Samples on Hand

From “Physicians Get Addicted Too,” an Atlantic story about opiates and addiction in West Virginia.

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”


Some of you may have noticed that things have been a little bit quieter than usual around here. While I’m still writing (and have plenty more in store), my attention was divided recently on a new passion project my wife and I just launched.

It’s called Kosher(ish), and it’s basically the first part of a new Jewish lifestyle brand and blog. Because why not? Also, because there aren’t enough fun things for us to dress our son in for the holidays, and Hanukkah isn’t the only one that deserves a t-shirt or some paper goods!

(We only have a few items for this 2018/5779 Hanukkah season, but if you’re in the market, time is running out to receive your order for the holiday.)

It’s not easy to balance a dinosaur-and-train-loving three-year-old, this sprawling website, a half-finished book, a new job, and a new venture! In the meantime, I have some exciting news about my student loans books coming soon and a bunch of great posts to close out the year.

Most of all, thanks as always for reading.

How to start a website

Despite the widely publicized demise of the blog, personal websites continue to exist, and writers like myself continue to publish them. I’ve also received a steady stream of requests for background information and approaches to maintaining a “successful” long-running website over the past decade, so here are my thoughts. What follows is most definitely my (long) personal opinion and is not necessarily prescriptive:


Motivation and Content

While most people have questions about the mechanics of choosing a platform and maintaining a website, those are ultimately the easier problems to solve. The content is ultimately the critical challenge.

You have to enjoy the writing, and you need to either pick a niche you really like or give yourself the flexibility to adapt. If your goal is traffic and money, you’ve probably already lost.

The vast majority of new personal websites (i.e. blogs) are abandoned within months.

There are a lot of reasons for the high blog mortality rate, but one of the ones I think people don’t anticipate is pigeonholing yourself into a niche that is overly narrow or unsustainable. When you choose or (not real sites, I think?), what do you do when you’re tired of posting about steel cut oats or graduate? How can your site grow with your interests?

Of course, the flip side is that you also need to find your voice. Just rewriting things other people have already said won’t keep you interested for long and probably won’t bring a lot of readers either.


Platform and Hosting

It’s worth discussing both what software you’ll use for your site and what hosting you’ll need vs. purchase at the same time because neither choice lives in a vacuum. The most important question that determines what suits your needs is the level of control you want. There are good fully-hosted turnkey solutions that allow you to create a website with minimal fuss and no technical skill and just get to writing. And then there are DIY options that require a bit more effort up front but leave you with the power to change every detail of your site and take it to new directions in the future.

You don’t need to learn to code to design and run a website anymore, no matter which avenue or platform you choose.

Several years ago, I would have recommended that anyone serious about running a website use and set up their own hosting. WordPress is a CMS (content management system) that can basically do anything and runs almost every site on the internet. It’s great, it’s easy to use, and it’s free.

The turnkey options were too inflexible to create what I would have considered a “good” site. You could always tell who was using an out-of-the-box platform or design with the handful of near-universal themes, the laziness of the free URL, the bylines that would say “posted by Admin” on every single post (of a single author blog). It was depressing. With everyone posting more and more on Facebook and Twitter, no wonder people thought blogging was dead.

Over the past few years, advances among web platforms coupled with a general trend toward clean, minimalist design have really leveled the field.


For web hosting, there are plenty of options. I have always used Dreamhost, which has one-click WordPress installation with automatic upgrades and a simple backend. You can purchase and manage new URLs and host multiple sites on the same cheap plan. I’ve paid $7 a month to host multiple sites with unlimited bandwidth and storage for over a decade and serviced millions of hits with basically 100% site uptime.

If you sign up here for a year of the shared unlimited hosting at $7.95, you get $50 off. Unlimited means unlimited websites, storage, traffic, email, etc. You’ll also get a free domain registration thrown. You’ll also have an optional free SSL certificate (that you’ll need if you ever want to sell anything). It’s an awesome deal that I took advantage of over a decade ago, and I’ve never looked back.

Bluehost is another common WordPress host. You’ll hear about them on basically every “how to start a website post” because they are a solid webhost that also happens to offer a really popular affiliate program. While their program doesn’t include a reader discount, their packages are a couple dollars cheaper than Dreamhost (except they don’t always include the increasingly important SSL certificate unless you pay more, depends on the shifting specials). Both companies offer various tiers of server upgrades if you find your site grows and you need more power.

If you don’t use the platform, you basically won’t need to pay for separate hosting, because the other reasonable options are full-service and the hosting comes included. One easy solution is to use (either for basically free or upgraded to a better plan as you need it), which is the commercial arm of the free WordPress CMS software: less control but more support. Personally, if I wasn’t into DIY, I’d pick Squarespace, which is a reasonably priced CMS with an excellent interface and nice clean themes. If you want to start a low-fuss online store, then go for Shopify.

Whatever you choose, just pay enough so that you don’t have lame corporate branding on it (like you often see with Wix sites). If you don’t take yourself seriously, why should anyone else?


Buy a real URL, even if you haven’t started yet or are not sure if blogging is for you. It costs about ten bucks a year. If that seems too steep, then you aren’t taking the idea of writing seriously. Please just buy a real URL, preferably .com (but .net or .org or probably .co is fine).

Every paid hosting option, whether WordPress via Dreamhost or Bluehost, Squarespace, etc will throw in a new domain registration if you sign up for a hosting package. Two birds with one stone, no excuses.

Part of running a successful site is being searchable and navigable. Your URL should be easy and memorable, and every post and page you write should be available at the same spot FOREVER. You aren’t going to build up link-juice from search engines by having crufty gross super-long URLs that you’ll need to completely change in a few months or years when you finally get serious. I know it’s not free, but again, if taking your project seriously isn’t worth forgoing a coffee or two a month, then why are you even contemplating it.


More Thoughts on Content

Far be it for me to give advice on what you (or anyone else) should write about. I write a poorly monetized personal website that meanders around a variety of topics including medicine, technology, writing, and personal finance, and it’s changed a fair bit over the past decade.

That far-ranging scope and the permission I’ve given myself to convert the questions and quests of my journey in medicine (and, to a lesser extent, writing and indie publishing) are what have kept me coming back to write for an audience of strangers here year after year.

On the flip side, a narrow scope may get you a more laser-targeted audience. If you want to make money, a narrow niche is much easier to sell to advertisers, pivot into a monetizable newsletter, or to target with upsells like the gazillions of overpriced e-courses you’ve seen cropping up online.

If it’s part of a business for which you might be willing to pay for traffic, a well-carved niche will also be easier to target for ads to attract the right kind of visitor and get a return on those sketchy sponsored Facebook posts.

But a narrow scope is also the fastest way to find yourself spinning the same handful of ideas into repetitive permutations and fluffy listicles. This–along with depression about having no traffic–is why so many people abandon their blogs. Most sites never make it to their one year anniversary.

I was happy to write about medical school stuff for a number of years. And I still do so on occasion when I think I have something valuable to add, but as I get more and more removed from that time of my life, it would be hard to imagine continuing to write here if the site was something that had “med school” somewhere in the title or where I felt constrained to stay on topic. However, starting from scratch with a new site or totally rebranding instead of just iterating and evolving would also be lame.

Now that’s in part the difference between starting a personal blog and a true business. If the primary goal is to make money, then sure, you can try to build up an audience and credibility while you have the energy and then later on try to sustain or grow the enterprise by bringing in outside writers, publishing lots of guest posts, etc. Just be aware that most people with this goal fail, and again–I can’t stress this enough–you should want to write.

Frequency & Activity

Many people try to drive traffic by publishing frequently. It is indeed true that search engines like to see a well-maintained, active site. And, it’s also true that if you post everything you publish to social media, you will likely get a greater number of clicks, and those clicks may even be a critical driver of the traffic you do see.

But that pressure results in a lot of people writing a lot of things that even they don’t care about. I don’t personally want to write the same thing more than once or twice, and it would be a debilitating killjoy to feel compelled to churn out trite, Madlib-like combinatorial garbage, throwing it against the wall week in and week out and hoping it sticks.

In my experience, organic search traffic comes from “high-quality” writing, especially that which gets linked to from reputable websites. I’ve never attempted to see if listicles perform well in the medical education niche, and frankly, I’m happy to remain ignorant.

Topical vs. Evergreen

Most personal sites probably function best at the outset when a significant portion of the posts are evergreen (meaning they stay relevant over the course of years). Current events and commentary are fun and keep things fresh, but the effort required to stay topical typically exceeds the staying power of the writing. When you have a lot of readers like or Daring Fireball, high-volume posting and topical commentary are basically the whole point. But for most people who are starting out writing part-time, your topical writing has no staying power and is mostly lost in the ether of the Internet. Make sure to take your time to write at least some really helpful stuff. Topical writing is more fun when you have an audience.

I believe that there is an inherent tension between writing for a periodical website like many blogs and writing to communicate ideas. Most informational sites should be generating content like a serialized novel, a larger overarching work split into manageable chunks and small sections. Instead, most sites meander through the same topics again and again like a pendulum swinging through the center. Where does a reader start? Why should a reader keep reading?

If you’ve ever read Lifehacker, you’ve seen this firsthand: the staff writers will often post the same hacks almost verbatim, apparently not even realizing that they’ve posted the same exact thing on multiple occasions before. Big successful websites do this and get away with it because even lame posts get clicks and clicks mean money.

You can do that too, of course, but if the goal is to build something you both enjoy doing and can be proud of, I’d argue for quality over quantity.

If you do end up writing an unruly tangle of posts about the same thing, then it becomes even more important to have strong site design/organization/navigation as well as to assemble your greatest hits into easy-to-find lists that help new readers really “get” what you have to offer. (Note: I’m 100% guilty of not following this advice.)


Good luck!

I think the internet is better off with more people owning their own content and maintaining their own presence online. Ceding our collective voices to Facebook has sped up the pace and volume of discussion, but it definitely has not made the world a better place.

I’m always happy to help.

An ad or two

For the past nearly 10 years of writing on this site, I have completely eschewed any form of display advertising. I’ve never wanted to jam the margins full of ugly banners that detract from the reading experience, and I definitely have no interest in being part of any of the usual industry practices of sneaky cookie-based endeavors, user tracking, gigantic data plan-choking scripts, or other things that make the internet worse.

My purposefully limited monetization has primarily been through Amazon affiliate links to things I write about anyway (see what I did there?). Over the years I’ve added relationships with student loan refinancing companies and a handful test-prep companies that I’m otherwise also interested in writing about, which is fine, but a big part of that has also always been to pass on discounts or bonuses to readers. This has always been a labor of love, which is why the vast majority of my writing doesn’t earn a cent and I keep giving away books for free.

This preamble is all to set up the news that the first ad I’ve ever run on the site is currently live. The reason you can’t see it is that it’s actually a time-limited sponsorship on a single popular (radiology) post. It’s from a company I respect with a relevant product and also includes a discount code. I’ve contemplated making the jump for a while now, and that’s the kind of ad I can get behind. If you’re a radiologist and happen to see it, cool. For the rest of you, it’s business as usual.

You may see eventually see an ad or two on a handful of posts or even maybe a single ad on the sidebar. Or you may not. I’d like to help justify (financially) the time it takes to maintain and grow this site, but it’s important to me to do so in a way that doesn’t jeopardize my editorial or the reader experience. That has and always comes first. There will never ever be any tracking of any kind, and I never collect any information from anyone ever.

If you’re a company–like the dozens that email every week asking me to publish your lame guest posts–and would like to reach a large unique audience of awesome medical students, residents, and other physicians, then get in touch.