Offcall Physician Spotlight: Meet Dr. Steven Farmer
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1. Steven, what do you think the public most misunderstands about being a physician in 2026? That the doctor in the room is the one making all the recommendations. Patients come in believing — reasonably — that their physician looks at their situation, applies their training, and recommends what's best. And that's still true in the exam room. But what actually happens to that recommendation afterward is shaped by forces most patients never see: what is covered, payment model incentives, and prior authorization workflows.
I spent years as a cardiologist — first in academic medicine and then working at CMS. That last chapter changed how I understood everything that came before it. The policy decisions made in Baltimore have profound clinical consequences at the bedside. A coverage determination isn't an abstraction — it's whether your patient gets the intervention or doesn't. Most physicians navigate that reality every day without the public even knowing it exists.
The misunderstanding I'd most want to correct isn't that medicine is hard — people know that. It's that the hardest parts in 2026 often have nothing to do with medicine.
2. What's one way you've coped with burnout that's actually made a difference? I redirected, rather than recovered.
There's a version of burnout advice that assumes the answer is rest — take a vacation, set your phone down, find a hobby. And maybe that works for some people. For me, the exhaustion was about the gap between what I could do for a patient and what the system would allow. That's a different problem, and it doesn't respond to rest.
What actually made a difference was finding a way to work on the system instead of just inside it. Moving into federal health policy — working at CMS while continuing to practice — gave me a context where the frustrations I'd accumulated clinically became actually useful. The things that had burned me out became the subject matter. I couldn't unsee what I knew about how coverage and payment decisions landed on real patients. But I could try to make those decisions better.
That's not a path everyone can take, and I'm not suggesting it as generic advice. But the underlying principle is: if the burnout is structural, the fix probably needs to be structural too. Figure out what specifically is grinding you down — and ask honestly whether you're trying to recover from it or address it.
3. What's the hardest part about being a physician that you think should be talked about more openly? Moral injury. Not burnout — moral injury. They're related, but they're not the same thing, and conflating them leads to the wrong interventions.
Burnout is exhaustion. Moral injury is what happens when you are forced, repeatedly, to act in ways that conflict with your values as a clinician. When you know what a patient needs, but the system isn't equipped to deliver it. When you understand that the payment structure is steering your patient toward a path you wouldn't choose if the incentives weren't there. When you're documenting for hours because the system requires it, and you're acutely aware that those hours came from somewhere — usually from your patients, or from yourself.
I've been on both sides of this. As a cardiologist, I felt it. As someone who spent time at CMS, I also watched it happen from the policy end — and saw how often the people writing the rules genuinely didn't understand the clinical reality they were governing.
The conversation about physician well-being has gotten better. But it still defaults too quickly to resilience frameworks and self-care language. What I'd want talked about more openly is the specific, systemic ways that medicine asks physicians to compromise their clinical judgment — and what it costs when we do that, year after year, without naming it.
4. Finally, who do you want to nominate next to get the next Physician Spotlight??
I'd like to nominate Dr. Rich Bruno.
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Dr. Steven Farmer is a cardiologist and health services researcher with extensive experience in clinical care, federal health policy, and academic research. He is a Senior Partner at ABIG Health and Clinical Associate Professor at George Washington University. Formerly Chief Strategy Officer at CMS, he led the development of national coverage policies and innovative payment models, including the TCET and BPCI-A initiatives.
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