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Nobody is Coming to Save You

Are you practicing medicine, hating every minute of it? Dreading going into work 2 days before your shift begins and needing a day to recover from your shift? Many are waiting for policy changes, salary increases, or new opportunities to save them. I believe nobody is coming to save you, which can be a liberating thought.

You Don’t Have to Suffer

The idea that we should just suck it up and work and suffer is a modern concept. I got it spoonfed to me when applying to medical school, when growing up as a kid, and when working in busy, underpaid locums positions.

Working hard is sometimes unavoidable, but suffering is optional. Suffering comes from not feeling like you have any control over your situation. And you may, in fact, have no control.

There are ways to practice medicine or live that don’t involve suffering. I don’t have an answer that would be individual to you, but waiting for something to change seems hopeless to me.

The Pay Doesn’t Matter

If you’re getting $130 now and hoping $150 would change your life, let me tell you, it ain’t gonna. If you’re making $150 and hoping for $200, 300, or 400 – no way will that change anything.

Perhaps you could work fewer hours and still make enough money to run your household. But you can accomplish the same thing by spending less.

My friend spends $75k on her grade school and high school kids’ tuition. That’s an optional expense. Anyone here telling me that’s a need and not a want is smoking something other than what I’m smoking, and I don’t want any.

The dining out, wine, coffee, car, and new clothes are optional. They are optional when you’re suffering so much that you need a Xanax and a bottle to make it to the next shift.

AI Will Make Your Work Harder

LLM and a GPT might write your note for you but you still have to proofread it. And if any time frees up because of it then you’ll have to do admin work.

Even if all the diagnosis burden is handled by a machine, you’ll have to do something else to fill that time. Because we are working for financial machine and that machine is hungry and protected from high up.

Depressing? I don’t think so. I still enjoy a genuine interaction with my patient despite the EHR and the ugly fucking lineolum and sterile exam room.

GLP1s Will Create More Work

When I post on LI I always wonder if I’m a little too much. Well, okay, I’m a little too much, true. But the same stakeholders who were drinking the Kool-Aid with robotic surgery, AI, and Fen-Phen are the same ones doing it with newert weight loss medication.


GLP1s won’t come to the rescue son. You still have to wake up and see patients who are asking you why their 700 calorie daily diet and their 3 hour daily treadmill sessions are not only helping them lose weight but they are actually gaining weight.

So, physics, apparently, also ain’t coming to your rescue.

The FDA and CDC Aren’t On Your Side

Let’s leave the pandemic out of this because I know it’s a sore topic and everyone will hear what they want to hear. But we have a healthcare system not governed by disease prevention, early intervention, and patient education.

The FDA is tasked with approving medications. The CDC wants disease obliterated at any cost – and I mean any cost. They have their tunnel vision glasses on and you better play ball.

If the FDA and CDC only played in the public health arena then these tactics would actually be incredibly effective. But when powerful commercial interest creeps in and they also dictate how you can practice medicine, the waters become murcy with feculency.

The Medical Boards Don’t Represent You

Physicians don’t even know that the state medical boards exist to protect patients from doctors. In fact, hinting at this can piss some doctors off. This Reddit post below highlights that nicely.

The job of a state medical board is hard. And when you grow too quickly with too few resources, then you’ll do a shitty job. Oh, right, kinda like when you have to manage a diabetic bomb in 7 minutes.

I just finished a consult with a physician whose sexual preference and dating choices were questioned in a 2.5-hour interrogation marathon.

I was under the impression that my colonic light bulb, midget fetish, and furry cosplay were off-limits. Guess not.

But … but, these medical boards also aren’t out to burn you if you are flying under the radar. But, you are literally gonna have to curb your altitude and play ball. If you do, you and the medical board can coexist nicely.

So, writing anything like what I’m writing here, bad idea. This is all “discoverable” when the state medical board pulls you before a judge. Ask me how I know!

There Are Plenty of NPs/PAs Ready to Replace You

Physicians are bred to view NPs and PAs as enemies. This is a narrow minded perspective to have. We have alienated our APP colleagues and shot ourselves in the foot by taking this stance.

Nevertheless, feeling burnt out? Trouble showing up to work? Don’t want to access the stagnant wages of the 1990s? We have an NP with a rather thick Nigerian, Greek, or Indian accept (your choice) ready to take your place.

If you want to run your own practice or join a sustainable medical group where APPs and physicians work together to improve a patient’s health outcome, now that makes sense. Plenty of such groups around.

You Have Options

You can leave medicine. No, like, really leave medicine, not just threatening fellow SM posters. Leave that chest-pumping shit for FB. Leaving medicine requires an exit strategy, not just dropping your white coat and walking out in the middle of patient care.

Work Less

You can reduce your hours and fill your time with things that mean more to you. But what? You get so bored on your days off. Dude, of course, you get bored on your days off! Boredom is your brain telling you that you are making a huge mistake. Don’t leave the Benjamins on the table! That’s $200 an hour you’re walking away from.

Play More

Start gardening, repairing the busted shit in your home, cooking, exercising, meditating, reading, cleaning, walking, volunteering, adopting, woodworking, rock climbing, welding, making porn, sowing, mending, journaling, yoga, making stained glass, traveling…

Spend Less

Cut your expenses. I still believe there is nothing more liberating for a physician than cutting their spending. You’ll never see the kind of freedom I experienced in 2012 when I first did that. I got rid of my Hummer, condo, car racing hobby, expensive clothes, fancy dining, wine, traveling, and gadget obsession. I don’t own a car living here in Long Beach, and even though others assure me that it’s impossible, that doesn’t change the fact that I don’t have any car expenses.


I made $60 an hour teaching at a community college. I loved it. But I make more money doing less now so I don’t have a reason to return to that.


Writing makes money any way you look at it. You reading these words makes me money because a couple of you will book a consulting call with me.

You can publish your own book series, make money with subscription-based blogs, and write for magazines and online publications—there are lots of options.


When I’m not in the US, I earn a lot of income from consulting. As a medical liaison, clinical expert, healthcare consultant, medical advisor, or whatever term they use, I sell my time at $200 per hour.

I started at $75 in 2016.

Leave SM

Stop reading anything outside of a book you’ve chosen. Delete this blog subscription, get off IG, get off FB, and stop watching the news.

The change in perspective you’ll enjoy is unbeatable. It’s like someone just took a VW off your back. Yes, the same wanderlust VW on that traveler van channel you’re drooling over.

Feeling Empowered

I feel empowered knowing that I have clinical insights that can help the right person live a better quality of life, save money, and enjoy better relationships with themselves and others.

I feel empowered knowing my skills are much more valuable than my medical license. I have proven that with my clinical consulting, my health coaching, and all the other crap I’ve dabbled in.

I feel empowered when I can get by without a cell phone subscription, without a car, no A/C, no new clothing, no alcohol, no $20 bag of coffee, and nobody around me to impress.

I feel empowered when I live in another country where others around me are making $700 an hour and living a better life, making 10x less than me.

I feel empowered knowing nobody is coming to save me because I don’t have to sit in my stained undies, watching boring Netflix, hoping I’ll be saved.

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