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.
I never sought out leadership. It found me. We met when I clumsily stumbled into it as a junior faculty. Razor-focused on patient care and teaching, I stared at my clinical leader with bewilderment when she asked me if I had thought about becoming an associate program director. While I questioned whether I had the experience or qualifications, I took on the role, and found deep fulfillment and joy in …
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What becoming a chief medical officer taught a shy doctor
We are taught from the first days of medical school that bedside manner is a clinical tool as vital as a stethoscope. We are told to listen, to mirror, and to connect. But for many of us, this directive has quietly morphed into a high-stakes performance. If you find yourself leaving the exam room physically exhausted, not from the medicine, but from the emotional labor of managing patient reactions, you …
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The people-pleasing in medicine that burns doctors out
Most institutions do not fail because they miss obvious moral harm. They fail because they overlook warning signs and protect themselves, rather than face what they reveal.
The debate over microaggressions concentrates on the initial act. Was the comment intentional? Was it serious? Did it violate policy? But those questions do not describe the whole moral event. In medicine, the deeper injury may begin after authority speaks. I call this institutional …
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Institutional betrayal in medicine begins after the harm
Science, especially Newtonian physics, has taught us to appreciate the elegant laws that govern the physical world. A moving object carries momentum. A stationary object possesses inertia. One tends to keep moving in its current direction until acted upon by an external force. The other resists movement until sufficient force is applied. These principles explain planets, automobiles, athletes, and machinery.
Perhaps less obviously, they also offer a useful way to understand …
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Health care resists change for the same reason planets do
I write this to “honor” my sister Gail on her sixty-seventh birthday, not with nostalgia, but with clarity. My sister Gail was the golden child when we were young. That never changed, not after adolescence, not after tragedy, not even after adulthood should have leveled the field. When our father died in an air crash, I was thirteen and she was eleven. The family mythology stayed intact: She remained the …
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Breaking generational patterns in a family of favorites
This morning I’m celebrating. I did something last night for the very first time. I walked on stage alone, opened my mouth, and sang. I’ve marveled at every singing performance I ever attended, wondering, how do they do that? And now, I can say, I have.
I’m a high-achiever. I say that with a bit of embarrassment. It feels like a pejorative term: the student who does it all, who joins …
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Physician perfectionism can keep you from ever trying
As pediatricians, we enter patients’ lives at moments of uncertainty. You learn how to listen for what is said and what is not said. You walk guardians through fevers, developmental milestones, and the thousand small worries that come with raising a child. Over time it all feels comfortable. Routine.
Then you become the parent. The questions you have answered so many times drip with new urgency, and your own uncertainty. Sleep, …
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Becoming a physician mother changed how I practice
Medical malpractice in the United States has evolved into a system plagued by substantial problems. Each year, the National Practitioner Data Bank (NPDB) reports statistics on an average of 13,000 medical malpractice lawsuits that are litigated. However, these are awards against practitioners, which account for one-third of all medical malpractice lawsuits that are litigated. Hence, 40,000 medical malpractice lawsuits are litigated.
Another source, Justpoint, reports that as many as 85,000 medical …
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The medical malpractice system rewards delay
My name is Tony Grandelis. I’m an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what addiction recovery has taught me about fixing a broken health care system, one principle at a time. Today, I want to talk about resentments, which are, in my opinion, some of the most under-recognized causes of burnout in medicine.
In recovery, …
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Resentment in medicine is a leading cause of burnout
Every physician carries the imprint of their training. Some of those imprints are gifts: a clinical insight, a way of listening, a habit of precision. Others are burdens we never asked for. We inherit not only the wisdom of our mentors, but also their blind spots, their anxieties, and sometimes their failings.
Early in my career, I trained under a mentor who, at the time, was widely admired. He was charismatic, …
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Guilt by association in medicine: My mentor fell, not me
Making the decision to leave clinical practice was a leap off a cliff into thin air when I wasn’t sure I had a place to land. Who was I, what would I do, if I wasn’t a physician? It felt like such a loss; I loved being able to do such deeply meaningful work.
This was back in the dark ages of the late 1990s, before “burnout” was a household word. …
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Women physicians are leaving. Whose problem is it?
As the anniversary of my father’s death approaches, I have been thinking about him as both a father and a surgeon. Those two parts of his life were never entirely separate, at least not for me. My surgical education began long before medical school, residency or fellowship, because I grew up watching how he approached his work, how he treated people and how seriously he took the responsibility that came …
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Put the patient first: a surgeon’s best lesson
Physicians are exiting medicine faster than the sector can replace them. We’ve been facing burnout, workforce shortages, growing administrative burdens, and other mounting pressures. Physicians are 82 percent more likely to burn out than workers in other occupations, and for many years, traditional practice models have offered few alternatives. As a result, there is a deepening sustainability crisis occurring in medicine.
As a practicing anesthesiologist for more than 30 years, …
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Why flexibility matters more for physician retention
The email arrived on a Tuesday afternoon. It thanked everyone for their dedication, praised the organization’s proud history, and announced that the hospital had been acquired. There would be new leadership, new opportunities, and a town hall meeting the following week. Clinical operations would continue as usual.
There was one thing missing. No one had asked the physicians.
For generations, doctors assumed that if the ownership of a hospital or medical practice …
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Physician unions are surging, and money is not why
Imagine walking into a busy clinic shift. The pages are going off, patients need attention, and the emotional weight of the work feels heavy on your shoulders. In moments like these, the ancient wisdom of Stoicism can serve as a quiet anchor. Philosophers like Seneca, Marcus Aurelius, and Epictetus understood that life brings many challenges. They taught practical ways to respond with clarity, courage, and compassion. Their reflections on action …
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Stoicism for physicians: a quiet anchor on hard shifts
A friend once asked me a question that stopped me in my tracks. Not externally. Internally. I am a highly verbal person inwardly, and while the conversation continued around me, another one had already begun in my head.
Earlier that day I had been cataloging the various grievances I believed had been inflicted upon me by another person I had once counted as a friend. After listening patiently for some time, …
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Why we need closure, and why we may not
In my thirty years of clinical practice, I have witnessed the landscape of the human face undergo a quiet, profound transformation. It is not happening through biology, but through the scalpel, the needle, and the digital filter.
For most of human history, an aging face was a history book. It served as a cartography of experience, where lines around the eyes mapped a lifetime of laughter, and furrows in the brow …
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Our obsession with youth is making us shallow
I still remember the mist that morning. Not because it was unusual, but because some mornings refuse to be forgotten.
I was approaching the end of my second year of surgical residency. The nervousness of my first few months had slowly given way to confidence. I could evaluate patients independently, formulate plans, and perform a growing number of procedures. I believed I was learning how to become a surgeon.
What I did …
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You could have been professional, but you chose kindness
I grew up as the son of a dead Air Force officer who made the ultimate sacrifice for his country. In Boston in the 1970s, that lineage didn’t shield me. It marked me. I walked around with a crewcut, government-issued BCG glasses (“birth-control glasses,” as every military kid knew), and a stubborn refusal to follow the crowd. That was enough to get me spat on more than once.
Those moments didn’t …
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The physician who refused to follow the crowd
I did not expect the red-carpet treatment. My illness came on abruptly, without a prodrome and without the courtesy of localizing symptoms, no cough, dysuria, or obvious source of infection.
One weekday morning, after stepping out of a hot shower, I collapsed onto the bathroom tile like a heap of wet seaweed. I attributed it to overwork, dehydration, and the predictable consequences of caring for everyone except myself. By the time …
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The physician as patient nobody wanted to listen to
