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A surgeon’s view on RVUs and moral injury

Physician

October 17, 2025

For over forty years, I worked as a general and vascular surgeon. For the last ten of those years, I was employed under an RVU-based compensation model. That period is when my dissatisfaction with medicine truly began. Complex, life-saving operations were reduced to “productivity units.” The pressure was relentless, the system unforgiving.

And unlike primary care physicians, surgeons do not have the option of concierge or direct-pay models. We are necessarily …

Meeting transgender patients with compassion and equity in health care [PODCAST]

The Podcast by KevinMD

Podcast

October 16, 2025

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

Infectious disease physician Tyler B. Evans discusses his article “Meeting transgender patients where they are: a health care imperative.” Tyler, an infectious disease specialist and author of Pandemics, Poverty, and Politics: Decoding …

Why your health is a portfolio to manage

Larry Kaskel, MD

Conditions

October 16, 2025

I’m not a financial advisor. But after 35 years in internal medicine and lipidology, I’ve realized that physicians are essentially wellth managers, stewards of human energy, rhythm, and resilience.

We help people diversify their time, protect their emotional capital, and build habits that generate compound interest in the form of years, vitality, and peace. In a way, our patients are portfolios: living, breathing balance sheets of choices and consequences.

It’s not money …

Reclaiming moral ambition in health care

Mick Connors, MD

Physician

October 16, 2025

When I started practicing medicine more than thirty years ago, I believed the system was imperfect but noble. We worked hard, we cared deeply, and I thought that if we just kept doing our best, things would gradually improve. I trusted that technology, new policies, and better organization would eventually bring us closer to the ideals of medicine. Some of those changes helped. Many did not.

If I am honest, there …

Pain control failures in fertility clinics

Maire Daugharty, MD

Conditions

October 16, 2025

“The Retrievals” is a podcast series hosted and written by Susan Burton and presented in cooperation with the New York Times that focuses on the failure of a Yale fertility clinic to address uncontrolled pain during procedures. As it turns out this was the result of a nurse surreptitiously replacing the pain medication fentanyl with saline to support her addiction. This apparently unfolded over the course of a year or …

Why what you do in midlife matters most

Michael Pessman

Conditions

October 16, 2025

Aging well is not solely a matter of luck or genes, in my experience as a gerontologist. The choices we make, the connections we nurture, and the support systems we build shape it. There is no better time than now to start—the latest research from 2024 and 2025 supports this.

Let us begin with a crucial insight: midlife is more important than we once imagined. In new studies, it has been …

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Why what you do in midlife matters most

When language barriers become a medical emergency

Monzur Morshed, MD and Kaysan Morshed

Physician

October 16, 2025

She clutched her chest, gasping for words that would not come in English. The nurse leaned in, trying to decipher. Her son was not there to translate, and the phone interpreter line was not connected yet. I could see her distress worsening. Precious minutes slipped away before we finally realized she was describing classic heart attack symptoms. That patient survived, but the outcome could easily have been different. And in …

A sibling’s guide to surviving medical school

Chuka Onuh and Ogechukwu Onuh, MD

Education

October 16, 2025

When we began medical school, we had dreams and plans for what the next four years would look like. After all, we had the privilege of being siblings on the same medical training journey. The truth we have realized over these past years is that nothing truly prepares you for how medical school will change your time, priorities, and even your sense of self. Therefore, the decisions you make (or …

Was Viagra the best heart drug we never had?

Bharat Desai, MD

Conditions

October 15, 2025

Prologue: the lost opportunity

Everyone knows Viagra as the “little blue pill” that revolutionized the bedroom. But what if its greatest potential was never about sex, but about saving lives?

A long-term study from Manchester followed men with both diabetes and a prior heart attack, about as high-risk a group as you can imagine. The results were astonishing: those who used sildenafil (Viagra) had a thirty-eight percent lower risk of another …

How to stay safe from back-to-school illnesses

Kevin King, PhD

Conditions

October 15, 2025

From daycare to college, the back-to-school season almost always correlates to one thing: a rise in respiratory illnesses. In late summer, when children are returning to their classrooms, outbreaks of illnesses like strep throat, influenza, COVID-19 and respiratory syncytial virus (RSV) become more common, and schools can quickly become amplifiers of community transmission. These infections can spread rapidly through contact with surfaces where the virus or bacteria is present, like …

The burden of the eldest daughter

Jessie Mahoney, MD

Physician

October 15, 2025

Were you the one who always held it together? The responsible one? The one who made sure everyone else was OK, sometimes at the cost of your own well-being?

For most eldest daughters, this role is inevitable. We don’t choose it. We are handed it, early and often, because we are so “capable.” We accept this role and excel at it. That’s what most eldest daughters do with whatever is handed …

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The burden of the eldest daughter

A doctor’s letter from a federal prison

L. Joseph Parker, MD

Physician

October 15, 2025

Understanding the legal process in America is not easy, and I do not envy the attorneys who try to defend doctors in court. I do envy them for their protections. Lawyers, for the most part, as elected members of Congress, create our laws. Others, also for the most part lawyers, are selected to be U.S. Attorneys, and they enforce those laws. Lawyers called judges control our courtrooms. Almost all of …

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A doctor’s letter from a federal prison

A surgeon’s reflections on God, intelligence, and being a good cell in the universe [PODCAST]

The Podcast by KevinMD

Podcast

October 14, 2025

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

Surgeon Fateh Entabi discusses his article “A surgeon’s take on God, intelligence, and cosmic responsibility.” Fateh reflects on how the complexity of the human body inspired him to think more broadly about …

A doctor’s tribute to her father

Manisha Ghimire, MD

Physician

October 14, 2025

“Who would you go on a date with, and why?” That was the question that came up in a recent speech workshop. People shared fun, lighthearted answers. But for me, the answer came straight from my heart. I would go on a date with my dad.

My father passed away nearly fifteen years ago, just before my life was about to begin a whole new chapter. I was newly married, preparing …

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A doctor’s tribute to her father

Can AI help physicians tackle health care’s most pressing challenges?

Microsoft & Nuance Communications

The link between financial literacy and physician burnout

Hayley Gates & Ketan Kulkarni, MD

Finance

October 14, 2025

An excerpt from The Savvy Physician: A Financial Wellness Handbook for Physicians and Professionals.

As a physician, helping people in need is among the greatest honors and privileges in the world. In the complex world of medicine, physicians and health care professionals have the opportunity and privilege to enormously contribute to patient well-being at a time of significant personal and/or family health crisis.

In addition, many physicians and health care professionals …

Treating autism and ADHD as a spectrum, not a contradiction

Ronald L. Lindsay, MD

Physician

October 14, 2025

He was five, wiry, and fast, so fast his mother looped her purse strap around his wrist in the waiting room. She spoke softly, in Spanish, explaining that he could not sit still, could not sleep, could not stop. As she described his meltdowns, he interrupted with nonsense sentences, unrelated to her words, untethered from context. It was not defiance; it was overflow.

I and my team of CNA Spanish interpreters …

The infectious hypothesis of heart disease revisited

Larry Kaskel, MD

Conditions

October 14, 2025

I have written here before about my growing conviction that coronary artery disease is not just about LDL, inflammation, or bad luck. It is time to talk about what might be the elephant in the cath lab: infection.

A recent pathology study out of Japan looked at coronary plaque samples from patients with symptomatic CAD. Using both immunohistochemistry and PCR, they found Chlamydia pneumoniae in every single sample. All fifty plaques …

Why bureaucracy is threatening the survival of private practice physicians [PODCAST]

The Podcast by KevinMD

Podcast

October 13, 2025

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

Neurologist Scott Tzorfas discusses his article “The crushing bureaucracy that’s driving independent physicians to extinction.” Scott shares his firsthand experience as a neurologist in private practice for three decades, where endless pre-authorizations, …

Why direct primary care (DPC) models fail

Dana Y. Lujan, MBA

Policy

October 13, 2025

I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.

When $1 million can’t save a bad idea

The University of Houston medical school launched a direct primary …