I am training at a place many consider the pinnacle of American medicine. I am proud of the care we deliver, the colleagues I work alongside, and the patients who entrust us with their lives. Yet as our healthcare system commits itself to building a “destination medical center,” I have seen a series of unintended consequences that make me question whether this goal of becoming the world’s premier center for medical care is as unequivocally good as it first sounded.
On paper, destination medicine sounds noble. Patients travel from across the country and the world seeking expertise that may not exist elsewhere. That expertise is real, and it is a privilege to care for patients who come to us after exhausting every other option. But the infrastructure and priorities required to sustain destination medicine carry trade‑offs that are rarely acknowledged. Those trade‑offs are often borne by the local patients who live nearby, the trainees who learn here, and the employees who rely on this system every day.
I see the unintended consequences in small, ordinary moments. Patients arrive late for routine blood work, flustered and apologetic after circling parking lots, looking for ramps that are now closed, rerouted by yet another expansion project. One patient fainted during his blood draw, not because he was medically fragile, but because he was dehydrated, stressed, and delayed. Expansion designed to serve future patients can quietly harm the ones standing in front of us now. I care for individuals who have driven hours, sometimes across state lines, not because they are having a true emergency, but because they have learned that presenting to our ED is the fastest way to see a specialist or to get a second opinion. When outpatient access narrows, people adapt. Those workarounds overload emergency services, increase costs, and expose patients to risks that could have been avoided with timely, local care.
Insurance compounds the problem created by becoming a destination medical center. As our hospital expanded its national reach, it simultaneously narrowed the insurance plans it would accept, leaving many longstanding patients caught off guard. This year, our hospital announced it would no longer accept certain Medicare Advantage and Dual Special Needs Plans. In the aftermath, established patients with UnitedHealthcare or Humana coverage panicked, uncertain whether they could continue receiving care and fearful that delays were intentional rather than administrative. Physicians were left to absorb the resulting fear and anger. In practice, destination medicine serves those who can afford to get here and stay here. But many cannot.
At the same time, resources increasingly flow toward a subset of patients who are already privileged. High‑revenue care brings faster scheduling, direct lines to physicians, concierge services, and parallel tracks of access. Care becomes less about medical urgency and more about financial or social capital. In this way, destination medicine risks normalizing inequity, quietly reinforcing the very disparities medicine claims to confront.
The expansion to a destination medical center is also impacting the way I train. I am gaining deep exposure to rare and complex diseases and access to advanced diagnostics that far exceeds what is typical in most training environments. But I am getting less experience with the volume, constraints, and uncertainty of everyday medicine. For example, in many practice environments, expensive studies such as PET/CT scans would typically be deferred to the outpatient setting or pursued selectively. Here, they are not uncommon during inpatient stays. While this access can meaningfully accelerate diagnosis, it has also blunted my clinical instincts, lowered my tolerance for uncertainty, and decreased my threshold for intervention. My primary care patients with new concerns are often scheduled for 40‑minute appointments. This abundance is a privilege and an extraordinary opportunity that allows for careful counseling and thorough discussion. However, it is not always representative of the environments in which most PCPs ultimately practice. Over time, I have noticed that this abundance can change visit dynamics, with patients hoping to address multiple chronic issues at once. When this happens, it can become challenging to focus as deeply on the one or two most pressing concerns. Depth is sacrificed for breadth, and exposure to truly acute care is limited. Being a good doctor means learning not only how to practice when resources are abundant, but also how to reason carefully and deliberately when they are not. Training in a system with nearly unlimited resources and access to specialist advice within minutes can unintentionally narrow our preparation for the real‑world settings where time, access, and cost are constant pressures.
The implications of expanding into a global destination for medical care do not stop at the main campus. Local clinics and regional sites within the same healthcare system are downsized or closed to redirect resources toward national and international growth. Communities that once depended on nearby care lose access as gleaming new buildings rise miles away.
I believe I have seen what destination medicine can look like when it is done right. For example, while on rheumatology consults, I heard a small rural hospital in Nebraska call for help managing a patient with systemic lupus erythematosus complicated by interstitial lung disease. The patient could not easily travel. Instead, the expertise did. Over the phone, my rheumatology consultant reviewed the acquired labs and imaging and discussed management options, helping guide next steps in real time. The local team felt supported. The patient received better care without leaving her community. To me, this is destination medicine at its best: world‑class expertise that moves toward patients, rather than requiring patients to move toward it.
I do not question the lives saved or the breakthroughs and discoveries made in my place of training. Destination medicine is valuable, but its benefits come with real trade-offs, including decreased access and resources for local patients, care that increasingly prioritizes privilege rather than need, and training that does not always prepare us for the everyday limitations many physicians ultimately face.
The question remains: Who are we building for, and who is left to absorb the fallout? If becoming the world’s premier medical center requires concentrating care, capital, and resources while shifting the burden onto local patients, trainees, and regional communities, then destination medicine risks falling short of the excellence it promises.
Dr. Lauren Fang is an internal medicine resident in Rochester, Minnesota. She enjoys coffee shops, board games, and spending time outdoors. Dr. Fang is a 2025–2026 Doximity Op-Med Fellow.
Illustration by April Brust
