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When you open your Match Day envelope, you step into an orthopedic surgery field that looks nothing like it used to. John E. Klibanoff, an orthopedic surgeon, discusses his article “Navigating your …
After Match Day, orthopedic surgery is finally open to every kind of surgeon [PODCAST]
There is a subtle but profound shift that happens when your identity changes.
Not the kind of shift that comes with a new title or role, but the kind that is forced. The kind that emerges when something foundational is altered, and the assumptions you once relied on no longer hold in the same way.
For physicians, identity is often tightly interwoven with decision-making. We are trained to trust our judgment, to …
The quiet shift that changes physician decision making
Chronic back, leg, and pelvic pain frequently result from degenerative spine conditions, disc herniations, spinal stenosis, facet arthropathy, sacroiliac joint dysfunction, or vertebrogenic pain. When conservative measures such as physical therapy, medications, and activity modification fail, interventional pain procedures provide targeted, minimally invasive options to address specific pain generators.
These techniques are typically performed on an outpatient basis with image guidance, offering shorter recovery times and lower risk compared to open …
Interventional pain procedures for chronic back pain
Health care workers understand the power of a record.
One sentence in a medical chart can follow a patient for years. A diagnosis, a risk label, or a preliminary impression may shape how future clinicians see that person. That is why we are taught to document carefully, update records when new information appears, and avoid turning uncertainty into a permanent label.
Public institutions should follow the same principle. When a state medical …
5 principles for protecting physician reputation
Who staffs the immigration detention centers, the temporary holding camps, the privately run facilities where thousands of frightened people are waiting behind fences and concrete walls?
That is not a rhetorical question. It is a practical one. There are doctors, nurses, administrators, guards, transportation workers, and contractors working inside these institutions today. Some believe they are helping under difficult circumstances. Others regard it as employment within a structure that continues because …
Profit motive in medicine: lessons from private detention
Before I ever stepped into a clinic, I learned diplomacy at the dinner table. I learned how silence could be strategic. How tone traveled faster than words. How disagreements could unfold without becoming rupture. How laughter, timed well, could soften a room. I watched adults negotiate boundaries, expectations, and emotions in real time and internalized something I would not be able to name for years: authority is not volume. It …
The quiet art of building trust with patients in pain
When Robert Kennedy Jr. (RFK) was confirmed as HHS director last February, overseeing the CDC, NIH, CMS, and FDA, many worried that modern medicines would become unavailable or scarce.
Instead, industry has received unexpected windfalls and green lights from the new policies. Exhibit A: the exoneration of hormone replacement therapy (HRT) from its well-documented links to cancer and cardiovascular effects. The “timing theories” at Wake Forest that helped turn HRT on …
RFK’s food pyramid is a win for industry, not health
35 years ago, I stood in a hospital hallway and made a decision that would define the rest of my professional life. I was halfway through my internship year in radiation oncology, a field of high-tech linear accelerators and clear-cut protocols, but my heart had drifted toward psychiatry. When I finally voiced my intent to switch, I didn’t find the collegial support we are taught to value in medical training. …
35 years after choosing psychiatry as a specialty
The physician gender pay gap persists after adjustment for specialty, hours, and productivity. A 2016 study in JAMA Internal Medicine found female physicians earned roughly $20,000 less per year than male counterparts after extensive controls. Subsequent analyses confirm similar patterns across specialties and career stages. Most of this literature treats the gap as evidence of discrimination. That framing identifies the problem but offers no mechanism and few remedies.
This …
The physician gender pay gap is an engineering problem
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You hear code blues overhead in a hospital all the time, but one on a psychiatry unit is different. A young patient died after a cardiac event, and what followed looked nothing like …
When a code blue on the psychiatry unit ends in a police interview [PODCAST]
I have spent years caring for patients with obesity, and one of the most meaningful parts of this work is seeing what happens when people finally receive comprehensive, evidence-based treatment. I have watched sleep apnea disappear, blood pressure normalize, joint pain ease, and liver disease reverse. I have watched people who spent years feeling dismissed by the health care system finally start to feel healthy and hopeful again. Those outcomes …
The hidden cost of GLP-1 insurance coverage mandates
There is so much going on in the world right now, which is precisely why I want to talk about a TV show.
Not for escapism. Because this particular show is doing something that medical schools across the country are now being required to stop doing.
The Pitt won Outstanding Drama Series at the 2025 Emmys. Season 2 just aired its finale. Season 3 is already confirmed. And if …
Social determinants of health belong in medical school
The May 2, 2026, New England Journal of Medicine (NEJM) Perspective, “From Mission to Margin in Academic Medicine,” articulates an internal struggle I feel frequently. All physicians recognize the formative environment Dr. Vyas describes as something that must be fiercely protected, and his call to action against the commodification of training resonates deeply. As an emergency department physician practicing outside of this setting, I recognize that when we succumb …
Mission over margin: a community ER doctor’s discipline
A typical commercial payer contract for an independent practice gets signed once, usually under time pressure during credentialing, and then sits untouched for three to five years. The practice receives annual fee schedule updates from the payer, treats them as the new floor, and moves on. The contract is filed and rarely opened again.
This is the diagnostic gap that costs independent practices more recurring revenue than any operational issue except …
Payer contract renegotiation costs independent practices
Medical malpractice is big business in the United States. The only database monitoring medical malpractice is the National Practitioner Data Bank (NPDB). The NPDB’s annual report claims only 13,000 medical malpractice lawsuits. The NPDB was first established by the Health Care Quality Improvement Act in 1986. It was created by politicians (attorneys) for the express purpose of tracking specific adverse actions against health care practitioners.
Only 13,000 lawsuits are hardly “big …
Medical malpractice lawsuits cost $56 billion a year
Transitioning from one part of the country to another can be daunting, though for me it has become a fascinating lesson in both what differentiates us and what remains remarkably the same. Geography changes. Accents shift. Customs vary. Yet suffering, fear, hope, and love seem to speak a language of their own.
I have continued to practice medicine much as I always have, in person, at the bedside, and in patients’ …
Bedside medicine and the meaning of physician presence
Last year around this time, a student offered me $1,000 to write the personal statement for their residency application.
Not to coach them through exercises that would help them write it themselves. Not to edit a finished draft. One thousand dollars for me to write 800 words about their life that they could submit alongside their transcripts and Dean’s Letter to the Electronic Residency Application Service (ERAS).
At first, it would have …
The residency personal statement is an identity problem
The U.S. health care system is adopting artificial intelligence faster than nearly any other sector, and for many patients, that’s unsettling.
Patients consistently say they trust AI far more when it supports doctors rather than replaces them. But the rapid integration of AI in medicine, particularly in clinical settings, has left many wondering: Is rising AI use helping clinicians do their jobs better? Or, as some technology leaders seem to hope, …
Doctors using AI are not being replaced by it
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A cardiologist who helped set national cholesterol and weight targets for 40 years now says those numbers can mislead. Richard M. Fleming, a physician specializing in cardiovascular and inflammatory disease, argues that weight …
GLP-1s, weight loss, and the inflammation tests your patient needs [PODCAST]
A physician, whom I will call Dr. Hannah, initially sought coaching from me to address burnout and optimize clinical documentation in the electronic medical record. One of the major challenges that surfaced in her first coaching session was that she did not know who she was outside of work. She also wanted to bring more joy, fulfillment, and meaning into her life. Dr. Hannah’s schedule was so intense that she …
Spirituality is a remedy for physician burnout
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