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The size and administrative complexity of American healthcare is profound. In 2023 national healthcare spending was more than $4.5 trillion, approximately $13,500 per capita, more than the GDP of all but one other nation of the world. There are more than 6000 hospitals, over a million physicians and more than 900 private payers, all subject to a labyrinth of conflicting incentives and constrained by overwhelming regulatory complexity.

Over the past twenty-five years, more than five hundred physician leaders from around the country have graduated from the Alliance MBA Program for Physicians. Though their respective practice settings and responsibilities have varied widely, there has been general consensus around many of the issues and challenges they face as physician leaders.

In 2022 Medicare Advantage (MA) enrolled 48 percent of the eligible Medicare population, representing $427 billion of Medicare spending.  The program was originally meant to save taxpayers money, but it never has.  Instead, MA has become rife with abuse, with large private insurers taking advantage of the rules  to overcharge the government …

For over a decade the term burnout has been used to describe the growing trend of physician distress. Stretched thin dealing with loss of autonomy and ever expanding administrative and regulatory burdens, physicians have increasingly reported feelings of frustration, exhaustion and reduced sense of accomplishment.

Physicians aren’t “burning out;” they’re suffering from moral injury. Moral injury—being forced into behaving in ways that go against an individual’s moral values and beliefs—is the proper explanation for what is frequently characterized as burnout in physicians and post-traumatic stress in soldiers.