Physician on-call compensation: the unpaid labor driving burnout

Physician
January 6, 2026

As an internal medicine physician, I’ve spent years watching one quiet assumption extract more unpaid labor from physicians than anything else in our system. It’s not charting. It’s not meetings. It’s not metrics.

It’s call.

I wrote a post on my LinkedIn page about my thoughts regarding call. It resonated with many physicians, and I received many messages. It became clear that being “on call” is something that is rarely spoken about …

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The real cost of U.S. health care dissatisfaction

Physician
January 6, 2026

There is a general undercurrent of dissatisfaction with health care in America that is, shall we say, palpable. Many studies and statistical analyses support this notion but I think a broader view is both valuable and less abstract than a data set. We could go measure the angle of the Leaning Tower of Pisa and evaluate the foundational errors, but it doesn’t take that level of granularity to see that …

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Artificial intelligence offers a lifeline to overwhelmed clinicians [PODCAST]

Podcast
January 5, 2026
YouTube video

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Physician executive Christina Johns discusses her article “Modernizing health care with AI and workflow.” Christina explains how clinicians in the U.S. are facing unprecedented burnout due to administrative burdens that detract from …

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The most venomous sea creatures to avoid

Conditions
January 5, 2026

An excerpt from 99 Ways to Die: And How to Avoid Them.

In response to this chapter, I expect to receive a battery of soaking wet letters from infuriated marine biologists, since each species deserves their own chapter, but my editor cut me off.

Flamboyant cuttlefish

The flamboyant cuttlefish is not to be confused with the flamboyant cuddle-fish, which does not exist. The cuttlefish, Metasepia pfefferi, looks like an orchid that ran …

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Adult autism assessment: ADOS-4 vs. narrative interviewing

Conditions
January 5, 2026

Over the past decade, there has been a marked rise in adolescents and adults seeking autism evaluations. Many of these individuals are intellectually intact, verbally fluent, and professionally capable, yet have lived for decades with persistent social fatigue, sensory sensitivities, difficulty interpreting unspoken social rules, emotional overwhelm, rigid or all-or-nothing thinking, challenges with transitions, and extensive masking or camouflaging behaviors, all without a diagnosis. When they finally seek clarity, the …

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AI in medicine risks: the new Oracle of Delphi?

Tech
January 5, 2026

“The danger isn’t that AI is too powerful; it’s that we stop questioning it.”

Artificial intelligence in medicine is often described as revolutionary, capable of diagnosing disease, predicting deterioration, and automating once-human decisions. But I want to suggest a different lens, one drawn not from technology, but from history.

Let’s go back to ancient Greece.

There, leaders turned to the Oracle of Delphi not for …

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Geography as destiny: the truth about U.S. life expectancy disparities

Policy
January 5, 2026

Every New Year arrives with its familiar rituals. We raise a glass, make a resolution, and offer a toast to things we hope will be different this time around: better habits, better balance, better health. We say “I’ll drink to that” as shorthand for optimism, an easy affirmation that the future is still negotiable and a longer life is possible.

Then along comes a map.

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EMR cognitive burden: the hidden cost of documentation

Physician
January 5, 2026

In basketball, when a player is called for a questionable foul, he may shrug and say: “Ball don’t lie.”

It means the game has a truth of its own. Reality asserts itself. Emergency medicine, unfortunately, rarely works that way.

We once spent most of our time with patients. Now a substantial portion of every shift is spent interacting with a screen, not because we prefer it, but because the system has evolved …

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Are mild hypertension guidelines driven by pharma ties?

Conditions
January 5, 2026

In the early 2000s, I included “drugs for mild hypertension” in my book, Money-Driven Medicine: Tests and Treatments That Don’t Work. By 2007, I proposed a Cochrane systematic review of randomized controlled trials (RCTs) to settle the debate. Cochrane is widely considered the “gold standard” of evidence-based medicine; its reviews can shift global clinical practice and multibillion-dollar drug markets.

In 2012, Cochrane published the systematic review of Pharmacotherapy for …

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The physician emotional toll of delivering bad news

Conditions
January 5, 2026

You can usually taste the excitement in the air during a first visit for pregnancy. It’s palpable. And the evidence for it is everywhere: the nervous fidgeting of hands. Do you place them on your lap or not-so-casually at your side? Paper drape sheet typically is balled up into tiny handfuls for better “grip” on this one-ply provider of modesty. And the quick glances back and forth between soon-to-be parents …

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Why midlife men feel lost and exhausted [PODCAST]

Podcast
January 4, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Emergency physician Kenneth Ro discusses his article “Why midlife men feel unanchored and exhausted.” Kenneth explains why men between 40 and 60 often visit clinics requesting hormone testing when they are actually …

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The Dr. Google debate: Building a doctor-patient partnership

Physician
January 4, 2026

If you’ve been practicing medicine for any length of time, you’ve likely felt that familiar moment of overwhelm when a patient walks in with a stack of printouts, a list of 30 questions, or a frustrated statement like, “Well, I did my research.” And if we’re honest, many of us feel our chest tighten just a little. We feel the time pressure. We feel the responsibility. And sometimes, we feel …

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Why home-based care fails without integrated medication and nutrition

Conditions
January 4, 2026

Consider Mrs. Chen, an 82-year-old woman discharged home after a minor ischemic stroke. On paper, her care plan was flawless.

Her physician intensified her antihypertensive regimen to protect vascular health (medication). Her well-meaning daughter, concerned about blood pressure, switched her to a strict low-sodium porridge diet, unknowingly slashing her protein intake (nutrition). Her physical therapist prescribed a daily walking program to rebuild confidence and strength (exercise).

Two weeks later, Mrs. Chen was …

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Psychedelic-assisted therapy: science, safety, and regulation

Meds
January 4, 2026

We are hearing stories about mushrooms and MDMA and see clinics advertise ketamine. We hear of friends chasing a spiritual reset. Many in America feel the weight of depression, trauma, and addiction inside families. Psychedelics sit at the center of this pressure, with hope on one side and hype on the other.

KevinMD already published multiple essays on psychedelic medicine since 2022, including pieces on what physicians need to know, prudence …

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Physician coaching: a path to sustainable medicine

Physician
January 4, 2026

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 …

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Methodological errors in Cochrane reviews of anticoagulation therapy

Conditions
January 4, 2026

My previous KevinMD article discussed a Cochrane Collaboration review that was completed in 2002 but was not published until 2006. This review examined three randomized controlled trials (RCTs) comparing anticoagulants with placebos or anti-inflammatory drugs for venous thromboembolism (VTE).

Along with my two co-authors, I found that across these three trials, anticoagulant-treated patients had six deaths out of 66 patients, compared to only one death out of 60 in the placebo …

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Why we deny trauma and blame survivors

Conditions
January 4, 2026

“The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter out loud: this is the meaning of the word unspeakable. Trauma survivors want to forget, observers want to forget, and society as a whole wants to forget. It is too painful to do otherwise. We push trauma away and it rears up in other ways: Atrocities, however, …

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Eldest daughter syndrome explains the hidden cause of physician burnout [PODCAST]

Podcast
January 3, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Board-certified pediatrician and certified coach Jessie Mahoney discusses her article “The burden of the eldest daughter.” Jessie explores the unique psychological weight carried by firstborn women who are taught early on to …

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Physicians’ end-of-life choices: a surprising study

Conditions
January 3, 2026

In July, I wrote about the importance of end-of-life planning (EOL). Shortly after, I read a study that examined physicians’ EOL plans with advanced cancer and Alzheimer’s disease (stage unspecified). The study encompassed nations with different forms of aid in dying, from the U.S., where a terminal coma is the only option most states allow, to Belgium, where physician-assisted dying (PAD) and euthanasia are available. Although the term suicide …

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Physician investment in patients: ethical risks and rewards

Physician
January 3, 2026

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 …

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