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Health care attorney Dennis Hursh discusses his article “wRVU threshold risks in physician contracts.” Dennis explains the critical distinction between a guaranteed salary and a draw against future earnings where failure to …
In medicine, we are trained to lead with logic. To analyze, evaluate, and act. We are praised for decisive thinking, efficiency, and evidence-based decisions. In the hardest moments of my life, career, and leadership, none of those tools brought me clarity.
Ten years ago, as a practicing pediatrician and physician leader, my personal life began to fall apart. My husband, who had always been steady and supportive, began to slide into …
“I’m surprised I haven’t had a kidney stone.”
It’s a running joke among my co-residents, when it’s 3 o’clock in the morning, with over 20 patients in the waiting room, and nobody can remember the last time they had water. Most days, my fluid intake is limited to the sips needed to swallow my antidepressants (to quote my parents, “you can’t just take them whenever you feel sad,” and “it’s not …
A man in his late 40s sits down in my office and says, “Doctor, I think my testosterone is low.”
Sometimes he is already holding lab results. Sometimes he is coming from a gym forum, a friend’s recommendation, or a late-night Google search. But almost always, the story sounds familiar: lower sex drive, fewer morning erections, weaker erections, fatigue, brain fog, mood changes, and that stubborn belly fat that seems to …
“Can AI scale in medicine?” is the wrong question.
The real question is: Can AI protect the soul of medicine while people who have never sat with our patients decide their fate?
The ADVOCATE program: an overview
The Trump administration recently launched the ADVOCATE program: Agentic AI-Enabled Cardiovascular Care Transformation. Run by ARPA-H, this initiative aims to build and deploy autonomous “clinical AI agents” for cardiovascular disease, with an FDA authorization pathway of …
Most clinicians know that eggs age. Fewer acknowledge that the uterus ages too.
In reproductive medicine, we often rely on the seed-and-soil analogy. The seed is the embryo. The soil is the endometrium, the inner lining of the uterus where implantation occurs.
Here is the part that deserves more explicit counseling and strategic planning: Even when embryo quality is controlled, uterine age can independently influence implantation, miscarriage risk, and live birth rates. …
Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural.
Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in. And when we can’t deliver what …
I learned medicine in hallways, in the classroom, and outside.
I learned how to apologize to a patient by watching my attending pull up a chair and say, “I should have done better.” I learned how teams actually work by overhearing tense but respectful disagreements during sign-out. I learned what it meant to belong by being given responsibility before I felt ready. None of those lessons happened on Zoom or Teams.
In …
Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems …
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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Mind-body connection in chronic disease: Why traditional medicine falls short.” Shiv explores the limitations of conventional medical models that focus …
My great-grandfather was a small-town doctor in the early 1900s.
It was a different time. A different place. A very different pace.
He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.
Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …
The number was specific: 18,000 steps.
It came from a retired hospital director in Taipei, a physician-administrator who spent four decades building services, negotiating budgets, and managing crises across a health care system that now treats an aging society as its primary patient.
Most physicians retire into silence. He retired into data.
But the more interesting revelation did not come from his smartwatch. It came from the dinner table.
A shift in governance
In Western …
As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …
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The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …
To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.
I am not a nurse. I am …
I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …
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Saravanan Kasthuri, medical director at Northwest Endovascular Surgery, and Jason McKitrick, executive director at the Office Based Facility Association, discuss their article “Medicare payment is failing rural health.” Saravanan and Jason analyze …
Let me start with a truth many of us sense long before we ever speak it aloud. We whisper it to ourselves on post-call mornings. We feel it in the drive home after another shift that took more than it gave. We carry it into our kitchens, into our bedrooms, and into the quiet moments where no pager or EMR alert can compete with what’s happening inside us.
The elephant in …
A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago.
The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to …
The pilot of a commercial aircraft, descending into near-zero visibility, hands control to an automated system designed for precisely that moment. The landing is flawless. The passengers are safe. The pilot announces it proudly. Technology functions exactly as promised.
A doctor on board writes, “It made me think about the health care journey I am on with AI. The safety and well-being of 140 people wasn’t left to human intervention; the …
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