55/100
influencer
You have authentic physician voice and real credibility, but you're trading depth for rhetorical impact. The piece diagnoses a genuine problem—unpaid primary care labor—but stops at emotional observation rather than causal analysis. No data, no specifics on financial impact, no exploration of *why* the system works this way. You're writing compelling op-ed, not thought leadership. The voice is strong enough to carry heavier thinking—you're not using that gift.
Dimension Breakdown
📊 How CSF Scoring Works
The Content Substance Framework (CSF) evaluates your content across 5 dimensions, each scored 0-20 points (100 points total).
Dimension Score Calculation:
Each dimension score (0-20) is calculated from 5 sub-dimension rubrics (0-5 each):
Dimension Score = (Sum of 5 rubrics ÷ 25) × 20 Example: If rubrics are [2, 1, 4, 3, 2], sum is 12.
Score = (12 ÷ 25) × 20 = 9.6 → rounds to 10/20
Why normalize? The 0-25 rubric range (5 rubrics × 5 max) is scaled to 0-20 to make all 5 dimensions equal weight in the 100-point CSF Total.
Quantitative data absent (1/5 rubric). Zero statistics, timelines, or financial impact estimates. Examples are vivid but unquantified—'time, cognitive load, phone calls' lacks any measurement of actual burden.
Evidence quality weak (2/5 rubric). Anecdotal ER/surgery examples are credible but lack causal analysis. No exploration of why ownership emerges in acute care but collapses in primary care. Personal authority present but reasoning stops at observation.
Novelty low (2/5 rubric). Repackages 20-year-old healthcare policy critique (primary care undervaluation, fragmentation). Unique angle on 'invisible labor' is underdeveloped. Missing contrarian courage—doesn't interrogate whether fragmentation might be rational or explore trade-offs.
Reasoning depth shallow (3/5 rubric). First-order diagnosis without second-order causal analysis. Diagnoses fragmentation but never asks *why* it exists, who profits, or what prevents market correction. No exploration of unintended consequences.
Hedge avoidance strong (5/5 rubric) but actionability weak (2/5 rubric). Authentic voice undermined by defensive softening ('And yes—the word ownership can sound off-putting...'). Final recommendation ('give PC money') is vague—no structural solution proposed.
🎤 Voice
🎯 Specificity
🧠 Depth
💡 Originality
Priority Fixes
Transformation Examples
'Ownership is: I will make sure this gets done — come hell or high water. And it's a dying art. In the best settings, ownership is a core value baked into a specialty's identity: In the ER, we don't pawn off lumbar punctures at shift change. Surgeons own post-op complications. It's just the right thing to do.'
'Ownership is: I will make sure this gets done—come hell or high water. But it's not dying because of weak character. It's disappearing because the system stopped creating accountability for it. In the ER, ownership is baked in: clear shift handoff, you're accountable for your patients' outcomes before you leave. In surgery, the surgeon's liability follows the patient. But in outpatient primary care, coordination happens across 8 different specialties, none of whom are tracking whether the referral got scheduled or the result got communicated back. The system didn't ask for less responsibility. It just made responsibility invisible. When no one sees the cost of dropped balls, no one owns them.'
How: Don't just describe what ownership *is*—explain why it exists in ERs and surgery but collapsed in primary care. What structural difference created this? Acute care has time-bound accountability (shift ends, patient stabilized or transferred). Primary care is diffuse, chronic, cross-specialty. Add: 'Ownership dies when responsibility becomes invisible—when tasks have no clear owner and outcomes aren't tracked back to you. The system didn't lose character; it lost feedback loops.'
And yes — the word 'ownership' can sound off-putting in the era of patient empowerment. Fine. 'Stewardship,' or 'accountability,' or 'making sure the ball doesn't get dropped.' I cannot under-emphasize just how easily this can and does happen in medicine if no one is paying attention or if someone lets their guard down.
The word 'ownership' grates in an era of patient empowerment—and that's exactly the problem. We've rebranded responsibility as 'shared decision-making' and 'care coordination,' which sounds modern until a result gets lost and no one claims it. The ball doesn't just get dropped. It rolls across three departments and everyone assumes someone else is watching it.
- Removed apologetic preface—led with the tension directly
- Replaced defensive 'Fine' with assertive reframing of the core problem
- Eliminated thesaurus padding—one strong statement instead of hedged alternatives
- Shifted from explaining the concept to illustrating its consequence
- Strengthened by acknowledging the real conflict rather than softening it
Derivative Area: Primary care undervaluation thesis. This tracks healthcare policy consensus since 2000 (AAFP campaigns, PCMH initiatives, 'House of Medicine' metaphors). You're restating established diagnosis in better prose.
Flip the narrative: Instead of 'primary care needs more money,' argue 'the system is *designed* to extract unpaid labor from primary care and we keep accepting it because we've reframed it as professional virtue.' Then ask: What if the solution isn't higher salaries but *not allowing the work to happen*? What if PCPs should refuse coordination tasks that aren't reimbursed and force the system to redesign instead of subsidizing dysfunction with their time? This challenges the underlying assumption that 'good doctors' absorb the cost.
- Why hasn't market competition fixed this? If primary care coordination creates value, wouldn't competing health systems pay more to attract high-ownership PCPs? What prevents this market correction?
- Is fragmentation actually rational for some stakeholders? Specialists avoid coordination burden, health systems avoid paying for it, patients get quasi-free care management. Is the system extracting value *intentionally*?
- What if restoring ownership creates *new* inefficiencies? Does it slow specialist throughput? Duplicate testing? Create gate-keeping that limits appropriate access? What are genuine trade-offs?
- Do patients actually want primary care ownership? Or do they want specialists? The patient empowerment rhetoric you mention—does it include wanting their PCP to own their gastroenterology referral, or do patients expect specialists to own their specialty?
- Is the solution really payment, or is it structural? Could you restore ownership through liability redesign, outcome tracking, or EMR architecture rather than money?
30-Day Action Plan
Week 1: Specificity—embed quantitative evidence
Audit your own practice: Track non-reimbursed coordination tasks for 1 week. Count hours spent on follow-up calls, result chasing, referral calls to specialists, insurance denials, patient education on medication adherence. Calculate total hours and multiply by your hourly billing rate. Document with timestamps.
Success: You have a specific number: 'PCPs spend X hours/week on coordination' and 'This equals $Y in unpaid labor annually.' This becomes your anchor data point for the next draft.Week 2: Nuance—add second-order reasoning
Rewrite the fragmentation section with causal analysis. Start: 'Why did fragmented care emerge?' Answer: Fee-for-service incentives. Then: 'What are the unintended consequences?' (Outcome chaos, coordination burden, specialist efficiency.) Then: 'What would restore ownership?' Consider: liability redesign, outcome tracking, capitation models, EMR interoperability. Explore trade-offs for each.
Success: Your rewrite includes at least one 'Why' and one 'What if' question. Readers should see causal chains, not just observations. One paragraph should make readers think differently about why the system works this way.Week 3: Originality—research the contrarian angle
Investigate: Why hasn't market competition fixed primary care compensation? Interview 3 health system leaders or practice economists. Ask: 'If PC coordination creates value, why don't you pay more for it?' Listen for the real constraint (profit margins, specialist dependence, patient expectations). Document contradictions between what policy says is needed and what systems actually do.
Success: You have 2-3 quotes or data points revealing why the system *tolerates* primary care undervaluation despite consensus that it's undervalued. This is the gap where original thinking lives.Week 4: Synthesis—draft high-CSF version
Rewrite the full piece integrating: (1) Your quantitative data on coordination burden, (2) Causal analysis of why fragmentation exists, (3) Research findings on why compensation hasn't improved despite consensus. Maintain your authentic voice but ground it in evidence and reasoning.
Success: You've written a piece that uses your original insight (invisible labor framing) but now supports it with data, explores *why* the system tolerates it, and hints at structural solutions beyond 'pay PCPs more.' This should feel like you've earned the argument.Before You Publish, Ask:
Can you name the specific reimbursement model (RVU, capitation, salary + bonus) that would restore primary care ownership, and what evidence shows it works?
Filters for: Distinguishes between diagnosis (fragmentation exists) and solution (structural change required). If you can't answer this specifically, you're still in op-ed mode, not thought leadership.What percentage of primary care time do you personally spend on non-reimbursed coordination work, and have you measured it?
Filters for: Specificity. Thought leaders speak from data, not intuition. If you're estimating rather than measuring, you're vulnerable to being dismissed as anecdotal.If we gave primary care 20% more pay tomorrow, would fragmented coordination actually improve, or would the system absorb the raise without structural change?
Filters for: Depth of causal thinking. Can you distinguish between treatment of symptoms (more money) vs. structural cure (redesigned accountability)? This separates observation from analysis.Who *benefits* from primary care coordination work going unpaid, and why haven't they agreed to compensate it?
Filters for: Originality and contrarian thinking. This question reframes the problem from 'primary care is undervalued' to 'the system profits from underpaying primary care.' Can you defend that harder claim?What's the strongest argument against your position? (E.g., 'Maybe fragmentation is actually efficient and restoring ownership would slow care?')
Filters for: Nuance. Thought leaders don't just make their case—they anticipate and address counterarguments. If you can't articulate the opposing view fairly, you haven't thought deeply enough.💪 Your Strengths
- Authentic physician voice with strong personality. No AI detection. Readers trust you because you sound real.
- Effective emotional framing. The ER lumbar puncture example and 'hot potato' metaphor resonate because they're concrete and specific enough to be credible.
- You've identified a genuine insight: framing coordination as 'invisible labor' rather than 'good doctor ethos' implies systemic design failure, not moral weakness. This is original and underdeveloped.
- Confident tone (hedge_avoidance 5/5). You're not apologizing for your argument—you're asserting it. This gives readers permission to take you seriously.
- Systems thinking present (4/5). You understand that fragmentation has ripple effects. You're close to explaining *why* it exists; you just haven't finished that thought.
You have the credibility, voice, and intuition for real thought leadership—you're just leaving the hard thinking undone. If you embed specificity (data on coordination burden), develop nuance (causal analysis of fragmentation), and push originality (interrogate why the system tolerates this), you move from 28 CSF to 65+. Your authentic authority as a physician means you don't have to choose between accessibility and depth. In fact, readers expect physicans to combine both. You're capable of this transformation. The question is whether you're willing to do the research and reasoning work that earns the platform you already have.
Detailed Analysis
Rubric Breakdown
Overall Assessment
This is authentic physician voice with strong personality and controlled rule-breaking. The writer deploys specific medical scenarios, confident assertions, and unconventional formatting strategically. Minimal AI patterns detected. Occasional over-explanation weakens directness, but the core voice is distinctly human and credible.
- • Confident assertions without hedging: 'It's a dying art,' 'it's time we start acknowledging it' show zero uncertainty. This is physician conviction, not AI fence-sitting.
- • Specific procedural/clinical details (lumbar punctures, post-op infections, seizure med compliance) that only someone who lives this would reference naturally. Not researched—lived.
- • Creative punctuation and formatting (the italics, the emoji usage, the stacked emphasis) feel intentional and controlled, not random. Shows mastery of the medium.
- • Mid-section apology/softening ('And yes—the word 'ownership' can sound off-putting...') undermines the confident tone and feels reactive rather than proactive. Defensive.
- • The 'Fine' opening to the thesaurus paragraph reads like responding to imagined pushback rather than owning the argument fully.
- • Slight redundancy in the final paragraph ('All specialties—and I mean ALL') adds emphasis but dilutes the punch of what's already a strong statement.
Rubric Breakdown
Concrete/Vague Ratio: 1:2.6
The piece relies heavily on abstract principles and rhetorical flourish rather than concrete data. While it contains vivid metaphors and specific medical scenarios (ER lumbar punctures, post-op infections), these lack quantitative support. No statistics, timelines, or specific outcomes are provided. The argument about primary care burden is compelling but unsupported by measurable evidence.
Rubric Breakdown
Thinking Level: First-order with occasional second-order glimmers
The piece makes a valid observation about responsibility gaps in modern medicine and correctly identifies primary care's structural burden. However, it relies on evocative examples rather than causal analysis. It diagnoses the problem well but doesn't explore why ownership collapsed, what incentives prevent it, or what systemic changes could restore it. First-order thinking wrapped in compelling rhetoric.
- • Identifies a real, underappreciated structural problem: responsibility gaps leave primary care holding the bag
- • Makes clear that unmeasured work is still work—valuable reframing of unpaid labor as economic extraction
- • Systems-level observation that all specialties depend on PC foundation (correct)
- • Uses concrete examples (lumbar puncture at 6:58pm, post-op infection) that illustrate rather than merely assert
- • Acknowledges the semantic tension (ownership vs. patient empowerment) showing some nuance
Rubric Breakdown
The piece repackages well-worn critiques of fragmented healthcare using emotional framing. While the ER/surgeon examples create relatability, the core argument—that primary care is undervalued and lacks accountability—mirrors decades of healthcare policy discourse. The execution is polished but conceptually derivative.
- • Framing coordination/follow-up work as invisible labor rather than as a character trait of 'good doctors'—this acknowledges systemic design rather than moralizing individual behavior.
- • The ER ownership example (lumbar punctures at 6:58pm) captures something specific about acute care cultures that outpatient settings lack—time-bound accountability creates ownership clarity.
- • Implicit acknowledgment that patient empowerment rhetoric can mask delegation of medical responsibility back to patients—rare honest tension.
Original Post
Medicine requires ownership. Not in the sense of "equity stake," nor “management” nor followup. I mean 𝙖𝙨𝙨𝙪𝙢𝙥𝙩𝙞𝙤𝙣 𝙤𝙛 𝙧𝙚𝙨𝙥𝙤𝙣𝙨𝙞𝙗𝙞𝙡𝙞𝙩𝙮 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘪𝘯 𝘧𝘳𝘰𝘯𝘵 𝘰𝘧 𝘮𝘦. Ownership is: “I will make sure this gets done — come hell or high water.” And it’s a dying art. In the best settings, ownership is a core value baked into a specialty’s identity: 🚑 In the ER, we “own” our lumbar punctures. We don’t pawn them off at shift change because we’re tired and it’s 6:58pm. 🔪 Most surgeons “own” the downstream mess too. Post-op infection? Persistent abdominal pain after you took out the gallbladder? They wince, sigh, and say: 𝘠𝘦𝘢𝘩… 𝘢𝘥𝘮𝘪𝘵 𝘵𝘰 𝘮𝘺 𝘴𝘦𝘳𝘷𝘪𝘤𝘦. It's not some heroic act — just the right and responsible thing to do. Now look at modern outpatient medicine, where everyone touches the patient but no one owns the outcome. Responsibility becomes hot potato — and when the music stops, the ball lands where it always lands. Can you guess it? 𝗣𝗿𝗶𝗺𝗮𝗿𝘆 𝗰𝗮𝗿𝗲. “Can you follow up the repeat CT in 6 months?” “Hey she’s still not taking her seizure meds — can you talk to her next visit?” “I found a mass on MRI. Referral placed. Can you call IR and see if they can squeeze in a biopsy asap?” That work is real. It. Is. Real. Work. Time, cognitive load, phone calls, nudges, pings, pokes, and requests to chase the thing nobody wants to chase. 𝗔𝗻𝗱 𝗶𝘁'𝘀 𝙘𝙧𝙞𝙩𝙞𝙘𝙖𝙡 𝘄𝗼𝗿𝗸 𝘄𝗲 𝗱𝗼𝗻’𝘁 𝗽𝗮𝘆 𝗳𝗼𝗿. We act like “assumption of responsibility” is a personality trait. But it’s actually labor. The labor that prevents the worst downstream failures. This is why Lisa's piece about the disappearing “Good Doctor” lands so hard. (And yes — the word “ownership” can sound off-putting in the era of patient empowerment.) Fine. "Stewardship," or "accountability," or "making sure the ball doesn’t get dropped." I cannot under-emphasize just how easily this can and does happen in medicine if no one is paying attention or if someone lets their guard down. I'm all for patient empowerment, but at the same time most people still expect the buck to stop with the doctor, not themselves. Primary care is the foundation of the whole machine. All specialties — and I mean ALL — depend on primary care as the foundation of this entire healthcare system, and it’s time we start acknowledging it with attention, spotlight, and 𝗺𝗼𝗻𝗲𝘆. …more