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Articles by Kara Pepper
Is your medical career a golden cage?
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 stream of patients. I was doing exactly what I trained my whole life for.
How the One Big Beautiful Bill could reshape your medical career
The so-called “One Big Beautiful Bill” was passed by both houses of Congress and signed into law by the president on July 4, 2025. This bill will have a sweeping impact on the already declining health care landscape in America. If you’ve been feeling a mix of confusion and frustration, you’re not alone. This isn’t just policy. This is your career, your practice, and your patients. This bill brings the largest cuts to Medicaid and Medicare in history. Nearly $1 trillion cut from Medicaid.
Marketing as a clinician isn't about selling. It's about trust.
Most of us didn’t go into medicine thinking about branding or strategy. We went into it to care for people. That was always the goal. If we want to reach more of the patients who need us, we have to look at how we’re showing up. If we want to build a practice that’s sustainable and aligned with who we are, it matters. It’s not about selling. It’s about connection. That starts with something simple: being excellent, and being kind.
From burnout to balance: 5 stages of career transformation
Not long ago, my husband and I had a sobering realization: If we did not make major changes, we would regret spending our best years using every ounce of our energy on work. We accepted that exhaustion from our jobs was normal. Burnout became our status quo, and even a sabbatical didn’t create lasting well-being. Unwilling to live with the regret of overworking, we ultimately made major changes and created careers that were fulfilling and healing.
The story of a physician, after a year sober
My first COVID vacation last year was spectacular, except that I barely remember three days because I was drinking to the point of amnesia. I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice. As an adult, I worked obsessively from Sunday evening to Friday afternoon.
What is the narrative that you hear when faced with uncertainty?
The first week of my big attending job, I saw a patient with fever, sore throat, no cough, and tonsillar exudates. Well-trained to manage septic shock, but having no idea how to practice in a primary care clinic, I crafted a vast array of infectious and inflammatory diagnoses. With a quick glance, my senior partner said, “You don’t know that this is strep?” Flushed and wanting to hide, I thought, “I am such an idiot. I’m totally going to kill all my patients.
Why you should not use BMI for your New Year's resolution
My patient balanced precariously in the bustling hallway as she carefully removed her boots and slipped into lightweight sandals. My medical assistant offered to hold her purse and jacket as my patient held her breath and stepped onto the scale. Squinting at the numbers, my patient sagged in frustration. “Same as last year.
Perfectionism is your nemesis, not your superpower
Ballet dancers and doctors are essentially the same people. Long before I entered medicine, ballet taught me the skills that made me successful in my clinical practice. I was a life-long learner. I improved my skills with daily practice. I was creative with limited resources. I strived for excellence and was rewarded for these efforts. The skills I learned as a professional ballet dancer prepared me well for medicine.
How to make peace with purpose
“Tell me, what is it you plan to do with your one wild and precious life?” – Mary Oliver, The Summer Day Ikigai is a Japanese concept that means “a reason for being.” The word “ikigai” is usually used to indicate the source of value in one’s life or the things that make one’s life worthwhile.
Call a consult: depression vs. burnout
CC: “I feel like crap.” HPI: 29-year old female internal medicine resident. Hasn’t seen sunlight in over three months due to 100 hour work weeks. Crying at work. Always exhausted and irritable. Isolated from friends and family. Feels guilty that she is not effective at work and home. States recent labs were normal.
Second victim syndrome in the time of COVID-19
Every physician I know has a story about an unanticipated patient event. A story that was traumatic at the time and easy to now recall in fine detail. A story that was so impactful that it still haunts them. When a patient suffers an adverse event, many people are affected — the patient, his or her family, and the health care providers.
Anticipatory grief during the COVID-19 pandemic
I woke up today wearing the lead suit of grief. I was tired, irritable, and tearful. I was angry at the lack of PPE and the risk that this poses to my colleagues. I was sad, anticipating the loss of my colleagues who are still alive and well. I was in denial, wondering if I could sneak my kids out of town for spring break. But in reality, I was grieving. Anticipatory grief is the feeling we get when the future feels uncertain, usually centering on worry about death.
Numb: How I survived as a physician
On my final day of work before beginning my self-imposed burnout sabbatical, a colleague asked, “Why don’t you just get on medication?” I remember thinking, “What am I medicating? I feel nothing.” I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted. But mostly, I was numb. But in reality, I have always self-medicated – with work.
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