Perversity in Medicine - When Vocation and Corporatization Clash.
Myron Yaster MD
There was no way for me to summarize today’s article from the New England J of Medicine so I’m reproducing it in its entirety. It is a primary care physician’s perspective on corporatization of medicine and is a follow-on to yesterday’s post: How Should America Pay for Anesthesia? Send your thoughts and comments to me (myasterster@gmail.com) and I will post in a Friday reader response.
Original article
Aronson L. Perversity in Medicine - When Vocation and Corporatization Clash. N Engl J Med. 2026 May 30. doi: 10.1056/NEJMp2602962. Epub ahead of print. PMID: 42223085.
In this age of corporate medicine, when health system leaders say, we are building the new hospital of the future alongside world-class facilities for biomedical research, I hear: we are playing to win in our current medical system rather than innovating to improve it, even though it is failing patients and causing unprecedented departures from the health professions.1,2
And when — the situational complexity and their good intentions notwithstanding — they say, we have acquired two more community based local hospitals, a move that will allow us to see more patients with complex medical needs at our flagship campus, I hear: having already ghettoized primary care and psychiatry, those desperately needed, health essential, underfunded services, into another former community based hospital where our cultural imperialism has already been established, we are continuing to invade foreign territories in search of locally scarce raw materials and significant captive markets, leaving the colonized literally and culturally impoverished while increasing our own wealth and power.
When they say, this process has taken time and the collective efforts of many, I can’t help but hear: we know you, the organization’s faculty, staff, and students, made very clear a few years ago that you were against this merger–acquisition, but we hope that because we can now impose our beliefs and traditions on these sites, you will overlook the fact that rather than listening to you, we found a way to work around you.
When they say, we’re expanding access to primary and secondary care at the new hospitals, I have learned from reports of similar acquisitions, local and national, to hear: we don’t really care about the brand dilution of our culture, standards, and reputation, as long as that weakening takes place far from the main campuses and the lucrative, tertiary-care needs we don’t try to prevent (including at the new sites where, almost immediately, primary care will be eliminated from the plans).
When they say, we look forward to welcoming our new teammates to our health system, I hear: we no longer pretend that health care is anything other than a business, and you “teammates” who wanted to help people and prioritize care and compassion are naive idealists with outdated notions of vocation and service.
When they say, “chief market officer” is the title of the person leading the merger with this latest new colony, I hear that although there may be some valid justifications for these moves, my basic assumptions about their primary motives and goals are correct.
And when, just months after the merger, they say, we have ambitious plans for the future, including increasing the census of both of our newly acquired hospitals over the next 2 years, I hear: we are not interested in improving health in our communities or providing adequate access to the primary care that improves health outcomes because in the real world you don’t make money from healthy people.
When they say, faculty physicians, please join us for coffee and donuts, I hear: we’re going to give you two drugs — one of which disrupts your microbiome; increases pain, depression, and fatigue; and contributes to obesity, diabetes, cancer, and heart disease4 — as a way of bribing you to be in the same room with us, because we suspect that you are well aware that a Venn diagram of your values and ours would show a steadily decreasing intersection.
When they say, our health system leadership team is committed to timely and transparent communication, I hear: our business school classes taught us that if we say this enough times, you’ll believe us, even when our actions suggest otherwise.
When they say, every August, as flu season approaches, we will again strive to keep our entire community healthy, and flu clinics will be open through September, I hear: although we’re aware that the optimal timing of flu shots is usually October, collecting data that show widespread staff vaccination is more important to us than doing what the evidence suggests is best for your health.
When they say, you have been approved for self-coding, I hear: here’s another task outside the skill set you spent years developing that we expect you to do without extra time or salary in the already inadequate minutes we have allotted for your patient visits but which legions of administrators will be monitoring to assess your productivity because we care far more about your billing than we do about either your ability to provide the care your patients deserve or your well-being as a clinician forced to choose between doing the right thing and doing what we demand.
When they say, we are spending over $4 billion to construct one of the most advanced hospitals in the country, I hear: we are once again banking on the fact that those of you who work in decrepit outpatient settings will be too ambitious, apolitical, busy, self-absorbed, debt ridden, conflict-adverse, downtrodden, or compliant to speak up as we build more and better tertiary and sub-subspecialty–focused sites while ignoring the current 5-to-10- month wait times for subspecialty care and exacerbating the primary care death spiral wherein systematic neglect leads to reliance on cheaper, less-qualified clinicians, which leads to poorer-quality care, which leads to more reliance on specialists, which leads to longer wait times, which leads to greater need for the advanced illness care from which our organization profits.
When they say, with these multiple, high-cost acquisitions and building plans we’re going to advance clinical innovation and strengthen services and programs, I hear: you think your patients’ last few interactions with outpatient services were bad, just wait until we find more ways to further distance patients from their “providers” — soon patients will look back fondly on their ability to schedule a visit with you months in the future for an issue you could have managed easily with an email or phone call had their message reached you, which it would have if we valued patient care enough to develop systems that promote rather than dismantle the sorts of patient–clinician relationships that drew you to medicine in the first place.
When they say, we’re not doing it just to grow. We’re doing it to position the university to take advantage of this magical time in science and health care, I hear: we are so out of touch with reality that we utter these words at the same historical moment when health care costs are Americans’ primary economic concern and major media outlets have declared that the U.S. health care system is broken and getting worse.
When they say, clinician satisfaction is up and burnout rates are down this year, I hear: we use our knowledge of statistics only in ways that suit our endgame, and here it behooves us to ignore the fact that the denominator has also changed, what with all the departures from our institution and clinical medicine in recent years and the many clinicians who are too busy or disillusioned to fill out surveys.
These are just some of the reasons why when I say, most missives from health system leaders strike me as adding insult to injury, I hope you hear: I have intentionally ignored the indisputable complexities and laudable goals of some corporate leaders in order to convey my emotional experience as a clinician, patient, and family caregiver, and that when I use the word “perverse” in reference to their vision and communications, I use it in its fundamental sense — to designate a deviation from what is right and good, by which I mean an intentional prioritization of business values over the primary mission of medicine and of business leaders’ own professional success over potentially risky but desperately needed reforms that aim first and foremost to improve human health.