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Kenneth Botelho, founding director of the doctor of medical science (DMSc) program at The College of St. Scholastica and a physician assistant, discusses his article “Federal graduate-loan caps threaten rural health care …
Capping student loans destroys the rural medical pipeline [PODCAST]
Can there actually be a medical profession with physicians as only employees in an industrialized corporate or socialized system with a union representing their collective interests? Does it matter, and should it matter? Are there still alternatives?
Asking another party, specifically the government, to solve major predicaments consuming the profession is not a plan. Worse, it is a clear sign of dependency and weakness. There is no other entity that can …
Is physician unionization the answer to a broken health care system?
Primary care providers and primary care medicine are on the downswing in the U.S., burdened with increasing demands of documentation and numerous complicated quality programs in the face of rapidly diminishing reimbursements. While the tribe is disappearing fast, enter its newest nemesis: artificial intelligence (AI).
You might wonder why AI is detrimental to primary care and primary care physicians. The common notion is that physicians, including primary care physicians, will be …
Will AI replace primary care physicians?
Most physicians sense it, even if they struggle to name it.
Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.
For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …
The decline of professionalism in medicine: a structural diagnosis
The phrase “board-certified” once carried a universal meaning. A physician had met rigorous training and testing standards and could practice confidently anywhere in the country. That clarity has faded. Today, certification and recertification requirements differ not only by specialty but also by which board you happen to fall under. What was once a single national standard has splintered into a patchwork of rules, fees, and timelines that seem designed less …
The patchwork era of medical board certification
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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician suicide prevention: a call to action.” Muhamad opens with the tragic losses of Dr. Nolan R. Williams and Dr. …
Physician suicide represents a silent epidemic demanding urgent reform [PODCAST]
One of the marks of a good physician is the ability to approach illness from two complementary angles. We bring scientific knowledge, training, and objectivity to understand what is happening in the body. But the work doesn’t end there. What truly elevates a clinician is the willingness to honor how the patient experiences their illness, the internal narrative that no lab test can measure.
This dual lens is not unique to …
How neurodiversity in relationships shapes communication
When my father-in-law died by suicide, our family did not just lose a person. We lost the gravitational center of a small universe.
He was a giant in my eyes. Not because of his curriculum vitae, though his was extraordinary, but because of the way he moved through the world: steady, modest, and relentlessly devoted to the people who needed him.
He had survived what should have broken a human being. As …
Physician suicide: a daughter-in-law’s story of loss and grief
“Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?”
He didn’t come in asking about his sleep.
He didn’t mention that his last meal the night before was at 11:30 p.m., eaten in front of a laptop glowing with unanswered emails.
He didn’t bring up the statin he’d been taking for years, the creeping fatigue he’d started to normalize, or the way his waistline had slowly expanded as his …
Why lifestyle matters more than BPC-157 and semaglutide
Most recognize me from posts about deductive reasoning on KevinMD, but I never explain deductive reasoning’s effect on a conventional medical malpractice lawsuit. Here is how it affects such a lawsuit.
All medical malpractice lawsuits have four things in common:
How deductive reasoning changes medical malpractice lawsuits
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Professor and senior associate dean of engagement Janet A. Jokela discusses her article “Reflecting on the significance of World AIDS Day from the 1980s to now.” Janet shares harrowing memories from her …
Personal memories reveal the transformation of HIV care over four decades [PODCAST]
It doesn’t take much to understand that women have had it tough throughout history. While seemingly in our age there is near parity (with many women heads of state in Mexico, Italy, Moldova, Iceland, etc.), they only gained the right to vote in the U.S. 105 years ago (with the 19th Amendment to the Constitution), which was 50 years after Black men in 1870 (the 15th Amendment). There have always …
How blaming women for a baby’s sex persisted through history
In hospital boardrooms across America, the “30-day readmission rate” is treated as a financial vital sign. It determines reimbursement levels under the Hospital Readmissions Reduction Program (HRRP); it influences star ratings; and increasingly, under new Department of Justice scrutiny, it serves as a barometer for potential “substandard care” investigations.
Yet, despite decades of regulation and millions spent on discharge planning software, the needle on preventable readmissions barely moves.
The industry is failing …
The “patient carryover crisis”: Why hospital readmissions persist
The room went quiet the way rooms do before something consequential, when conversation thins and all you can hear is the pulse in your ears.
“Captain Kumar,” the instructor said, “you have an in-flight engine failure. What do you do?”
I stood at attention, spine locked, as my classmates turned toward me with the focused expectation of a clinical team evaluating a tenuous presentation. A bead of sweat slid down my temple. …
How flight surgeon training mirrors medical residency stress
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Health care strategist Dana Y. Lujan discusses her article “Is direct primary care sustainable in a downturn?” Dana explains how the rising cost of living and subscription fatigue are challenging the retail …
Economic reality tests the limits of subscription medicine [PODCAST]
On December 5, I started my hospital shift learning that the ACIP (Advisory Committee on Immunization Practices) had voted against offering universal administration of hepatitis B vaccine at birth, opposing the long-standing practice endorsed by experts. After a long day of examining newborn babies and counseling families, my mind drifted back to the announcement and unearthed a memory of a boy named Sam.
Sam was born a healthy newborn to loving …
Why ACIP’s ruling on universal hepatitis B vaccination endangers newborns
I have spent my career practicing medicine in the real world: caring for patients, managing uncertainty, and making decisions where the stakes are personal and immediate. In recent years, I have also spent considerable time designing and deploying medical software that uses artificial intelligence in live clinical environments. Together, these experiences have reshaped how I think about the future of our profession.
That combination of experiences has led me to a …
AI in medicine: Why it won’t replace doctors but will redefine them
Last week, I spent over two hours on a prior authorization for a patient who needed a medication she’d been stable on for years. Two hours of hold music, transferred calls, and faxed forms, while patients waited.
That same week, Anthropic announced Claude for Healthcare: An AI system that can verify coverage requirements, build claims appeals, and streamline prior authorizations in minutes. OpenAI launched ChatGPT Health days earlier. Both promise to …
Claude for Healthcare vs. administrative burden: a physician’s review
I come from a long line of physicians. My grandfather was a pioneer in pharmacy and biochemistry, so influential that a museum now bears his name. My father, also a doctor, was cut from a very different cloth. I have written before about our strained relationship and the heavy expectations placed on a child born into a family with a reputation to uphold. Those tensions shaped my early views …
The burden of being both doctor and family: an ethical reflection
I proudly bear the title of “Dad,” and my daughter is five (going on 15), fiery, carefree, and unmistakably precocious, yet still my silly, innocent, sweet little girl. I imagine many girls with older brothers develop a similarly spirited personality. However, with her brothers being slightly older, I’ve watched that same innocence gradually diminish in them, as they are being slowly exposed to life’s complexities through school, friends, and their …
A physician father on the Dobbs decision and reproductive rights
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