Physician

Disruptive physician labeling: a symptom of systemic burnout

Physician
January 30, 2026

More physicians than ever are reaching out for support after being labeled disruptive, inefficient, delinquent, reactive, or poor communicators.

These are highly skilled, deeply committed professionals being written up for professionalism concerns, communication issues, behavior, and “reactivity.” These cases span every specialty, gender, and stage of career.

This is not a reflection of declining professionalism. It is a predictable outcome of practicing in an untenable and broken system. It is an expected …

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Medicine changed me by subtraction: a physician’s evolution

Physician
January 30, 2026

I used to think medicine would change me by adding things. Knowledge. Confidence. Authority. Certainty. I assumed growth would look like accumulation, more skills, more answers, more control. What actually happened was the opposite. Medicine changed me by subtraction.

When I started writing as a medical student, everything felt sharp and exposed. The hospital was loud, inefficient, and often cruel in ways no one named out loud. I wrote about scut …

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The hidden costs of the physician non-clinical career transition

Physician
January 30, 2026

I entered medicine believing (perhaps naïvely) that experience mattered. Triple board certification, years of clinical practice across three specialties, and working in New York City felt like assets that would translate beyond the bedside. Like many burned-out physicians, I assumed that transitioning into a non-clinical role would be difficult, but not absurdly so.

I was wrong.

Over several years, I applied to what felt like thousands of positions in pharmaceutical companies, utilization …

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The poet who changed my DNA

Physician
January 29, 2026

In 1983, The Outsiders featured Robert Frost’s “Nothing Gold Can Stay” and, augmented by Francis Ford Coppola’s cinematic genius, it planted a seed, one I was unaware of at the time.

Nature’s first green is gold,
Her hardest hue to hold.
Her early leaf’s a flower;
But only so an hour.
Then leaf subsides to leaf.
So Eden sank to grief,
So dawn goes down to day.
Nothing gold can …

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Why the real flex in life is freedom of time and self

Physician
January 28, 2026

You know the real flex in life is to be able to stretch out like a cat on a random Tuesday and not worry about bills or appointments or being anywhere.

I think there’s something truly to be said about time freedom (and not only time freedom, but freedom of self) where we can let go of the guilt and shame and all these things that hustle culture has ingrained in …

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Clinical attachment in medicine: How familiarity creates safety

Physician
January 28, 2026

You don’t learn this in medical school: Clinical familiarity creates attachment.

Not the kind we mean in romance. Not even the kind we mean in psychotherapy. Something quieter and more automatic, built through repetition and stakes.

You don’t have to say anything deeply personal for it to happen.

You just have to show up again. And again. And again.

Same hallway turns. Same waiting room chairs. Same voice calling your name. Same pace in …

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Why clinical excellence isn’t enough to sustain a physician-owned hospital

Physician
January 27, 2026

Most physicians begin their careers with a deeply held belief: If treatment is good, patients will come. It feels intuitively correct, and early in practice it often appears to be true. Clinical outcomes build trust, trust brings patients, and for a time the system seems to sustain itself. Yet after years of working inside physician-owned hospitals, group practices, and large corporate health systems, I have learned an uncomfortable truth. Good …

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Leading with love: a physician’s guide to clarity and compassion

Physician
January 26, 2026

In medicine, we are trained to lead with logic. To analyze, evaluate, and act. We are praised for decisive thinking, efficiency, and evidence-based decisions. In the hardest moments of my life, career, and leadership, none of those tools brought me clarity.

Ten years ago, as a practicing pediatrician and physician leader, my personal life began to fall apart. My husband, who had always been steady and supportive, began to slide into …

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Patient expectations in primary care: the structural mismatch

Physician
January 26, 2026

Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural.

Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in. And when we can’t deliver what …

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The telehealth trap: Why single-service roles lead to burnout

Physician
January 26, 2026

Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems …

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Multifactorial drivers of the U.S. physician shortage: a data analysis

Physician
January 25, 2026

The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …

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Alex Pretti: a physician’s open letter defending his legacy

Physician
January 25, 2026

To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.

I am not a nurse. I am …

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Why I chose disruption over conformity in medicine

Physician
January 25, 2026

I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …

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The elephant in the room: Why physician burnout is a relationship problem

Physician
January 24, 2026

Let me start with a truth many of us sense long before we ever speak it aloud. We whisper it to ourselves on post-call mornings. We feel it in the drive home after another shift that took more than it gave. We carry it into our kitchens, into our bedrooms, and into the quiet moments where no pager or EMR alert can compete with what’s happening inside us.

The elephant in …

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Why the primary care system failure forces unnecessary referrals

Physician
January 24, 2026

A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago.

The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to …

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AI in medicine vs. aviation: Why the autopilot metaphor fails

Physician
January 24, 2026

The pilot of a commercial aircraft, descending into near-zero visibility, hands control to an automated system designed for precisely that moment. The landing is flawless. The passengers are safe. The pilot announces it proudly. Technology functions exactly as promised.

A doctor on board writes, “It made me think about the health care journey I am on with AI. The safety and well-being of 140 people wasn’t left to human intervention; the …

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Racial mistaken identity in medicine: a pervasive issue in health care

Physician
January 24, 2026

President Trump recently made national headlines by calling a female reporter “Piggy,” an act widely decried as outrageous, even for a man who doesn’t shy away from misogyny. It’s one thing to intentionally refer to someone with a derogatory, dismissive label. This kind of behavior should appropriately be met with indignation and moral outrage. But what happens when we carelessly (and repeatedly) call someone a name that belongs to …

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AI and moral development: How algorithms shape human character

Physician
January 23, 2026

Most of us don’t notice moral development happening while it is happening. Moral character forms quietly, through repetition, through what we get used to doing and through what we slowly stop doing without much forethought.

Artificial intelligence matters from a moral perspective long before it ever potentially becomes conscious or autonomous. Although AI may or may not confront us with dramatic ethical dilemmas, it does change our moral lives in a …

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A 6-step framework for new health care leaders

Physician
January 21, 2026

Assuming a new health care leadership role is both exciting and daunting. Even in the best circumstances, new leaders must navigate a complex web of expectations, relationships, and organizational priorities.

Drawing on over 30 years of health care leadership experience, we have observed that while new leaders bring enthusiasm and vision, they often encounter predictable obstacles. Many receive little to no formal leadership training, leaving them without a structured approach to …

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Why health advocacy needs foresight and backcasting tools

Physician
January 21, 2026

At some point in their careers, health practitioners find themselves preoccupied with issues that go beyond the confines of the clinical room. Beyond diagnoses and prescriptions lies a larger health care landscape, one shaped by policy, economics, culture, technology, and power. Health professionals then begin to ask how this broader system affects not only their individual patients, but also communities and society at large. It is often at this intersection …

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