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Vascular surgeon Paula Muto discusses her article “Give the health care dollar back to patients.” Paula argues that the government shutdown over health care funding misses the real issue of administrative bloat …
Bureaucracy now consumes most of your health care spending [PODCAST]
Between 2005 and the present, 195 rural hospitals have closed, with a 50-hospital net reduction occurring just between 2017 and 2023. These closures, compounded by significantly worse measures of social determinants of health (SDOH), high prevalence of Medicaid or Medicare patients, and longer commute times, have created a crisis of access for rural Americans.
The disproportionate impact on rural residents
Compared to their urban and suburban counterparts, …
Rural health care crisis: Can telemedicine close the gap?
I was halfway through reviewing what looked like an excellent locums opportunity when I realized the hourly rate was the least important number in the agreement. The compensation was strong. The schedule was flexible. Travel was covered. On the surface, it seemed straightforward.
But what ultimately determined whether the opportunity made sense had very little to do with pay. It had to do with clarity.
The difference between conversations and contracts
Locums conversations …
Reviewing locum tenens agreements: Look beyond the hourly rate
As an integrative and functional medicine physician, I prescribe hormone therapy. I also see its misuse daily.
Hormone replacement therapy (HRT), including bioidentical hormone therapy (BHRT), has re-entered menopause care with force, correcting decades of dismissal and undertreatment. That correction was necessary, but the pendulum has swung too far.
What I am seeing clinically is not thoughtful, physiology-based care. It is hormone-first medicine that bypasses stress physiology, nervous system dysregulation, trauma, metabolic …
The misuse of hormone therapy in menopause care
Among the people exiting the hospital, I could easily pick out the medical staff leaving their shifts. It wasn’t by their clothing or the time of day, but by the unspoken language of relief on their faces: a calm twinkle in the eyes or a gentle softness around the forehead and jaw. Dawn or dusk, the look was always there. I hoped I’d have it too when I left later …
Physician burnout: Finding peace in a broken health care system
Clinicians often notice a frustrating pattern: Women in midlife follow standard weight-loss advice, eat less and move more, yet see little progress. Calories are reduced, exercise increases, and still the scale barely moves. This is often blamed on motivation, discipline, or compliance. But in many cases, the real issue is not behavior. It’s physiology.
Perimenopause and menopause are not simply estrogen-deficient states; they are states of altered signaling, altered tissue responsiveness, …
Why “eat less, move more” fails for midlife weight loss
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Pediatrician Trevor Cabrera discusses his article “Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine.” Trevor explains how choosing the path of an independent contractor allowed him to pay off massive …
Locum tenens offers physicians a path to freedom [PODCAST]
During my first two years as a medical student, I have often been struck not only by how much medicine has advanced, but by how frequently the foundations of health are overlooked. This perspective was shaped early in my career through my first postgraduate role, where I spent three years collecting patient data for a multisite study evaluating a lifestyle-based intervention to reverse metabolic syndrome.
At a data analysis meeting with …
Lifestyle medicine vs. medication: Why prevention is the future
We are frequently told that our health care system is expensive. However, most of us, including physicians, have no notion about what the health care system really is, to judge whether or not we are getting our money’s worth.
There are four major structural models for a health care system:
…
Understanding the 4 models of health care: Where the U.S. fits
You became a physician because you were driven. You studied longer, pushed harder, and tolerated pressure better than most. You needed to be right and usually were. That formula worked. It got you through pre-med, medical school, residency, and into practice. It earned you respect and built your reputation.
But at some point, quietly, subtly, that same formula can start working against you. I realized this after reading Marshall Goldsmith’s book, …
What got you here won’t get you there: a physician’s guide to leadership
Welcome to the first weeks of the new year. A great moment to check in.
How are you doing? How are you feeling? Energy level?
The first days of the new year come with a lot of excitement and a lot of pressure.
Excitement for the sense of renewal and becoming better versions of ourselves. Excitement in putting the last year to rest and starting with a clean slate. Excitement at putting down …
The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions
Single-payer health care is generally defended with “heart-wrenching” virtue signaling divorced from any cost, economic, or financial reality. The idea that any scarce service or commodity is a right and therefore should be free is fanciful, but impossible. With an indebtedness of $38 trillion and growing, adding greater than $40 trillion as estimated for the cost of “Medicare for All” would absolutely drive the country into insolvency. Even without single-payer, …
Single-payer health care vs. market-based solutions: an economic reality check
I remember. It is a gorgeous summer day as the sunlight streaks through the redwood canopy. My grip clenches the dangling rope. My stance wobbles on the itty-bitty circular disk. I am uncertain. Teeter-tottering, I plot my next move. It does not happen. I plummet. My harness transforms into a bucket swing, saving me from the forest floor. I sway in the pleasant breeze. I cannot finish the Level 1 …
Learning from patients: How a physician gained strength and resilience
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Postdoctoral researcher Wei Zhang discusses the article “Peripheral artery disease prevention: Saving limbs and lives.” Wei explains how peripheral artery disease acts as a silent burden on the “life-highway” vessels of …
Early screening saves limbs from silent vascular disease [PODCAST]
For the past month and maybe longer, I have been waking up with pressure in my chest. It worsened in December and continued to worsen in the new year. I had identified it as anxiety, but felt it was of a different quality than my run-of-the-mill anxiety. This feeling was more anguished.
During the first week of January, I volunteered at a clinic, where I saw patients, assessed, and treated psychiatric …
The “ethical canary”: How moral injury signals systemic failure
Our current scheme and its overbearing credentialism is out of date and cannot keep up with a rapidly changing health care environment. Greater flexibility is needed for the well-being of patients and physicians alike.
Professional burnout and anticipated physician shortages continue to be highly debated topics. Indeed, the American Medical Association reports that 45 percent of physicians have symptoms of burnout, and the Association of American Medical Colleges anticipates a …
Beyond Flexner: Why we must rethink medical training reform
Recently, I was asked to write about my experience as a rural emergency physician in New Mexico. The timing was uncanny: I am in the final shifts of my first job out of my emergency medicine residency on the East Coast, having spent more than four years working in emergency departments across western rural New Mexico, primarily within the Indian Health Service.
Summarizing this experience concisely feels impossible. Every emergency physician …
Rural emergency medicine in New Mexico: a physician’s firsthand account
She did not begin with the abuse; she began with sleep.
“I do not know why the news is bothering me so much,” she said. “I cannot turn it off. I feel on edge all the time.”
She was in her late 50s, successful, articulate, and with no prior trauma history documented in her chart. She insisted she was not “overreacting,” just “sensitive to injustice.” At the time, headlines were saturated with …
Trauma reactivation: Why news headlines trigger past abuse
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Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Why CPT coding ambiguity harms doctors.” Muhamad analyzes the landmark case of United States v. Ron Elfenbein, where …
Ambiguous billing rules threaten every doctor in practice [PODCAST]
Every day, millions of Americans take medications to manage chronic conditions or prevent disease. Prescription drugs are vital tools in modern medicine, but in some circumstances, they can also lead to serious adverse drug interactions, diminished quality of life, and even life-threatening complications.
This is a complex issue with high stakes for patients. Older adults, in particular, are often prescribed multiple drugs by different doctors for different reasons. The Centers for …
Deprescribing in health care: Why less medication can be more
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