Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

The economic shift from fee-for-service to direct primary care

Health Policy
March 9, 2026

According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compliment. It is a diagnosis. And for a profession that has spent decades accepting influence as a substitute for economic ownership, it is long past time to read it that way. For decades, physicians …

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The economic shift from fee-for-service to direct primary care

A celebrity patient and the core of patient confidentiality

Physician
March 9, 2026

During my second year of private practice, I was still close enough to academics to miss morning conferences, but far enough along to appreciate a predictable lunch break. It was then that I had an encounter that taught me why the core ethics of medicine must remain steady, even when the patient is someone the world recognizes. It happened on a Thursday, a day when the clinic usually looked like …

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A celebrity patient and the core of patient confidentiality

Finding balance in political turmoil: a poem on resilience

Conditions and Diseases
March 8, 2026

The world has slipped out of rhythm,
like a clock knocked from the wall
that still insists on ticking,
though the hours no longer agree.

Nothing aligns with the way it lived
in my body a year ago.
Then, there was a sense of ballast.
Morning came without dread
clinging to its edges.
I could rise,
place my feet on the floor,
and believe, perhaps naively,
that the ground would hold.

I believed the voices we chose would,
at minimum, remember us.
That disagreement was …

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Finding balance in political turmoil: a poem on resilience

Names as social texts: Navigating cultural identity in medicine

Medical Education
March 8, 2026

I cannot recall the first time my name was mispronounced; that is the point. It happened so often that no single moment stands out. The sounds were altered to make them easier. In first grade, a boy loudly said my name sounded like “cereal.” I disliked it but did not tell a teacher. Early on, I learned how others would value attributes like skin color, regardless of my permission.

When adults …

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Names as social texts: Navigating cultural identity in medicine

Medicine in 1926: What being a doctor was really like

Physician
March 7, 2026

Even with all the incredible advances in medicine over the past 70 years, there remain severe deficits in the care of many serious deadly diseases. Pancreatic cancer, multiple sclerosis, glioblastoma, Alzheimer’s, ALS, and ovarian cancer easily come to mind in that desperate category.

However, let’s get a perspective of what it was really like to practice medicine a hundred years ago. What kind of doctors were there? What did they do? …

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Medicine in 1926: What being a doctor was really like

Rebuilding patient trust through the evolutionary mismatch framework

Conditions and Diseases
March 4, 2026

How one reframing changed the way my patients think about me, and their health.

Every day, a patient sits across from me, arms crossed, waiting for me to tell them what pill to take. Or worse, waiting for confirmation of what they already believe: that the medical system has nothing real to offer, their doctor is just a middleman for pharma companies or an insurance shill, and that the answer to …

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Rebuilding patient trust through the evolutionary mismatch framework

The future of employer-aligned DPC and physician autonomy

Health Policy
March 3, 2026

A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.

It is a satisfying idea. It is also an empirically untested one.

The history of DPC is built on physicians willing to challenge entrenched …

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The future of employer-aligned DPC and physician autonomy

Navigating the international dentist U.S. pathway

Conditions and Diseases
March 3, 2026

The moment I decided to become an American-trained dentist, I was holding a textbook in India. I was a first-year dental student in India when it happened. I had just bought my textbooks for the semester, the thick, heavy kind that feel important in your hands, and I started flipping through them.

Page after page, I kept noticing something. The authors. Their names. Their affiliations. Almost all of them were from …

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Navigating the international dentist U.S. pathway

Medical ethics and AI: Why losing oversight endangers patients

Physician
March 3, 2026

At the end of December 2025, the American Medical Association (AMA) Journal of Ethics ceased its operations, now just a relic of the past. Its inception began in September 1999 with a journal theme entitled “Virtual Mentor Launches with a Nod to William Osler.” It references ethical decision-making, praise for Sir William Osler’s Aequanimitas, and the experience of the spoken word from a doctor to a patient’s ears. Its …

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Medical ethics and AI: Why losing oversight endangers patients

Physician free speech rights under fire: the DOJ vs. patient education

Physician
March 1, 2026

I never imagined that providing standard, evidence-based medical care, and explaining that care clearly to patients, could put me at risk of federal prosecution.

Yet that is the position I find myself in today.

I am a board-certified family medicine physician and the founder of a small queer- and trans-owned clinic providing gender affirming care. Our clinic is now at the center of a Department of Justice appeal after we Read more…

Physician free speech rights under fire: the DOJ vs. patient education

Treating methamphetamine-associated dental disease in safety-net clinics

Conditions and Diseases
March 1, 2026

He came in wanting to get his smile back. I did not know he was also asking for his life.

He sat down in my chair and did not say much at first.

That happens a lot in a MassHealth practice in Massachusetts. People come in with more than just one problem. They carry shame, years of avoiding problems, and a lifetime of being told by systems, situations, and sometimes even their …

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Treating methamphetamine-associated dental disease in safety-net clinics

Primary care receives only five cents of every health care dollar [PODCAST]

Podcast
February 28, 2026
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Family physician and health benefits advisor Jonathan Bushman discusses his article “The 5 percent problem: the low value of primary care.” Jonathan contrasts the grueling decade of training and massive debt required …

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Primary care receives only five cents of every health care dollar [PODCAST]

Learned helplessness and self-efficacy in tobacco treatment

Physician
February 27, 2026

Treatment of people who use tobacco is different. Most treatments given to patients are reasonably successful, but cigarette smokers who are trying to quit will make multiple attempts before they remain abstinent, sometimes as many as twenty. Within hours of stopping, nicotine users can begin to experience withdrawal symptoms which include craving, anxiety, irritability, and restlessness that continue to increase and can rapidly be relieved by another cigarette.

Some people trying …

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Learned helplessness and self-efficacy in tobacco treatment

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The enduring value of the physical exam in modern medicine

Physician
February 26, 2026

I recall the moment I fully grasped the critical importance of the physical exam and how easily it can be overlooked, often with serious consequences.

Early in my fellowship, an elderly patient was referred to our team with an apparently straightforward case of sciatica. His MRI revealed a disc herniation at L5/S1 with foraminal narrowing, prompting discussion about whether an epidural injection or surgery would be more beneficial. I was tasked …

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The enduring value of the physical exam in modern medicine

From Singapore to Canada: a blueprint for primary care transformation

Health Policy
February 26, 2026

Recently, Dr. Tara Kiran made headlines when her robust national OurCare survey revealed 5.9 million Canadians still lack a primary care provider, the point-of-entry health professional, like a family doctor or nurse practitioner, who provides routine care.

Those who do have a primary care provider often wait weeks for an appointment, then get rushed through in minutes. Emergency departments overflow with patients who have nowhere else to go.

The federal government …

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From Singapore to Canada: a blueprint for primary care transformation

Health care price transparency: Why patients are bypassing insurance

Physician
February 26, 2026

I recently went to Quest Diagnostics for a TB test and a couple of basic labs my doctor ordered. At check-in, I recalled my insurance had changed in the new year and I did not have the updated information readily available. I did not have time to reschedule nor sort it out so figured I could pay cash and reconcile it later. That seemed reasonable, if inconvenient.

When I asked what …

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Health care price transparency: Why patients are bypassing insurance

Informed refusal vs. denied care: a dental case study

Conditions and Diseases
February 25, 2026

I went in for a routine dental cleaning. It was never provided.

I’ve spent my career on multiple sides of health care, independent practice, hospital-owned systems, and health insurance, which has made me acutely aware of how incentives and operational norms can quietly shape care. Still, what happened during this visit surprised me.

After I was brought back to the exam room, I was told bitewing X-rays would be taken before the …

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Informed refusal vs. denied care: a dental case study

Agentic AI: the key to saving annual preventive exams

Physician
February 21, 2026

Annual preventive exams have been a staple of American medicine for decades. Yet despite their importance, preventive visits remain underutilized in American health care, which is no surprise in a system that centers sick care and incentivizes churning out services instead of improving outcomes.

In fact, only 60% of Medicare beneficiaries complete their annual well visits, and less than 65% of children under 19 complete their well-child check-ups. When …

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Agentic AI: the key to saving annual preventive exams

Physician burnout: Finding peace in a broken health care system

Physician
February 20, 2026

Among the people exiting the hospital, I could easily pick out the medical staff leaving their shifts. It wasn’t by their clothing or the time of day, but by the unspoken language of relief on their faces: a calm twinkle in the eyes or a gentle softness around the forehead and jaw. Dawn or dusk, the look was always there. I hoped I’d have it too when I left later …

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Physician burnout: Finding peace in a broken health care system

The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions

Physician
February 19, 2026

Welcome to the first weeks of the new year. A great moment to check in.

How are you doing? How are you feeling? Energy level?

The first days of the new year come with a lot of excitement and a lot of pressure.

Excitement for the sense of renewal and becoming better versions of ourselves. Excitement in putting the last year to rest and starting with a clean slate. Excitement at putting down …

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The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions

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