grows even larger.
California’s MICRA law was originally designed to bring some stability with caps on noneconomic damages. Yet recent changes through AB 35 have steadily raised those caps, with further increases baked in. While meant to support patients, many physicians worry it will encourage more claims and drive up costs. California already sits near the top in raw volume of malpractice payments reported to the National Practitioner Data Bank. Even “winning” a case leaves scars on reputational, psychological, and financial. It’s not just stressful; it’s demoralizing.
The practical reality for physicians hasn’t changed much. Frivolous or low-merit suits are still relatively low-risk for plaintiffs and their attorneys, who often work on contingency. Filing is easy; discovery is expensive and time-consuming for the defense. The National Practitioner Data Bank tracks these reports, and while California’s per-capita figures aren’t the absolute worst, the sheer volume combined with high defense costs contributes to the sense as mentioned above that the system is stacked against the provider.
This isn’t theoretical. Studies have long shown that tort reform environments, including damage caps, influence where doctors choose to practice. Physicians are more likely to locate in (or stay in) states with balanced liability rules, and the opposite is true as well, but some leave high-risk environments for greener pastures.
The same unfair dynamic plays out in employment lawsuits against physician practices. California’s strong labor and discrimination laws (like FEHA and wage-and-hour rules) often let a prevailing employee recover their attorney fees from the practice. But if the doctor-employer wins, getting their own fees and costs back is extremely difficult as usually only possible if the claim is deemed outright frivolous, a very high bar.
This one-way street lowers the risk for filing complaints and raises the cost of defending them. It encourages “throw it at the wall and see what sticks” litigation like discrimination claims, wage disputes, and wrongful termination allegations. Practices often settle nuisance cases not because they’re liable, but because fighting everyone to the end drains time, money, and focus away from patients.
I warned in March that taxes and board scrutiny are pushing doctors out. In April I showed how administrative overload is burning us out. Add this legal asymmetry on top, and the message becomes clear. Practicing in California increasingly feels like a high-stakes gamble where physicians carry most of the downside risk, even when they’re right.
This matters deeply because California is already short thousands of physicians, especially in primary care and in underserved areas like the Central Valley and Inland Empire. When talented doctors cut hours, retire early, move to states with more balanced rules, or leave clinical medicine, patients are the ones who suffer with longer waits, reduced access, and care that feels more rushed.
Good doctors have never opposed accountability. When real harm occurs, patients deserve justice. The problem is the current system often treats every claim as equally viable, with little downside for weak or opportunistic filings. It turns every patient interaction and every employment decision into a potential legal landmine.
Real solutions to the burnout and shortage crisis that has been highlighted won’t come from wellness programs or more resilience training. They require tackling the structural issues head-on: punitive taxes and board actions, suffocating bureaucracy, and a tilted legal playing field that makes defensive medicine and constant self-protection feel necessary for survival.
California has the talent and innovation to lead health care. It could also lead by creating a fairer environment, the one that protects patients without making the practice of medicine feel punitive. Until we address all three legs of this stool, the exodus and the burnout will continue. And patients will pay the heaviest price.
Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.
Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.
Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.
