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Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Leaving medicine can feel like erasing 20 years of work. What if it isn’t a loss at all, but a language problem you can solve? Physician executive Shveta Gupta, a pediatric hematologist-oncologist, joins to unpack why so many doctors quietly fuse their identity with the white coat, and why a change in role can feel like being sent back to zero.

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 made a few of these myself, which is why I can describe them this precisely.

Many individuals drawn to a career in medicine possess a driven, high-functioning intellect that often masks concurrent manifestations of neurodevelopmental idiosyncrasies, most notably attention deficit hyperactivity disorder. While this profile often contributes to the grit required for clinical training, it also introduces a significant vulnerability: a heightened level of emotional variability and rejection sensitivity dysphoria.

Psychiatry is now asking a question that would have sounded like science fiction three years ago: Should “AI psychosis” become a clinical diagnosis? Researchers at King’s College London, led by doctoral fellow Hamilton Morrin, have just published a preprint examining more than a dozen cases in which sustained conversation with AI chatbots appears to have triggered or deepened delusional thinking.

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 surgery, I learned the difference. The incision was on my back, beyond my field of vision.

Physicians routinely track measures that can reveal changes in a patient’s health long before those changes become symptomatic. Blood pressure, heart rate, weight, and other familiar measures have earned a place in clinical care because following them over time provides information that can guide intervention. For an aging population, balance deserves similar attention because it can reveal changes in functional health before they result in injury or loss of independence.

As a frontline physician in South Sudan, I see approximately two hundred patients on call day across two public hospitals. Discussions about agentic AI often assume that every autonomous system will operate under the supervision of experienced specialists. That assumption reflects the reality of high-income health systems, but not mine. In our pediatric referral hospital, the hematology-oncology service is staffed by only two hematologists.

I think of “Tim” often. He was a coworker, dedicated to his job as a staff member and doing his best on behalf of our medical students, staff, and faculty. He was smart, funny, insightful, and always helpful. Having no local family, he retired early and was happily settling into retirement in the community. We did not hear from him for a while. Then the bad news arrived. He had died at home of natural causes, alone. You see, ironically, Tim hated going to the doctor.

The more capable AI becomes at answering clinical questions, the more important it is to ask whether we are asking the right questions. Medicine is not becoming less human; if anything, it is becoming more dependent on the human qualities it has always needed: judgment, responsibility, and the ability to act with care amid uncertainty. AI may change how information is delivered, but it does not decide what matters.

Local news has always been a mirror: imperfect, sometimes distorted, but still a reflection of what a community believes matters. In Jacksonville, that mirror has become increasingly fogged. Last night, it reflected almost nothing of public value. For nearly twenty minutes, English-speaking viewers watched the demolition of an empty indoor mall, a structure long abandoned except for a megachurch occupying the old Belk store.