You arrive on time: 8:20 a.m. for your 8:30 appointment. You’ve done your part; you showed up early, brought your insurance card, and maybe even filled out the forms online. You expect to see your doctor at 8:30. After all, that’s what the schedule says. But the clock, like the system, runs on its own rules. At 8:35, you’re still at the front desk. They’re scanning your card, verifying your …
The problem with the 15-minute doctor appointment
The first thirty years of my life were about becoming a doctor. I grew up in a middle-class family in a safe neighborhood with good schools and steady routines. My parents valued hard work and education, and I learned early that if you studied, followed the rules, and kept your head down, good things would follow. Private Catholic elementary school, public high school, then college and medical school. Every step …
The difference between a doctor and a physician
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 …
Reclaiming moral ambition in health care
I’ve been listening to Viola Davis’s memoir, Finding Me, and it’s been sitting heavy on my mind. She vividly describes how being both Black and poor isn’t just a struggle—it’s a one-two punch that shaped every aspect of her life. It’s not just about lacking resources; it’s about being trapped in a system that was never designed to let you win.
That message keeps hitting me because I’ve …
Why Medicaid is failing Black children despite record spending
For the past 30 years, I’ve witnessed medicine evolve—new technologies emerge, new treatments are developed, and wellness programs are implemented—but one thing remains stubbornly unchanged: the relentless, often destructive, quest for validation. As I reflect on my career, I can’t help but see a parallel with the TV series Severance, where employees’ work selves—their “innies”—are literally separated from their personal lives—their “outies.” In our profession, our innie is the part …
Why chasing validation is destroying physicians’ sense of self
There is something strangely captivating about the RVU (relative value unit) system in medicine. It’s as if it has become our own “precious”—a golden ring that offers power and financial viability, yet comes at a great cost. Just like the One Ring in Tolkien’s The Lord of the Rings, the RVU system exerts a powerful, almost mesmerizing hold on the medical profession. It promises us control—of our practices, our autonomy, …
Why physicians can’t let go of the golden RVU ring
In medicine, when something isn’t working, we tend to fix it. Whether it’s a treatment plan that isn’t delivering results or a clinical process that’s creating inefficiencies, we identify the problem, adjust the approach, and find a better solution. But when it comes to the RVU (relative value unit) system—the very framework that dictates how physicians are compensated—we seem to be stuck. Despite growing evidence of its flaws, its inherent …
Why the RVU system is failing health care and how to fix it
The quadruple aim represents an ambitious, holistic vision for the future of health care: improving population health, enhancing the patient experience, reducing per capita costs, and improving the work-life balance of health care providers. While many health care systems have adopted this framework, the widespread use of the relative value unit (RVU) system fundamentally undermines these goals. Far from facilitating the quadruple aim, the RVU system creates a chasm between …
Working as a pediatrician offers a unique and unparalleled joy—a privilege shared among those who dedicate their lives to caring for children and supporting families. This summer, while working on a U.S. military base in Germany, I experienced this joy in its fullest form. Rather than my usual role of just seeing sick kids in an ER, I’ve had the incredible opportunity to serve as a primary care pediatrician. Whether …
How can you not love being a pediatrician?
From the heart of one doctor to another, let’s address the evil spirit haunting our halls: burnout. It has become the unwelcome companion of many physicians, including myself, who frequently lament our moral injuries and the mistreatment that seems to shadow us. We seek refuge as wellness coaches or in the serene embrace of time away, hoping for respite. We call for laws and policies to protect us from the …
Physician burnout: We’re partly to blame, here’s how to fix it
If you are a physician planning to move to a new hospital or take a contract job in another state, prepare yourself for the daunting process of credentialing. As a pediatric emergency physician who frequently provides locum coverage, I’m intimately familiar with the cumbersome, repetitive, and costly scavenger hunt that accompanies credentialing at each new hospital. This process must be endured every time, at every hospital, with no sharing of …
The credentialing scavenger hunt: Navigating hospital credentials
In the ever-evolving landscape of modern health care, physicians often grapple with myths and misconceptions that can hinder our ability to provide the best possible care to our patients. As we stand at the precipice of change in 2023, it’s vital to confront these fallacies with courage, humility, and self-awareness. The path to a better health care system is paved with the stones of truth found in the counterpoints to …
Physician-led health care transformation: Debunking myths
I have long held the conviction that pediatricians, either in unison or in partnership with hospitals, have the potential to catalyze positive transformation within health care. The vision is clear: pediatricians leading the way, safeguarding health care from detrimental influences and steering it towards a brighter horizon. Yet, despite the rallying cries for innovation—be it through maintaining private practices, embracing direct primary care, or advocating for physician-owned hospitals—there is an …
Is unity possible in pediatrics?
Children’s hospitals are acclaimed for their outstanding care, and they would be my absolute choice for my child’s hospital needs. Nevertheless, there is a pressing concern that the underlying philosophy of these institutions is shifting, with financial pressures incentivizing competition rather than cooperation in the field of pediatrics. If hospitals were to dominate primary care, it could potentially exacerbate the departure from a value-driven approach, which is crucial for advancing …
Assessing hospital involvement in pediatric primary care
My overall feeling is that independent practices cannot survive in isolation, nor can they single-handedly drive the transformation needed for value-based care, population health, or to ensure that the most vulnerable have the primary care access they need. We do require financial partners and investment. However, it’s crucial to ensure that we align with the right partners who share a vision that will continuously improve pediatrics for the long term.
During …
Navigating the growing interest of private equity in pediatrics
Rural health for children is in trouble. Don’t take my word for it, just ask the CDC.
“The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their …
Why aren’t more pediatricians leaning into rural health?
First, I want to extend my thoughts, wishes, and prayers to Damar Hamlin, his family, and his teammates. Seeing his collapse on television stirred many emotions in me; I can’t imagine what those who were on the field or in the stadium experienced.
As a pediatric emergency physician, I can tell you that anything related to cardiopulmonary resuscitation (CPR) is difficult. America got a real glimpse of the horrors of CPR …
I was doing a procedure on a child last night, and the mother said to her son: “I want you to be a doctor, make lots of money and buy me a house.”
Of course, it was 11 p.m. on a Friday night, and I was making my riches doing a procedure on an anxious four-year-old in the emergency department.
Doctors make a good income after they finish 25 years of education …
5 ways to be financially successful as a physician
I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …
Thank you for performing CPR on my child
I am not a curmudgeon, but I am worried about the current plight of health care and the attack on the Hippocratic Oath. Bigger health care is sold as better and more efficient with the premise of lowering health care costs. The promised financial outcomes and efficiencies for the physician and their patients have not materialized. Instead, while physicians struggle with non-clinical demands on their time, patients are being pushed …
The Hippocratic Oath, updated for today
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