Are 10 percent (or 25 percent) of all the physicians in your specialty breaking the law?
Of course not! Who would think such a thing?
Your friendly neighborhood “nonprofit” hospital, that’s who!
I have been reviewing physician employment agreements for almost 40 years, and in the last few years I have noticed a spike in the number of agreements that “cap” physician salary. A shocking number of hospital employment agreements provide that the …
The ED is swamped with new patient arrivals. As a result, the 20-year-old who told the triage nurse he is having difficulty breathing waits an hour before his turn in the triage room. The emergency department technician hands me the ECG—sinus tachycardia—and takes the vitals.
Me: “What brings you to the emergency department today?”
Him: “I feel like I cannot breathe. It started all of a sudden at work.”
As I scroll through …
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Emergency physicians Resa E. Lewiss and Courtney M. Smalley discuss their article, “Why point-of-care ultrasound belongs in emergency department triage.” Amid the crisis of overcrowded waiting rooms and long wait times, they …
“My PSA came back at 6.2 — does that mean I have cancer?”
It’s one of the most common and emotionally charged questions I hear in the clinic. The prostate-specific antigen (PSA) test, once celebrated as a breakthrough in early cancer detection, has become a double-edged sword. For many men, a slightly elevated PSA level is enough to trigger panic — and for some physicians, enough to trigger a biopsy.
But here’s …
An excerpt from Medicine is a Practice: The Rules for Healthcare Marketing.
“I’m late! I’m late! For a very important date!”
— The White Rabbit, Alice’s Adventures in Wonderland, Lewis Carroll
Lewis Carroll wrote about the tardiness of the White Rabbit in Alice’s Adventures in Wonderland in 1865. The problem of tardiness is older than the White Rabbit, and lack of punctuality plagues every profession and human interaction. Unfortunately, in the medical …
Medicine has long valorized the early riser – the physician who arrives before sunrise, who joins 7:30 a.m. meetings and stays for evening journal clubs, case conferences, and post-dinner networking events. These scheduling patterns have come to symbolize dedication, productivity, and professionalism. However, for many physicians, particularly those with caregiving responsibilities, these norms reflect more than tradition; they represent structural exclusion.
The architecture of medical professionalism was built on an outdated …
Physicians are human. Medicine is a career—not a lifelong vow of self-sacrifice.
Yes, for some, it may feel like a calling. But let’s be clear: Choosing medicine doesn’t mean surrendering your identity forever. Times have changed. Our mindset must, too.
Working part-time, seeking balance, or transitioning into leadership, education, or non-clinical roles is not a betrayal of the profession. It’s growth. Yet these choices are too often dismissed as abandonment.
We must let …
“The value of intuition in clinical practice” prompted me to reflect on one of the deeper regrets I carry from my clinical practice—those moments when I didn’t fully acknowledge or act upon a parent’s intuition, often a mother’s, that something was wrong with their child.
As clinicians, we are trained to listen for clinical “buzz words”—specific complaints or symptom patterns that guide our diagnostic reasoning. These cues form the backbone …
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Certified financial planner Brian Case discusses the article, “Personal financial planning shouldn’t be a taboo subject.” They explore the often-overlooked link between financial stress and the crisis of physician burnout, turnover, and …
The Pitt was compelling TV.
As an emergency nurse educator for a Stanford campus in Northern California, there is one thing that is required viewing for my new graduate nurses: The Pitt.
The ambitious series did an admirable job portraying the complex world of the emergency department. The procedures were clinically accurate. The spectrum of patients and social issues was nuanced and believable. They even showcased the incidence of post-COVID PTSD, an …
She was 68. Diabetic. Living alone with chronic osteoarthritis. Like many patients, she carried a story more complex than any preoperative checklist could capture: a long history of opioid dependence, obesity, limited mobility, and no one at home to help her recover.
Her total knee replacement—performed with state-of-the-art robotic precision—was flawless. The surgical plan was executed to perfection. The implant was perfectly aligned. She was discharged on time, per protocol.
But protocol …
In today’s evolving health care environment, value-based care is reshaping the future of medicine. The push toward value-based care demands innovative, cost-effective, and patient-centered solutions. A promising yet underutilized strategy is medicine repurposing, the practice of using existing medicines for new therapeutic purposes. Drug repurposing provides a strategic pathway to improving health outcomes while minimizing costs. A compelling example of this approach is the use of clonidine, a long-established cardiovascular …
The modern medical profession presents practitioners with an abundance of opportunities that extend far beyond traditional patient care. Today’s physicians navigate complex roles as clinicians, researchers, educators, administrators, and community leaders while maintaining personal relationships and spiritual well-being. Rather than viewing these diverse responsibilities as competing demands, successful physicians learn to integrate them into a balanced approach that prioritizes meaningful contribution over external recognition.
The myth of perfect balance
The concept of …
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I won’t be using CVS pharmacies anymore. Sure, I may still need to send prescriptions their way as a physician—but as a consumer, I’m done.
Why?
CVS has recently implemented a new phone system that forces callers to leave a voicemail instead of waiting on hold. The idea is to streamline operations, letting pharmacy staff return calls when they have time. It’s supposed to manage call volume, reduce wait times, and shield …
Health care regulatory bodies have embraced a dangerous “accuse first, prove later” strategy that is eroding the foundation of our health care system. Physicians, the bedrock of patient care, are being subjected to accusations based on flimsy, illegitimate reports or random audits. Rather than building cases on substantial initial evidence, these authorities thrive on retrospective scrutiny—analyzing old notes, reframing past actions, and bending interpretations of guidelines to validate their accusations. …
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Internal medicine physician and author Robert C. Smith discusses his article, “Medicine’s mental health crisis: why the system is failing us.” He reveals the shocking disparity in care, where only 25 percent of patients with mental illness receive any treatment compared to 70 percent for …
That was one of my uneventful night duties—until early morning. As usual, I had a hectic on-call day, where I barely got half an hour for dinner—which we consider routine. Around 3 a.m., I received a request for an abdominal CT scan for a middle-aged male patient with abdominal pain. The surgeons were suspecting mesenteric ischemia—blockage in abdominal vessels, which can be life-threatening.
I glanced through the scan, trying to open …
When I began the journey to becoming a doctor, I believed success was a destination—a finish line I’d reach if I just worked hard enough, studied long enough, and sacrificed deeply enough.
And I did all those things.
I pushed through sleepless nights in college. Carried the weight of relentless pressure in medical school. Survived the grind of residency, where time lost all meaning. I lived with my eyes fixed on the …
What is psychotherapy?
Psychotherapy is a talking process between a patient and a psychotherapist. Psychotherapy makes connections among feelings, thoughts, impulses, and behaviors to understand what works and what gets in the way of meeting life’s goals, reaching one’s fullest potential, feeling successful, and being fulfilled. This is accomplished by self-reflection. By examining life patterns, changing, improving, and unlearning emotional and behavioral habits that get in the way and are no …
President Trump signed into law the One Big Beautiful Bill Act (H.R. 1)—a 1,000+ page legislative thunderclap that had just cleared Congress, reshaping the landscape of American domestic policy as fireworks lit the sky. Branded as a domestic reset—heavy on tax cuts, defense expansion, and deregulation—it was not sold as a health care bill. But for those of us on the front lines of medicine, particularly in rural America, make …
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