Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
There is a subtle but profound shift that happens when your identity changes.
Not the kind of shift that comes with a new title or role, but the kind that is forced. The kind that emerges when something foundational is altered, and the assumptions you once relied on no longer hold in the same way.
For physicians, identity is often tightly interwoven with decision-making. We are trained to trust our judgment, to …
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The quiet shift that changes physician decision making
Who staffs the immigration detention centers, the temporary holding camps, the privately run facilities where thousands of frightened people are waiting behind fences and concrete walls?
That is not a rhetorical question. It is a practical one. There are doctors, nurses, administrators, guards, transportation workers, and contractors working inside these institutions today. Some believe they are helping under difficult circumstances. Others regard it as employment within a structure that continues because …
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Profit motive in medicine: lessons from private detention
35 years ago, I stood in a hospital hallway and made a decision that would define the rest of my professional life. I was halfway through my internship year in radiation oncology, a field of high-tech linear accelerators and clear-cut protocols, but my heart had drifted toward psychiatry. When I finally voiced my intent to switch, I didn’t find the collegial support we are taught to value in medical training. …
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35 years after choosing psychiatry as a specialty
Medical malpractice is big business in the United States. The only database monitoring medical malpractice is the National Practitioner Data Bank (NPDB). The NPDB’s annual report claims only 13,000 medical malpractice lawsuits. The NPDB was first established by the Health Care Quality Improvement Act in 1986. It was created by politicians (attorneys) for the express purpose of tracking specific adverse actions against health care practitioners.
Only 13,000 lawsuits are hardly “big …
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Medical malpractice lawsuits cost $56 billion a year
Transitioning from one part of the country to another can be daunting, though for me it has become a fascinating lesson in both what differentiates us and what remains remarkably the same. Geography changes. Accents shift. Customs vary. Yet suffering, fear, hope, and love seem to speak a language of their own.
I have continued to practice medicine much as I always have, in person, at the bedside, and in patients’ …
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Bedside medicine and the meaning of physician presence
A physician, whom I will call Dr. Hannah, initially sought coaching from me to address burnout and optimize clinical documentation in the electronic medical record. One of the major challenges that surfaced in her first coaching session was that she did not know who she was outside of work. She also wanted to bring more joy, fulfillment, and meaning into her life. Dr. Hannah’s schedule was so intense that she …
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Spirituality is a remedy for physician burnout
When institutions begin to fear the consequences of telling the truth, the First Amendment becomes a parchment promise rather than a living principle. Medicine is not immune to this cultural shift. Physicians who once spoke freely about patient safety, training standards, and systemic failures now hesitate, not because they lack conviction, but because the corporate structures around them punish candor. The result is a profession that has lost not only …
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The quiet loss of dignity in medicine
In anesthesia, we meet patients at one of the most vulnerable moments of their lives. We care for patients as a team, and I’m grateful for the skilled certified registered nurse anesthetists (CRNAs) I work alongside every day. Often, we are asked to earn trust quickly, while patients place their safety and comfort in our hands. What we offer in those moments goes beyond technical skill. This is my attempt …
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Anesthesiologist bedside manner matters more than skill
He is an engineer from Guatemala, in his sixties. The Spanish accent has gone mostly quiet after decades in the States, but not entirely. Six months ago I did a radical prostatectomy on him. Localized disease, favorable risk, I spared the nerves. It went the way you hope these things go.
Today, sitting across from me in my clinic, his prostate-specific antigen (PSA) is 0.05. Which, if you are not in …
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Doctor patient trust cannot be automated
What if I told you that burnout is not the most dangerous thing happening to primary care physicians right now? I actually think there’s something worse, and it’s happening quietly. Because many experienced doctors are slowly losing something they never expected to lose: themselves.
Not their license. Not their income. Not even their career. Themselves. Their energy. Their personality. Their joy. Their curiosity. Their life outside medicine.
Hello, I’m Dr. Gani. And …
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Physician burnout is quietly costing doctors themselves
I had matched into one of my top pick residencies, and I was living out my “dream life.” I was a very proud active-duty military member, and I was an oral and maxillofacial surgery resident. I loved where I lived, and my co-residents were amazing. The program fit my personality, and I was surrounded by extremely supportive attendings with few exceptions. I had gotten exactly what I had hoped for …
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Overcoming physician burnout during medical residency
The challenges in dealing effectively with this issue are compounded by multiple factors. These include an overall national shortage of physicians, particularly in rural communities, as well as being more prevalent in some specialties than others.
In addition, if an impaired physician has been a long-standing member and past leader of the medical staff, is responsible for a significant number of hospital admissions, has consistently participated in the institution’s annual fundraising …
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Why hospitals delay action on impaired physicians
I have been gathering information about the neuroscience of happiness for over a year now, since the completion of my previous book, Legal Mind in Medicine, and decided to put a glimpse of it in an article form for the Memorial weekend reading.
Happiness stands as a central human pursuit, shaping our physical health, mental resilience, productivity, and relationships. As physicians, understanding the science of well-being offers real value. It …
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Lifestyle, mindfulness, and the neuroscience of happiness
We spend a lot of time talking about how broken the medical system is: burnout, moral injury, administrative overload, loss of autonomy. We propose solutions: better workflows, more staffing, policy reform, technological innovation. But there is a harder truth we tend to avoid. The overall medical training system needs an overhaul.
Medical training does not just teach knowledge and clinical skill; it shapes identity, hierarchy, and thought patterns. From the earliest …
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Why medical training ignores the business of medicine
Patients often assume that someone is directing their care. That there is a clinician who sees the whole picture, integrates the information, and guides what happens next. In many cases, that is not how modern care is structured. Patients move between clinicians (primary care, specialists, urgent care, consultants), each focused appropriately on a specific aspect of the problem. Each encounter may be thorough. Each decision may be reasonable. Each plan …
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Fragmented care needs clinical direction, not more data
We were on a call recently with a physician who told us, almost in passing, that she’d been seeing patients on a telemedicine platform for four years. She said it the way you’d mention a hobby. Then she added, before we could say anything, that of course it was just a side gig.
She’d been doing it for four years. It was her practice.
We’ve had some version of that conversation hundreds …
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Telemedicine as a career, not a side gig
A physician receives the letter. It is short, formal, and absolute. A complaint has been filed. An investigation is underway. In that moment, something shifts. Not just professionally, but personally. The identity built over years of training, sacrifice, and responsibility suddenly feels fragile. Every decision, every note, every outcome is now seen through a different lens. What follows is rarely discussed. Not in training. Not in hospital corridors. Not even …
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How a medical investigation drives physician burnout
My daughter had been home sick for three days. Not the kind of sick that keeps you in bed, but the kind that lingers just enough to keep you home, well enough to be bored. She was restless, observant, and thinking. She is 10.
Her dad stayed home with her the first day. I took the second. By the third day, I went back to work. I arranged my schedule so …
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How physician burnout impacts modern health care
