Policy

Direct primary care in low-income markets

Policy

November 22, 2025

Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.

I previously argued that physicians must answer five market questions before …

Why medical organizations must end their silence

Marilyn Uzdavines, JD & Vijay Rajput, MD

Policy

November 14, 2025

Professional medical organizations, such as the American Medical Association (AMA), American Hospital Association (AHA), and American College of Physicians (ACP), do more than set policy. They are custodians of medicine’s ethical core, defenders of science, and guardians of public trust. Yet, at critical moments, these organizations too often fall back on a strategy of silence. That silence is not neutral. It carries real consequences.

Mixed messages, missed voices

Consider a recent example. …

The flaw in the ACA’s physician ownership ban

Luis Tumialán, MD

Policy

November 14, 2025

“The most expensive piece of medical equipment is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.” Dr. Atul Gawande, an endocrine surgeon practicing at Brigham’s Women and Children Hospital in Boston, Massachusetts, wrote those words in the June 1, 2009, edition of the New Yorker in an article entitled, “The Cost Conundrum.” In that article, Dr. Gawande compared health care expenditures …

The paradox of primary care and value-based reform

Troyen A. Brennan, MD, MPH

Policy

November 13, 2025

An excerpt from Wonderful and Broken: The Complex Reality of Primary Care in the United States.

In a health care system full of paradoxes, this is perhaps the most striking. Primary care delivering value-based care is seen by many as the solution for an inefficient, inequitable, and poorly-performing health care system. Yet it is a shocking mess of burnout and depletion. With all the radical intention of Lenin, we must …

Deaths in custody highlight crisis in Philly prisons

Kendall Major, MD, Tommy Gautier, MD, Alyssa Lambrecht, DO, and Elle Saine, MD

Policy

November 12, 2025

The Kensington community is still reeling after the deaths of Amanda Cahill and Joey Gabor, who both died in custody shortly after being arrested during the area’s controversial narcotics sweeps at the end of 2024. While we don’t know the details behind these deaths, they are alarming and depict the vulnerability of those incarcerated with substance use disorder. We as physicians working to curtail the opioid epidemic must advocate for …

South Carolina’s CON repeal: an opportunity for doctors

Marcelo Hochman, MD

Policy

November 11, 2025

Imagine having to ask your competitors for permission to open a new business: a corner café, a diagnostic clinic, or a surgical center. For decades, that was the reality in South Carolina health care. Certificate of Need (CON) laws gave entrenched hospital systems the power to contest new outpatient facilities, imaging centers, and physician-led ventures. It stifled competition, raised costs, and preserved the status quo.

That era is ending. In 2023, …

Why ACA subsidies aren’t the main issue

Andrew Murphy, MD

Policy

November 10, 2025

As a physician with decades of experience, I have watched health care in this country change from a patient-centered calling into a profit-driven corporate enterprise. Much of the current political rhetoric surrounding the Affordable Care Act (ACA) conveniently ignores the real structural issues that drive up premiums and reduce access for ordinary Americans.

The recent claim that, if Republicans “get their way” and ACA tax credits expire, insurance costs will skyrocket …

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Why ACA subsidies aren’t the main issue

The physician mental health crisis in the ER

Ronke Lawal

Policy

October 24, 2025

The numbers are staggering. Americans made 139.8 million emergency department visits in 2024, that is 42.7 visits per 100 people, with behavioral health issues driving an unprecedented surge. Behind these statistics lies a harsh reality: depression, a leading cause of ill health and disability worldwide, is overwhelming our emergency departments with cases they were never designed to handle. This tsunami of mental health crises creates a vicious cycle. …

Why the MAHA plan is the wrong cure

Emily Doucette, MPH and Wayne Altman, MD

Policy

October 22, 2025

“Make America Healthy Again (MAHA).” Finally, something we can all agree on.

The new MAHA report with its pages of promises taps into something real, something we see daily in primary care practice: Many Americans feel unwell, unheard, and unprotected by the very institutions meant to support them. Compared to our peer countries, we live shorter, sicker lives, suicide rates are rising, and even our children are …

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Why the MAHA plan is the wrong cure

How AI on social media fuels body dysmorphia

STRIPED, Harvard T.H. Chan School of Public Health

Policy

October 18, 2025

The alarming relationship between artificial intelligence and adolescent body dysmorphia

That is what the American Health Law Association called the global increase in social media usage: an epidemic.

Indeed, social media usage and reliance, especially by youth, is becoming a mental health phenomenon quickly escalating out of control.

Nearly 25 percent of youth report spending over four hours on social media daily, with 46 percent of adolescents claiming that social media …

Why direct primary care (DPC) models fail

Dana Y. Lujan, MBA

Policy

October 13, 2025

I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.

When $1 million can’t save a bad idea

The University of Houston medical school launched a direct primary …

Why doctors are losing the health care culture war

Rusha Modi, MD, MPH

Policy

October 12, 2025

The interview ends. The line goes dead. A senior CDC official has resigned, not because the science changed, but because the room did. Within forty-eight hours, CDC Director Monarez is fired by tweet, three senior leaders walk out, and a deputy from HHS (Jim O’Neill, a Silicon Valley investor turned political enforcer) is slotted in as acting CDC chief.

The headlines say turmoil. That is the polite word for capture.

Meanwhile, the …

The smart way to transition to direct care

Dana Y. Lujan, MBA

Policy

October 6, 2025

Physicians tell me they want out of the insurance grind, but they’re terrified to actually do it. That fear is costing them years of autonomy they could already have.

As someone who supports both DPC and concierge physicians, I believe in the purity of the DPC model, but I also believe in practical pathways to get there. Hybrid models aren’t the compromise position; they’re the strategic bridge that makes the transition …

Bearing witness to the gun violence epidemic

Michelle Weiss

Policy

October 6, 2025

I stare down at the ground below me, closing my eyes tight, trying to hold back the tears. “Push it down. Deep breath in. Breathe it out … slowly … again …” The mantra I say in my head whenever it suddenly becomes too much.

I open my eyes to the view of the ground, unwillingly taking a snapshot of the view that surrounds me. Like the slow click of a …

The false link between Tylenol and autism

Anonymous

Policy

October 5, 2025

The 9/22 White House press conference regarding acetaminophen raises two serious concerns. First, the scientific accuracy of the purported link between acetaminophen and Autism Spectrum Disorder (ASD) is dubious. Additionally, the norms of public communication concerning whether a President should offer medical advice existed for good reason. The heads of CMS, NIH, and FDA were present, but did not dispute in real time the essential claim that Tylenol causes autism.

Second, …

Why doctors are leaving insurance-based care

Dana Y. Lujan, MBA

Policy

October 2, 2025

For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer “nice-to-have” side projects. They’re becoming essential pathways for physicians to reclaim careers, reduce burnout, and meet patient expectations in an evolving health care landscape.

Burnout is pushing physicians to the edge.

The pandemic only magnified …

Congress must make telemedicine permanent now

Ryan Nadelson, MD

Policy

September 30, 2025

On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.

I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. …

Why we need national nurse-to-patient ratios

Brendan Fasick, RN and Abby Ehrhardt, RN

Policy

September 28, 2025

My current feeling as a nurse is more closely related to those of a line cook than to what I imagined nursing would be. Patients arrive with complex medical needs, yet we are forced to see them as checklists to be processed before the next shift arrives. Turnover feels like moving products down a line instead of treating people with care and dignity. This is not a failure of individual …

Treating the economy like a crashing patient

Larry Kaskel, MD

Policy

September 27, 2025

We all know the look of a patient about to crash. The monitor has not flatlined yet, but the story is already in the vitals: The pulse is racing, the pressure is dropping, the skin is clammy.

That is the U.S. economy right now. Debt overload looks like a chronic hemorrhage. High interest rates are a sustained hypertensive crisis. Political paralysis is the family arguing in the hallway while the patient …

The crisis of antisemitism in our hospitals

Carrie Friedman, NP

Policy

September 26, 2025

On October 7, 2023, more than 1,200 people were murdered in a single day in the Hamas-led terror attacks in southern Israel, and over 250 individuals were taken hostage. This was the deadliest antisemitic attack since the Holocaust. For many Jewish health care workers, it marked a devastating shift: Our hospitals and clinics were no longer safe, not because of external conflict, but simply because we are Jewish. We had …

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