Matt Downen

Dad. Husband. Doctor. Illini. Thoughts unoriginal. Jokes are dad quality. Reserve the right to change my opinion over time.

[Matt Downen @amdownen]

Can we convince the European tourists to stick around for SEC tailgates?

[Luke Cannon @lukecannon727]

The cashier at Home Depot just asked me if I wanted to round up to support the SpaceX IPO

[Echoes of War @EchoesofWarYT]

The richest man in America signed a document that could have gotten him hanged, and when someone sneered that he was safe because no one would know which Charles Carroll to come for, he picked up the pen and told the British exactly where to find him.

His name was Charles Carroll, and the colonies were crawling with men who shared it. His own father was Charles Carroll of Annapolis. So when the Declaration of Independence came to him for signing in 1776, a delegate made a cruel little joke. He said Carroll risked nothing by signing. There were so many Charles Carrolls that the King's men would never know which one to hang.

Carroll didn't argue. He leaned over the page and added three words to his signature: "of Carrollton." The name of his estate. His address. He was the only signer in the entire room who wrote down where he lived, and he did it on purpose, so that if the British wanted to come hang the traitor, they would know exactly which door to knock on.

That is who Charles Carroll of Carrollton was.

Here is what makes the moment even sharper. He was not a man with little to lose. He was the single wealthiest man in the thirteen colonies and the largest private landowner among them. While George Washington and John Hancock get talked about as rich men, it was Carroll who topped them all. When he signed, he was wagering the biggest personal fortune in America against a noose.

And he was the last man anyone would have expected to be there at all. Carroll was Catholic. In colonial Maryland, a colony founded as a Catholic refuge that had since turned on its own, Catholics could not vote. They could not hold public office. They could not worship in public. The most educated, wealthiest man in America was, in the eyes of the law, a second-class subject barred from the very government he was helping to create. He had spent seventeen years being educated by Jesuits in France and spoke five languages fluently, and back home he still could not legally cast a ballot.

So he became the only Catholic to sign the Declaration of Independence, putting his name on a revolution that he hoped would build a country with room for men like him. That was its own enormous bet, made by a man the existing system had already shut out.

Then he simply outlived everyone.

Thomas Jefferson and John Adams both died on the same astonishing day, July 4, 1826, exactly fifty years after the Declaration. When they were gone, Charles Carroll of Carrollton was the last living signer left on earth. For six more years he was the final human link to that room in Philadelphia, the last hand that had signed, a living relic of the founding that ordinary Americans traveled to see and shake.

He finally died in November 1832 at the age of ninety-five, fifty-six years after he wrote his address on a treason document and dared the empire to come find him.

The richest man in America. The only Catholic. The last one standing. He had more to lose than any of them, every legal reason to stay quiet, and he signed his full address anyway.

We remember the names we were handed in school. We forget the man who made sure his couldn't be mistaken for anyone else's.

Which Founding Father do you think history shortchanged the most?

[Matt Downen @amdownen]

Just had to fill out a prior authorization for losartan. What are we doing folks?

[Matt Downen @amdownen]

@spencerpratt @libsoftiktok

[Wholesome Side of 𝕏 @itsme_urstruly]

I know every generation has their class struggles, but let me tell you about the summer of 1990 when Supersoakers hit the market and only a few kids could afford them and the rest of us were hunted for sport.

[Matt Downen @amdownen]

@CoffeeBlackMD Congrats!

[Matt Downen @amdownen]

New dadstone, girl doesn’t need me to push her on the swing to get started anymore. 😢

[Jason Howerton @jason_howerton]

Here’s the thing people don’t understand: Your time and focus is finite. Every moment you spend not building something meaningful is more of less wasted.

Now, if you do not have a desire for an extraordinary life, you can maximize for “me time” and go golfing and play video games for hours a week. I’m not judging. That’s the path a lot of men take.

But if you want to be wealthy and have a happy, well-adjusted family, you’re going to have to lock in and protect your time by building the things that matter most to you.

Priorities properly ranked:

1. Relationship with God
2. Family
3. Building (business/career)

(Side bar: building a family is even more challenging and time exhaustive as building a successful company. You’re not a babysitter, you’re the spiritual and literal head of the family).

If you can fit other stuff in regularly, great. But as soon as it starts taking precedent over the important things, you’re cooked.

When you get older & kids are out of the house, this equation changes. You can take the trips and play golf on Monday.

But if you are in the season of leading a family, do not fall for this psyop that your time and effort should be spent pleasing yourself. Build.

[Matt Downen @amdownen]

@realdocspeaks @molsjames Yikes

[Matt Downen @amdownen]

@tedfrank @OrinKerr @Eric_Reynoldsmd

[Paleoncologist @JOSEPH45075332]

Congressman Murphy,

Thank you for sharing my post.

As a fellow physician, I was disappointed by your comments on physicians leaving practice early.

While dedication to the field is essential, blaming those leaving ignores deeper problems.

The practice of medicine has changed dramatically since we graduated—especially post-HITECH and ACA. The recent Permanente Journal study I referenced (May 2026) shows physicians are now exiting clinical practice at an average age of 48 (down from 57 in 2011). Roughly 20% leave within the first five years, with similar losses every five years thereafter. These are outstanding students who endured grueling training; they're not "unmotivated." The field simply isn't what they signed up for.

Data from the Annals of Internal Medicine (link below) also show the annual rate of physicians leaving practice has roughly doubled in recent years, from about 1.6% to 3.1%. Out of a million physicians, that is 30,000 - the equivalent of approximately 200 graduating med school classes lost, every single year.

Additional surveys indicate that a substantial portion plan significant reductions in work or early exit in the coming years. What a tremendous loss of talent and investment.

We can do better. The issues are well known and not the doctors. We’ve lost autonomy - most doctors are now employees with little influence over their practice. We battle insurance prior authorizations, click through EMRs late into the night, and pay for unproven maintenance of certification amid stagnant RVUs.

No one excelled in premed and med school to spend their career fighting the system and archaic EMRs instead of treating patients.

I know your record includes strong support for physicians—Medicare reimbursement protections, reducing regulatory burdens, and highlighting burnout. I urge you to double down on fixing these systemic issues rather than questioning the commitment of those voting with their feet.

And physicians who quit tell only half the story. Many more surveys show that as many as a third of physicians plan to retire in the coming years.

Physicians like you are uniquely positioned to lead.
Don't blame the victims. Let's fix the system.

Respectfully

https://t.co/8vMWQaQpfo 0pubmed

https://t.co/dI6Z0Y3CCV

https://t.co/Gy9lD5kUKr

https://t.co/AP1h3u1Ovg

https://t.co/KkiSqB5fLM

https://t.co/8UOcK5lpdO

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

It’s a million small annoyances compounded every day that drives doctors to quit.

Being condescended to by administrators when we ask for simple fixes to basic problems.

“No we won’t replace the broken keyboards in clinic.”
“Yes you have to pay for your own translator.”
“No you can’t change what note template you use.”
“Yes we will refer to you as a provider.”

Then when you try to get actual patient care done, it’s even more roadblocks. Can’t get a bed to transfer in a patient. Can’t get OR time. Can’t get working equipment.

At some point you become jaded and bitter. You see what your expertise can get in the non-clinical marketplace: often the same money for 10% of the hassle. So you leave and never look back. And there’s one less doctor out there practicing medicine.

[Michael Foster @thisisfoster]

Here’s a simple way to get unstuck when you’re worried, overwhelmed, or overthinking a decision.

Ask yourself one question:

What kind of thing am I dealing with?

Most issues fall into one of three categories.

1. Settled Things

These are things that have already been decided.

Your birth family.
Your nation of origin.
Your height.
Your past decisions.
Your upbringing.
Things you did.
Things done to you.

Some of these things were decided by your own past actions. Others were decided by God’s providence. As Paul says in Acts 17:26, God determined our appointed times and the boundaries of our dwelling place.

You can’t go back and change these things.

So the question is not, “How do I undo this?”

The question is, “Does this have any bearing on what I should do now?”

If not, leave it alone. Don’t spend your life fighting settled things.

2. Action Things
These are things you have some real control over.

Your diet.
Your exercise.
Your spending.
Your work ethic.
Your attitude.
Your friendships.
Your theological knowledge.
Your presentability.
Your habits.
Your skills.

These are your controllables.

You may not control everything about your health, finances, relationships, or future. But you usually control more than you think.

So if the issue falls here, don’t overthink it.

Take direct action.

Start small if you have to. Make the call. Go on the walk. Open the Bible. Apologize. Apply for the job. Pay the bill. Clean the room. Do the next faithful thing.

3. Prayer Things

These are things outside your direct control, but not outside God’s control.

The economy.
The weather.
The housing market.
The availability of a suitable spouse.
Other people’s choices.
Timing.
Open doors.
Closed doors.

You can’t force these things. You can’t grab the steering wheel of providence.

But God can act.

So you take indirect action through prayer. You ask. You wait. You prepare. You remain faithful. You do what you can do and trust God with what only He can do.

So ask yourself:

Is this settled?
Then accept it and learn from it.

Is this actionable?
Then do something.

Is this outside my control?
Then pray and trust God.

This is a simple framework, and yes, it’s a little reductionistic. But that’s the point. The goal is not to explain every complexity of life. The goal is to get you unstuck.

Most people waste too much energy trying to change the past, control what belongs to God, or pray about things they simply need to obey.

So categorize the issue.

Then act accordingly.

Accept what is settled.
Act on what is yours.
Pray over what belongs to God.

[Real Doc Speaks @realdocspeaks]

https://t.co/LYH3ew3ObA Another day, another anti-physician article from the Wall Street Journal.

I don't see any mention in the article that 60% of NPs graduate from online schools with no oversight of the clinical hours.

Medical Students receive 5,000 supervised and standardized clinical hours in Medical School, aren't allowed to practice, and must complete a residency.

The author does not list her healthcare credentials in her bio, which instead highlights stories such as the quest to build a better rice cooker.

The WSJ should be writing about how self-funded employers should use transparent TPAs and DPC physicians to cut out the majority of the healthcare middlemen.

Now that @MartyMakary and @VPrasadMDMPH are out at the FDA, the WSJ had to find another anti physician angle to publish! @KatyTalento @HCLibertyLab @noahkaufmanmd @HeathVeuleman @AtlasMD @mcuban @DutchRojas @mass_marion @DrDiGiorgio @crappiedoc

[Shane Pruitt @shane_pruitt78]

Your job is to plant the good seed of the Gospel, not to change their heart. That is God’s job.

Don't get your job and God's job mixed up.

[Bryan Johnson @bryan_johnson]

This is it.
Everything learned spending millions on longevity.

From: Your Immortal Unc and Auntie.
To: Our Immortal nieces and nephews.

0. Sleep is the world's most powerful drug.
1. Be in your bed for 8 hours
2. Same bedtime every night, any time before midnight
3. Don’t eat right before bed
4. Calm foods for dinner
5. No screens 1 hour before bed
6. Avoid added sugar (be aware it’s in everything)
7. Avoid all things in an American convenience store
8. Avoid fried foods
9. Shoes off at the door
10. Eat whole foods, particularly veggies fruits nuts legumes berries
11. Walk a little after meals or air squats
12. Get your heart rate high routinely
13. Lift heavy things
14. Stretch daily
15. Water pik, floss, brush, tongue scrape, morning and night
16. Make an effort to drink water
17. Get sunlight when you wake up (UV is low)
18. Protect skin in midday sun
19. Stand up straight
20. See at least one friend once a week
21. Avoid plastic where you can (in all things)
22. Circulate air in rooms
23. When stressed, breathe, learn to calm your body
24. Go to the dentist
25. Avoid sitting for long times
26. Protect your hearing, the world is too loud
27. Alcohol is bad for you
28. Finish coffee before noon
29. Avoid bright lights after sunset
30. If obese, look into a GLP
31. Sleep in a cold room
32. Texting while driving is dangerous
33. Turn off all notifications
34. Limit social media use
35. Don’t smoke anything
36. If you struggle to sleep, read a physical book before bed
37. 1 hour before bed have a calm wind down routine: bath, read, light walk, listen to music
38. The body is a clock and loves routine. Have a daily morning and evening schedule.
39. Avoid long distance travel where you can
40. Baby steps first: incorporate new things slowly
41. Do less… most things don’t work.

Bonus points if you get your blood checked.

Start here, it will change your life.

[Matt Downen @amdownen]

@elonmusk Kansas!

[Matt Downen @amdownen]

@Eric_Reynoldsmd @DocBottsNY

[Matt Downen @amdownen]

@ChrisMartzWX Too level headed for X