Physicians writing on KevinMD about running a practice: staffing and overhead, the payer paperwork that arrives with every patient, ownership and consolidation, the administrators and executives who now employ most physicians, and the models physicians have built to get out from under all of it. 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, Physicians and administrators: what physicians say about who runs medicine, in their own words, and Private equity and corporate medicine: what physicians say, in their own words.

Improving patient access starts with board governance

Patient
September 24, 2026

In most medical practices, daily operations rely on a familiar routine. Information moves between teams as appointments begin, and direct care continues alongside the administrative tasks that support it. These processes were designed years ago, built around historical demands and earlier models of care delivery. As patient needs change and clinical pressures grow more complex, the supporting systems beneath them do not always keep pace. Gaps begin to appear in …

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Improving patient access starts with board governance

Physicians paid for G2211 twice. Most never bill it.

Physician Finance
September 23, 2026

In 2024, Medicare cut every physician’s rates about 2 percent to fund a code that 3 out of 4 of them never billed. The cut was automatic. The code has to be claimed by hand.

The code is G2211. CMS calls it a visit complexity add-on. In plain words, it pays for office visits where you are the patient’s ongoing doctor, either as the continuing focal point for all their care …

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Physicians paid for G2211 twice. Most never bill it.

Private equity in medicine did not kill private practice

Health Policy
September 21, 2026

On September 16, Senators Warren, Wyden, and Merkley, with Representatives Ocasio-Cortez, Hoyle, and Subramanyam, introduced the Stop Corporate Takeovers of Physicians Act. Modeled on an Oregon law that took effect this year, it would bar private equity funds, insurers, and other for-profit corporations from owning or controlling medical practices, close the friendly-physician loophole, and limit restrictive covenants. Most physicians will like most of what is in it. I do.

But the …

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Private equity in medicine did not kill private practice

Insurance companies are being sued over directories that aren’t real [PODCAST]

Podcast
September 17, 2026
YouTube video

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Your insurance company says these therapists take your plan. Most of them do not. That is the allegation behind seven class action lawsuits now moving through courts from Massachusetts to California. Attorney Steve …

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Insurance companies are being sued over directories that aren’t real [PODCAST]

Why physician financial freedom matters more than salary

Physician Finance
September 17, 2026

An excerpt from Essays and Echoes: Reflections from a Life in Medicine.

In the CBS series Blue Bloods, the 2014 episode “Most Wanted” finds Assistant District Attorney Erin Reagan considering leaving her government job to join a private law firm. The appeal is clear. The new job would pay much more, and her daughter is nearing college age. Erin is not choosing between good and greed. She is …

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Why physician financial freedom matters more than salary

Burnout isn’t only about autonomy, it’s about your bank account [PODCAST]

Podcast
September 16, 2026
YouTube video

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Physicians stay in jobs they cannot afford to leave. The wellness conversation talks about resilience and meaning, and never about what is in your bank account. Stanley Liu, cardiologist, financial planner, and founder …

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Burnout isn’t only about autonomy, it’s about your bank account [PODCAST]

Charitable giving for physicians: 7 strategies for 2026

Physician Finance
September 12, 2026

Americans give hundreds of billions of dollars to charity each year, making philanthropy a defining feature of our national culture. That generosity benefits more than the organizations and communities receiving support: Research suggests that giving can also improve the donor’s happiness, sense of purpose, and connection to others. Our government actively encourages this behavior through charitable tax deductions and other incentives, reflecting a longstanding public-policy judgment that private generosity serves …

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Charitable giving for physicians: 7 strategies for 2026

The sweet spot before physician financial independence

Physician Finance
September 12, 2026

Many physicians believe they can’t escape burnout or an unsustainable career until they’ve become financially independent. Thankfully, it’s not true.

The idea of financial independence (FI) is simple: build enough wealth such that earned income becomes optional. For financial planners, financial independence is a mathematical problem to solve. I might be able to run your numbers in a Monte Carlo analysis and demonstrate you have, say, an 84 percent chance of …

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The sweet spot before physician financial independence

Negotiating physician compensation works better in groups

Physician Finance
September 10, 2026

Most physicians who have ever asked for a raise or tried negotiating their compensation have likely heard some version of the same sentence: “We have a standard package for the whole department. I can’t make an exception for you.”

Most doctors hear that as a brush-off. It isn’t. It’s the most honest thing an administrator will say to you all year.

They genuinely can’t do it. A one-off adjustment creates a parity …

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Negotiating physician compensation works better in groups

How doctors lose money investing: 6 failure modes

Physician Finance
September 9, 2026

I have been pitched investments in a doctors’ lounge, at a conference dinner, and twice in a specialty group chat. Every one of them came from another physician. That is not bad luck. That is the design.

This piece is about the specific ways physician money gets lost, and what actually works against each one. Not general advice about saving more. Named failure modes, with the fix for each. I have …

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How doctors lose money investing: 6 failure modes

Hiring medical office staff who actually follow through

Physician
September 9, 2026

There are two types of employees: the go-getters and the gunnas. The go-getters are those who have a clear vision of setting out to do something, giving it their all, and accomplishing it. They don’t need to be monitored. They are the first to arrive for a meeting or at work and the last to leave at the end of the day. They are self-starters and serve as role models …

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Hiring medical office staff who actually follow through

Credit balances in medical practices have a deadline

Physician Finance
September 8, 2026

Most independent practices know their accounts receivable to the dollar. Far fewer can say what their credit balances total, how old the oldest one is, or who is supposed to be doing something about them. A credit balance sits in the practice management system as a negative number on a patient or payer account, it rarely triggers an alert, and it quietly inflates the bank balance the owner looks at …

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Credit balances in medical practices have a deadline

Why weak branding is costing private practices patients and talent [PODCAST]

Podcast
September 7, 2026
YouTube video

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Patients now choose doctors the way they shop for everything else, judging your practice online before they walk in. Ashley Gay, a branding expert, argues that a strong brand is not about ego …

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Why weak branding is costing private practices patients and talent [PODCAST]

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A national medical license would cut administrative burden

Physician
September 3, 2026

Lawyers have to know the laws of the state where they practice. Physicians largely do not. Medical norms, ethics, and morals are close to universal, which means physician practice could in principle be governed by universal law. There are exceptions. Contraception is one, where even clinical practice is governed by state-specific law.

The broader pattern is stranger than the exceptions. Neither lawyers nor physicians should have to acclimatize to institutional norms …

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A national medical license would cut administrative burden

Physician autonomy predicts who leaves, not exhaustion

Physician Finance
September 2, 2026

A friend told me he had counted it out. Eleven more years and he could stop. He said it the way you would read a lab value, flat, no feeling in it. He is a good doctor. He was not describing a job. He was describing a sentence he had to serve.

That word, trapped, comes up more than exhaustion does.

This piece is about that feeling and what the evidence actually …

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Physician autonomy predicts who leaves, not exhaustion

Patient balance collection is nobody’s actual job

Physician Finance
September 2, 2026

A patient is checking out after a routine visit, and the front desk has to say the number out loud: 400 dollars, today, under the deductible. The patient’s face changes. The staffer wasn’t hired for this conversation and doesn’t have much beyond “that’s what the system says you owe.”

This exact scene runs in practices everywhere, multiple times a day, and almost nobody standing at that desk was ever specifically trained …

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Patient balance collection is nobody’s actual job

Student loans are not blocking your practice ownership

Physician Finance
August 30, 2026

Clinicians are trained to demand certainty before they act. In the operatory or the exam room, that risk-averse instinct is exactly what keeps patients safe. Applied to career decisions, the same instinct becomes one of the most expensive habits in modern health care.

There is a sentence I hear almost every week from young clinicians, and it sounds so responsible that nobody ever questions it: “I’ll think about ownership once my …

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Student loans are not blocking your practice ownership

How to run private fund due diligence like a reviewer

Physician Finance
August 26, 2026

I have reviewed manuscripts for more than thirty journals. The habit is always the same. Skip the abstract. Go straight to the methods, because that is where the paper either holds up or falls apart.

Then a fund pitch lands in your inbox and the habit disappears. The deck opens with a big number, and most of us read that number the way we would never read an abstract.

First, the words, …

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How to run private fund due diligence like a reviewer

The certification process that has no off-ramp

Physician
August 25, 2026

For those of you navigating the American Board of Internal Medicine’s (ABIM) Maintenance of Certification, I thought this anecdote might shed some additional light on the problems with the process.

On June 26, I had a two-level spinal fusion. On May 9, I called the board to see if it was possible to “stop the clock” on the questions, since I anticipated, correctly in retrospect, that I would not be in …

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The certification process that has no off-ramp

Prior authorization appeals stopped being a decision

Physician Finance
August 24, 2026

The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because the last three appeals went nowhere and there’s no real reason to think this one would be different.

Nothing about that moment is really a decision anymore. It stopped being one a while back, and nobody noticed exactly when.

The …

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Prior authorization appeals stopped being a decision

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