Physician reimbursement cuts collide with AI audits

Conditions and Diseases
September 19, 2026

Physician reimbursement has faced sustained downward pressure for years, while insurers have expanded tools, including AI-driven audits, prior authorizations, and retrospective reviews, so that they can recover or limit payments after (or before) services are delivered. This dynamic contributes to practice strain, consolidation, and reduced patient access. Evidence from Medicare data, physician surveys, and industry analyses supports the core concerns. Not every claim of intentional misconduct or pure profit extraction …

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Physician reimbursement cuts collide with AI audits

Patient communication ends when the patient understands

Patient
September 19, 2026

For decades, we have been told the stories of medicine through the eyes of the people who provide it. Medical dramas place doctors and nurses at the center of the narrative: the brilliant surgeon making impossible decisions, the exhausted emergency physician racing against time, the nurse carrying the emotional weight of caring for patients through crisis. Even in today’s most authentic medical dramas, including The Pitt, patients are often catalysts …

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Patient communication ends when the patient understands

Grief after cancer treatment belongs in follow-up visits

Conditions and Diseases
September 19, 2026

Recently, a patient of mine shared her final follow-up after successful cancer treatment. Instead of celebrating the clear scans, she burst into tears.

Recovery from serious illness is often seen as a triumphant return to normal life, but the reality is far more complex. For many patients, the end of treatment marks the beginning of a new emotional journey that is rarely discussed or anticipated. As patients recover, the losses from …

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Grief after cancer treatment belongs in follow-up visits

Why the family medical history lives with women caregivers

Physician
September 19, 2026

Across the different hospitals and services where I have trained, I have noticed something I did not expect to notice. When we ask who knows the patient’s medications, who can explain what happened during the last hospitalization, or who we should call in an emergency, the answer is very often a woman. A mother. A wife. A sister. A daughter.

A specific memory I have: a seventy-year-old man with diabetes and …

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Why the family medical history lives with women caregivers

Fragmented care left nobody responsible for the patient

Conditions and Diseases
September 19, 2026

After my wife Kathy died, I spent months replaying the events that led to her death. As a physician, I naturally searched for explanations. As a husband, I searched for accountability. What I found instead was a troubling lesson about modern institutions. They are often brilliant at analyzing complexity and surprisingly poor at recognizing the obvious.

Kathy’s medical history was undeniably complex. End-stage renal disease. Coronary artery disease. Heart failure. Peripheral …

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Fragmented care left nobody responsible for the patient

Non-opioid pain management gets separate pay in 2026

Conditions and Diseases
September 19, 2026

As the third-highest opioid-prescribing medical specialty representing 6 to 8 percent of all U.S. opioid prescriptions, orthopedic surgeons carry an outsized share of responsibility for reducing patients’ opioid exposure. Orthopedic procedures dominate this pattern as they represent four of the five surgeries with the highest opioid prescription rates among patients aged 45 to 64. Even more alarming, orthopedic surgeons often treat young and active patients, and for many, surgery …

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Non-opioid pain management gets separate pay in 2026

Why acne, chin hair, and irregular cycles are more than an ovary problem [PODCAST]

Podcast
September 18, 2026
YouTube video

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A condition named for the ovaries turns out to run through the muscle, the liver, and the pancreas. Insulin is the signal connecting them, and different organs hear it differently. Oluyemisi Famuyiwa, reproductive …

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Why acne, chin hair, and irregular cycles are more than an ovary problem [PODCAST]

4 workflow fixes that cut physician burnout at the source

Health Technology
September 18, 2026

Introduction

If you ask any physician why they chose a career in health care, administrative documentation, tracking down patient information, or navigating the endless automated phone systems of external clinics are unlikely to be part of the answer. Most of us entered this field to care for human beings. Yet across nearly every specialty today, clinicians spend far more hours staring at computer screens, wrestling with EHR interfaces, and managing operational …

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4 workflow fixes that cut physician burnout at the source

Burnout or job dissatisfaction: 4 causes usually in play

Physician
September 18, 2026

How do I know if I’m burned out or just unhappy at work? On the surface, this is a straightforward question. Job burnout is one thing; professional dissatisfaction is another. We have validated survey questions for each, like the Maslach Burnout Inventory and the Physician Worklife Survey, and measures that can differentiate burnout from dissatisfaction, like the Professional Fulfillment Index. But I’ve found that when physicians are no longer thriving …

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Burnout or job dissatisfaction: 4 causes usually in play

A poem about political division and the will to begin again

Conditions and Diseases
September 18, 2026

I watch the world spinning faster
than I can follow,
a wheel thrown down a hill
with no one reaching for the brake.

Decisions made in haste,
words fired like arrows,
people stepping over the rights of others
as though compassion
has become an inconvenience.

Where is the moral compass
we once carried inside our hearts?

Somewhere above us,
a man sits upon his golden throne,
surrounded by wealth
and power and influence,
and maybe he thinks he can
control the world.

The people below think,
“If he …

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A poem about political division and the will to begin again

Nurse advocacy: The shackles came off before he died

Conditions and Diseases
September 18, 2026

It wasn’t long ago that my new homeowners insurance company threatened me, stating I have to get a new roof. Of course they weren’t going to cover it. The last time I had a new roof installed was 2004.

My fellow ICU nurse friend said, “Get my daddy. He has his own roofing company.” And so I did. Patty was an awesome ICU nurse. Well respected with an affluent family. I …

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Nurse advocacy: The shackles came off before he died

Muhamad Aly Rifai, MD, on psychiatry and physician prosecution: a KevinMD subscriber spotlight

KevinMD
September 18, 2026

Muhamad Aly Rifai, MD

Muhamad Aly Rifai, MD is a psychiatrist, internist, and addiction medicine physician, and the founder, chief executive officer, and chief medical officer of Blue Mountain Psychiatry in the Greater Lehigh Valley, Pennsylvania. He has published 37 essays on KevinMD since …

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Muhamad Aly Rifai, MD, on psychiatry and physician prosecution: a KevinMD subscriber spotlight

Patient satisfaction scores punish the doctors who say no

Physician
September 18, 2026

In the digital age, we have been conditioned to trust the social proof of a high star rating. We see five stars on a retail site and immediately assume the product is excellent. But as a psychiatrist, I have learned that when it comes to medicine, that logic is fundamentally flawed. In fact, if you encounter a physician with 375 five-star reviews and not a single negative comment on social …

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Patient satisfaction scores punish the doctors who say no

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Insurance companies are being sued over directories that aren’t real [PODCAST]

Podcast
September 17, 2026
YouTube video

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

Your insurance company says these therapists take your plan. Most of them do not. That is the allegation behind seven class action lawsuits now moving through courts from Massachusetts to California. Attorney Steve …

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Insurance companies are being sued over directories that aren’t real [PODCAST]

Frivolous malpractice lawsuits are a governance failure

Physician
September 17, 2026

It’s time to call out medical malpractice for what it really is. Dick Durbin’s own words define what is behind medical malpractice. “Before I was elected to Congress, I worked in a courtroom. For years, I defended doctors and hospitals, and for years, I sued them on behalf of people, who were victims of medical malpractice.”

Dick Durbin became a lawyer in 1969. He was first elected to Congress in 1982. …

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Frivolous malpractice lawsuits are a governance failure

Why physician outsourcing is a warning sign for hospitals

Physician
September 17, 2026

History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those cared for by midwives. The hospital still looked functional, the wards remained open, physicians continued working, and the institution carried on. But something inside the system was profoundly wrong. Semmelweis …

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Why physician outsourcing is a warning sign for hospitals

12 psychiatrists missed my medication-induced psychosis

Conditions and Diseases
September 17, 2026

During deliberations in the recent murder trial of Lindsay Clancy, jurors made an unusual request. They asked to see the bags of prescription medication bottles that had been introduced into evidence.

Clancy’s defense had argued that she was suffering from postpartum psychosis when she killed her three young children in 2023, and that her condition had been compounded by overmedication and inadequate psychiatric care. Prosecutors disputed that account. After weeks of …

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12 psychiatrists missed my medication-induced psychosis

The Pennsylvania measles outbreak and the cost of forgetting

Conditions and Diseases
September 17, 2026

On Saturday, August 29, 2026, a headline in my local paper caught my eye. There were 460 confirmed measles cases in Pennsylvania as of Friday, August 28, according to the Pittsburgh Tribune-Review. As of Wednesday, September 16, there are 731 cases in 38 of Pennsylvania’s 67 counties, and over 120 hospitalizations.

A brief search of the CDC website shows that since 1991, the number of measles cases nationwide has been in …

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The Pennsylvania measles outbreak and the cost of forgetting

AI governance in health care has to reach the exam room

Health Technology
September 17, 2026

Hospitals and health systems have spent the past several years building AI governance programs. They have formed committees, written policies, reviewed vendors, and debated where these tools belong in clinical care. That work matters.

But as a physician, I worry that too much of the conversation still stops short of the exam room. A health system can approve a tool, complete a compliance review, and satisfy a governance checklist while leaving …

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AI governance in health care has to reach the exam room

Why physician financial freedom matters more than salary

Physician Finance
September 17, 2026

An excerpt from Essays and Echoes: Reflections from a Life in Medicine.

In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is …

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Why physician financial freedom matters more than salary

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