35 years after choosing psychiatry as a specialty

Physician
May 27, 2026

35 years ago, I stood in a hospital hallway and made a decision that would define the rest of my professional life. I was halfway through my internship year in radiation oncology, a field of high-tech linear accelerators and clear-cut protocols, but my heart had drifted toward psychiatry. When I finally voiced my intent to switch, I didn’t find the collegial support we are taught to value in medical training. …

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35 years after choosing psychiatry as a specialty

The physician gender pay gap is an engineering problem

Physician
May 27, 2026

The physician gender pay gap persists after adjustment for specialty, hours, and productivity. A 2016 study in JAMA Internal Medicine found female physicians earned roughly $20,000 less per year than male counterparts after extensive controls. Subsequent analyses confirm similar patterns across specialties and career stages. Most of this literature treats the gap as evidence of discrimination. That framing identifies the problem but offers no mechanism and few remedies.

This …

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The physician gender pay gap is an engineering problem

When a code blue on the psychiatry unit ends in a police interview [PODCAST]

Podcast
May 26, 2026
YouTube video

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

You hear code blues overhead in a hospital all the time, but one on a psychiatry unit is different. A young patient died after a cardiac event, and what followed looked nothing like …

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When a code blue on the psychiatry unit ends in a police interview [PODCAST]

The hidden cost of GLP-1 insurance coverage mandates

Medications
May 26, 2026

I have spent years caring for patients with obesity, and one of the most meaningful parts of this work is seeing what happens when people finally receive comprehensive, evidence-based treatment. I have watched sleep apnea disappear, blood pressure normalize, joint pain ease, and liver disease reverse. I have watched people who spent years feeling dismissed by the health care system finally start to feel healthy and hopeful again. Those outcomes …

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The hidden cost of GLP-1 insurance coverage mandates

Social determinants of health belong in medical school

Medical Education
May 26, 2026

There is so much going on in the world right now, which is precisely why I want to talk about a TV show.

Not for escapism. Because this particular show is doing something that medical schools across the country are now being required to stop doing.

The Pitt won Outstanding Drama Series at the 2025 Emmys. Season 2 just aired its finale. Season 3 is already confirmed. And if …

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Social determinants of health belong in medical school

Mission over margin: a community ER doctor’s discipline

Physician
May 26, 2026

The May 2, 2026, New England Journal of Medicine (NEJM) Perspective, “From Mission to Margin in Academic Medicine,” articulates an internal struggle I feel frequently. All physicians recognize the formative environment Dr. Vyas describes as something that must be fiercely protected, and his call to action against the commodification of training resonates deeply. As an emergency department physician practicing outside of this setting, I recognize that when we succumb …

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Mission over margin: a community ER doctor’s discipline

Payer contract renegotiation costs independent practices

Physician Finance
May 26, 2026

A typical commercial payer contract for an independent practice gets signed once, usually under time pressure during credentialing, and then sits untouched for three to five years. The practice receives annual fee schedule updates from the payer, treats them as the new floor, and moves on. The contract is filed and rarely opened again.

This is the diagnostic gap that costs independent practices more recurring revenue than any operational issue except …

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Payer contract renegotiation costs independent practices

Medical malpractice lawsuits cost $56 billion a year

Physician
May 26, 2026

Medical malpractice is big business in the United States. The only database monitoring medical malpractice is the National Practitioner Data Bank (NPDB). The NPDB’s annual report claims only 13,000 medical malpractice lawsuits. The NPDB was first established by the Health Care Quality Improvement Act in 1986. It was created by politicians (attorneys) for the express purpose of tracking specific adverse actions against health care practitioners.

Only 13,000 lawsuits are hardly “big …

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Medical malpractice lawsuits cost $56 billion a year

Bedside medicine and the meaning of physician presence

Physician
May 26, 2026

Transitioning from one part of the country to another can be daunting, though for me it has become a fascinating lesson in both what differentiates us and what remains remarkably the same. Geography changes. Accents shift. Customs vary. Yet suffering, fear, hope, and love seem to speak a language of their own.

I have continued to practice medicine much as I always have, in person, at the bedside, and in patients’ …

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Bedside medicine and the meaning of physician presence

The residency personal statement is an identity problem

Medical Education
May 26, 2026

Last year around this time, a student offered me $1,000 to write the personal statement for their residency application.

Not to coach them through exercises that would help them write it themselves. Not to edit a finished draft. One thousand dollars for me to write 800 words about their life that they could submit alongside their transcripts and Dean’s Letter to the Electronic Residency Application Service (ERAS).

At first, it would have …

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The residency personal statement is an identity problem

Doctors using AI are not being replaced by it

Health Technology
May 26, 2026

The U.S. health care system is adopting artificial intelligence faster than nearly any other sector, and for many patients, that’s unsettling.

Patients consistently say they trust AI far more when it supports doctors rather than replaces them. But the rapid integration of AI in medicine, particularly in clinical settings, has left many wondering: Is rising AI use helping clinicians do their jobs better? Or, as some technology leaders seem to hope, …

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Doctors using AI are not being replaced by it

GLP-1s, weight loss, and the inflammation tests your patient needs [PODCAST]

Podcast
May 25, 2026
YouTube video

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

A cardiologist who helped set national cholesterol and weight targets for 40 years now says those numbers can mislead. Richard M. Fleming, a physician specializing in cardiovascular and inflammatory disease, argues that weight …

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GLP-1s, weight loss, and the inflammation tests your patient needs [PODCAST]

Spirituality is a remedy for physician burnout

Physician
May 25, 2026

A physician, whom I will call Dr. Hannah, initially sought coaching from me to address burnout and optimize clinical documentation in the electronic medical record. One of the major challenges that surfaced in her first coaching session was that she did not know who she was outside of work. She also wanted to bring more joy, fulfillment, and meaning into her life. Dr. Hannah’s schedule was so intense that she …

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Spirituality is a remedy for physician burnout

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Philanthropy for scientific research is underused

Conditions and Diseases
May 25, 2026

I often wonder why giving has so little to do with how much one has. A millionaire may hesitate to part with even a few thousand dollars for a person in need, while someone with only a modest savings may readily give away a meaningful share of it for a good cause. Clearly, something deeper is at work than what we see outwardly. This raises an important question: why does …

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Philanthropy for scientific research is underused

Why high-functioning adults are delaying psychiatric care

Conditions and Diseases
May 25, 2026

A pearl forms when an irritant gets trapped inside an oyster and can’t get out. The oyster doesn’t remove it. It layers over it until damage becomes structural. That’s what I keep seeing in patients who waited years before seeking psychiatric care.

The delay is often interpreted as denial or avoidance. In practice, many adults are functioning exactly well enough to normalize their suffering. They become so fluent at carrying anxiety, …

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Why high-functioning adults are delaying psychiatric care

The quiet loss of dignity in medicine

Physician
May 25, 2026

When institutions begin to fear the consequences of telling the truth, the First Amendment becomes a parchment promise rather than a living principle. Medicine is not immune to this cultural shift. Physicians who once spoke freely about patient safety, training standards, and systemic failures now hesitate, not because they lack conviction, but because the corporate structures around them punish candor. The result is a profession that has lost not only …

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The quiet loss of dignity in medicine

Anesthesiologist bedside manner matters more than skill

Physician
May 25, 2026

In anesthesia, we meet patients at one of the most vulnerable moments of their lives. We care for patients as a team, and I’m grateful for the skilled certified registered nurse anesthetists (CRNAs) I work alongside every day. Often, we are asked to earn trust quickly, while patients place their safety and comfort in our hands. What we offer in those moments goes beyond technical skill. This is my attempt …

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Anesthesiologist bedside manner matters more than skill

Doctor patient trust cannot be automated

Physician
May 25, 2026

He is an engineer from Guatemala, in his sixties. The Spanish accent has gone mostly quiet after decades in the States, but not entirely. Six months ago I did a radical prostatectomy on him. Localized disease, favorable risk, I spared the nerves. It went the way you hope these things go.

Today, sitting across from me in my clinic, his prostate-specific antigen (PSA) is 0.05. Which, if you are not in …

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Doctor patient trust cannot be automated

Is coaching in medical education replacing mentorship?

Medical Education
May 24, 2026

Walk into any medical school or residency program today and you will find coaching everywhere. There are coaches for Step exams, OSCEs, research productivity, wellness, leadership, residency applications, and even “professional identity.” On the surface, this seems like progress, offering structured support, individualized feedback, and measurable outcomes. But beneath this expansion lies a more uncomfortable question. Are we replacing meaning-making mentorship with episodic, transactional coaching?

Coaching: what it does well

At its …

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Is coaching in medical education replacing mentorship?

A medical school experience that redefined providing care

Medical Education
May 24, 2026

My first experience of “providing care” did not unfold as I had imagined: after years of training, thoroughly studying everything there is to know about the human body, and being perfectly prepared to care for someone. Instead, it began quietly, with a white coat and a stethoscope that fit about as comfortably as my pseudo-physician identity, that is, to all of my friends not in medicine.

It was early in my …

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A medical school experience that redefined providing care

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