Surviving the Healthcare System

I’m writing this book out of the painful experience of surviving the healthcare system.

To put it mildly, I often tell people that healthcare systems care for their physicians and non-physician providers about as tenderly as a pimp treats their sex workers.

A healthcare labor attorney once told me that working in medicine is a lot like working for a mining company. At the time, I thought she meant the work was just hard—grueling, maybe. But I came to realize what she really meant: there are casualties, and the system expects them. It’s built to keep going, no matter how many bodies it loses. When someone breaks, burns out, or dies, the system doesn’t pause to ask why. It just replaces them and carries on.

In 1999, the Institute of Medicine published a report that should have been a turning point. It was titled To Err is Human: Building a Safer Health System, and it pulled back the curtain on something many of us working in medicine already knew in our bones: that medical errors are a leading cause of death in the United States. The IOM estimated that up to 98,000 people die every year in hospitals due to preventable mistakes. That’s more than the annual deaths from car accidents, breast cancer, or AIDS at the time.

What stood out to me wasn’t just the number—it was the cause. These weren’t rogue providers making careless mistakes. The report emphasized that most errors were not the fault of bad apples, but rather symptoms of broken systems: medication mix-ups, surgical mishaps, diagnostic failures, poor communication, flawed protocols. And yet, here we are, decades later, still burying patients—and providers—because those systems haven’t changed.

We talk all the time about the looming physician shortage, as if it's a mystery. But it’s not a mystery. It takes a minimum of eleven years to produce a single physician—four years of college, four of medical school, and at least three years of residency. That’s if everything goes smoothly. No delays. No detours. And yet, despite all of that investment—despite how hard it is to replace even one doctor—we still manage to lose over 300 physicians to suicide every single year. That’s the size of an entire medical school class. Gone. Every year. It's as if a plane full of doctors crashes annually, and nobody blinks. Because the truth is, the system doesn’t care.

Instead of fixing what’s broken, the industry keeps shifting the burden back onto individuals. First, it was stress management. Then it was a burnout. Now it’s resiliency. The buzzwords change, but the message stays the same: If you’re suffering, it’s your fault. You need to meditate more. Take yoga. Practice gratitude. Download the wellness app. Just don’t question the 16-hour days, the moral injury, the crushing administrative load, or the fact that you’re working in a system where you’re punished for caring too much or slowing down to do the right thing.

And this mindset doesn’t just affect physicians. Nurse practitioners, physician assistants, nurses, techs—we’re all being ground down by the same machine. We’re all disposable in a system that’s addicted to productivity metrics, cost-cutting, and denial. The only difference is that we don’t even have reliable data on how many non-physician providers we’re losing to this grind. I wish we did. Because if you’re in this system, you feel it. Whether you’re an MD, a PA, or an RN, the walls are closing in.

A big part of the problem is how healthcare is structured and funded in the U.S. There are two main funding streams: employer-sponsored insurance and government programs like Medicare and Medicaid. If you’re employed and lucky, you might get decent coverage through your job. Medicare is for those over 65 or with certain disabilities. Medicaid is for low-income individuals, jointly funded by state and federal governments.

And then there’s the growing population of uninsured and underinsured. These are the people who either have no coverage at all or technically have insurance but can’t afford to use it due to sky-high deductibles. So when they need care—a surgery, an ER visit—they're slammed with bills they’ll never be able to pay. That’s how a health crisis becomes a financial crisis. That’s what we call financial toxicity. And it’s why medical debt is the leading cause of bankruptcy in this country.

Meanwhile, market logic doesn’t work in healthcare the way people think it does. Medicare sets the benchmark for what it will pay for services, and private insurers usually follow. But those payments don’t go up—they go down. Every year. Imagine working in a profession where instead of getting a raise, your salary is cut—3% this year, another 3% the next. First, you trim the fat. Then you cut into muscle. Eventually, you’re slicing into bone.

That’s where we are. And it’s not just harming patients. It’s killing the people who are trying to care for them.

I want to be clear about something else, too. I’m writing this as a physician, and yes—that shapes how I see the system. But I don’t for a second believe the suffering is limited to doctors. Nurse practitioners and physician assistants are out here doing some of the heaviest lifting for a fraction of the pay and far too little respect—both from the system and sometimes even from their physician colleagues. That’s not right. And it’s not sustainable.

This book isn’t just a takedown of the system—it’s a witness statement. It’s what I’ve seen. What I’ve lived. And I’m still here, somehow, not because the system helped me heal—but because I refused to let it finish me off.