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Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer, raises a …
20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]
In oncology and survivorship care, one of the most common (and often least visible) experiences patients carry is fear of recurrence.
For many people, finishing treatment brings a sense of relief. But it can also bring something quieter that lingers. A watchfulness. A heightened sensitivity to the body. A subtle shift in how the future feels.
For others, this way of thinking begins earlier (at diagnosis, during treatment, or in the spaces …
Fear of cancer recurrence is a human response, not a flaw
We are living in an era where attention, not information, is the scarce resource. And what we pay attention to (not what we claim to value) reveals the architecture of our priorities.
Consider a few comparisons that, though deliberately absurd, tell a deeper truth. We now have more Marvel movies than major classes of antibiotics. The world produces more aspiring pop singers than there are widely used chemotherapy regimens. Strangely enough, …
The attention economy is starving public health
Daria D. learned how dangerous a “ghost network” is while fearing that her son would kill himself. Daria was desperate to find a psychiatrist to help her teenage son, who was suicidal. She called more than a dozen doctors listed in her insurance company’s provider directory. Half were listed with telephone numbers that did not work. The other half said they did not take her insurance or could not see …
Mental health ghost networks are badly hurting patients
After a scribing shift, I opened TikTok and found myself inside a growing hub the internet calls “Doc-Tok,” a thriving community of health care professionals sharing clinical takes, career glimpses, and the unfiltered reality of working in medicine. What I did not expect was how much of it was fear. Providers describing terminations over comments that any other member of the public could post freely. Nurses parsing their captions for …
3 changes physicians on social media need from institutions
In primary care, practice overhead is commonly described as 50 to 60 percent of collections. That range is repeated in continuing education, in vendor marketing, and in the operational frameworks new practice owners are handed when they ask what normal looks like. The range is not wrong. It is just too broad to be operationally useful.
A primary care practice running at 58 percent overhead might be perfectly stable, undercompensating its …
Why your overhead percentage is the wrong benchmark
I once cared for a patient I’ll call Maria, a middle-aged professional with severe spinal disease and years of stable function on a carefully monitored opioid regimen. She’d never lost a prescription, never shown signs of misuse, and passed every urine drug screen. Then her clinic was acquired by a large health system, and new policies arrived with a single message: cut opioid doses or risk scrutiny. Within months, Maria’s …
The opioid crackdown is harming chronic pain patients
I am writing this from a hospital bed, though it took far longer than it should have to get here.
I was directly admitted by a surgical team for treatment of a post-surgical infection. The expectation in such cases is straightforward: admission to an inpatient unit for monitoring, treatment, and recovery. Instead, I spent hours in a secondary waiting room, followed by placement in a chair in a shared emergency department …
ED boarding fails patients before treatment begins
Both during and since the COVID-19 pandemic, multiple theorists and pundits have postulated that COVID-19 was being developed as a bioweapon, and was mistakenly (or purposely) released from a containment lab, purportedly in China. Other researchers say no. But, either way, the effects upon our country, our society, our health care delivery (with emergency departments and hospitals overwhelmed, while many clinics were forced to shut down), our …
RFK’s HHS cuts leave the U.S. open to a bioweapon attack
I am alive because of a heart transplant.
That heart belonged to a young man in his twenties. His mother is now part of my life. She loves me, worries about me, and carries the unimaginable reality of losing her son while knowing his heart is still beating inside someone else. That “someone else” is me.
Because of that, taking my anti-rejection medication is not optional. It is survival.
For my entire transplant, …
Insurance denial after transplant: Approval isn’t access
I said something in a medical school interview that I probably shouldn’t have said in a medical school interview.
It was a group interview, and we were waiting for one of the other interviewees in our group (he had back-to-back interviews and was running late). To pass time, the examiner, who just so happened to be the head of medical admissions at the medical school, asked why we applied to that …
The MCAT requirement persists as a norm, not as a tool
Reason for consultation
Burnout. Workforce decline. Moral distress. Concern regarding physician formation.
Chief complaint
Burnout.
History of present illness
Medicine presents with burnout. Chronic. Recurrent. Poorly responsive to treatment.
Associated symptoms now include workforce shortages, declining interest in primary care, moral distress, loss of meaning, and concern regarding what kind of people the profession is forming.
Treatment efforts have been substantial. Wellness initiatives. Resilience training. Mindfulness. Workflow redesign. Administrative intervention. Repeated attempts to improve work-life balance. Partial …
Physician burnout is not the whole diagnosis
Recently, a popular YouTuber and his wife shared a deeply personal and painful decision with their large online audience. After announcing their pregnancy earlier in 2026, routine screening tests indicated a high likelihood that their baby had Down syndrome, also known as Trisomy 21. They reportedly followed up with amniocentesis, a diagnostic test that confirmed the diagnosis. In an emotional video, they reacted to the results live on camera, clearly …
Prenatal testing for Down syndrome is not a verdict
Recent discussions surrounding aging and scientific innovation have raised important questions about how scientific creativity should be measured. A recent article in Science approached this issue primarily through bibliometric and disruption-based analyses, perspectives that were subsequently discussed and amplified in other outlets, including Nature.
Still, scientific creativity may not always be fully captured through disruption metrics or bibliometric patterns alone, a concern raised in recent responses discussing the limitations …
Why scientific creativity and aging defy citations
The first time it really hit me how small my world had gotten, it was not during a hospital stay or anything big like that. It was something simple. I remember thinking about running out to grab something quick, just a normal errand. And then it hit me that even that was not really an option for me anymore. It was just a regular day. That was the part that …
What does mental health when bedbound actually look like?
My colleague had a vision. Not the kind that comes from a business school classroom or a venture capital pitch competition, but the kind that comes from years of practicing medicine and watching colleagues slowly lose the thing that brought them into this field in the first place. Autonomy. Joy. The feeling that you are actually helping someone, not just generating documentation.
The three of us, my CEO colleague and two …
Built for physicians, by physicians: our founder story
I built my career on caring, compassion, and a deep desire to help others.
As a psychiatric nurse practitioner with a doctorate, I was trained to understand suffering: to listen closely, recognize patterns, and validate experiences that others might overlook. That work wasn’t just professional. It was personal. Long before I became a clinician, I was a patient.
I have lived with symptoms for most of my life. But like many patients, …
How clinicians with chronic illness lose more than health
My father’s melanoma diagnosis arrived on a Tuesday. By Thursday, we had a plan of care. By the following Monday, I was back at work seeing my own patients, pretending the world had resumed its normal shape. But it hadn’t. Not really. Because his cancer didn’t pause between appointments, didn’t stop growing or spreading, and neither did the fear, the questions, or the quiet unraveling that comes with navigating a …
Physician advocacy can close the gap between appointments
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 …
Medical hierarchy is silencing young doctors who want to write
For decades, the medical community has accepted a foundational principle of cardiovascular care: patients with non-valvular atrial fibrillation (AFib) require aggressive, lifelong stroke prophylaxis. When a patient also presents with stable coronary artery disease (CAD), standard practice has historically gone a step further, layering an antiplatelet such as aspirin on top of an oral anticoagulant such as warfarin or a modern direct oral anticoagulant (DOAC). To frontline hospitalists and patients, …
Is anticoagulation bleeding risk worse in the real world?
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