The physician mental health crisis in the ER

Policy
October 24, 2025

The numbers are staggering. Americans made 139.8 million emergency department visits in 2024, that is 42.7 visits per 100 people, with behavioral health issues driving an unprecedented surge. Behind these statistics lies a harsh reality: depression, a leading cause of ill health and disability worldwide, is overwhelming our emergency departments with cases they were never designed to handle. This tsunami of mental health crises creates a vicious cycle. …

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Is mental illness the root of mass shootings?

Physician
October 24, 2025

(Author’s note: This article has been a year in the making. Each time another mass shooting makes headlines, I think, this is the moment to speak, and then life intervenes. The opportunity to contribute meaningfully feels missed. But the cruelest irony is this: Wait ten more days, and there will be another tragedy to make the conversation relevant again. That, in itself, is the most heartbreaking fact of all.)

“Study my …

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How new physicians can build their career

Finance
October 24, 2025

Introduction

In a recent episode of the Wealth Planning for the Modern Physician podcast, host David Mandell, JD, MBA, welcomed Dr. Michael Ast, an orthopedic surgeon specializing in adult reconstruction and joint replacement surgery. Beyond being an accomplished clinician at the Hospital of Special Surgery in New York, Dr. Ast also lectures often on business and career issues, and is especially passionate about teaching younger physicians how to build their practices …

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Moral distress vs. burnout in medicine

Physician
October 24, 2025

“To practice medicine,” a mentor once told me, “is to live with the tension between what you can do and what you should do.”

I didn’t understand him then. I do now. It is two in the morning in a Chicago hospital. The unit hums with fluorescent fatigue. A man in his fifties lies gasping for air, his lungs crowded by metastatic cancer. His chart lists “full code.” His daughter, sobbing …

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Why doctors make bad financial decisions

Finance
October 24, 2025

Doctors, I like to think, are fairly intelligent people. We worked hard in school, extremely hard in residency, and continue to refine our skills decades into practice. In addition to being intellectual, we are often experts in our fields. We enjoy more respect and higher salaries than most professions. Our work can be humbling and challenging, and it exposes us to the flawed nature of humans. Despite deeply understanding that …

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Is your medical career a golden cage?

Physician
October 24, 2025

What if the career you spent your life building, the one filled with achievement, purpose, and prestige, is now the cage you cannot escape? That question did not just haunt me; it held me back for years.

I was a successful urologist, specialized in advanced prostate cancer detection, robotic surgery, and men’s health. From the outside, I had it all: a thriving practice, financial security, a respected reputation, and a steady …

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Medicine fails its working mothers

Physician
October 24, 2025

As I sit breastfeeding a newborn and hastily switch to pump while the newborn (my fourth child) dozes, I have some thoughts that I think are particularly timely given concerns that are facing millions of families of young children in our country. Maternal and infant mortality continue to be worryingly high in the U.S., especially for women and children of color and in socially vulnerable areas of our country. The …

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Diagnosing the epidemic of U.S. violence

Physician
October 24, 2025

As a physician, I am trained to diagnose not just the presenting symptom but the underlying pathology. This is the same lens through which many of us in the medical community view the epidemic of American violence. For years, organizations from the AMA to the CDC have called it a public health crisis. This is not merely a metaphor; it is a clinical framework pioneered right here in Chicago by …

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A neurosurgeon’s fight with the state medical board [PODCAST]

Podcast
October 23, 2025
YouTube video

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Neurosurgeon Jeffrey Hatef, Jr. discusses his article “Guilty until proven innocent? My experience with a state medical board.” In this episode, Jeffrey shares the shocking story of how his medical license was …

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Traveling with end-stage renal disease

Physician
October 23, 2025

My wife, Kathy, had stage 4 end-stage renal disease. She was slowly dying, but never stopped living. Her resilience in managing peritoneal dialysis made travel possible, even with the logistical complexities involved. Ireland had long been on our bucket list, inspired by Kathy and Stephanie’s earlier visit while we lived in Peoria. With careful planning, we booked our flights using points out of Orlando, knowing the drive would minimize Kathy’s …

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The high cost of PCSK9 inhibitors like Repatha

Conditions
October 23, 2025

When the FOURIER trial was published in 2017, cardiologists and lipidologists everywhere hailed it as proof that lowering LDL with PCSK9 inhibitors “saves lives.” But when you actually read the data, not the press releases, it’s hard not to shake your head.

Over a median of 2.2 years, evolocumab (Repatha) reduced nonfatal heart attacks by about 0.9 percent and had no significant impact on death. The absolute risk reduction for all-cause …

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Why non-work stress fuels burnout

Conditions
October 23, 2025

While work-related stress continues to be a major cause of burnout, new research shows that non-work stressors like caregiving demands, financial instability, and personal life conflicts also greatly increase the risk. Yet, the dominant narrative has not caught up, and many still believe burnout is only a workplace problem, overlooking the deeper, life-wide imbalance it often reflects.

Recently, I spoke to a nurse on sick leave for the third time …

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Why wellness programs fail health care

Conditions
October 23, 2025

Jodie Green and I have been following each other on social media for a couple of years, and we finally had a conversation a few months ago. We discussed our appreciation for the work each of us is doing to support doctors and all other health care professionals, including my efforts and Jodie’s with her organization, the Clinician Burnout Foundation. We’re amplifying meaningful resources that are available for …

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Canada’s 2025 health care crisis explained

Physician
October 23, 2025

In 2025, Canada’s universal health care or Medicare system confronted a stark wake-up call. Many high-visibility service disruptions exposed the health care delivery model’s fragility and stress points. There were emergency room (ER) closures and specialty service interruptions.

In British Columbia, many hospitals repeatedly and increasingly closed their ERs for hours or days due to staffing shortages. The hospitals in large cities like Delta and Mission had multiple separate ER shutdowns. …

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First physician employment agreement mistakes

Finance
October 23, 2025

I have been representing physicians for over 30 years, and I am still amazed by the attitude of most young physicians going into their first attending position. These are smart, accomplished, fully qualified physicians who have received some of the best clinical training in the world. And yet, many of these highly trained individuals in a field with massive shortages seem reluctant to acknowledge even the slightest modicum of self-worth.

Bear …

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Treating chronic pain in older adults

Conditions
October 23, 2025

For decades, I treated patients with chronic pain. One truth became evident early: most older adults prescribed narcotics use them responsibly. My clinical acumen, shaped over more than forty years, intuitively knew this to be true. Still, I understood that intuition and opinion alone are insufficient. Compassion in medicine must be paired with objectivity.

Now the data confirms what practice long suggested. A national survey of adults aged 50 and older …

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A nurse’s story of hospital bullying

Conditions
October 23, 2025

An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was cheap and, even better, considered a “legal high” as it was not detectable in drug tests. Josh came to the emergency room psychotic, paranoid, and hallucinating, with hypertension and SVT. …

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Confronting the hidden curriculum in surgery

Education
October 23, 2025

“It is, I think, not easy to exaggerate the importance of the informal social element in the promotion of science and learning.”
– Abraham Flexner, 1930

As stated by Mr. Flexner, the importance of the informal social element of science and learning is one of the key fundamentals of the hidden curriculum, a well-understood but unspoken rule in medical education and training. The hidden curriculum consists of the unspoken or implicit …

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Protecting physicians when private equity buys in [PODCAST]

Podcast
October 22, 2025
YouTube video

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

Veteran attorney Dennis Hursh discusses his article “Private practice employment agreements: What happens if private equity swoops in?” In this episode, Dennis explains how private equity acquisitions of medical practices complicate the …

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Why faith and academia must work together

Education
October 22, 2025

Ten years. That’s how long I carried around this idea I just couldn’t seem to put into action. I wanted to speak openly about this tension I felt as both an academician and an ordained minister. Yes, this false notion that my academic life and my spiritual life had to run on separate tracks. Not only did I want to openly discuss this tension; I wanted to do something about …

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