Hospital-Based Medicine

The quiet hospital financial crisis threatening health care

Conditions

April 17, 2026

During the first months of COVID-19, the threat was unmistakable. Hospitals were stretched to capacity. ICU beds were made wherever space could be found. Frontline staff worked on adrenaline, obligation, and the unspoken recognition that at any second the whole thing could collapse. It was defined by volume that was relentless, tangible, and measurable. But the crisis today is different. It is much quieter. It does not announce itself with …

Closing the execution reliability gap in health care systems

Katherine Owen, RN

Conditions

April 16, 2026

Health care has made extraordinary progress in clinical knowledge. Diagnostic capabilities have advanced, treatments have become more precise, and predictive analytics now help clinicians identify patients at risk for complications or readmissions. Yet despite these advances, health care systems continue to struggle with a familiar challenge: Care plans that look clear inside the hospital often break down once patients return home. Medication instructions are misunderstood. Follow-up steps are delayed. Symptoms …

Recognizing structural drift and institutional failure in health care

Tiffiny Black, DM, MPA, MBA

Conditions

April 16, 2026

Most institutional failures appear sudden. A hospital collapses under regulatory scrutiny. A leadership crisis erupts. A safety breakdown exposes systemic weaknesses that had remained invisible for years. When these moments occur, they are often described as unexpected. But in complex systems like health care, failure rarely arrives without warning. The warning signs are almost always present long before the crisis becomes visible. The challenge is that institutions often learn to …

Why your patient isn’t filling that prescription (and won’t tell you) [PODCAST]

The Podcast by KevinMD

Podcast

April 15, 2026

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

What happens when a patient can’t afford the treatment you prescribe but is too embarrassed to say so? Health care executive Adam Cunningham joins the show to unpack the devastating ripple effects of …

How the hidden war in medicine affects young doctors

Amr Ehab, MD

Physician

April 10, 2026

An excerpt from The Hidden War in Medicine: The Fight No One Warned Us About.

We entered medicine believing something many young doctors believe. That medicine was a noble profession built on collaboration, compassion, and a shared mission: fighting disease! We had many glorious moments that make you cry tears of joy when a patient had been finally healed. From the outside, that is the image everyone sees. Doctors working …

The hidden crisis of trainee health during medical residency

Chinyelu E. Oraedu, MD

Physician

April 9, 2026

In medicine, we are trained to recognize risk in our patients. But we often overlook those same risks in ourselves. Sometimes, the system overlooks them, too. During residency, performance is expected and endurance assumed. Health often declines quietly and almost invisibly. We label it “dedication”; we claim “resilience.” In reality, it is often neither. I learned this lesson over 48 hours, two days that would reshape both my career and …

Why loving organizations are the secret to ending burnout in medicine [PODCAST]

The Podcast by KevinMD

Podcast

April 7, 2026

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

Physician coach Apurv Gupta discusses the article “What is a loving organization?” Apurv describes his model of a loving organization as a system that designs the clinical environment to make safety and …

When patients ask to pray: Navigating spirituality in medicine

Lauren Davis, MDiv and Vijay Rajput, MD

Physician

April 7, 2026

Requests for prayer at the bedside are more common than many clinicians admit. Yet these moments often unfold quietly, undocumented, unexamined, and rarely addressed in training. Whether a clinician identifies as religious, spiritual, secular, or uncertain, such requests can stir discomfort. Still, patients continue to ask.

Sometimes it is direct: “Doctor, will you pray with me before surgery?”

Other times it is woven into hope: “I am praying God gives your steady …

Surviving ventricular tachycardia: What I learned as a patient

Loretta Cody, MD

Physician

April 6, 2026

What happens when the doctor becomes the patient? Is there anything learned or reinforced? For me, it was a life-changing experience both personally and professionally when I became the patient.

My story began on New Year’s Eve. I had been feeling dizzy associated with some chest pain and was scheduled to have a stress echo at my local hospital to make sure all was OK (of course it would be OK, …

How night shift medicine exposes the reality of physician stress

Chinyelu E. Oraedu, MD

Physician

April 2, 2026

At 2 a.m., the hospital is quieter but the stakes are not. A single page can alter the trajectory of a patient’s life. A subtle clinical shift can mark the difference between stability and decline. At night, there is less margin for error, fewer immediate resources, and no room for hesitation. Not long ago, I was called to evaluate a patient who “just did not look right.” The vital signs …

Finding purpose as an international medical graduate in the U.K.

Dr. Afsar Ashraf and Dr. Amal Pulikkal

Physician

April 1, 2026

The second time I landed in the U.K., the dream felt different. My first trip was for an exam; this time, it was for good. I walked into the arrivals hall with two bags. One was a worn suitcase packed with stethoscopes and textbooks. The other was invisible but far heavier, filled with my parents’ hopes and my wife’s unwavering faith.

In the bustling chaos of the international boarding area, after …

The Silent Variance: How patient friction destroys health care revenue

Donna Harvin‑Graham, MBA

Conditions

March 28, 2026

As health systems move into the 2026 fiscal year, CFOs and hospital boards have already approved their operating budgets. Capital is set aside for oncology expansions, MRI upgrades, and EHR enhancements. Revenue projections are built on patient volume, reimbursement assumptions, and clinical trial enrollment targets.

On paper, the math works. The P&L looks stable.

After more than 20 years in enterprise operations and financial systems, I know budgets fail long before the …

Health care affordability crisis: lessons from the NYC nursing strike

Marc Henry Estriplet, MD, MPH

Physician

March 25, 2026

As a physician who lives and has practiced in NYC, the largest nursing strike in the city’s history has broken my heart. It has saddened me that our nurses could not be the heroes they truly are and that hospitalized patients experiencing some of the worst days of their lives had not received the best quality care that they could and should get.

And this is just the start of a …

A resident’s first surgery: When the patient teaches the doctor

Kaylan Baban, MD, MPH

Physician

March 21, 2026

“Dr. Baban? Dr. Baban?”

His slurred voice rasps across the room, weak but insistent, cutting through chiming monitors, buzzing fluorescent lights, and the screeching pager slung next to the empty gnaw in my stomach. I freeze where I stand, one hand scratching out post-operative orders on the last emergency surgery of the day, the other midway to the nursing station phone, grasping the silenced pager. My eyes sweep over the recovery …

Night shift health tips: How to protect your circadian rhythm

Chinyelu E. Oraedu, MD

Physician

March 12, 2026

When I started working the night shift as a nocturnist straight out of residency, no one prepared me for the physical and mental toll that lifestyle would take on my body. My motivation for pursuing this job opportunity was to spend my daytime hours with my young children: twin boys and my daughter all under five years old.

Night shift work keeps hospitals running, cities safe, and essential services moving while …

Why hospitals shouldn’t own physician practices: 6 key reasons

David Wild, MD

Physician

March 8, 2026

Over the past two decades, hospital systems have increasingly acquired physician practices, arguing that integration improves care coordination, lowers costs, and stabilizes struggling practices. In reality, this consolidation has often produced the opposite effect: higher costs, reduced physician autonomy, diminished innovation, and care that is less responsive to patients’ needs. While hospitals and physicians must collaborate closely, ownership is not collaboration, and hospital systems should not be in the business …

The Blanket Sign: Recognizing difficult patient encounters in the ER

George Issa, MD

Physician

March 4, 2026

It is honestly impressive the lengths people will go to cure their illnesses, or, alternatively, to lovingly nurture their favorite delusions. And to be fair, I get it. We have all been sick. I am a doctor and I have still Googled home remedies for canker sores, tooth pain, and ingrown toenails. The difference is that experimenting with saltwater rinses is unlikely to end your life.

When it comes to actual, …

“Disruptive” behavior is often a cry for help from depleted doctors [PODCAST]

The Podcast by KevinMD

Podcast

March 2, 2026

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

Pediatrician and certified coach Jessie Mahoney discusses her article “Disruptive physician labeling: a symptom of systemic burnout.” Jessie argues that the rising number of “disruptive” labels slapped on highly skilled doctors is …

Managing a Black Swan in health care: a lesson in transparency

Joseph Pepe, MD

Physician

February 2, 2026

An excerpt from On All Sides of the Bed: One physician’s/CEO’s journey.

In the early summer of 2013, our hospital collided with a Black Swan.

Before Europeans discovered Australia, they were familiar only with white swans. The discovery of black swans overturned a long-held assumption. In business and risk theory, a “Black Swan” refers to a rare, unpredictable event with massive consequences, a concept popularized by Nassim Nicholas Taleb. For us, …

Why clinical excellence isn’t enough to sustain a physician-owned hospital

Dr. Bhavin P. Vadodariya

Physician

January 27, 2026

Most physicians begin their careers with a deeply held belief: If treatment is good, patients will come. It feels intuitively correct, and early in practice it often appears to be true. Clinical outcomes build trust, trust brings patients, and for a time the system seems to sustain itself. Yet after years of working inside physician-owned hospitals, group practices, and large corporate health systems, I have learned an uncomfortable truth. Good …

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