Physician

Patient expectations in primary care: the structural mismatch

Physician
January 26, 2026

Patient frustration is something many of us carry home at the end of the day. Much of that frustration, however, isn’t personal; it’s structural.

Many patients don’t realize that different primary care models are designed to deliver fundamentally different experiences. They expect concierge-level access and time within insurance-based practices. They want same-day appointments, unhurried visits, and immediate physician availability, regardless of the model they’re in. And when we can’t deliver what …

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The telehealth trap: Why single-service roles lead to burnout

Physician
January 26, 2026

Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems …

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Multifactorial drivers of the U.S. physician shortage: a data analysis

Physician
January 25, 2026

The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …

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Alex Pretti: a physician’s open letter defending his legacy

Physician
January 25, 2026

To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.

I am not a nurse. I am …

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Why I chose disruption over conformity in medicine

Physician
January 25, 2026

I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …

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The elephant in the room: Why physician burnout is a relationship problem

Physician
January 24, 2026

Let me start with a truth many of us sense long before we ever speak it aloud. We whisper it to ourselves on post-call mornings. We feel it in the drive home after another shift that took more than it gave. We carry it into our kitchens, into our bedrooms, and into the quiet moments where no pager or EMR alert can compete with what’s happening inside us.

The elephant in …

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Why the primary care system failure forces unnecessary referrals

Physician
January 24, 2026

A patient with diabetes, hypertension, and obesity comes in for her annual wellness visit. The physician has already spent 20 minutes on chronic disease management and lifestyle guidance. As the visit wraps up, the patient mentions daily heart palpitations that started a month ago.

The exam was benign. The physician has two choices: spend another 20 minutes performing an EKG, discussing differential diagnoses, and developing a workup plan; or refer to …

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AI in medicine vs. aviation: Why the autopilot metaphor fails

Physician
January 24, 2026

The pilot of a commercial aircraft, descending into near-zero visibility, hands control to an automated system designed for precisely that moment. The landing is flawless. The passengers are safe. The pilot announces it proudly. Technology functions exactly as promised.

A doctor on board writes, “It made me think about the health care journey I am on with AI. The safety and well-being of 140 people wasn’t left to human intervention; the …

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Racial mistaken identity in medicine: a pervasive issue in health care

Physician
January 24, 2026

President Trump recently made national headlines by calling a female reporter “Piggy,” an act widely decried as outrageous, even for a man who doesn’t shy away from misogyny. It’s one thing to intentionally refer to someone with a derogatory, dismissive label. This kind of behavior should appropriately be met with indignation and moral outrage. But what happens when we carelessly (and repeatedly) call someone a name that belongs to …

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AI and moral development: How algorithms shape human character

Physician
January 23, 2026

Most of us don’t notice moral development happening while it is happening. Moral character forms quietly, through repetition, through what we get used to doing and through what we slowly stop doing without much forethought.

Artificial intelligence matters from a moral perspective long before it ever potentially becomes conscious or autonomous. Although AI may or may not confront us with dramatic ethical dilemmas, it does change our moral lives in a …

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A 6-step framework for new health care leaders

Physician
January 21, 2026

Assuming a new health care leadership role is both exciting and daunting. Even in the best circumstances, new leaders must navigate a complex web of expectations, relationships, and organizational priorities.

Drawing on over 30 years of health care leadership experience, we have observed that while new leaders bring enthusiasm and vision, they often encounter predictable obstacles. Many receive little to no formal leadership training, leaving them without a structured approach to …

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Why health advocacy needs foresight and backcasting tools

Physician
January 21, 2026

At some point in their careers, health practitioners find themselves preoccupied with issues that go beyond the confines of the clinical room. Beyond diagnoses and prescriptions lies a larger health care landscape, one shaped by policy, economics, culture, technology, and power. Health professionals then begin to ask how this broader system affects not only their individual patients, but also communities and society at large. It is often at this intersection …

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How system strain contributes to medical gaslighting in health care

Physician
January 20, 2026

Medical gaslighting has become a widely discussed concept in health care. The term is often misunderstood as implying intentional dismissal or manipulation by clinicians. In reality, most encounters that patients later describe as gaslighting do not arise from ill intent. They arise from something far more common and far more complex: communication breakdown under system strain.

Understanding medical gaslighting requires examining the clinical encounter from both sides of the stethoscope, not …

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Why tele-critical care fails the sickest ICU patients

Physician
January 20, 2026

Not long ago in a community intensive care unit (ICU) in a midsized American city, I cared for a sick young woman who had just delivered a baby. Part of the placenta, which is supposed to be fully expelled following delivery, remained in her uterus. This condition, known as “retained products of conception,” provided an opportunity for bacteria to infect the retained tissue. The infection spread from her uterus to …

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Difficult patients in medical history

Physician
January 19, 2026

During the COVID-19 pandemic, while some people learned to bake bread and my family made the dubious choice of adopting a high-anxiety poodle who bites, superstar author Lisa See spotted an unopened book on her shelf about women’s medicine in Imperial China. In a fortuitous chain of discovery, Ms. See stumbled upon the name of Tan Yuxiang, a lady doctor during the Ming Dynasty, who published a book of her …

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Why every physician needs a sabbatical (and how to take one)

Physician
January 16, 2026

In the first episode of The Pitt season 2, Dr. Robby reveals he’s taking a three-month sabbatical, his last shift before heading to a UNESCO World Heritage Site in Canada. For a primetime medical drama to feature a physician stepping away for three months signals something important: Sabbaticals are entering the cultural conversation about how doctors survive in modern medicine.

But here’s what the show doesn’t tell you: Most physicians can’t …

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The moral injury of “not medically necessary” denials

Physician
January 16, 2026

The first denial arrived not with cruelty or malice, but with a phrase so familiar it barely registers as language anymore: “not medically necessary.” The cancer drug, recommended by oncologists and supported by evidence and standard of care, was rejected. No phone call. No physician-to-physician conversation. Just an automated letter and a bureaucratic pause inserted into a life that no longer had room for delay.

The family appealed. They fought. They …

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Is physician unionization the answer to a broken health care system?

Physician
January 15, 2026

Can there actually be a medical profession with physicians as only employees in an industrialized corporate or socialized system with a union representing their collective interests? Does it matter, and should it matter? Are there still alternatives?

Asking another party, specifically the government, to solve major predicaments consuming the profession is not a plan. Worse, it is a clear sign of dependency and weakness. There is no other entity that can …

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The decline of professionalism in medicine: a structural diagnosis

Physician
January 15, 2026

Most physicians sense it, even if they struggle to name it.

Something fundamental has changed in medicine. Not the science. Not the patients. Not even, at root, the doctors themselves. What has changed is the status of medicine as a profession, and with it, the psychological footing that once made the work bearable.

For much of the last century, medicine functioned as a profession in the classical sense. That meant more than …

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The patchwork era of medical board certification

Physician
January 15, 2026

The phrase “board-certified” once carried a universal meaning. A physician had met rigorous training and testing standards and could practice confidently anywhere in the country. That clarity has faded. Today, certification and recertification requirements differ not only by specialty but also by which board you happen to fall under. What was once a single national standard has splintered into a patchwork of rules, fees, and timelines that seem designed less …

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