Why clinical excellence isn’t enough to sustain a physician-owned hospital

Physician
January 27, 2026

Most physicians begin their careers with a deeply held belief: If treatment is good, patients will come. It feels intuitively correct, and early in practice it often appears to be true. Clinical outcomes build trust, trust brings patients, and for a time the system seems to sustain itself. Yet after years of working inside physician-owned hospitals, group practices, and large corporate health systems, I have learned an uncomfortable truth. Good …

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Emergency department metrics vs. reality: Why the numbers lie

Policy
January 27, 2026

The emergency department didn’t suddenly get worse.

The numbers did.

Every shift, emergency clinicians are measured by dashboards that insist on telling a familiar story: Door-to-provider times are too long, length of stay is unacceptable, left-without-being-seen rates are creeping up. The implication is clear. We’re slow. We’re inefficient. We’re failing.

But those numbers are no longer describing clinical performance. They’re describing system saturation.

Emergency departments today operate in conditions that were once considered temporary …

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Hashimoto’s disease in adolescent girls: Why it’s often overlooked

Conditions
January 27, 2026

Hashimoto’s disease is the most common cause of hypothyroidism in children and adolescents, yet it remains frequently overlooked, particularly in adolescent girls. Fatigue, mood changes, weight gain, and cognitive slowing are often attributed to mental health conditions or dismissed as normal features of puberty, delaying diagnosis and treatment. This pattern reflects a broader failure to recognize how autoimmune thyroid disease presents during adolescence, and how gendered assumptions shape clinical interpretation …

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Hidden financial dangers of wRVU thresholds in medical employment agreements [PODCAST]

Podcast
January 26, 2026
YouTube video

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Health care attorney Dennis Hursh discusses his article “wRVU threshold risks in physician contracts.” Dennis explains the critical distinction between a guaranteed salary and a draw against future earnings where failure to …

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Leading with love: a physician’s guide to clarity and compassion

Physician
January 26, 2026

In medicine, we are trained to lead with logic. To analyze, evaluate, and act. We are praised for decisive thinking, efficiency, and evidence-based decisions. In the hardest moments of my life, career, and leadership, none of those tools brought me clarity.

Ten years ago, as a practicing pediatrician and physician leader, my personal life began to fall apart. My husband, who had always been steady and supportive, began to slide into …

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Why doctors ignore their own advice on hydration and health

Conditions
January 26, 2026

“I’m surprised I haven’t had a kidney stone.”

It’s a running joke among my co-residents, when it’s 3 o’clock in the morning, with over 20 patients in the waiting room, and nobody can remember the last time they had water. Most days, my fluid intake is limited to the sips needed to swallow my antidepressants (to quote my parents, “you can’t just take them whenever you feel sad,” and “it’s not …

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Low testosterone in men: a doctor’s guide to TRT safety

Conditions
January 26, 2026

A man in his late 40s sits down in my office and says, “Doctor, I think my testosterone is low.”

Sometimes he is already holding lab results. Sometimes he is coming from a gym forum, a friend’s recommendation, or a late-night Google search. But almost always, the story sounds familiar: lower sex drive, fewer morning erections, weaker erections, fatigue, brain fog, mood changes, and that stubborn belly fat that seems to …

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Agentic AI in medicine: the danger of automating the doctor

Tech
January 26, 2026

“Can AI scale in medicine?” is the wrong question.

The real question is: Can AI protect the soul of medicine while people who have never sat with our patients decide their fate?

The ADVOCATE program: an overview

The Trump administration recently launched the ADVOCATE program: Agentic AI-Enabled Cardiovascular Care Transformation. Run by ARPA-H, this initiative aims to build and deploy autonomous “clinical AI agents” for cardiovascular disease, with an FDA authorization pathway of …

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Uterine aging in IVF: Why the “soil” matters as much as the seed

Conditions
January 26, 2026

Most clinicians know that eggs age. Fewer acknowledge that the uterus ages too.

In reproductive medicine, we often rely on the seed-and-soil analogy. The seed is the embryo. The soil is the endometrium, the inner lining of the uterus where implantation occurs.

Here is the part that deserves more explicit counseling and strategic planning: Even when embryo quality is controlled, uterine age can independently influence implantation, miscarriage risk, and live birth rates. …

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Patient expectations in primary care: the structural mismatch

Physician
January 26, 2026

Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural.

Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in. And when we can’t deliver what …

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AI in medical education: the risk to professional identity formation

Education
January 26, 2026

I learned medicine in hallways, in the classroom, and outside.

I learned how to apologize to a patient by watching my attending pull up a chair and say, “I should have done better.” I learned how teams actually work by overhearing tense but respectful disagreements during sign-out. I learned what it meant to belong by being given responsibility before I felt ready. None of those lessons happened on Zoom or Teams.

In …

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The telehealth trap: Why single-service roles lead to burnout

Physician
January 26, 2026

Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems …

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Healing chronic illness requires treating the mind alongside the body [PODCAST]

Podcast
January 25, 2026
YouTube video

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Internal medicine and functional medicine physician Shiv K. Goel discusses his article “Mind-body connection in chronic disease: Why traditional medicine falls short.” Shiv explores the limitations of conventional medical models that focus …

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How modern health care design strains patients and clinicians

Conditions
January 25, 2026

My great-grandfather was a small-town doctor in the early 1900s.

It was a different time. A different place. A very different pace.

He knew his patients. He knew their families. He understood their lives, not just their symptoms. Care happened in the context of relationship because that was simply how medicine worked.

Today, health care looks very different. The science is better. The technology is stronger. We can do things now that would …

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Physician retirement: a cultural shift from system to self

Conditions
January 25, 2026

The number was specific: 18,000 steps.

It came from a retired hospital director in Taipei, a physician-administrator who spent four decades building services, negotiating budgets, and managing crises across a health care system that now treats an aging society as its primary patient.

Most physicians retire into silence. He retired into data.

But the more interesting revelation did not come from his smartwatch. It came from the dinner table.

A shift in governance

In Western …

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ADHD and cannabis use: Navigating the diagnostic challenge

Conditions
January 25, 2026

As a psychiatrist, I increasingly meet patients who come in convinced they have attention-deficit/hyperactivity disorder (ADHD). They arrive prepared: an online screening test, a list of symptoms (poor concentration, low motivation, distractibility) and often a quiet sense of relief at finally having an explanation. Then I do what physicians are trained to do. I take a careful history. I review medications. I ask about sleep, mood, anxiety, substance use, and …

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Multifactorial drivers of the U.S. physician shortage: a data analysis

Physician
January 25, 2026

The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …

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Alex Pretti: a physician’s open letter defending his legacy

Physician
January 25, 2026

To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.

I am not a nurse. I am …

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Why I chose disruption over conformity in medicine

Physician
January 25, 2026

I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …

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Medicare cuts are destroying independent rural medical practices [PODCAST]

Podcast
January 24, 2026
YouTube video

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Saravanan Kasthuri, medical director at Northwest Endovascular Surgery, and Jason McKitrick, executive director at the Office Based Facility Association, discuss their article “Medicare payment is failing rural health.” Saravanan and Jason analyze …

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