I was watching Michigan take on Nebraska the other Saturday when a popular sandwich chain dropped its latest ad: “Our new 500-calorie Fit Sandwich!” Catchy. Marketable. But let’s be honest, it’s mostly bread, a little processed meat, and not much else. Yes, it comes in under 500 calories, but so does half a sleeve of Oreos. Does that make Oreos “fit”? This is the oldest trick in nutrition marketing. We …
Why a 500-calorie meal isn’t always fit
Suicide is the elephant in the room in medicine. We rarely speak about it openly, yet it remains a silent epidemic, among our patients, and tragically, among physicians themselves.
I first encountered this reality as a medical student in Tennessee in 2022. One of my earliest patients was not much younger than I was. Because we were close in age, I felt we …
A doctor’s promise after a patient’s suicide
In Season 1 of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, sat down with Dr. Desmond “Desi” McGuire, a respected ophthalmologist and founder of Retina Associates of Orange County. Their conversation traced Dr. McGuire’s path from childhood influences and early career choices to building a thriving practice and navigating the financial ups and downs of medical entrepreneurship. For physicians seeking guidance on balancing clinical …
Building a practice and avoiding business pitfalls
On my first week of onboarding as an attending, before I had seen a single patient, I met the boulder in a training room.
It arrived as a screenshot. The EHR instructor clicked into a demo chart and a cascade opened: quality gaps, refill requests, preventive care nudges, “smart” routing rules that promised efficiency and smelled faintly of delegation without authority. I had imagined the threshold to attendinghood as a clean …
The first week of an attending physician
Obesity affects one-third of the adult U.S. population, including physicians, and is estimated to cost $147 billion annually. How does the Body Mass Index (BMI) of the physician affect the relationship with patients and the care provided? According to a study in Obesity magazine, “Understanding physician body weight as a possible barrier to obesity care is critical given the important role physicians can play in helping patients manage or lose …
How physician obesity affects patient care
Two emergency physicians with similar training work at the same hospital. Both have twelve years of experience. Both are contracted to work 2,000 hours per year, see roughly twenty patients per shift, and supervise staff. One is a man, the other is a woman. The same work, the same training, the same conditions. Not the same salary: The woman earns about $21,000 less each year.
That is not a hypothetical. That …
Why women ER doctors earn $21,000 less than men
Oncology has long been described as a discipline ruled by biology. Tumor pathways, mutational signatures, margins, and survival curves dominate how we measure, categorize, and predict outcomes. We are taught early in training that tumor biology is king, and much of our decision-making revolves around this truth. Yet, after years of practicing surgical oncology in India, I have learned that biology alone rarely determines the fate of my patients. Culture …
When culture has the final word in cancer care
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Physical therapist and physician advocate Kim Downey, mental health counselor Nikolai Blinow, and family physician and physician coach Tonya Caylor discuss their article “Focusing on well-being versus wellness: What it means for …
Why shifting from wellness to well-being matters for physicians and patients [PODCAST]
I began my career as a nurse practitioner in primary care, where patient visits are often limited to 15 or 20 minutes to manage complex conditions like hypertension, diabetes, and COPD. What struck me was how often these medical issues came with a psychological overlay like depression, anxiety, panic attacks, and trauma. That shaped the course of treatment as much as lab results or medications. The pace of primary care …
A nurse practitioner on leaving the medical machine
In the ER, we ask, Was he wearing a seatbelt
Partly for the note, but partly so we can remove ourselves
From exploded flesh, splintered bones,
Not sure if we can save that eye.
Something in us says, that will not be me;
I take precautions. We live on,
On the strength of the stories we tell ourselves.
But in the ICU, when one of our own has come in,
After a well-informed try at smothering the spark,
There …
A poem for a physician in the ICU
A system hemorrhaging talent: the scale of the crisis
The global health care system is teetering on the edge of a catastrophic workforce deficit, with the World Health Organization projecting a shortfall of 11 million health workers by 2030. Nowhere is this crisis more acute than in the behavioral health sector, which is not merely losing talent but hemorrhaging it. The time for action is not just now, it’s yesterday.
Community …
The mental health workforce is collapsing
Our one and only daughter has gone off to college. My wife and I dropped her off the weekend before. As we made the four-hour drive from Houston to Baton Rouge along I-10, the road stretched ahead, both endless and fleeting, as if time itself were torn between holding on and letting go. Between bursts of laughter and quiet silences, we spoke of classes, friendships, boys, the discipline of focus, …
The stoic cure for modern anxiety
When most people talk about obesity, the blame often falls on donuts, McDonald’s, fast food, lack of exercise, or lack of willpower.
But as a primary care physician, I see a different reality. Obesity is not always born from a donut, and it is not always caused by time poverty. Yet in many cases, it grows out of time poverty, a system that robs people of the space to think, to …
Obesity is the infant of time poverty
The gimmick of the day is to make -preneur the suffix of the year. Solopreneurs. Doctorpreneurs. Digipreneurs. Trumpreneurs. It should come as no surprise then, that leaderpreneur has appeared in your latest Google search. What is a leaderpreneur, anyway, and why should anyone care? Recognizing that there are as many definitions of leadership, entrepreneurship, and innovation as there are practitioners of those arts, here is my take:
Entrepreneurship is the pursuit …
The difference between a leader, a manager, and an innovator
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Orthopedic surgeon Michael Day discusses his article “Why it’s time for doctors to become performance coaches.” Michael explains why public trust in U.S. health care is declining and how patients are increasingly …
Why physicians should embrace the role of performance coaches in health care [PODCAST]
When the FDA put a black box warning on tofacitinib in 2021, the message was blunt: more heart attacks, more cancers, and more blood clots. The warning came from the ORAL Surveillance trial, which followed over 4,000 patients with rheumatoid arthritis already at high cardiovascular risk. Compared to TNF blockers, patients on tofacitinib had:
…
Tofacitinib: a lesson in heart-immune health
Physicians tell me they want out of the insurance grind, but they’re terrified to actually do it. That fear is costing them years of autonomy they could already have.
As someone who supports both DPC and concierge physicians, I believe in the purity of the DPC model, but I also believe in practical pathways to get there. Hybrid models aren’t the compromise position; they’re the strategic bridge that makes the transition …
The smart way to transition to direct care
Caring for someone with Alzheimer’s is not just exhausting; it is emotionally disorienting. You lose pieces of someone you love, slowly, in a thousand small ways. And while books, doctors, and websites talk about the medical side of Alzheimer’s, there are things they do not prepare you for like the guilt, the grief, the unexpected laughter, and how much it can break your heart. If you are in this role …
7 things no one tells you about being a caregiver for someone with Alzheimer’s
I stare down at the ground below me, closing my eyes tight, trying to hold back the tears. “Push it down. Deep breath in. Breathe it out … slowly … again …” The mantra I say in my head whenever it suddenly becomes too much.
I open my eyes to the view of the ground, unwillingly taking a snapshot of the view that surrounds me. Like the slow click of a …
Bearing witness to the gun violence epidemic
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine her painful toe. I tried to avoid her, yet I could not say no. Through my grief and exhaustion, conditioned by years of striving to live a life of purpose, …
A doctor’s struggle with burnout and boundaries
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