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.

Why clinicians leave and why they used to stay

Health Policy
June 25, 2026

Health care keeps asking how to recruit more clinicians.

That question matters. But it is not the only one. We should also be asking why fewer clinicians are staying.

Across the country, health care leaders are sounding alarms about workforce shortages, access challenges, burnout, and turnover. The proposed solutions are familiar: increase reimbursement, recruit more clinicians, expand training programs, and improve efficiency.

All of those efforts matter. But much of the conversation still …

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Why clinicians leave and why they used to stay

Rural health equity starts outside the clinic walls

Health Policy
June 25, 2026

Health care is fundamentally broken when the patient has to choose between a day’s wages and a basic clinical checkup. In the rural landscape of California’s Imperial Valley, this is not a hypothetical dilemma. It is a daily reality for thousands of frontline agricultural workers and underserved families.

As a primary care physician operating independent clinics along the California-Mexico border, I have watched the conventional, centralized health care delivery system repeatedly …

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Rural health equity starts outside the clinic walls

Evidence-based medicine needs a broader view of evidence

Physician
June 24, 2026

One of the most common questions physicians ask when evaluating a new idea is simple: “Where is the evidence?” It is an appropriate question.

Scientific evidence has transformed modern medicine. It has helped identify beneficial therapies, eliminate ineffective treatments, improve patient safety, and extend human life. Few would argue against the enormous contributions of evidence-based medicine. As a physician, neither would I.

Yet over time, I have become concerned that we sometimes …

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Evidence-based medicine needs a broader view of evidence

Are physicians and nonphysician clinicians interchangeable?

Physician
June 24, 2026

After years in medicine, one loses patience with arguments that blur needed distinctions. One of the most consequential appears in claims that expanding roles for nurse practitioners, physician assistants, and other nonphysician clinical providers justify treating them as equivalent to physicians. Because care is team-based and work often overlaps, we are asked to believe that distinctions in training, judgment, supervision, and accountability matter less than they once did.

Teamwork is necessary …

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Are physicians and nonphysician clinicians interchangeable?

Language barriers in health care begin with the effort

Physician
June 24, 2026

When I was younger, I would sometimes take over a phone call for my parents, perhaps with the cable company or our phone service, if the conversation moved too fast or became too technical. They never asked me to do so in person, but occasionally, when I was feeling frustrated after tagging along on a trip to the bank or the store, I would interject a few words in Chinese …

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Language barriers in health care begin with the effort

A hard week is not a verdict on a physician’s career

Physician
June 22, 2026

It was a hard week.

A colleague was suddenly gone, thirteen years of patients, of history, of complicated cases, and just like that, the rest of us were absorbing it. The calls. The messages. The patients showing up at my clinic needing someone. My own patients waiting longer. Notes to review that weren’t mine. Work landing on my desk that nobody planned for and nobody asked me about.

I kept my charts …

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A hard week is not a verdict on a physician’s career

How relationships affect health, seen from the exam room

Physician
June 18, 2026

For the first decade of my medical career, I thought I was treating bodies. By the second decade, I noticed something else. I was usually treating relationships. Patients almost never told me directly.

A woman in her late forties came into my office last year. She had gained 22 pounds in a year, on a routine that had worked for the decade before it. Her labs were normal. Her thyroid was …

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How relationships affect health, seen from the exam room

Guidelines are not evidence: the research to practice gap

Physician
June 16, 2026

The patient would come in with a printout.

You know the one. Pulled from a website you’ve never heard of, about a mechanism you weren’t taught in medical school, asking about a test that isn’t in your standard workup. For a long time, my answer was some version of: I’m not familiar with that, the evidence isn’t there, let’s focus on what we know. Which was the honest answer. It was …

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Guidelines are not evidence: the research to practice gap

Recording medical visits is your legal right

Conditions and Diseases
June 11, 2026

Patients are not guests in their own medical care. Their bodies are examined, their symptoms interpreted, their diagnoses explained, their treatment risks discussed, their consent sought, and their lives affected by the plan that follows. Yet when patients try to lawfully document those care conversations, they are too often treated as if they are doing something improper. They are told they are “not allowed” to record. They are told it …

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Recording medical visits is your legal right

Diagnosis shock is the missing piece in patient encounters

Conditions and Diseases
June 11, 2026

In a recent piece on KevinMD, patient advocate Alan P. Feren explores what he calls “unfinishedness” in medicine: the gap between what clinicians consider a complete visit and what patients actually experience. His observation is both valid and important: Physicians may achieve administrative closure through documentation, diagnoses, and treatment plans, yet patients can leave feeling confused, overwhelmed, or adrift.

However, there is a critical piece missing from this conversation, one …

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Diagnosis shock is the missing piece in patient encounters

Rural health care delivery is not a coverage problem

Physician
June 11, 2026

Earl Haskell doesn’t exist. But thousands of patients exactly like him do. They live in counties where the nearest hospital is more than an hour away. Where the local clinic closed years ago. Where a chest pain isn’t just a symptom, it’s a logistical problem. Earl is a composite. His reality is not.

He lives in Loving County, Texas, the least populated county in the United States. On a map, it …

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Rural health care delivery is not a coverage problem

The direct primary care HSA rule did not fix access

Health Policy
June 11, 2026

In a few weeks, the direct care community will celebrate the one-year anniversary of getting what it had been asking for. By the end of the first quarter, before the rule had been in effect for a single full billing cycle, it was already clear that the more consequential effect was not affordability. It was market design. As I wrote in January, when tax-advantaged dollars enter a care model, they …

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The direct primary care HSA rule did not fix access

The one question that measures physician integrity

Physician
June 9, 2026

There comes a night, somewhere near the end of a long career, when a physician sits alone with himself after the corridors have emptied and the pagers have gone quiet. He turns the years over in his mind, the patients who lived and the ones who did not, the diagnoses made in time and the ones missed, the easy hours and the impossible ones, and he discovers that the question …

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The one question that measures physician integrity

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Medical hierarchy is silencing young doctors who want to write

Physician
June 6, 2026

When people wear hierarchy as a badge of honor, they literally stunt the growth of young doctors, especially in settings where resources are already limited.

I graduated from the Latin American School of Medicine in Havana, Cuba in 2023, and have since returned home to serve my community. I am the first doctor from my village of Logwerle, Central Equatoria State, South Sudan, East Africa, and the first to speak four …

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Medical hierarchy is silencing young doctors who want to write

Why military patients carry pain a chart can’t explain

Physician
June 6, 2026

He came to me with chronic neck pain and headaches that would not quit. The diagnosis was already there: neck pain, degenerative disc disease, chronic headaches. But a diagnosis is not the same thing as a story.

We built a sports medicine treatment plan around what I could find on exam: trigger point injections, massage, soft tissue work. The pain would improve, then return. Every four weeks became every two because …

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Why military patients carry pain a chart can’t explain

You don’t have to feel called to medicine to be a good doctor [PODCAST]

Podcast
June 5, 2026
YouTube video

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

Is medicine a calling or just a job? Christie Mulholland thinks that question is the wrong one, and answering it keeps physicians stuck in burnout. Christie, a palliative care physician and certified physician development coach, returns to the show to introduce a …

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You don’t have to feel called to medicine to be a good doctor [PODCAST]

When a divorce ends a physician’s career

Physician
June 5, 2026

Anyone who has been gaslit knows it feels like hell on earth. We might as well be soldiers in a foreign war. When we return from the war of gaslighting, we deal with PTSD. Eventually, we feel the healing of the wounds.

I am one of thousands of victims of gaslighting in Colorado. All victims have unique stories. In pursuing justice for many of these victims, I’ve learned that lawyers, judges, …

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When a divorce ends a physician’s career

Military sports medicine and the cost of readiness

Physician
June 5, 2026

I came to military medicine as a sports medicine physician. At first, it seemed like an unexpected place for that training. But the more soldiers I treated, the more obvious it became: What better place for sports medicine than the military?

Sports medicine is built around performance, load, recovery, rehabilitation, and preserving function over time. In military medicine, the language changes but the principles are the same. Return to sport becomes …

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Military sports medicine and the cost of readiness

When difficulty swallowing pills looks like noncompliance

Conditions and Diseases
June 4, 2026

An older patient tells the health care team that swallowing medications is difficult. Pills get stuck in the throat. Some trigger gagging. Others are skipped altogether because taking them has become an ordeal. The concern is documented, the difficulty is acknowledged, and in some cases, a swallowing assessment is even performed. Yet the prescription remains unchanged.

Weeks later, the patient has missed doses or stopped the medication altogether. The medical record …

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When difficulty swallowing pills looks like noncompliance

What happened when I brought faith into medicine

Physician
June 2, 2026

There is a topic that has been avoided since the beginning of the Age of Enlightenment in medical discourse. Nothing to do with diagnosis, prognosis, or treatment protocols, but about the invisible human nature that holds patients together when science runs out of answers. That conversation is about faith.

I personally did not have it for a long time. For most of my thirty-five years in medicine, I kept faith neatly …

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What happened when I brought faith into medicine

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