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.
To be honest, I never imagined myself treating A-list celebrities and professional athletes in Manhattan. As a young physician in Juárez, Mexico, I spent my earliest years working in community clinics and even pharmacies on the city’s impoverished peripheries. Back then, the idea of practicing at one of the most prestigious hospitals in the United States (let alone as a pain management specialist) was unthinkable. And yet, only a few …
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The opioid crisis in wealthy zip codes
Suicide is the elephant in the room in medicine. We rarely speak about it openly, yet it remains a silent epidemic, among our patients, and tragically, among physicians themselves.
I first encountered this reality as a medical student in Tennessee in 2022. One of my earliest patients was not much younger than I was. Because we were close in age, I felt we …
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A doctor’s promise after a patient’s suicide
On my first week of onboarding as an attending, before I had seen a single patient, I met the boulder in a training room.
It arrived as a screenshot. The EHR instructor clicked into a demo chart and a cascade opened: quality gaps, refill requests, preventive care nudges, “smart” routing rules that promised efficiency and smelled faintly of delegation without authority. I had imagined the threshold to attendinghood as a clean …
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The first week of an attending physician
Two emergency physicians with similar training work at the same hospital. Both have twelve years of experience. Both are contracted to work 2,000 hours per year, see roughly twenty patients per shift, and supervise staff. One is a man, the other is a woman. The same work, the same training, the same conditions. Not the same salary: The woman earns about $21,000 less each year.
That is not a hypothetical. That …
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Why women ER doctors earn $21,000 less than men
In the ER, we ask, Was he wearing a seatbelt
Partly for the note, but partly so we can remove ourselves
From exploded flesh, splintered bones,
Not sure if we can save that eye.
Something in us says, that will not be me;
I take precautions. We live on,
On the strength of the stories we tell ourselves.
But in the ICU, when one of our own has come in,
After a well-informed try at smothering the spark,
There …
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A poem for a physician in the ICU
Our one and only daughter has gone off to college. My wife and I dropped her off the weekend before. As we made the four-hour drive from Houston to Baton Rouge along I-10, the road stretched ahead, both endless and fleeting, as if time itself were torn between holding on and letting go. Between bursts of laughter and quiet silences, we spoke of classes, friendships, boys, the discipline of focus, …
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The stoic cure for modern anxiety
When most people talk about obesity, the blame often falls on donuts, McDonald’s, fast food, lack of exercise, or lack of willpower.
But as a primary care physician, I see a different reality. Obesity is not always born from a donut, and it is not always caused by time poverty. Yet in many cases, it grows out of time poverty, a system that robs people of the space to think, to …
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Obesity is the infant of time poverty
The gimmick of the day is to make -preneur the suffix of the year. Solopreneurs. Doctorpreneurs. Digipreneurs. Trumpreneurs. It should come as no surprise then, that leaderpreneur has appeared in your latest Google search. What is a leaderpreneur, anyway, and why should anyone care? Recognizing that there are as many definitions of leadership, entrepreneurship, and innovation as there are practitioners of those arts, here is my take:
Entrepreneurship is the pursuit …
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The difference between a leader, a manager, and an innovator
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine her painful toe. I tried to avoid her, yet I could not say no. Through my grief and exhaustion, conditioned by years of striving to live a life of purpose, …
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A doctor’s struggle with burnout and boundaries
These days, getting spun out into a state of worry and panic is just a click away: Turn on any device for constant updates on the chaos around us.
Adding to this, on a personal level, the last six years have been the most difficult and transformative period of my life. I had never imagined that I would experience and recover from the darkness of depression and suicidality six years ago, …
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Unhooking from the ego in medicine
Ever been so tired you forgot your own name? I remember a junior doctor on strike in London who told me exactly that. Thirty-six hours awake, stumbling into the children’s ward, staring at a prescription pad. “I couldn’t even remember my own name,” he said, “let alone the right antibiotic dose.”
That was not about wages. That was about survival, his and the children’s.
Yet the story always gets told the same …
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Why doctors strike: a matter of survival
Everywhere in American medicine today, you hear the word leadership. Hospitals advertise leadership programs. AMCs hold leadership retreats. Colleagues are urged to “develop as leaders.” Yet when you talk to practicing doctors (the ones actually seeing patients), most will tell you all they want is to do their work, fairly scheduled, with decent colleagues, and without interference.
That is the paradox of the physician leader. Everyone talks about leadership, but almost …
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Stop trying to lead doctors like corporate employees
We were walking up the fairway on the ninth hole when one of my patients asked, “Larry, when should I come in for my annual?” I had a seven-iron in hand, breeze at my back, and I answered without thinking: “Doesn’t matter.” He looked at me like I had just duffed a wedge. To him, it sounded like I did not care. In a way, I suppose I mishit that …
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Rethinking the value of the annual physical
During the COVID-19 pandemic, I cared for a patient in the intensive care unit whose condition was critical. When I asked how he was feeling, he said, “Doctor, I am not afraid. My family is praying for me, and I believe God will give me strength.” Despite receiving the best medical interventions available, it was clear that his faith, cultural practices, and the support of his family played an undeniable …
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The role of faith and culture in patient recovery
In the late 1990s, Yahoo dominated the internet by organizing websites. Human editors manually reviewed, categorized, and arranged them into a hierarchical directory, essentially a digital Yellow Pages. This worked while the web was small, but the approach couldn’t scale. Google took a radically different path. Instead of relying on human judgment, they built algorithms to crawl, index, and rank pages based on links and relevance. This allowed them to …
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Health care is having its Yahoo moment
In the grand edifice of American medicine, where the Enlightenment’s promise of rational progress once shone brightly, a shadow now lengthens across the corridors: the tyranny of the metric. Conceived in the spirit of Taylorism’s efficiency and Deming’s quality control, these numerical arbiters were meant to elevate the healer’s art, transforming subjective judgment into objective excellence. Yet, as with so many well-intentioned intrusions of bureaucracy into human affairs, they have …
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The measure of a doctor, the misery of a patient
My mind became the centerpiece of my identity early on in life. I lived so intimately with my thoughts that I came to believe this is who I was. As academic success and the praise of being “the smart one” set me apart, I internalized a sense of uniqueness. Others saw it too, which created early recognition… and isolation.
And here lies the hidden cost:
The hidden cost of a physician’s intellectual identity
In the early 1990s, while the American Academy of Pediatrics was formalizing its vision of the “medical home,” we were already living it, without a name, without a policy statement, and without institutional applause. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We did not call it a medical home. We …
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Building the medical home before it had a name
Twenty years ago, when I started medical school, I had no idea that this would be my path. Coming from a research background in cancer biology and biophysics, I did not have much exposure or interest in integrative medicine. My path to practicing integrative and functional medicine and incorporating new modalities to my foundation as a general internist, was not linear, and not expected.
I was pregnant twice during my three-year …
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My journey into integrative medicine started as a patient
In medicine, we’re trained to stay. To endure. To prove our worth by how much we can carry and how long we can carry it. Our roles become our identities. Our achievements and labels become scaffolds of self-worth. In medicine, stepping down is often labeled as a sign of weakness. So we hold on to roles even when they no longer fuel us. We are usually still doing the job …
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Stepping down in medicine is an evolution
