Why physician leaders never stop worrying

Like those of you who oversee your practices and have to make payroll for all your doctors, technicians, billing people, and other staff, department chairs spend a fair amount of time worrying about the future. Patient volumes, operating room access, keeping referring physicians satisfied, dealing with less-than-cooperative payers, and accounts receivable all need to be monitored, plus there is the decision about whether to sell the practice to a private equity group.

In academics, we also have to worry about the availability of National Institutes of Health funding for our scientists and the costs associated with teaching residents, fellows, and medical students. (Spoiler alert: Education is a major financial loser for departments like mine.)

And it is easy these days to find much to worry about. Just pick up a newspaper, or visit a news website or app (as younger readers prefer to do these days), and you find yourself bombarded with horrific crimes, economic challenges or predictions of recessions, political dysfunction, and faulty science. I remember thinking that when the Berlin Wall came down and the Soviet Union ended, the world faced a bright future free of wars and the expense of maintaining and using large armies. It seemed that there would be so much less to worry about. Obviously, as attested by daily reports of armed conflict in Ukraine and the Middle East, I got that wrong.

An old worry, freshly quoted

As a case in point, I recently read the following newspaper editorial: “It is a gloomy moment in history. Not for many years—not in the lifetime of most men who read this paper—has there been so much...deep apprehension.... In our own country there is a universal commercial prostration and panic, and thousands of our poorest fellow-citizens are turned out against the approaching winter without employment, and without the prospect of it.... Russia hangs as usual, like a cloud, dark and silent upon the horizon.... Of our own troubles no man can see the end.”¹ Can you think of a more complete list of worries that we face?

Now, although it is true that I only recently read the editorial quoted above, it was published not last week but in the October 10, 1857, issue of Harper's Weekly. The fact that almost 2 centuries ago Americans were worrying about the same seemingly insurmountable problems that their descendants lament today makes me believe that we humans have our problems and always will, but we would be wise to fret less and just get on with what needs to be done. As Mother Teresa said: “Do not worry about why problems exist in the world—just respond to people’s needs.”

Peter J. McDonnell, MD

E: pmcdonn1@jhmi.edu

McDonnell is director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, and chief medical editor of Ophthalmology Times.

Reference

1. The lesson of the day. Harper’s Weekly. October 10, 1857:642. Accessed September 17, 2026. https://archive.org/details/sim_harpers-weekly_1857-10-10_1_41/page/n1/mode/2up