Not long ago, an insurance contract dispute arose at my institution. Suddenly, changes in coverage threatened the continuity of care for dozens of our patients. The clinic soon convened meetings to manage the fallout. We deliberated over who could be transferred, who needed bridge coverage, and which patients were most at risk of falling through the cracks. We were reduced to scrambling for stopgap solutions while the real systems-level decisions were made by people who had never met our patients. The process felt less like practicing medicine and more like practicing damage control. Insurance woes may be a familiar reality to veteran clinicians, but for my coresidents and me still early in training, it was a revelation, and not a welcome one.
This summer, I will enter my final year of psychiatry residency. As the job market looms and I witness the changing landscape of healthcare, I sense that my coresidents and I are facing a stark reality. While the mission that we have inherited as physicians feels as crucial as ever, the systems that allow us to offer care are under increasing strain. From private equity buyouts of physician practices, to the growing pressure to incorporate artificial intelligence into clinical decision-making, to increased time dedicated to insurance tasks, it is clear doctors are continuing to lose our independence to moneyed interests. As the caregivers working between patients and corporations, we often get stuck in the middle, managing the pernicious fallout. This financialization of healthcare does more than induce a sense of moral injury, it comes at a cost to the people we care for. The question is whether my generation of physicians and patients will accept that cost as inevitable, or work to do something about it.
Across healthcare, physicians seem to have developed a sense of fatigue following decades of erosion of the profession. However, it is important for physicians to acknowledge that our own actions are part of what got us into the current dilemma. Rather than unite and confront changing economic winds together, physicians have often responded individually, seeking personal financial security within the system. Some may argue that our hands have been forced, either by medical school debt or a need to start earning later in life, but the more that physicians have capitulated to corporate logic, accepting a wage in exchange for generating revenue, the closer we edge toward a world where the labor of doctoring itself becomes fully commoditized.
With our cooperation, the corporatizing and MBA-led forces within medicine have gradually recast doctors as revenue-generators instead of healers. The refrain I hear from fellow trainees is not necessarily that they are worried about compensation, but that the field now puts economic considerations like insurance negotiations and productivity metrics above the forms of meaning-making — connecting with patients, working out a diagnosis, alleviating suffering — that attracted us to medicine in the first place. Under the current model, it also feels like we have created two distinct classes of physicians who are emerging as “winners” and “losers”: those who perform high-margin, interventional procedures and those who provide preventive, longitudinal care, respectively. Without acknowledging this divergence in our current reimbursement system and transparently discussing ways to fix it, it is likely physicians will remain divided.
While we put off those difficult conversations, the broader market continues to view medicine as a source of untapped revenue. As investors grow hungrier for higher returns, both doctors and their patients have become vulnerable to ever greater market pressures. Mental health and maternity wards, for example, are being shut down as investors concentrate on high-reimbursement service lines. And private equity continues to wield its influence in healthcare, having poured $750 billion into the field over the past two decades. Ultimately, this will advantage the doctors who focus on complex procedures and the wealthier patients who have the means to choose their care. As Julian Tudor Hart, a physician who coined the inverse care law, described it, when healthcare becomes a commodity it distributes like champagne: abundantly for the wealthy, not at all for everyone else.
This financialization dynamic makes it difficult to imagine what an alternative might look like. In the current political climate, a single-payer system feels like a mirage. But the absence of one structural solution does not mean that physicians are bereft of options for pushing back. The answer, I believe, lies in building a formidable block of physician power from the ground up, one capable of challenging the status quo collectively from within the existing system.
This is not a radical idea. Labor organizing and collective action has historically been how workers in any industry reclaim power that has drifted to management and capital. Nurses have done it. Teachers have done it. More and more residency programs have unionized. Attending physicians, by contrast, have largely resisted, in part because of our professional identity that prizes individualism and in part because of complicated labor laws that restrict organizing. Many doctors fear that solidarity might also come at the cost of their remaining economic independence. Historically, doctors have often viewed themselves as “above” labor as well, and stigma around the word “union” or even “labor” likely persists. But the irony is that the system has already recast many of us as hired hands. Managed care is eroding physician and patient autonomy, quietly, incrementally, and with little physician or patient input. Staying fragmented does not protect us; rather, it simply makes us easier to manage.
What would collective action look like in practice? For starters, it could mean physicians educating each other and showing up en masse to state legislative hearings on insurance regulation. It could mean building a political movement alongside our patients to demand systemic change. And it could mean expanding early-career physician involvement in medical societies, steering advocacy work toward tackling these issues. In the arena of AI, governance decisions are already being made without physician input, and physicians should advocate for their place at the policy table.
Fundamentally, collective action could also mean hospital-employed physicians continue unionizing, as is already beginning to happen in several health systems across the country. Unionizing does not require unanimity on every policy question, but it does require enough solidarity to gather influence and earn a seat at the table where decisions are made. For doctors, unionizing may also be a way to stand up for our patients. The physicians at Allina Health who unionized in 2023 weren’t striking for salaries; they were striking for time, the very thing corporate productivity metrics seek to minimize. One can view their collective action less as a labor grievance and more as a defense of the patient-physician relationship. And Allina isn’t an outlier; one recent JAMA article surveying physician unionizing campaigns found that they were primarily motivated by noncompensation concerns like working conditions (85%), lack of voice in management (81%) and patient care concerns (54%), rather than financial compensation (4%).
A future solution will also require addressing the challenges that have kept attendings from unionizing: variations in employment status, antitrust issues, and income disparities between specialties. Some doctors may argue that unionization may lead to further regulatory constraints or obstruct patient-first ethics. However, we have likely reached a moment where doctors are already constrained by managed care rules, and in terms of patient-first ethics, one can equally argue that unionizing is necessary to stand up for patient rights. To establish this solidarity, I believe physicians need to first rebuild professional ties across specialties and to create durable spaces for discussing our collective challenges. The American Medical Association seeks to lobby for physician interests, but its mission too often appears to advocate for the status quo. Physicians for a National Health Program is one such organization trying to build increased awareness and dialogue around a more physician-and-patient-centered future.
The generation of physicians entering the workforce today is uniquely positioned to lead this shift. We are training at a time when, without proper stewardship or regulation, AI threatens to devalue our knowledge and flatten the nuances of clinical judgment. We have watched our country grow skeptical of medicine over the course of a pandemic. We have seen what happens when doctors stay silent while administrators make wide-reaching clinical decisions. We are not naive about the flawed system we are inheriting, but we are also not yet old enough to be resigned to a certain fate.
The cynicism I encounter in residency is real and understandable. But cynicism is not the same as powerlessness. If we hope to regain the public’s trust, we first have to show that we are in the fight for our country’s healthcare, not just our livelihood. By reclaiming our role as the primary stewards of care, not just at the bedside but in the policy conversations that shape what the bedside may look like, we have a genuine opportunity to redirect the future of American medicine. The horizon looks complicated from where I am standing. But MBAs are not coming to save us. The problem is our own to diagnose and treat.
Dr. Brendan Ross is a psychiatry resident in New York City. He enjoys reading, writing, and spending as much time as possible outside. Dr. Ross is a 2025–2026 Doximity Op-Med Fellow.
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