Perhaps you are standing in the same place I once stood: From the outside, everything looks great, but on the inside, you’re running on fumes.
In my mid-40s, I was on the verge of becoming a full professor. Our dream house was under construction. My retirement plan was on track so I could stop working before 60. Our kids were grown and thriving, launching their own lives. On paper, life was …
Physician coaching: a path to sustainable medicine
At its best, the doctor-patient relationship is an intimate one. Often, our patients appear before us in the most vulnerable moments of their lives. We treat their diseases, but we also tend to their emotional and spiritual well-being. That kind of intimacy can be meaningful and rewarding, but it can also breed awkward and even potentially compromising interactions. That is particularly true when money gets involved.
Despite widespread dissatisfaction with the …
Physician investment in patients: ethical risks and rewards
I’ve recently been intrigued by this question: Are you giving from extra or essence?
In many respects, giving from one’s essence is what burnout is all about. Your energy reserves (emotional, physical, mental, cognitive) are heading rapidly toward empty. Because of a mismatch between the energy drain from internal and external stressors and the ability to replenish your energy, you are left depleted.
I see this mismatch daily in the physicians whom …
How physician coaching helps restore energy reserves
Wellness programming must evolve beyond institutions if we are serious about supporting physicians, especially women physicians.
For wellness to be taken seriously, it had to begin within institutions. Those efforts offered visibility and legitimacy. But institutional wellness is not the whole answer.
For 17 years, I led wellness initiatives inside a large medical organization. I saw the value of bringing attention to physician well-being. I also saw the limitations. Six years ago, …
Why physician wellness programs must evolve beyond institutions
An excerpt from Pandemics, Poverty, and Politics: Decoding the Social and Political Drivers of Pandemics from Plague to COVID-19.
We talk about health as if it were an individual act of will, a matter of personal choice or risk tolerance. But anyone who has walked alongside people living in poverty, in refugee settlements, in overcrowded housing, or on the street knows that illness does …
Public health and primary care integration
For decades, many have documented the decline of the physical exam. As imaging grew more powerful, labs more precise, and algorithms more accurate, the stethoscope and reflex hammer faded in importance. Some even speculated that technology would eventually make hands-on diagnostic skills obsolete.
But the next era of medicine may flip that prediction on its head.
Picture a future where artificial intelligence participates in nearly all patient management decisions. This seems inevitable …
The physical exam in the AI era
America’s physician shortage is no longer a distant projection. It is happening now, steadily, one resignation, early retirement, and practice closure at a time.
A nationwide, longitudinal analysis published in Annals of Internal Medicine tracked more than 712,000 physicians caring for Medicare patients over a decade and found a troubling trend: Physician attrition from clinical practice rose from 3.5 percent in 2013 to 4.9 percent in 2019, across every specialty, …
Physician attrition rates rise: the hidden crisis in health care
Frivolous medical malpractice lawsuits are endemic and infect everyone whether they realize it or not. The greed of plaintiffs, attorneys, medical experts, and malpractice carriers, coupled with the ineptitude of the tort system, causes avoidable costs. Everyone pays the price.
Some plaintiffs sue for medical malpractice just because they harbor a grievance against a doctor and their claim has no attributable merit. Plaintiff attorneys, who are looking for business, advertise …
How frivolous lawsuits drive up health care costs
The discomfort I felt around supervising did not arise in the clinic. It arose while reading the agreements meant to define it.
Supervisory agreements. Collaborative designations. Regulatory language that needed to be reconciled (carefully, deliberately) because names, roles, and obligations matter. Like many physicians, I have signed these documents countless times. But reading them slowly, rather than reflexively, produced an unexpected unease, one that felt structural rather than personal.
The language was …
The shifting meaning of supervision in modern health care
For decades, medicine has spoken the language of hazard ratios, Kaplan-Meier curves, and median survival differences. We have become fluent in the grammar of precision oncology, genomic signatures, driver mutations, targeted therapeutics, and real-time disease monitoring. But there is one language we have not yet mastered: the language of the patient’s lived experience.
Personalized medicine cannot stop at matching the right drug to the right tumor. It must also include personalized …
Personalized scientific communication: the patient experience
An excerpt from Wipe Out, Rise Up: A Surf Session In Being a Leader, Pushing Past Limits, and Sustaining Health. Copyright © 2024 Scott Ellner. Published by BrightRay Publishing. All rights reserved.
Growing up in Southern California, I was well-acquainted with the waves of the Pacific Ocean. Cold water from Alaska flowed down the coast, meeting the warm, sunny climate of Los Angeles, roasted by the heat of the Santa …
From law to medicine: Witnessing trauma on the Pacific Coast Highway
Early in medical school, a professor warned us: “Never prescribe for someone who isn’t your patient.” He shared a story of writing a simple antibiotic for a friend who later developed Stevens-Johnson syndrome, a devastating outcome that haunted him long after. His message was clear: There is a bright line between caring and causing harm.
Fifteen years out, we now understand just how blurry that line really is.
“First, do no harm” …
Why doctors struggle with treating friends and family
As a 93-year-old physician, I am well acquainted with the ravages of aging and the continuous adaptations we all must make to accommodate its increasing demands. One area that is particularly troublesome is nocturia with repeated, late-night calls to the toilet. This is not only an issue of disturbed sleep, but also of safety. Nocturia involves leaving my bed, turning on a light, and making my way to the bathroom, …
A simple nocturia management technique for seniors
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In a valuable episode of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, spoke with Dr. Matthew Provencher, an orthopedic surgeon, Navy veteran, former team physician for the New England Patriots and Boston Red Sox, and current partner at The Steadman Clinic in Vail, Colorado. Dr. Provencher’s story spans small-town roots, elite military service, academic medicine, professional sports, and entrepreneurial ventures. His journey offers physicians …
Lessons on leadership from a Navy surgeon and NFL doctor
Some illnesses do not storm the body to the brink of death. They don’t show up in emergency rooms or leave dramatic scans behind. Yet they quietly hollow a life from the inside, stealing ease, stealing spontaneity, turning ordinary days into endurance tests. Autoimmune disease and chronic pain often live in that space: not terminal, but relentless; not fatal, yet capable of dimming the world so deeply that survival becomes …
Sjogren’s, fibromyalgia, and the weight of invisible illness
In the annals of social science, few imperatives are more solemnly intoned than the necessity of measuring racism with the cold precision that only quantification can provide. Only when bias is reduced to p-values and effect sizes may one confidently proclaim, “Behold, the incontrovertible evidence of racism,” secure in the knowledge that no reasonable interlocutor can wriggle free on the strength of anecdote or wounded sentiment. Yet such measurements, to …
When racism findings challenge institutional narratives
I direct a Faculty Well-being Champions Program overseeing 47 physician champions across 33 departments. I also practice palliative care part-time and coach physicians navigating burnout. I liaise with well-being leaders nationwide, some at programs just checking a wellness box, others genuinely trying to get it right. This year taught me that well-being work reveals patterns. The same destructive habits show up across institutions, specialties, and conversations.
As 2025 closes, here are …
5 things health care must stop doing to improve physician well-being
My last patient of the day had been to four other doctors before coming to see me. She was coming in for abdominal pain that had been going on for about two years and had seen multiple specialists that resulted in multiple tests, in hopes to get an explanation for her symptoms. She came in wanting answers, but also skeptical of me. Skeptical of my ability to help her, skeptical …
Why patient trust in physicians is declining
I recently returned from a truly magical trip to Iceland. While there, my husband and I hiked, ate wonderful food, and soaked in a different culture.
On day five of six, we ventured out to find what was described as a “hot springs river,” a body of water fed equally by glacier melt and geothermal hot springs. As a floating enthusiast, this was a must-see for me.
We hiked for an hour, …
Mindfulness in the journey: Finding rewards in the middle
Every now and then I go back to a book I read decades ago. Sometimes it feels dated, a period piece. Sometimes it sounds uncannily current, as if it has been waiting. And sometimes it does both at once, which is more unsettling.
Recently I reread Moral Dilemmas in Medicine, first published in 1975. I read it as a younger physician, still believing that if you learned enough and tried …
Moral dilemmas in medicine: Why some problems have no solutions
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