Doctors and Patients United to Take Back Healthcare

Peter Kowey, MD - Author of Failure to Treat coming Fall 2025

As a veteran cardiologist, I have had the opportunity to observe firsthand the inexorable

decline of our medical professions. There are many reasons for our misfortune, the most

important of which is administrative overreach. The growth in the number of hospital

administrators in America, orders of magnitude faster than the number of health care providers (HCPs), has led to a critical, if not downright absurd, misdirection of health care resources, and a consequent decline in the quality of patient care. The media has coined a term “administrative harm,” led by David Brooks in his Death By A Thousand Paper Cuts column inJanuary of 2024 (ref). We who work in medicine know about the damage done by

administrators, caused in large part by their lack of knowledge of the core business. We know it started long ago and that it is nowhere near its zenith.

Non-physicians have taken over the leadership of every facet of healthcare, including

outpatient practices, surgical centers, nursing homes, home healthcare agencies, the

pharmaceutical industry and insurance companies. The reasons are clear. First, medicine has

become a big business, with nearly five trillion dollars spent on healthcare in the United States in 2022. Whoever imagined that a money machine of that size wouldn’t attract corporate raiders and business types from every direction, especially private equity? And their timing couldn’t have been better. They proliferated just as Health Care Providers (HCPs) realized that they simply didn’t have the time or the expertise to manage what was quickly evolving into an administrative quagmire.

Once they insinuated themselves, the suits propagated quickly. They were able to use

the large profits that healthcare generated to reward themselves with high salaries, large staff

and plush offices. Presidents hired vice-presidents who hired assistant and associate vice-

presidents who hired an army of assistants while expanding and growing the number of

departments each would oversee. CEOs packed boards with financial friends who were only too happy to rubber stamp any scheme that would make more money for the institution, patient care be damned. Degree programs in health care administration attracted thousands of applicants who had no trouble finding make-work jobs.

At the same time, HCPs have been on the defensive. Physicians were once the most

respected professionals. Now Americans place us no better than fourth on the list behind

engineers, pharmacists and veterinarians. There are many reasons for this decline. Consider

the diabolical fee-for-service payment system, the tyranny of health insurance companies, the gluttony of drug manufacturers, the failure of regulatory oversight, the imposition of needless certifications, the medical education fiasco, the fragmentation and depersonalization of care, the rise of technocracy, the reports of research cheating, the myth of diversity and inclusion, the incursion of electronic medicine, and perhaps most destructive, the incursion of private equity.

HCPs are under siege. Physicians and other healthcare providers work with the

Damocles Sword of malpractice poised over their neck. They have taken the blame for things

that happen to patients that are caused by any flaw in the system in which they work, such as

insurance company denial for important tests and treatments. Their response is to practice

defensive medicine, ordering billions of dollars of tests that serve no purpose other than “ass

covering.” More than fifty percent of healthcare professional time is spent at a computer, and

not much of that effort has any direct patient benefit. Most of what is dumped into a physician electronic medical record inbox relates to coding, billing and documentation. Medical journals abound with editorials about “physician burnout” that no HCP has time to read. Nonetheless, burnout is real and has led to resignations, early retirement, and a scramble to find jobs that don’t include patient care.

For now, HCPs will do what they have always done: put the patient first because that’s

how they were trained, and ironically, why they have been so easy to exploit. Many will revert

to being shift workers and punch the clock as ordered by their “bosses.” They will defer to their professional organizations to represent them and watch as nothing changes. Witness the blind eye turned to requests to suspend a recent deep cut in Medicare payments to HCPs and hospitals, despite lobbying by several professional societies. Political leaders will continue to do nothing but skirt the issue as they did in the 2024 elections. Trump’s “concepts” of a healthcare plan was a miserable cop-out while Harris did nothing but demonstrate her lack of understanding of the magnitude of the crisis. Appointing sycophants with no knowledge of medicine to leadership positions in pivotal Federal agencies will make a bad situation far worse.

Alternatively, we can choose to fight, to take off the gloves and apply pressure on our

legislators and regulators to give us our profession back. We can relentlessly push back until

control is fully restored to the people who truly understand the core business: HCPs with a

wealth of patient care experience who are willing to devote a significant percentage of their

time to administrative duties for which they are properly compensated.

If we choose to fight, we will never succeed alone. Instead of quietly “soldiering on,” we

must engage with our most valuable allies, our patients. We must help them understand why

the quality of their medical care, for years to come, is in the balance. We must communicate

with them at every opportunity, in exam room conversations, in seminars, and in writings, as I plan to do, with my soon-to-be-published collection of healthcare disaster stories*. They need to know that HCPs, people who know the most about health care, are being exploited and marginalized by bean counters. We must arm them with unbiased and reliable information so we can cogently argue for the changes that our professions so desperately need. Together, we can advocate for caps on salaries for administrators of non-profit organizations, tight regulation of private equity, HCP representation on hospital boards, unionization of house officers and employed physicians, incorporation of business training into medical school curricula, HCP input into hospital certification and training standards, and active participation in pricing decisions.

And if those band-aids don’t close the gaping wound, pressuring legislators to pursue the long overdue overhaul of how our government pays for healthcare for its citizens.

HCPs can’t continue to advocate without help. We must join forces with our patients, to

uphold our oath to provide them, all of them, with the very best medical care.

Peter R. Kowey, MD, FACC, FHRS, FAHA, FACP, FCCP, FCCP

William Wikoff Smith Chair, Cardiovascular Research

Professor of Medicine and Clinical Pharmacology

Bryn Mawr, PA

* Failure to Treat: Tales from a Broken Healthcare System

Medical Misadventures and How to Avoid Them

Heliotrope, September, 2025