In the aftermath of the COVID-19 pandemic, trust in the U.S. health care system has plummeted. A recent survey found that distrust is particularly high among women, individuals aged 25 to 64, Black Americans, rural residents, and those with lower income and educational levels. This erosion of trust has real consequences — those who trust the system are significantly more likely to get vaccinated and seek preventive care, directly impacting public health outcomes.
To restore trust, we must move beyond diagnosing the problem and focus on actionable solutions that empower both patients and clinicians. As a board-certified, self-employed neurohospitalist and clinical neurophysiologist, I have navigated the health care system from multiple angles, incorporating a hybrid model of practice that includes telemedicine for inpatient services in remote hospitals, remote interpretation of EEGs and intraoperative monitoring for surgical patients, and medico-legal evaluations for TBI patients. I also teach residents and fellows at a Los Angeles hospital serving predominantly underserved populations. Finally, my locum tenens assignments allow me to delve into the challenges that rural hospitals and practices face across the country.
Through this experience, I have witnessed firsthand the disparities in health care access, particularly for uninsured and underinsured patients who often wait months for an outpatient neurology appointment. These delays frequently result in avoidable complications and hospital readmissions, a stark contrast to the seamless access enjoyed by those with robust insurance coverage. Additionally, my work in telemedicine has revealed how technology can bridge some of these gaps, yet systemic underfunding and policy barriers continue to limit its widespread implementation. Below are key areas where we can take meaningful steps toward rebuilding trust.
Investing in Public and Safety Net Institutions
Public health care institutions and federally qualified health centers serve as vital safety nets, yet they remain underfunded and understaffed. Governments must ensure that funding translates into patient care rather than administrative overhead or excessive executive compensation. A well-supported safety net infrastructure can improve health care access for vulnerable populations and reduce disparities.
Empowering Health Care Workers
The current corporatized health care model often prioritizes profits over care, leaving physicians overburdened and under-compensated. Physicians need fair wages, reasonable workloads, and autonomy in their practice environments. Collective action through unions and independent, physician-led practices can provide a counterbalance to exploitative corporate models.
As a self-employed physician, I have firsthand experience in creating a practice where quality of care takes precedence over volume-driven metrics. Unlike many employed physicians bound by non-compete clauses and rigid RVU-based productivity models, I have the freedom to spend adequate time with patients, focus on preventive care, and cultivate trust with patients and other specialists. Expanding opportunities for independent practice and small-group physician-led models can serve as a blueprint for a more patient-centered system.
Shifting from Sick Care to Preventive Medicine
The U.S. health care system remains largely reactive, focusing on late-stage interventions rather than proactive prevention. Physicians need more time to counsel patients on lifestyle changes and disease prevention. In my own practice, I emphasize patient education, dedicating time to conversations about nutrition, exercise, and mental health — key factors that determine long-term health outcomes. Encouraging this model on a broader scale requires systemic reimbursement changes that prioritize prevention over procedures.
Increasing Transparency and Equity
Mistrust in health care is often fueled by opaque financial and administrative structures. Patients frequently encounter surprise billing, conflicts of interest among insurers, and complex pharmaceutical pricing models. Transparency in hospital pricing, equitable reimbursement policies, and regulatory oversight of pharmaceutical companies and insurance providers can help restore credibility.
Strengthening Primary Care Access
A strong primary care system improves health outcomes and reduces ER visits, yet many Americans struggle to access basic care. Increasing reimbursement rates for primary care visits and reducing administrative burdens can help physicians focus on patient relationships rather than paperwork. In rural and underserved areas, expanding primary care residency programs and incentivizing long-term practice commitments can bridge gaps in care.
When it comes to improving the health care system, physicians must actively participate in advocating for reforms. Supporting policies that prioritize patient welfare over corporate interests, challenging restrictive employment contracts, and pushing for equitable funding models are all crucial steps.
In my own journey, self-employment has allowed me to sidestep many of the constraints that hinder quality patient care in larger systems. However, independent practice should not be the only pathway to ethical, patient-centered medicine. Systemic reforms must ensure that all physicians, regardless of employment model, can practice in environments that value trust, transparency, and preventive care.
Rebuilding trust in health care requires a collective effort from policymakers, institutions, and clinicians. By addressing systemic inequities, prioritizing patient relationships, and empowering physicians, we can create a system that serves everyone equitably. Trust is not a given — it must be earned through action. If we commit to these changes, we can restore faith in a system that should prioritize care and physician wellness above all else.
Dr. Cabrero is a neurohospitalist and clinical neurophysiologist who practices independently and is self-employed. He runs his own S corp as a solo practitioner.
Illustration by Diana Connolly
