I spent years inside the healthcare system.

I sat in the meetings.
I spoke with health system CEOs.
I spoke with hundreds of healthcare investors.
I watched the incentives operate behind closed doors.

And I've come to a difficult conclusion:

The fee-for-service healthcare system is barreling recklessly toward an inevitable endpoint.

If the system gets its way, healthcare's future will look something like this:

A handful of physicians supervising massive fleets of AI health agents and minimally trained "providers" credentialed through a weekend of online coursework.

You may laugh and call that hyperbole.

I used to think so too.

Then I heard healthcare executives and investors openly describe versions of this future themselves.

Not privately whispered concerns.
Strategic goals.

The system is systematically burning the doctor-patient relationship to the ground — and both physicians and patients are largely taking it lying down.

Before I go further, let me be concrete for a moment, because this argument deserves more than moral indignation.

The United States spends more on healthcare per capita than any other high-income country — nearly double what Germany spends, almost triple what the United Kingdom spends. And yet on virtually every meaningful outcome metric — life expectancy, maternal mortality, chronic disease burden — we rank near the bottom of our peer group.

Researchers at the University of Chicago calculated that delivering guideline-compliant primary care for an average patient panel would require 26.7 hours per day. There are only 24 hours in a day. That is the structural math of the system we have built.

Primary care physicians now spend a median of 36.2 minutes on the EHR per patient visit — and that doesn't include the 6.2 additional minutes of after-hours documentation happening after 5:30 PM and on weekends. Researchers have taken to calling this "pajama time." Nearly half of family physicians report burnout. Those who do are significantly more likely to leave practice within the year.

These are not the metrics of a system optimizing for care.

They are the metrics of a system optimizing for margin.

The money is being extracted. The care is being compressed. And the relationship that was supposed to be the product — the physician and the patient, in a room, with time and trust — has been reduced to a billing encounter.

Worse, physicians are being psychologically manipulated into helping build the very machinery designed to replace them.

Here is how it works.

Physicians are told that documenting everything in the EHR is patient safety. So they document. Obsessively. For hours after their last appointment. At home, after dinner, while their families wait.

They are told that training AI-assisted documentation tools makes care more efficient. So they train them. Feeding their own clinical reasoning into systems their institutions own and their employers monetize.

They are told that participating in value-based care models, algorithmic productivity dashboards, and AI-driven clinical decision support is modernization. Progress. The future of medicine.

So they participate.

And with each act of dutiful compliance, physicians contribute another layer of their expertise — their pattern recognition, their differential reasoning, their years of hard-won clinical judgment — to the dataset that corporate healthcare hopes will ultimately devalue their labor.

I want to be clear: I am not anti-technology. AI will do genuinely remarkable things in medicine. It already is. The issue is not the tool. The issue is who controls the tool, and in whose interest it is deployed. Right now, the honest answer to both questions is: not physicians, and not patients.

At some point, we need to stop confusing compliance with virtue.

It is watching your neighbors get robbed in broad daylight and convincing yourself your silence is somehow moral because the thieves promised efficiency.

I know this because I had to reckon with it myself.

I spent years inside traditional healthcare telling myself my intentions were enough — that proximity to a broken system was the same as fixing it. That working within the machinery, however compromised, was still better than walking away. Eventually, I had to admit that wasn't integrity. It was comfort dressed up as virtue.

American households have never paid more for healthcare while receiving a more diluted, fragmented, and shallow product.

The system increasingly appears designed to serve everyone except the patient and physician.

There is a word for a structure that extracts maximum value from both the producer and the consumer while delivering minimum output to either.

We usually don't use that word when we're talking about healthcare.
Maybe we should start.

Not because I stopped caring about patients.

Because I care too much to continue participating in a model that I believe is actively destroying the foundation of medicine itself.

The only way to safeguard the physician-patient relationship is to strip healthcare down to the studs and rebuild it from first principles.

Not endless layers of administrators, utilization managers, private equity firms, PBMs, insurers, consultants, and algorithmic productivity dashboards that distort care at every step.

I know what the rebuilt version feels like — because I practice inside it now.

It is not complicated.
It is just medicine.
The kind most of us went to medical school to practice.

The technology isn't the enemy. The middlemen who captured it are.

And the path forward is not to fight the system from inside it — it is to build something outside it that is so clearly superior, in care quality and in human dignity, that the comparison eventually becomes impossible to ignore.

Healthcare will not be fixed by adding more layers.

It will only improve when enough physicians and patients decide to opt out of the system entirely — and build something worthy of the relationship that medicine, at its best, has always been.

I understand these views may sound harsh. Maybe even cold.

But I can no longer participate in a system that seems increasingly committed to serving every interest except the people it was originally built for.

REFERENCES

1. Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the time needed to provide adult primary care. J Gen Intern Med. 2023;38(1):147–155. doi:10.1007/s11606-022-07707-x

2. Rotenstein LS, Holmgren AJ, Horn DM, Lipsitz S, Phillips R, Gitomer R, Bates DW. System-level factors and time spent on electronic health records by primary care physicians. JAMA Netw Open. 2023;6(11):e2344713. doi:10.1001/jamanetworkopen. 2023.44713

3. Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. A time-motion study of primary care physicians' work in the electronic health record era. Fam Med. 2018;50(2):91–99. doi:10.22454/FamMed.2018.184803

4. Khullar D, Bond A, et al. Turnover and burnout among family physicians. JAMA Intern Med. 2026. doi:10.1001/jamainternmed.2026.0271