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.
Clinical trial enrollment in rare cancers remains stubbornly low. In T-cell lymphomas, a heterogeneous group of over a dozen distinct subtypes affecting roughly 9,000 new patients annually in the United States, fewer than 7 percent of eligible patients participate in clinical trials. This statistic has persisted for decades despite growing recognition of the problem by professional societies, advocacy organizations, and regulatory agencies.
The conventional explanation focuses on awareness. Patients don’t know …
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Clinical trial navigation is a clinical access problem
The day I met my own system from the wrong side of the bed
I’ve spent a career on the clinician side of the bed: explaining procedures, reassuring families, and signing orders that were supposed to make pain tolerable and recovery humane. Then I had shoulder surgery in Florida.
I went in with a regional block, a plan, and the quiet confidence of someone with a high pain tolerance. Physical therapists have …
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When policy erased my post-operative pain control
There are commercials on TV by prominent plaintiff personal injury law firms advertising for clients. One promotes “If we don’t win, you don’t pay.” Another promotes the notion that anyone who owns a phone already has a lawyer. Still others promote the types of injuries that can be monetized, but never mention medical malpractice.
All imply that a contingency fee totally forgives clients of all legal transaction costs. All imply a …
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A frivolous malpractice lawsuit still raises your premium
For years, I gave my patients advice that I was not following myself. Reduce your stress. Protect your sleep. Listen to your body. Set healthier boundaries. Then I would finish a full day of back-to-back appointments and stay late answering inbox messages, reviewing charts, completing forms, and responding to insurance demands. I would go home physically tired but mentally still at work, replaying the day and thinking about everything waiting …
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Why primary care burnout is really a patient-care problem
Imagine with me, it’s January and you are sitting at work. Your muscles start to ache, and you have a strong desire to lay your head down on the desk for a quick rest. Maybe you overdid it shoveling snow a couple of days ago. Maybe you slept wrong.
Over the next 24 hours, you feel worse. You develop a headache. Your eyes burn. Your nose drips like a faucet one …
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A cold cost $945. The cost of primary care is broken.
I had been driving for fourteen years before I moved to the United Kingdom two years ago. Back home in Malaysia, driving had become almost instinctive. It was something I rarely thought about. But moving countries meant starting over. To continue working as a community psychiatry registrar, I needed a U.K. driving license.
Twice I took the practical driving test. Twice I failed. I could spend hours dissecting the examiner’s decisions, …
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How a failed driving test shook my confidence in medicine
She was a young mother.
We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped.
CPR began immediately. The obstetric team delivered the baby while compressions continued. Thirty minutes passed. No pulse. We kept going. Every voice in the room was thinking out loud. What are the reversible causes? Keep going. Don’t …
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The grief health care workers carry after maternal death
I am writing this from the slow, disciplined landscape of recovery (one repaired shoulder, one sling, and one unrepairable truth): Medicine did not suddenly become fragile when AI arrived. It did not suddenly become threatened when APRNs and NPs expanded their scope. It did not suddenly become replaceable in the twenty-first century.
Medicine became fragile when institutions discovered they could dispose of physicians and still call it progress.
I know this because …
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The physician disposability nobody wants to name
The health care system is supposed to put the patient first. Physicians evaluate, diagnose, treat, and manage risk. Hospitals, insurers, administrators, and regulators exist to support that clinical relationship and not to displace it.
Yet the current structure of American medicine produces the opposite outcome. Patients face longer waits and higher barriers. Independent physicians confront declining real reimbursement and mounting administrative demands. Practices are acquired by health systems. Physicians spend more …
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The hidden payment gap crushing independent physicians
An excerpt from Essays and Echoes: Reflections from a Life in Medicine.
Every year, someone ranks the best states in which to practice medicine, presumably because physicians have been unable to make major life decisions without consulting a color-coded map.
The 2026 WalletHub survey evaluates all 50 states and Washington, D.C., across 19 measures, including physician wages, malpractice costs, hospital availability, projected competition, and burnout. Montana ranked first, New York …
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What do best states to practice medicine rankings miss?
I was in my car in the parking lot. It was a long day at the clinic. And I did not want to go back in the next morning.
Us doctors aren’t supposed to say that. When we feel it, we always repeat the same things to ourselves. “You’re tired.” “You’re burned out.” “You need sleep, or a vacation, or perspective, because do you have any idea what you have?” Those …
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Why I left insurance-based medicine and came back
If you are sued and satisfied with your defense, read no further. If not, you may find this article helpful.
Merit is inconclusive in every medical malpractice lawsuit ever filed, and it starts with the certificate of merit. To be clear, a certificate of merit is not proof of negligence. Proof is determined at trial. Merit is a measure for the reliability of evidence used in the proof of negligence, and …
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Why merit decides a medical malpractice case
When patients describe a disappointing health care experience, we often assume the problem occurred in the examination room. Sometimes it did. But after years of caring for patients in urgent and emergency settings and helping lead a high-volume orthopedic urgent care practice, I have learned that many negative patient experiences begin long before the physician walks through the door.
A patient may arrive in pain and not know how long the …
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Patient dissatisfaction begins before the doctor walks in
Hospital peer review is one of medicine’s most important mechanisms for protecting patients and maintaining professional standards. Physicians possess the clinical expertise necessary to evaluate the work of other physicians, particularly when questions involve complex procedures, specialty-specific judgment, or unusual complications.
But this structure creates an unavoidable tension. The physicians most qualified to evaluate a colleague may also be the physicians who compete with that colleague for patients, referrals, operating-room access, …
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Hospital peer review needs recusal rules, not assumptions
When I was just a Medium-Sized Bad Wolf loping through the forest, I stumbled upon a doctor in a white coat, carrying a bag of supplies. It was Sunday night, and dinner options were scarce, since most other humans were home with their families.
“Where are you going so late, Doctor?”
She sighed. “Another patient who refused the flu vaccine is sick with the flu, so I’m bringing them Tamiflu.”
I tricked her …
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Medical satire: A wolf can pass as your doctor now
I am writing this from the slow, disciplined landscape of recovery (one repaired shoulder, one sling, and one unrepairable truth): Medicine did not suddenly become fragile when AI arrived. It did not suddenly become threatened when APRNs and NPs expanded their scope. It did not suddenly become replaceable in the twenty-first century.
Medicine became fragile when institutions discovered they could dispose of physicians and still call it progress.
I know this because …
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Medicine disposed of physicians long before it feared AI
In my primary care practice, few moments carry as much quiet weight as when an older patient leans in and says, “Doctor, I’m worried about my memory.” That moment is increasingly common, given that an estimated 42 percent of adults who reach age 55 will develop dementia in their lifetime, so nearly every family will face a version of it. It takes courage to say those words out loud, …
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Cognitive assessment in primary care almost never happens
We all have times when we wonder, “Did I choose the right profession? Should I recommend a medical career for my children? Is it time to retire?” These questions creep into the minds of mid-career physicians. We often ask ourselves how we should address the mid-career blahs. What can we do to improve our professional satisfaction? How can we combat the dullness and tedium of our workday lives? And how …
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5 ways to beat mid-career physician burnout
My shift started at 7 a.m. The overnight physician wishes me a good shift. We both know that’s mostly luck. I pick up my first patient before I’ve taken a sip of coffee.
My first few patients are what we affectionately call “bread and butter.” An ankle injury. A cough that’s lingered for two days. Back pain. A medication refill. Someone wants an MRI today because they’ve had headaches for three …
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What one emergency room shift really costs a doctor
