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.

Setting boundaries as a physician doesn’t mean caring less

Physician
September 21, 2026

For years, I thought good doctors always said yes.

Can you squeeze in one more patient? Yes. Can you answer this message before you leave? Of course. Can you finish this chart tonight? Yes. Can you take care of just one more thing? Absolutely.

It rarely felt like a major decision. Each request seemed small. A few more minutes. One more patient. One more message. But small yeses have a way of …

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Setting boundaries as a physician doesn’t mean caring less

Distrust of science is inviting the Middle Ages back

Physician
September 19, 2026

A few days ago, I saw a fake book cover online that was so ridiculous I laughed out loud. It was beautifully designed: deep red. Ornate gold lettering. The kind of cover that looks as though it belongs in a medieval monastery, chained to a wooden desk while a monk copies its contents by candlelight.

The title? How to Avoid Vaccines & Die Like a Medieval Peasant. The author? Robert F. …

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Distrust of science is inviting the Middle Ages back

Why the family medical history lives with women caregivers

Physician
September 19, 2026

Across the different hospitals and services where I have trained, I have noticed something I did not expect to notice. When we ask who knows the patient’s medications, who can explain what happened during the last hospitalization, or who we should call in an emergency, the answer is very often a woman. A mother. A wife. A sister. A daughter.

A specific memory I have: a seventy-year-old man with diabetes and …

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Why the family medical history lives with women caregivers

3 choices that protect physicians in the attention economy

Physician
September 14, 2026

Medicine has developed a new mental health illness of the “attention economy.” The term was introduced by psychologist and Nobel laureate Herbert A. Simon, who argued that an abundance of information creates a scarcity of attention, making human attention an increasingly valuable resource. Physicians always depended on attention to the patient, trainee, colleagues, and the required attention to quiet work of becoming wiser. Yet professional life increasingly unfolds within an …

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3 choices that protect physicians in the attention economy

Doctors were told to be blind to the cost of care [PODCAST]

Podcast
September 13, 2026
YouTube video

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He counts four wounds in American medicine. Patients rarely bring up the first one, which is what health care costs. Narinder Singh Parhar is a physician with more than three decades in internal …

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Doctors were told to be blind to the cost of care [PODCAST]

Why are fewer family physicians delivering babies?

Health Policy
September 11, 2026

A family physician can complete residency fully prepared to care for low-risk pregnancies and deliveries, only to discover that the hospital where they practice will not grant obstetric privileges, their employment contract does not include deliveries, or the demands of call are unsustainable. The consequences extend beyond an individual physician’s career. In rural communities, it means the loss of a clinician who can provide maternity care close to home.

The rural …

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Why are fewer family physicians delivering babies?

Does cash-pay medicine change the standard of care?

Physician
September 11, 2026

Not long ago, I attended a webinar on regenerative medicine. The speaker was the sort of polished, confident expert you expect at these events. During the Q&A, someone finally asked the question that always comes up: Does insurance cover any of this?

The answer was a flat no. Cash only. And not a small sum, either. A number that made even me, after decades in medicine and not easily shocked by …

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Does cash-pay medicine change the standard of care?

Remote wound monitoring works only with a clinical loop

Physician
September 9, 2026

As the saying goes: A picture may be worth a thousand words. In health care, it may spare a thousand words used to explain by telephone what “the incision seems more open,” “more red than I expected,” or “concerned that the wound is not healing right” means.

However, a photograph is not a diagnosis. Sending one is not, by itself, a treatment plan.

More than twenty years ago, after my fifth spinal …

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Remote wound monitoring works only with a clinical loop

Book publishing scams took $7,500 from me by wire transfer

Patient
September 8, 2026

About a year ago, KevinMD published an article that I wrote about avoiding online scams when one is highly visible in media as a patient advocate. During that year, I’ve come to recognize that I should have taken more of my own advice on the subject.

I have also learned that the technology supporting online criminals has expanded at a far faster rate than I’d anticipated. AI-based search engines can …

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Book publishing scams took $7,500 from me by wire transfer

How to tell which abnormal test results actually matter

Physician
September 5, 2026

You open your health portal before bed, mostly out of habit, and there it is: a number in red. Or your doctor mentions, almost in passing, that your cholesterol has crept up and your blood sugar is “borderline.” Nothing hurts. You feel the same as last week. But something has shifted, and you know it. You’ve become a person with a problem.

I want to make the case that a red …

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How to tell which abnormal test results actually matter

Why medicine needs a national physician license now

Physician
September 4, 2026

After more than three decades of practicing medicine in Maryland, I recently applied for medical licensure in Washington, D.C. I expected the process to be similar to neighboring Virginia, which offers an efficient pathway to licensure by endorsement or reciprocity for experienced physicians in good standing. Instead, I discovered that where I went to medical school more than thirty years ago (not my decades of practice, triple board certification, U.S. …

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Why medicine needs a national physician license now

When you have five doctors and no one is directing your care [PODCAST]

Podcast
September 2, 2026
YouTube video

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

You can have five doctors and still have no one actually in charge of your care. That gap is where patients get lost. In this episode, retired surgeon and patient advocate Alan P. …

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When you have five doctors and no one is directing your care [PODCAST]

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Why primary care burnout is really a patient-care problem

Physician
September 2, 2026

For years, I gave my patients advice that I was not following myself. Reduce your stress. Protect your sleep. Listen to your body. Set healthier boundaries. Then I would finish a full day of back-to-back appointments and stay late answering inbox messages, reviewing charts, completing forms, and responding to insurance demands. I would go home physically tired but mentally still at work, replaying the day and thinking about everything waiting …

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Why primary care burnout is really a patient-care problem

A cold cost $945. The cost of primary care is broken.

Physician
September 2, 2026

Imagine with me, it’s January and you are sitting at work. Your muscles start to ache, and you have a strong desire to lay your head down on the desk for a quick rest. Maybe you overdid it shoveling snow a couple of days ago. Maybe you slept wrong.

Over the next 24 hours, you feel worse. You develop a headache. Your eyes burn. Your nose drips like a faucet one …

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A cold cost $945. The cost of primary care is broken.

Why do physicians freeze with LGBTQ+ patients?

Conditions and Diseases
August 31, 2026

“Doc, your next patient is nonbinary.” I say some version of this to physicians when I teach about LGBTQ+ affirming care, then ask, “What is the first thought that comes to mind?” The responses come quickly: “I freeze.” “Oh, God. We were never taught that.” “I don’t know what to say.” “I don’t want to say the wrong thing.” Sometimes there is nervous laughter. Sometimes there is silence.

These are highly …

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Why do physicians freeze with LGBTQ+ patients?

Why a 20-year-old needed a full set of dentures

Conditions and Diseases
August 29, 2026

I fitted a 20-year-old for a full set of dentures last year.

Not implants. Not a partial. A complete set, top and bottom, the kind I was trained to expect on patients in their seventies. By the time he sat in my chair, there was nothing left to save. Years of untreated decay had worked through enamel, then dentin, then the roots themselves, one tooth at a time, until removal was …

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Why a 20-year-old needed a full set of dentures

Why I left insurance-based medicine and came back

Physician
August 29, 2026

I was in my car in the parking lot. It was a long day at the clinic. And I did not want to go back in the next morning.

Us doctors aren’t supposed to say that. When we feel it, we always repeat the same things to ourselves. “You’re tired.” “You’re burned out.” “You need sleep, or a vacation, or perspective, because do you have any idea what you have?” Those …

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Why I left insurance-based medicine and came back

What patients don’t say in the dental chair

Conditions and Diseases
August 28, 2026

There is a question I have learned to ask that almost never appears in any clinical protocol. Not “Where does it hurt?” or “How long have you had this problem?” But something much quieter: “Is there anything else you’d like me to know?”

The answers to that question have taught me more about patient care than I expected. Over time, I’ve realized that patients rarely come into the clinic carrying only …

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What patients don’t say in the dental chair

Patient dissatisfaction begins before the doctor walks in

Physician
August 27, 2026

When patients describe a disappointing health care experience, we often assume the problem occurred in the examination room. Sometimes it did. But after years of caring for patients in urgent and emergency settings and helping lead a high-volume orthopedic urgent care practice, I have learned that many negative patient experiences begin long before the physician walks through the door.

A patient may arrive in pain and not know how long the …

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Patient dissatisfaction begins before the doctor walks in

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