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Articles by Pat Rich
What LEGO taught me about attention to detail
I enjoy building LEGO projects with my grandchildren, because it is possible to sit with a grandchild for several uninterrupted hours, unlike video games or watching them scroll on cell phones. Our last project was a LEGO Technic set, which lets the child learn about engineering principles like cams, levers, and fulcrums. This project was estimated to take 7 to 8 hours to complete. We made the mistake of misplacing a piece by just one hole, and the additional pieces didn’t fit in the construction.
Administrative harm is the burnout we don’t measure
As physicians, regardless of our specialty, we share a singular, defining orientation: a fiduciary commitment to the patient sitting in front of us. Whether we are operating on a heart, managing complex diabetes, or counseling a family through a life-altering diagnosis, our patients grant us extraordinary latitude. They do so based on a deeply held understanding that our clinical judgment will be exercised solely in their best interests.
How administrative costs are crushing physician practices
Over the past decade, administrative costs in the U.S. health care system have climbed sharply, reshaping how money moves through the system. National health spending now tops $5 trillion, but a growing chunk goes to bureaucracy rather than actual care. This leaves medical providers with thinner margins, contributes heavily to physician burnout, and creates barriers for patients.
Physician contract review is about what is missing
She had already signed the lease. A friend of ours, a hospitalist, had accepted an attending position in the Chicago area. The contract stated she could be assigned to work at any of the practice’s contracted hospitals. She read it carefully. She asked which hospital she’d be based at. They told her. She found an apartment nearby, signed a lease, and started planning her life around a commute she could live with. Then the practice lost their contract with that hospital.
The administrative burden crushing California medicine
Think of the entire health care system as a chess game where the goal is to achieve a healthier population by checkmating against the “darker side,” which represents disease, poor outcomes, inefficiency, and the human suffering of untreated or delayed chronic conditions like pain. The patient should be the king: The most important piece. Everything revolves around protecting and empowering them.
How to negotiate a physician sabbatical in private practice
When I tell other physicians that I negotiated a sabbatical from private practice, a full semester abroad with my family, followed by months of extended travel, the reaction is almost always the same. It starts with disbelief, moves quickly to calculation (“But who covered you? What happened to your income?”), and ends, more often than not, with a version of: “I could never do that.” I understand the reaction because I had the same one, for years, before I did it.
Administrative burden is driving severe physician burnout
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptoms warranting a specific imaging study, medication, or procedure. You know what they need. The evidence is clear. But instead of moving forward with care, you are forced into a gauntlet of prior authorizations, peer-to-peer reviews, and endless documentation.
Overcoming resource constraints in American medicine
For much of modern American medicine, we operated with an unspoken assumption: Resources would expand to meet demand. If complexity grew, we added specialists. If volume increased, we built. If margins tightened, we layered new reimbursement strategies. That operating model now feels more like an illusion. Workforce shortages, supply chain instability, climate disruption, and rising costs have made constraint structural rather than episodic.
Fighting the ‘Infodemic:’ Can AI and micro-trust save public health?
Fighting the ‘Infodemic:’ Can AI and micro-trust save public health? Ontario experts at TOPHC 2026 argue while AI-driven misinfo is ‘terrifying’ threat, the same tech could be key to rebuilding public trust. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
Physician tax strategies: Why your tax bill is so high and how to fix it
If you are frustrated by your high tax bill, you are not alone. I have spoken with many doctors who experience sticker shock when they see their total annual tax liability after completing residency. Stories in the media, such as The Atlantic’s recent study on billionaire taxes, about how rich people avoid taxes only fan the flames.
Why PrescribeIT failed: All the cost, none of the benefit for clinicians
Why PrescribeIT failed: All the cost, none of the benefit for clinicians Dr. Karim Keshavjee tells FHLIP conference that a lack of provider incentives—not technical flaws—killed Canada’s national e-prescribing system. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
New federal data interoperability legislation good start but more needed
New federal data interoperability legislation good start but more needed Canada’s leading health organizations warn that mandating data standards won't fix a fragmented system without dedicated funding, clinician support, and national compliance targets. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
Living with vitiligo: Overcoming shame and control
For those who know me personally, you know that I have vitiligo. Vitiligo is an autoimmune disease affecting the skin, where there are patches of depigmentation (the skin appears white or pink). It is sometimes associated with other medical conditions. I met someone recently and they said that they were curious about my skin. I am used to looks or questions and am happy to educate people about vitiligo, so I didn’t mind.
Cometh the AI scribe: Addressing Canadian MD admin burden
Cometh the AI scribe: Addressing Canadian MD admin burden The latest CMA/CFIB data suggests that time saved by automation will largely be allocated to physician wellbeing rather than increasing system capacity. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
a physician's review
Last week, I spent over two hours on a prior authorization for a patient who needed a medication she’d been stable on for years. Two hours of hold music, transferred calls, and faxed forms, while patients waited. That same week, Anthropic announced Claude for Healthcare: An AI system that can verify coverage requirements, build claims appeals, and streamline prior authorizations in minutes. OpenAI launched ChatGPT Health days earlier.
Why physician business literacy matters
Most physicians practicing medicine today were trained to diagnose and treat patients, not to navigate one of the most complex industries in the world, an industry characterized by ever-changing payer contracts, evolving reimbursement structures, complex and sometimes mystifying coding, and challenging operational realities.
How stigma in psychiatry affects patients
As a psychiatrist, I often find myself confronting not only the symptoms of mental illness but also the deep scars left by stigma. Even in 2025, despite advances in neuroscience and a growing cultural focus on mental health, stigma remains one of the greatest barriers to healing. It manifests in silence, shame, and misunderstanding, and it affects patients, families, and even those of us within the psychiatric profession.
When patients self-diagnose from TikTok
It’s a moment I’ve come to recognize too well as a psychiatry resident: a patient walks into my office already convinced of their diagnosis. They’ve watched a dozen videos, followed mental health influencers on Instagram, and taken online quizzes that “confirmed” what they suspected. They have ADHD, or autism, or borderline personality disorder. They’re not here for an evaluation; they’re here for validation. On one hand, this moment feels like progress.
wRVU threshold risks in physician contracts
Many physicians do not seem to grasp the risks inherent in physician employment agreements that impose a minimum threshold of wRVU production. However, there can be many pitfalls in these agreements. What is the effect of the threshold? The first pitfall is determining the effect of a threshold. Some agreements provide a salary “assuming a minimum threshold of” some number of wRVUs. I have reviewed many agreements with a provision like that which did not have any teeth.
How your past shapes the way you lead
Leadership is often discussed in broad strokes: some leaders are structured and precise, while others are flexible and improvisational. But behind those visible styles lie quiet personal and generational histories, the emotional terrain that shaped how we learned safety, trust, and control. I’ve come to see that these histories profoundly influence how we lead and how we’re perceived as leaders, especially in health care, where the stakes are high and human stories run deep.
Why the media ignores healing and science
I recently published a reflection on KevinMD, “A doctor’s duty on 9/11 in a small town,” a piece about clinical duty, quiet advocacy, and legacy. Boston University included it in my nomination for their Advocacy, Equity & Social Justice Alumni Award. I sent it to every major news outlet in my region. No one responded. One station asked if I’d go on camera. I agreed. Then, silence.
An attorney's guide to your first physician contract [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Health attorney Dennis Hursh discusses his article “First physician employment agreement mistakes.” Dennis shares his amazement after 30 years in health law at the timidity of new attending physicians during contract negotiations. He explains why the “seller’s market” created by a massive physician shortage means that young doctors have far more leverage than they think.
Mining your health data to build a stronger Canada
Mining your health data to build a stronger Canada Experts warn that fragmented medical records put billions in value and future AI innovation at risk. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
Fixing the system that fails psychiatric patients [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube.
Why plain language isn't enough for patients
In modern medicine, the use of plain language is a fundamental clinical skill. This is especially critical when health decisions can profoundly affect a patient’s life, impacting their financial stability, ability to work, personal independence, and mental well-being, as well as their capacity for managing daily care, recognizing warning signs, and adhering to treatment plans.
Telehealth licensing barriers hurt patients
The highway from western North Carolina to northeast Georgia is dark at five in the morning. One of my long-time patients grips the wheel and drives two hours for a 15-minute visit with the doctor she trusts. She could have met me by video from her kitchen, but the law forbids it. The moment she crosses that state line, I lose the right to care for her. That’s not medicine. That’s madness. We tell patients to use technology, to stay engaged, and to seek care early.
First physician employment agreement mistakes
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.
What an active shooter taught me about being a doctor
“Do you know what it feels like, to know you could die at any moment?” His words linger in the air, heavy, long after the threat of violence has passed, long after our team has calmed him with words and soft gestures. It is not the first time a patient’s family member has swung at me, nor will it be the last. But it is the first time with a patient so close to death in the room, with family so distraught that social rules and etiquette are abandoned for raw grief and emotion.
Why shifting from wellness to well-being matters for physicians and patients [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube.
What patients do not see behind the white coat
“I was excited to see you today because I thought you were going to answer all my questions,” a patient once told me. I smiled, masking the insecurity. “I wish I could.” The truth is, I often cannot (at least not in a single visit). Medicine is rooted in curiosity and lifelong learning. Patients expect certainty, but doctors live with uncertainty. We know enough to know how much we do not know. The difference between those expectations and reality breeds disappointment and frustration on both sides.
The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients
Why Indian pharmaceutical companies run the risk of driving up U.S. consumer drug prices when scaling too quickly: the diseconomics of scale. Why the U.S. looks to India as a global supply chain hub for medications India’s pharmaceutical industry saves U.S. consumers billions, but scaling too fast is a mistake. Premature scaling through mergers and acquisitions (M&A) is not just unsustainable, it is reckless and a recipe for inefficiency, error, and rising prices for U.S. consumers.
How I stopped typing notes and started seeing my patients again
I still remember the day the shiny new EHR went live. We were promised instant access to every lab, perfect legibility, and (my favorite buzzphrase) “more time for patient care.” What arrived instead was a blinking cursor waiting for someone to type every blood-pressure reading, family-history nuance, and treatment plan. That “someone” was often the physician.
Why so many patients ask for drips-and what doctors wish they knew
As a doctor working in a primary health care setting, it’s become routine, almost expected, to hear patients ask for a drip. Sometimes it’s after they’ve listed their symptoms, sometimes they say it right after walking in: “Doctor, please just give me drip.” And often, the complaints aren’t serious. It could be catarrh, a mild fever, or even plain tiredness. At first, I didn’t understand it.
Physician practice ownership: risks, rewards, and reality
A physician’s financial journey isn’t always linear, and the journey can’t always be predicted in a how-to book. While the hospital-employed physician normally gravitates toward a path filled with benefits and retirement plans, the equity owner physician, or physician practice owner—both terms used interchangeably—has a much different pathway. Let’s dive into the equity owner physician a bit further. Why choose ownership? Like the term “business owner,” equity ownership physician is a generic term.
The unseen burden patients carry between appointments
A man sat in my waiting room, heart racing—not from chest pain, but from panic. He’d been Googling his symptoms all night. Not afraid of what is—terrified of what might be. This is the anticipatory anxiety of modern medicine—a silent epidemic that strikes before any diagnosis ever does. Patients no longer arrive with just symptoms. They bring stories already constructed. Hours of scrolling. Threads of worst-case scenarios. Algorithms feeding fear.
FDA delays could end vital treatment for rare disease patients
The FDA is failing rare disease patients. I’m one of them. I’ve been on elamipretide for three years now. It is the only treatment that has made a meaningful difference in my life with primary mitochondrial myopathy—a degenerative genetic condition that impairs how my cells convert food and oxygen into energy. Mitochondria provide over 90 percent of the energy our bodies need; when they fail, the highest-demand tissues—like muscle, brain, and heart—are hit the hardest.
Why financial planning is a critical tool for physician well-being [PODCAST]
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Certified financial planner Brian Case discusses the article, “Personal financial planning shouldn’t be a taboo subject.” They explore the often-overlooked link between financial stress and the crisis of physician burnout, turnover, and the alarming rate of physician suicide.
(Lots) more paperwork for Ont. docs due to proposed civil law changes?
(Lots) more paperwork for Ont. docs due to proposed civil law changes? Legal community warns: New civil law rules could burden Ontario physicians with affidavits. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
How I redesigned my life as a physician without abandoning medicine
It was 7:45 a.m., and I stood frozen in the middle of a sidewalk on campus, barely awake undergrads shuffling past me on their way to morning classes. My daily walk to work cut through a part of the university where the college of medicine sits beside student dorms. It is a path I’d tread as a wide-eyed student, a determined trainee, and now, a weary attending. That morning, I couldn’t help but wonder what my younger self would think of me now. I was tired, uninspired, and lost.
4 traits every new attending physician needs to thrive
When I conduct therapy for doctors after residency, I am supporting new attending physicians as they navigate one of the most intense and disorienting transitions of their careers. These early attendings often arrive feeling untethered. They’re rediscovering who they are, working through long-ignored anxiety, stepping into their authority, and trying to build lives that don’t begin and end with medicine.
Why would any physician believe that the practice of medicine will become less abusive for them in the future?
The perpetuation of the increasing abuse of physicians across our nation has reached a level now that is essentially unrepairable. The Medical-Industrial-Economic Complex (Deep State of Medicine) has been the aggressive predator of the medical profession for decades. It is not by chance that the planning for the takeover of health care and the medical profession came into being decades ago.
The hidden war on doctors: Understanding administrative violence
Administrative violence in medicine is often understood as harm to patients due to systemic issues; however, administrative violence in medicine is also a process used to inflict harm on physicians, destabilizing the medical field on both systemic and individual levels.
‘No one is in charge’: Experts warn Canada’s health data chaos is blocking AI progress
‘No one is in charge’: Experts warn Canada’s health data chaos is blocking AI progress E-health 2025: Day 1 – Canada’s health data is screwed up and marked by over 70 EMR systems, siloed records, and poor data standards. Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
How blockchain could rescue nursing home patients from deadly miscommunication
Imagine a health care team treating your elderly loved one—without the full picture. This is the reality of the U.S. health care system. Our system is failing nursing home residents, the most vulnerable population, by dragging out an outdated, inefficient data-sharing system. To improve nursing home care, health data must be efficiently shared and organized across hospitals and facilities, ensuring tailored treatments for patients with complex conditions.
CMA vows to address member drain
CMA vows to address member drain With membership cut in half can the Canadian Medical Association still claim to speak for Canada’s doctors? Register for free access or login. Canadian Healthcare Network is an independent online community for Canadian healthcare professionals in medicine and pharmacy. It is the online home of the Medical Post and Pharmacy Practice + Business.
Patients are not waiting: What MCDA twin parents teach us about shared decision-making
Monochorionic diamniotic (MCDA) twin pregnancies come with more scans, more risk, and more decisions to make in very little time. Parents are expected to absorb complex medical information, navigate unfamiliar terminology, and act quickly, often under pressure. When care teams do not meet that need for clarity and support, parents do what any reasonable person would do. They go looking for answers.
How social media and telemedicine are transforming patient care
In today’s digital world, health care is no longer confined to hospital walls. Social media platforms are influencing health behaviors, while telemedicine technologies are redefining patient-doctor interactions. But are these innovations improving health care, and what are the risks, if any? This article explores how digital platforms, namely social media and telemedicine technologies, are reshaping patient care and bridging gaps in education, access, and engagement.
The anesthesia spectrum: Guiding patients through comfort options in oral surgery
“Will I be asleep or awake during my procedure?” This is the first question many patients ask before oral surgery. It reveals a common misconception: That anesthesia works like a light switch. It doesn’t. Anesthesia exists on a spectrum with multiple options that can be tailored to your specific needs, procedure type, and anxiety level.
How fake news about transgender mice is hurting real patients
Poisoned puppies, rats on cocaine, transgender mice: these might sound like the beginning of a bizarre joke, but they’re at the center of growing political attacks on medical and scientific research. Senator Ted Cruz calls it the “woke nonsense” of the Biden administration’s “far-left ideology,” and Donald Trump has amplified the message, using a primetime congressional address to claim researchers are attempting to turn mice transgender.
How DrKoop.com rose and fell: the untold story behind the Surgeon General’s startup
“I’ve had two major messages that I’ve tried to get out to the public all my professional life,” Koop proclaimed. “One is to take charge of your own health. The other is that there is no prescription I can give you that is more valuable than knowledge…. I’ve tried the non-profit world, and the non-profit world is not interested in supporting those messages on the Internet or in any other way.” Koop had first encountered actor and entrepreneur John F.
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