Health Journal Online

Tag: Problem

  • America’s Doctor Shortage Isn’t a Training Problem — It’s a Retention Problem. RM GME Is Driving Change.

    America’s Doctor Shortage Isn’t a Training Problem — It’s a Retention Problem. RM GME Is Driving Change.

    For years, the national conversation around America’s physician shortage has focused on expansion. More medical school seats. More residency slots. A larger training pipeline. Yet increasing volume alone has not translated into equitable access to care.

    The deeper issue may not be how many physicians the country trains, but where they ultimately choose to practice and whether they remain there.

    The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036. As of September 2024, nearly two-thirds of primary care Health Professional Shortage Areas were concentrated in rural communities. The challenge is not only supply. It is distribution and retention.

    Without structural intervention, expanding training capacity risks reinforcing existing geographic imbalances.

    Residents Medical Center of Graduate Medical Excellence, known as RM GME, was built around that premise.

    Reframing Workforce Strategy

    RM GME develops and sponsors graduate medical education programs in partnership with hospitals and healthcare systems, with a strategic focus on rural and safety-net institutions. In 2024, the organization achieved accreditation as an ACGME sponsoring institution, allowing it to oversee residency programs under its own institutional framework.

    “We recently became an ACGME-accredited sponsoring institution. Our first independently sponsored residency program launches in California, and our intention is to replicate that model in underserved markets nationwide — Dr. Michael Everest, founder of RM GME.

    The organization positions itself not as a placement intermediary, but as a graduate medical education infrastructure model designed to align training with long-term community workforce needs.

    The Overlooked Variable: Residency Churn

    A persistent but under-addressed dynamic in healthcare workforce policy is residency churn. Physicians frequently train in underserved environments, only to relocate to larger metropolitan systems after graduation. Hospitals that invested in their development face renewed shortages. Communities lose continuity of care.

    Research published in Health Affairs and the Journal of Rural Health has consistently shown that physicians are more likely to practice in the type of community where they complete their residency. Training location influences practice location. Yet many residency programs remain concentrated in already saturated urban centers.

    “Workforce stability begins during training. If we want physicians to practice in underserved communities long term, we have to build programs that are rooted in those communities from the outset. — Dr. Everest”

    RM GME-supported programs emphasize continuity through a guiding principle of post-training community engagement. Residents are encouraged to continue practicing in the same region for a period of at least three years following graduation, reflecting the program’s long-term community investment philosophy.

    “This is not about coercion or compliance. It reflects institutional values and strategic intent. When a community invests in training physicians, the goal is lasting impact. — Dr. Everest”

    Rather than relying on contractual retention mechanisms, the model focuses on designing programs where long-term practice aligns naturally with professional growth and community integration.

    Infrastructure That Supports Sustainability

    Retention is not secured by philosophy alone. Physicians training in rural and safety-net settings often operate with fewer academic resources than their counterparts in large academic medical centers. To address this gap, RM GME integrates AI-supported educational tools that provide adaptive knowledge assessment, conversational academic support, and personalized exam preparation.

    For residents balancing demanding clinical schedules, structured academic reinforcement can influence confidence, performance, and long-term professional satisfaction. In RM GME’s framework, educational infrastructure is part of the workforce strategy.

    If physicians feel supported during training, the likelihood of sustained engagement increases.

    A Model That Tests a Larger Hypothesis

    Loan forgiveness initiatives and financial incentives have attempted to address geographic disparities for decades. While they have produced incremental improvements, rural shortages persist.

    RM GME’s approach tests a different hypothesis. Durable workforce reform may depend on embedding graduate medical education directly within underserved communities and aligning institutional design with continuity from the beginning.

    “Our focus is long-term workforce alignment. Training physicians is essential. Ensuring they remain where they are most needed is what ultimately determines impact. — Dr. Everest”

    If the physician shortage is fundamentally a distribution crisis, the future of workforce reform may depend less on expanding seats and more on rethinking where those seats are placed.

    As RM GME scales its ACGME-accredited sponsorship model, its community-rooted approach will serve as a case study in whether structural GME design can influence where America’s physicians choose to build their careers.

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  • When Extreme Tiredness Signals a Health Problem

    When Extreme Tiredness Signals a Health Problem

    Pregnancy fatigue hits nearly every expectant parent, especially early on when hormones surge and the body rapidly adapts to support new life. Feeling tired during pregnancy can resemble jet lag that never fully lifts, even after a full night’s sleep. While this exhaustion is often normal, certain patterns may point to pregnancy complications such as anemia, gestational diabetes, thyroid imbalance, or infection. Knowing when pregnancy fatigue is expected—and when it signals a medical concern—helps safeguard both maternal health and fetal development. Understanding the difference allows timely care without unnecessary worry.

    Fatigue tends to ebb and flow across trimesters as hormones, blood volume, and metabolism shift. Short naps, balanced meals, and proper hydration often help, but they don’t address every cause. When tiredness becomes extreme, sudden, or limits daily function, pregnancy complications should be ruled out. Early recognition allows for simple screening and treatment that can restore energy and reduce risks later in pregnancy.

    Pregnancy Fatigue Causes: Normal Hormonal Shifts

    Pregnancy fatigue is most intense in the first trimester, driven largely by progesterone. This hormone rises rapidly and has a sedative effect on the brain, slowing reaction times and increasing sleep pressure. At the same time, estrogen fluctuates and blood production ramps up to supply oxygen and nutrients to the placenta, forcing the heart to work harder even at rest.

    According to the American College of Obstetricians and Gynecologists (ACOG), early pregnancy fatigue is closely tied to hormonal changes and increased cardiovascular demand as the uterus grows and blood volume expands. ACOG notes that these shifts are expected and usually stabilize after the placenta takes over hormone production in the second trimester.

    Other contributors stack on quickly. Nausea and vomiting reduce calorie intake and deplete electrolytes, while emotional stress disrupts sleep cycles. Many pregnant people also experience fragmented sleep from frequent urination or vivid dreams. Energy often rebounds around weeks 14–20, only to dip again late in pregnancy as physical strain, back pain, and breathing discomfort return.

    Tired During Pregnancy: When Anemia or Diabetes Strikes

    Feeling tired during pregnancy can cross from normal into concerning when anemia or gestational diabetes enters the picture. Iron requirements jump significantly during pregnancy to support red blood cell production. When iron stores fall, oxygen delivery drops, leading to exhaustion that rest alone cannot fix.

    Based on information from the World Health Organization (WHO), anemia in pregnancy is commonly defined by hemoglobin levels below 11 g/dL and is associated with fatigue, dizziness, and reduced physical tolerance. WHO emphasizes that iron deficiency remains one of the most common and treatable causes of excessive tiredness during pregnancy worldwide.

    Gestational diabetes creates a different fatigue pattern. Hormones from the placenta interfere with insulin function, causing blood sugar spikes after meals followed by sharp crashes. This can feel like sudden exhaustion paired with thirst, nausea, or blurred vision. Routine screenings during mid-pregnancy catch most cases early, but unexplained, persistent fatigue can be an early clue worth investigating.

    Red Flags: Extreme Tiredness Needing Urgent Care

    Extreme tiredness during pregnancy becomes a red flag when it appears suddenly, worsens rapidly, or comes with other symptoms. Fever, burning during urination, or back pain may signal infections that stress the body and increase fatigue. Shortness of breath, chest pain, or calf swelling require immediate evaluation for clot-related conditions.

    According to the Centers for Disease Control and Prevention (CDC), severe fatigue combined with symptoms like shortness of breath, headaches, or vision changes can also be associated with hypertensive disorders of pregnancy or serious infections. The CDC stresses that prompt care significantly reduces risks for both parent and baby.

    Mental health also matters. Depression during pregnancy often presents as overwhelming exhaustion, loss of motivation, and emotional numbness rather than sadness alone. When fatigue makes daily tasks feel impossible or is paired with hopeless thoughts, reaching out for support is essential and effective.

    Managing Pregnancy Fatigue Safely Day to Day

    Managing pregnancy fatigue starts with small, consistent habits rather than drastic changes. Eating balanced meals every few hours helps stabilize blood sugar and prevents energy crashes. Pairing protein with complex carbohydrates keeps fuel steady, while adequate hydration supports circulation and amniotic fluid levels.

    Light movement plays a surprising role. Short walks or prenatal stretching increase oxygen delivery and reduce stiffness that worsens tiredness. Sleep quality matters more than quantity, so side sleeping with pillow support and limiting late-day naps can improve nighttime rest. Prenatal vitamins fill nutritional gaps, but supplements should always match provider guidance.

    Mind-body approaches also help. Breathing exercises, gentle yoga, and brief relaxation breaks lower stress hormones that sap energy. When fatigue is addressed from multiple angles, many pregnant people notice meaningful improvements within weeks.

    Pregnancy Fatigue and Tired During Pregnancy: Knowing When to Act

    Pregnancy fatigue and tiredness during pregnancy sit on a wide spectrum, from normal adaptation to warning signs that deserve attention. Listening to the body and noticing changes over time matters more than comparing energy levels to others. Most causes of extreme tiredness are identifiable and manageable with simple tests and targeted care. Acting early protects long-term health and supports a steadier, safer pregnancy experience. Awareness, not alarm, is the key to staying well.

    Frequently Asked Questions

    1. Is pregnancy fatigue worse in the first trimester?

    Yes, pregnancy fatigue is usually strongest in the first trimester due to rapid hormonal changes. Progesterone has a calming effect that increases sleepiness. The body is also using extra energy to build the placenta. Many people feel some relief in the second trimester.

    2. Can dehydration make tired during pregnancy worse?

    Dehydration can significantly worsen fatigue during pregnancy. Blood volume increases, raising fluid needs beyond normal levels. Even mild dehydration can cause headaches and low energy. Regular water intake throughout the day helps prevent this.

    3. How do I know if my fatigue is anemia-related?

    Anemia-related fatigue often comes with dizziness, pale skin, or shortness of breath. It doesn’t improve much with rest alone. A simple blood test can confirm iron levels. Treatment usually improves energy within weeks.

    4. When should I call a doctor about extreme tiredness during pregnancy?

    You should call if fatigue is sudden, severe, or paired with fever, chest pain, or breathing issues. Persistent exhaustion that interferes with daily life also warrants evaluation. Mental health symptoms alongside fatigue are equally important. Early care leads to better outcomes for both parent and baby.



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  • Addiction, Trauma, and the Problem of Being Present

    Addiction, Trauma, and the Problem of Being Present

    The Power of Then

    I remember one day in rehab, after a particularly gruelling day of group therapy, the facilitator decided to end with a mindfulness meditation. Feeling exhausted and overstimulated, I welcomed the chance to close my eyes and shut out the world for a little while.

    But as she guided our awareness through the body, I became painfully aware of what was happening inside mine—the tightness in my jaw and throat, my heart pounding, the knot of fear twisting in my stomach. My body didn’t feel like a safe place to be; it felt like a war zone.

    When the meditation ended, she reminded us of how important it is in recovery “to live in the now.” And that left me with a burning question that I didn’t dare ask: What if my now feels unbearable?

    When the meditation ended, she reminded us of how important it is in recovery “to live in the now.” And that left me with a burning question that I didn’t dare ask: What if my now feels unbearable?

    For many people in recovery, being in the body can feel like stepping onto enemy territory. It’s where we hold the emotional pain, unresolved trauma, and survival responses we’ve spent years trying not to feel. Mindfulness invites us to tune in—to become aware of our bodies and minds, to sit with our emotions and thoughts. 

    To many people, this is a neutral concept. However, for the addict in recovery, it’s also being asked to return to the danger our addiction once protected us from.

    I once heard someone say, “You can’t feel the power of now until you’ve healed the power of then.” That statement really stuck with me. 

    When the nervous system is carrying trauma—when we’re dysregulated, overwhelmed, or trapped in a state of fight/flight/freeze—mindfulness doesn’t always feel supportive. Sometimes it simply heightens our awareness of the pain and discomfort within, without giving us the resources to cope.

    The Root of Addiction

    Many experts in the trauma and addiction field believe trauma sits at the root of addiction. Gabor Mate, one of the most influential voices in this work, invites us to shift the question from, Why the addiction? to, Why the pain? 

    Many of us are working from an outdated idea of what trauma actually is. Trauma isn’t defined by the event. It’s defined by what happens inside of us as a result of the event, the imprint it leaves on our body and mind.

    That reframing, turning the attention toward the suffering beneath the behavior, was one of the most powerful turning points in my recovery.

    You might be reading this and thinking, “This doesn’t apply to me. I don’t have trauma.” Yet many of us are working from an outdated idea of what trauma actually is. Trauma isn’t defined by the event. It’s defined by what happens inside of us as a result of the event, the imprint it leaves on our body and mind.

    Trauma expert Pat Ogden describes trauma as “any threatening, overwhelming experience that we cannot integrate.” When understood this way, it becomes more relatable. It’s not limited to catastrophic events; it also includes the undigested life experiences most of us carry in varying degrees—the moments that shape how safe we feel in the world, in our relationships, and in our own bodies.

    If substances became a way to soothe, regulate, or find relief from the imprint of those experiences, that is the link between trauma and addiction. Addiction doesn’t manifest without reason. It’s your body and nervous system attempting to restore balance—to escape an unbearable now—when nothing else seems to work.

    The Challenges Mindfulness Presents

    Mindfulness isn’t inherently problematic for everyone living with trauma; for some, it’s deeply supportive. The difficulty for some people living with symptoms of trauma is that mindfulness can sometimes intensify those symptoms, and in some cases even cause re-traumatisation.

    Mindfulness eventually became one of my greatest resources. But in the early days, before I was trauma informed, I often pushed through discomfort, believing that was part of the practice. I remember one meditation in particular where I forced myself to sit with an increasingly uncomfortable sensation in the pit of my stomach. I was convinced that if I just stayed with it long enough, I’d eventually reach some blissful state of transcendence. Instead, it sent me into an intense dissociative state which lasted for weeks—something I later learned is not uncommon for trauma survivors. 

    This is why it’s important to understand the potential challenges of mindfulness for some—so that if you do encounter problems, you know it’s not a sign of failure. It’s simply a signal from your nervous system that more safety is needed.

    Here are some primary signals to pay attention to: 

    Focusing on the body or breath can be activating

    Trauma lives in the body as physical sensations, constriction, tension, and survival responses. When we bring awareness to the breath, or to areas that hold this survival energy—the chest, throat, belly—these sensations can feel overwhelming.

    Mindfulness can trigger traumatic memories or flashbacks

    Turning inward creates space for memories, images, or emotions that were previously suppressed to rise to the surface. When they do, the body and mind may react as if the past is happening again. In other words, we start experiencing the power of then.

    Stillness can feel threatening to a dysregulated nervous system.

    For someone who is used to living in a state of fight, flight, or chronic hypervigilance, stillness can feel unfamiliar and unsafe. Even the feeling of calm can feel threatening when the body is used to scanning for danger.

    Self-observation can activate shame or self-judgement

    Turning attention inward can make self-critical thoughts louder, especially for someone whose trauma involved blame, guilt, or a loss of self-worth.

    None of this means mindfulness should be avoided. Far from it. It simply means the practice may need to be approached differently: with more pacing, choice, and with safety at its core.

    Practising Mindfulness Safely

    Safety is the foundation of trauma recovery and one of the cornerstones of trauma-informed mindfulness. David Treleaven, founder of Trauma-Sensitive Mindfulness, emphasises that mindfulness for trauma survivors must be flexible, and adapted to suit an individual’s nervous system and needs. Instead of pushing through discomfort, this approach supports choice, regulation, and autonomy.

    Here are some adjustments you can make to your mindfulness practice when you start to feel activated: 

    1. Start outward. For many people, beginning with external anchors feels more supportive than turning the attention inward. Noticing sounds, feeling your feet on the floor, or gently orienting to your surroundings can help settle the nervous system.
    2. Switch it up. Once a sense of grounding is established, you can then gently approach your inner experience. It can help to move between inner and outer awareness, so that if anything becomes too intense, you can shift your focus back outward, adjust your posture or pause completely. Having a reliable anchor, something that feels supportive to return to, can be especially helpful.
    3. Get mobile. Movement can also be a powerful bridge to presence. Walking, stretching, or gentle swaying may feel more accessible when stillness feels too threatening. You don’t have to sit motionless in a lotus position to be mindful. 
    4. Open your eyes. For some people, closing their eyes means they can’t scan for danger. As people are learning to find safety, practising with eyes open, or with a soft gaze, can also reduce the vulnerability that may come with closing the eyes.
    5. Be gentle with a noisy mind. It’s also worth noting that the mind—even when busy or critical—can feel safer than the body. Understanding this can help reduce frustration when the mind doesn’t quieten in the way we might expect.

    One of the most important things to remember with trauma-sensitive mindfulness is that you have choice and autonomy. Treleaven says, “We want them to know that in every moment of practice they are in control.” So, if things become too much, return to what feels safe. Stay within your window of tolerance, which allows for some discomfort, but not to where it’s overwhelming.

    When practiced with care, mindfulness can be one of the greatest tools for trauma healing and addiction recovery. For me, the benefits were profound, so much so that I wrote a book about it. But the greatest benefit was reconnecting with that part of myself that addiction and trauma never touched: the part that was always there, quietly watching, peaceful and still. My true self!

    Mindfulness doesn’t rewrite the past, but when we can embody a sense of safety, it helps us to hold it differently. So that the power of then no longer overshadows the power of now.



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  • Can’t Solve A Problem? Sleep On It—It’s Backed By Science, Here’s Best Nap For Better Thinking

    Can’t Solve A Problem? Sleep On It—It’s Backed By Science, Here’s Best Nap For Better Thinking

    Have you heard the saying “if you can’t fix an issue, just sleep on it”? It’s not just random advice to calm you down before bed, science now proves how sleep can help you think clearly and solve a problem.

    In a recent study published in the Journal of Sleep Research, investigators examined how a specific type of sleep, afternoon naps, helps in creative problem-solving.

    The researchers conducted problem-solving experiments in a group of 58 people below the age of 30 from Texas State University. Half of the participants were allowed to take a two-hour afternoon nap before solving a puzzle they had previously been unable to solve, while the other half attempted the puzzle without sleep.

    The results showed that people who took a nap before solving the problems performed better than those who stayed awake. On average, the sleep group solved 43% of the problems, while the wake group solved only 15%.

    The researchers concluded that this is because sleep, especially the type that includes the REM phase, helps people in an analogical transfer to solve issues that could not be done before the nap. Analogical transfer is the ability to use insights from a different problem to solve a new, related problem.

    Rapid eye movement (REM) sleep is a phase where your eyes move rapidly in different directions, and brain activity becomes as high as when you’re awake. “This sleep stage [REM] may play a key role in putting past experiences to best use by establishing and strengthening associations that are not readily apparent in our waking lives,” the researchers wrote.

    “My previous research has focused on understanding how memories change during sleep. However, the reorganization of knowledge that occurs during memory consolidation undoubtedly impacts other aspects of cognition as well. I was specifically interested in how the initiation and/or strengthening of connections between new and old memories can assist in problem-solving,” said study author Carmen E. Westerberg, a professor at Texas State University.

    “The main takeaway is that if you have a difficult problem that you cannot solve, processes that occur while you are sleeping may give you insights after waking that could help to solve the problem,” Westerberg added.

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