Practical write-ups and the MD-Universe Podcast — on licensing, reimbursement, and the business of medicine. Free, no account needed.
The National Board of Physicians and Surgeons recertifies physicians for $189 every two years, needs 50 hours of CME and no exam, and is accepted by every hospital accreditor in the country. On 7 August 2026 Florida became the first state to let those physicians call themselves board certified in advertising. Texas banned MOC requirements in 2017 and still will not.
Every hospital must query the National Practitioner Data Bank about you at appointment and every two years, and subscribing hospitals hear about a new report within 24 hours. Until this spring you saw your own file only by paying for a snapshot. A free account now shows everything, alerts you when a report is filed, and starts the correction clocks before credentialing does.
PSLF's 120-month clock counts qualifying employment, and for most physicians it started in July of intern year. Buyback converts forbearance months into qualifying payments priced at the income you had then — and a 2023 rule opened the program to California and Texas physicians paid through medical groups.
Since 1 October 2025 an algorithm at Cigna pays level 4 and 5 E/M claims one level lower using claim data alone — the chart is never opened. Aetna runs a parallel program in nearly every commercial state. Each downcode costs $40 to $59 at Medicare rates, the reversal path is written into the policy itself, and Maryland has already ordered every affected claim repaid.
Transitional care management pays $220 to $299 for a follow-up visit most practices already schedule, yet national claims data show the code going unbilled after the overwhelming majority of eligible discharges — and half the time the qualifying visit happened anyway and went out as a $136 problem visit. The difference is a phone call inside two business days.
Medicare's longitudinal-care add-on paid out $394 million in its first year, yet two-thirds of physicians never billed it once. The code takes no extra documentation, attaches to visits you are already doing, and the 2025 and 2026 rule changes quietly widened it. The arithmetic on leaving it off runs to five figures a year.
JAMA's five-center study of 1,809 clinicians measured what ambient scribes actually return — 16 minutes of documentation time per clinical day, half an extra visit a week, and no change at all in after-hours EHR time. Burnout fell hard anyway. Price the license against those numbers, not the demo.
Milliman's 2025 benchmarking puts commercial professional reimbursement at 148% of Medicare and hospital outpatient at 263%. Same procedure, same day, and the multiple nearly doubles depending on who owns the room. Meanwhile 37% of practices have never once reopened the contract that sets the 148%.
Algorithms write the denials now. Since January plans must decide in seven days and give a reason — but nothing requires them to deny less, and CMS declined to regulate the software at all. Meanwhile over 80% of Medicare Advantage appeals are overturned and only about 20% of physicians file one.
The pass-through deduction rises to 23% in 2026 and the phase-out band widens by $50,000, which pulls a lot more physician owners inside it. Inside that band, every dollar your practice puts into a retirement plan destroys 23 cents of deduction — so the standard advice to max everything tax-deferred stops being automatically right.
Nearly $30 billion bought electronic records for almost every hospital in America. It did not buy the ability to move them. Here is the whole arc — what was built, what quietly went wrong, the four hurdles left, and the one fix that needs no new technology at all.
Google ran 300 live video consultations pitting its AMIE system against 30 board-certified primary care physicians, and rated it on par or better on history, diagnosis and management. It still cannot prescribe, sign, bill or be sued — which is exactly why this is an ownership story rather than a replacement story.
Thirty-two states bar corporations from practising medicine. The management services organisation is how capital got in anyway — and the 2026 legislative wave is the first serious attempt to close the gap.
Ownership is not one decision with one price. It ranges from a $30,000 direct-care practice to a surgery-center stake to a hospital Congress has banned you from building. Here is the real cost of each.
Physician-owned practices fell to 36% of the market while corporate owners overtook hospitals for the first time. Here is what the ownership data actually says, and what it means for the offer in front of you.
Physicians name EHR burden, staffing and administrative load as their top stressors, year after year. The funded response is usually a seminar about coping — and the evidence for that is thin.
Burnout instruments answer one question well: is a negative state present. They were never built to tell you whether a physician is actually doing well, and an entire field of wellness programming has been conflating the two.
The federal ban made headlines in 2024. Its complete unwinding, finished in 2026, made far fewer — and plenty of physicians are still negotiating as though it exists.
With the federal ban gone, the practical route is not a legal challenge after the fact. It is a narrower clause agreed before you sign — and scope is where employers actually have room.
Physician employment disputes are remarkably unoriginal. The same handful of structural traps recur across specialities and markets — and all of them are visible before signing.
A decade of training for clinical competence, and effectively zero hours for the negotiation that determines your income, your mobility and your legal exposure for years afterwards.
Every real estate tax strategy for physicians reduces to one structural question — can the losses be classified as non-passive? There are two realistic answers, and most households qualify for only one.
Syndication marketing opens with projected returns. A real diligence process opens with the sponsor and the debt, and treats the projection as the final input rather than the first.
Physicians hear "depreciation" and think "deduction". The complete sentence is "deduction now, partially reversed later at a rate higher than you expect" — and the sale year is where most investors learn it.
Locums gets framed as a burnout escape hatch or a gap-filler between real jobs. Treated as a deliberate instrument, it is neither — and it opens retirement options a W-2 job never will.
Pitched as easy passive income and rarely either. The pay gap between casual freelancing and specialised CME work is enormous, and it tracks commitment almost exactly.
Rates run $500 to $1,000 an hour, and most physicians doing this work charge well under market — largely because nobody tells them what market is.
No call, no panel, no clinic. Chart review has moved from a retirement-era wind-down to a routine income stream for physicians in the middle of their careers.
Malpractice cover gets treated as an onboarding formality. Four specific clauses account for nearly every unpleasant surprise physicians report.
Captive insurance is legal and legitimate versions exist. It is also one of the most reliable ways for a high-earning physician to end up in a multi-year IRS examination.
Training is the only stretch of a medical career with a low income and high-stakes financial decisions happening at once. Some of the standard advice survives scrutiny. Some of it does not.
Buying umbrella coverage is the easy part and almost every physician eventually does it. The problem is believing it covers more than it does, and finding the boundary only after a claim is filed.
Most physicians buy disability insurance once and never reopen it. The base policy is the easy half — the riders decide whether it pays in the situations that actually happen.
Claims-made policies are cheap up front because the real cost arrives the day you leave. Here is how to find out what you owe before it becomes a five-figure surprise.
The mechanics are two steps and take ten minutes. Almost every expensive mistake happens somewhere other than those two steps — in old accounts, missed forms, and money left sitting still.
Sixteen strategies, from the buckets every physician should fill first to the six-figure real-estate plays — and the gimmicks to leave alone.
Put in $100,000, borrow $1.9 million, collect 13% in US dollars with no currency risk. The product is real and the math checks out — but for a US-taxed physician one number decides the whole thing, and no video mentions it. Window closes 30 September 2026.
From September 1, 2026, the Texas Medical Board verifies CME exclusively through CE Broker. If TMB cannot verify your hours there, you cannot renew. This comes from Senate Bill 912, which requires Texas licensing bodies to verify CE through an electronic tracking system.
Since March 1, 2026 every physician renewing a Texas licence must submit proof of citizenship or lawful presence — not only IMGs, and not only at initial licensure.
Interventional cardiology sees a 3.2% cut. A plain-language breakdown of what changed and who’s affected most.