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Joseph Pepe is a physician executive.

Managing a Black Swan in health care: a lesson in transparency

Joseph Pepe, MD
Physician
February 2, 2026

An excerpt from On All Sides of the Bed: One physician’s/CEO’s journey.

In the early summer of 2013, our hospital collided with a Black Swan.

Before Europeans discovered Australia, they were familiar only with white swans. The discovery of black swans overturned a long-held assumption. In business and risk theory, a “Black Swan” refers to a rare, unpredictable event with massive consequences, a concept popularized by Nassim Nicholas Taleb. For us, …

Read more…

Managing a Black Swan in health care: a lesson in transparency

Should older physicians face competency tests?

Joseph Pepe, MD
Physician
September 28, 2025

Commercial airline pilots are required to retire at 65 under Federal Aviation Administration regulations. It’s not ageism; it’s safety. Yet physicians, whose decisions can be just as life-or-death, face no such requirement. As a former internist, chief medical officer, and hospital CEO, I have seen what happens when physicians practice past their prime. The results can be dangerous, heartbreaking, and entirely preventable.

When “going out on top” doesn’t happen

During my tenure …

Read more…

Should older physicians face competency tests?

A doctor’s guide to preparing for your death

Joseph Pepe, MD
Physician
September 15, 2025

Let us get this straight: Enjoying life is amazing. You should do more of it. Every day, if you can. But if you are truly committed to living well, you also need to get comfortable with something most people avoid like mystery meat at a buffet: preparing for your death.

Not obsessing over it. Not fearing it. Just preparing, so your loved ones are not left trying to solve your digital, …

Read more…

A doctor’s guide to preparing for your death

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  • Most Popular

  • Past Week

    • Rethinking the role of family physicians vs. specialists

      Ronald L. Lindsay, MD | Physician
    • Why clinical listening skills outpace artificial intelligence

      Ryan Egeland, MD, PhD | Tech
    • A humorous parody of medical specialties and the modern patient

      Sidney J. Winawer, MD | Physician
    • Administrative burden is driving severe physician burnout

      Kayvan Haddadan, MD | Physician
    • Pharmacy closures threaten our entire public health system

      Timothy Lesaca, MD | Physician
    • The hidden clinical cost of HCC coding in primary care

      Jeffrey H. Millstein, MD | Physician
  • Past 6 Months

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      The Podcast by KevinMD | Podcast
    • The controversy over Maintenance of Certification for grandfathered physicians

      Bernard Leo Remakus, MD | Physician
    • Why clinicians fail at writing expert reports

      Tracy Liberatore, Esq, PA | Conditions
    • Rethinking the role of family physicians vs. specialists

      Ronald L. Lindsay, MD | Physician
    • Evidence-based medicine vs. clinical judgment: a medical student’s perspective

      Jay Pendyala | Education
    • How hindsight bias distorts clinical medicine

      Olumuyiwa Bamgbade, MD | Physician
  • Recent Posts

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    • Why relationship-centered care matters in medicine

      John Wei, MD | Physician
    • The quiet hospital financial crisis threatening health care

      Ganesh Asaithambi, MD, MBA | Conditions
    • Why I would never compromise on withdrawing care until I saw it firsthand [PODCAST]

      The Podcast by KevinMD | Podcast
    • How language shapes physician migration and medical training

      Omer Ahmed | Education
    • Closing the execution reliability gap in health care systems

      Katherine Owen, RN | Conditions

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