“Reducing health disparities in underserved communities, is the driving force behind my desire in becoming a physician assistant.”
Those were the opening words of my personal statement when I applied to PA school. They captured a passion I had carried for years and were reflected in both my employment and my community service.
Now that I am a practicing provider, I see the complexity of achieving that vision within a healthcare system that is, at its core, profit-driven. Increasing access and delivering quality care are often treated as secondary goals when profit margins are at stake. This reality has forced me to reconcile the difference between the ideals that drew me into medicine and the system I must work within.
Historically, the U.S. healthcare system has prioritized treatment over prevention. Preventive services are reimbursed at lower rates compared to surgical interventions, and providers are naturally incentivized to perform procedures with higher reimbursement. This creates the troubling possibility of unnecessary surgical recommendations—not always because of clinical need, but because of financial structures that reward them.
Exploring Solutions
Some suggest lowering reimbursements for surgeries and procedures. Yet this risks pushing providers to perform even more interventions to make up for financial loss. Others call for reestablishing a model of care that rewards prevention. While promising, this can unintentionally minimize patient accountability. Providers can only guide, educate, and treat—patients themselves must take responsibility for their health choices. When non-compliance undermines care, it leaves providers frustrated and disheartened.
Another lens is utilitarianism: allocating a predetermined level of resources to achieve “the greatest good for the greatest number.” But this approach assumes that resources are finite and inevitably excludes some patients. It also cannot account for sudden shifts in need, as we witnessed during the COVID-19 pandemic.
One area that seems especially promising is transparency. If costs were more standardized and visible across healthcare facilities, unnecessary procedures might be curbed, and spending could be better managed. Additionally, stronger regulation of private equity firms and corporate ownership of practices is necessary. The corporatization of medicine has accelerated the prioritization of profit, often at the expense of patients.
Reconciling Reality and Passion
I don’t claim to know the solution. The system is more intricate than any single reform. But what I do know is that I now understand how providers become burned out, disillusioned, and jaded. Even as a new provider, I feel the weight of constant pressure for productivity, metrics, and profit.
“Medicine is a business,” a friend told me recently. I knew this intellectually from my years in public health research, but living it is different from reading about it. I didn’t anticipate the internal ethical conflict, the exhaustion, or the dissonance between my passion for reducing disparities and the corporate system I practice within.
Sometimes I wonder if corporate medicine is not for me. Other times I wonder if I need to “get with the program” to survive professionally. At my core, though, my desire is unchanged: I want to practice medicine in a way that prioritizes compassion, equity, and patients themselves.
Even in a system that too often values profit over people, that commitment is what keeps me grounded.
Remember you are loved❤️