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, …
“Do any of you have children?” the patient’s mother asked each of my team members during rounds. I (STG), as the attending, quickly jumped in and mumbled, “Yes, I have (as a foster parent),” and redirected the conversation back to the medical management of her child.
It was not until a week later, when I was attending a talk on microaggressions, that I realized my team members may have perceived the …
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 …
There was an article published recently addressing the shortage of pediatricians. Though the article focused on this specific shortage, it actually raised many additional questions regarding the physician workforce in general. It is difficult to disagree that continuing to decrease reimbursement, increasing maddening payment schemes, and increasing regulatory requirements to pediatricians and physicians in general will have predictable results. There will be physician shortages, and patient access will be compromised.
Hospitals …
When I’m not knocking on exam-room doors as a pediatrician in New York City, I’m knocking on voters’ doors in Northampton, Pennsylvania—a small county that could determine the outcome of this year’s nail-biting presidential election.
Each time I walk up to a voter’s front door, my heartbeat quickens. You would think a doctor who talks to total strangers every day would be immune to such jitters. But even with a door-knocking …
Ecclesiastes was probably written by many ancient scholars, although Jewish tradition holds that it was written by King Solomon. Whatever the provenance, I think the first chapter holds a nugget of wisdom that we need to try hard to remember:
What has been is what will be,
and what has been done is what will be done; there is nothing new under the sun.
Is there a thing of which it is said,
“See, …
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We welcome Ron M. Aryel, a pediatrician who shares his powerful journey through medical school and residency as a physician with cerebral palsy. Facing discrimination, ableism, and hostility from colleagues and superiors, Ron …
P.K. presents for a medical evaluation to the early intervention program. He is 26 months old. P.K.’s parents self-referred to the early intervention program because of concerns regarding a delay in his development. The mother reports that he is not saying any words and is not following directions. He does not turn to the sound of his name. He appears to be in his own world. When I, the pediatric …
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We explore the unique challenges faced by patients with intellectual and developmental disabilities (IDD) during dental appointments. Our guests, Brian Jones, a health care executive, and Tina Saw, a dentist and health care …
Reflections: Day 5
It’s a strange feeling to look down at my phone calendar and realize that nothing will be grayed out because it happened, but only because time keeps ticking.
It’s interesting and beautiful to watch my kids keep moving forward as the community around us is so devastated: playing music, rediscovering the joy that is reading, helping clean up the yard, making a game out of who does which chore …
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 …
February 2017: Second day on service in months, and already I feel wiped. It’s exhausting. I feel that it is meaningful but so draining. And still, I’m not sure that I am even doing a good job.
A month later, I came home from a multi-level marketing (MLM) party at a colleague’s house, announcing my excited plans to embark on a new venture. I was going to start selling MLM skin …
A physician in the pediatric intensive care unit (PICU) requires vast medical knowledge along with emotional resilience. I always thought I had a strong sense of compassion for my patients and their families until I had my own baby 1.5 years ago. It completely shifted my perspective. I started to understand parental grief and fear on a personal level, which reshaped my approach to work.
Before having a baby, I was …
When I took the final exam after years of pediatric training, hearing my professors say, “You are now qualified and equipped to manage a pediatric clinic; congratulations” was a deeply touching moment for me. I felt fortunate to experience the profound satisfaction of seeing my efforts to help children recognized and appreciated. With eager anticipation, I awaited the assignment to the place where I would begin my journey as a …
About midway through my pediatric residency program at a well-known children’s hospital on the East Coast in the mid-1990s, I found out what was wrong with me.
I told the chief of the pediatric emergency department, a Jewish woman, that I had finally learned the name of a device after I had patients use it many times. I knew what it was for, but I hadn’t learned its name. It was …
I am the combination of two very different worlds—my mother is originally from El Salvador and Catholic, and my father is from Pakistan and Muslim. My parents are original trailblazers in my mind, creating a life together despite the unsure gaze of their respective families, who questioned the durability of their relationship, largely because they had never experienced one like theirs before. As a child and into adulthood, I felt …
At the November 2022 Obesity Week in San Diego, it was clear something big was happening. A late-breaking session released results of the STEP TEENS phase IIIa trial, showing 16 percent weight loss in adolescents with obesity treated with once-weekly semaglutide (Wegovy) for 68 weeks. The side effects were manageable and similar to those experienced in adults: nausea, vomiting, and constipation.
A month later, semaglutide received FDA approval for weight management …
As I led small group sessions during our medical school’s recent orientation, I was struck by the nervous excitement and hope radiating from our new first-year students. Their enthusiasm was palpable yet tinged with apprehension about the challenging journey ahead. Two themes emerged from our discussions. The first was a desire to dive in and tackle challenges ahead. As one student stated, “Enough talking, let’s start doing.” The second was …
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