Why malpractice lawsuits are rarer but more expensive than ever

Almost 50 years into practice, a cardiologist says American health care is getting worse by the day. Peter R. Kowey specializes in heart rhythm disorders and ran a cardiology division for 25 years. This episode is based on his article "Why a broken health care system keeps getting worse," published on KevinMD. You'll hear how the lack of universal health care puts cost into almost every exam room decision, from tests to prescriptions. He describes administrators setting 15- to 20-minute visits to generate revenue, and why he says physicians ceded that control themselves. You'll also hear why he doubts more medical schools will fix the doctor shortage, and how hard it is for foreign-trained specialists to practice here. His fixes start with basics: cheaper drugs, care for everyone, more use of nurse practitioners and physician assistants for high blood pressure and diabetes, and bipartisan pressure on lawmakers. Hear why he warns even his wealthy neighbors that no one is immune. If this episode helped, follow The Podcast by KevinMD on Apple Podcasts or Spotify, and leave a rating.

Being offered partnership in a medical practice is usually good news, but not always. One physician paid $60,000 to buy in, then signed a contract making her cover all of a $325,000 bonus her two partners had given themselves. That meant $9,000 a month out of her pay, and leaving would keep her liable for a third of the office leases until she was replaced. Health law attorney and Physician Agreements Health Law founder Dennis Hursh discusses his KevinMD article "The partnership offer that cost her $325,000." He estimates he has reviewed four or five dozen partnership agreements and found only two really bad deals. You'll hear what to ask for in your first employment agreement, while you can still negotiate: the practice's finances, the shareholder agreement, the buy-in method, and partnership criteria. He also covers a partner title with no ownership or vote, a clause giving one founder 60 percent of every vote, and which decisions should be unanimous. Stay for the gut check and questions to ask before becoming anyone's business partner.

Doctors and nurses are trained to take excellent care of other people's health, and often don't look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little time to process a patient's death. Internal medicine and critical care physician Narinder Singh Parhar discusses his KevinMD article "The health care workforce crisis we keep ignoring." With nearly four decades in hospital and ICU medicine, he explains why clinicians treat self-care as self-indulgence and what feeds burnout, from training culture to productivity demands. You'll hear what you can do yourself, from exercise that strengthens your back and hips to regular meals and sleep. He makes the case for asking for protected meal time, seeking mental health support, and banding together with colleagues. Health systems have their part too: appropriate staffing, less unnecessary documentation, AI tools that save physician time, and healthy leadership role models. Stay for the whole plan, from what you can change yourself to what your health system has to do.

The office chairs most of us sit in all day have little science behind them, and the popular fixes may not be much better. Turner Osler is a trauma surgeon and epidemiologist. This episode is based on his article "How the benefits of active sitting change desk work," published on KevinMD. You will hear why life table analyses suggest the people who sit the most lose about two years of life, where the 90-90-90 posture came from, and why lumbar support has largely failed. You will hear what goes wrong with kneeling chairs and yoga balls, and why he says standing desks are even worse, citing a 2018 Ontario study of 6,300 people followed for 12 years in which heart disease was doubled in the group that stood. You will also learn how active sitting builds movement into the workday by changing the environment rather than relying on willpower, and what a moving surface could do for people who use a standing desk. Press play for why you do not have to accept the chair you are sitting in.

A physician was fired by the doctors she had trained, in part because she preferred to see her own patients herself. Moral injury, she argues, does not require 100-hour weeks. Sarah A. Vlach is a physiatrist and sports medicine physician. This episode is based on her article "Moral injury doesn't care how many hours you worked," published on KevinMD. You will hear how her working conditions slowly deteriorated, including nine months without a medical assistant, and why her first response was to knuckle down and work harder. She describes how financial incentives like RVUs now shape decisions in both corporate and private practice, and why she sees a two-track system forming as more clinicians move to cash-based care. She offers advice for new physicians starting out with large loans, and she explains how the Physician Support Line and writing about the experience helped her. Press play to hear what she wishes she had done sooner, and why she has found there is life after being a physician.