Recent headlines confirm what many Americans have sensed for the past few years: the U.S. Department of Health and Human Services (HHS) is in crisis. A sweeping wave of layoffs is reshaping federal health agencies at every level—from the NIH to the CDC to the FDA. Some dismiss this as a political maneuver or an act of chaos. Others see it as an attack on career civil servants. I see it differently. This is what rock bottom looks like. And from here, the only direction left is up.

The public’s patience has expired.

The erosion of trust in federal health institutions didn’t happen overnight. It’s been a slow burn, fueled by neglect, opacity, and a palpable detachment from the American public. During the height of the COVID-19 pandemic in 2021, an internal audit found that close to 50 percent of HHS employees weren’t logging into their email or computers. While patients were lining up at ERs and ICUs were overflowing, the nation’s top health bureaucracy was operating in what felt like a virtual ghost town.

The baby formula crisis of 2021 and 2022 exposed similar dysfunction. FDA employees failed to act swiftly on contamination concerns, leading to critical shortages and terrified parents scrambling across state lines for infant nutrition. That wasn’t just a bureaucratic oversight—it was a national trauma. Then came the conflicting mask guidance, the vaccine mandate controversies, and the sense that federal agencies were often reactive rather than proactive, aloof rather than accountable.

Americans noticed. And they remembered.

Unconventional leaders for unconventional times

In 2025, a new slate of health leaders were appointed: a new HHS Secretary, a new NIH Director, a new CDC Director, and a potential new Surgeon General. These appointments were immediately criticized as “unconventional.” Protesters decried the lack of transparency and the absence of traditional public health credentials. But maybe we need to reconsider what counts as a qualification in a system that is fundamentally broken.

After all, we are the sickest wealthy nation on earth.

We have one of the highest maternal mortality rates among developed countries. Our rates of obesity and diabetes are astronomical. Chronic disease is normalized. Mental health disorders have skyrocketed. We are a nation addicted to prescription drugs and increasingly ambivalent about our children’s futures. Our educational scores are slipping, our children’s health is declining, and life expectancy—once a point of national pride—is now in free fall.

The old system, the one built by conventional leaders and managed by career bureaucrats, is the one that got us here. Why not try something different?

The cost of disconnection

The irony is bitter: the Department of Health and Human Services was designed to protect the most vulnerable Americans. Yet over time, it became unmoored from the communities it was meant to serve. HHS employees rarely set foot in clinics. Public health experts spent more time on Zoom than on zip codes where help was needed. They became data-driven but not people-focused. The nation became a chart, a projection, a curve to flatten—while actual suffering went unacknowledged. The bungling of the illicit synthetic fentanyl crisis and overdoses related to it is a whole issue by itself that requires a separate blog and more attention.

The COVID-19 pandemic didn’t create this disconnect. It exposed it.

While the rest of us were scrambling to secure PPE, closing our practices, or working overtime to comfort the grieving and sick, many HHS agencies simply stopped showing up—literally and figuratively. The resentment is real. Many Americans no longer see these institutions as trustworthy or even competent.

That’s a dangerous place for any democracy to be. And in this Republic where four physicians were among the signatories of the Declaration of Independence, this is a chance to rebuild with intention.

Change is painful—but necessary.

Layoffs at the NIH, FDA, and CDC have triggered predictable outrage. Some long-serving staffers feel blindsided. Others lament the loss of institutional memory. But let’s not romanticize what was.

I say this as someone who worked within the system. I saw the talent, the brilliance, the commitment—but I also saw the complacency, the inertia, and the almost religious attachment to outdated models of care and data interpretation. Every time a federal agency fails to deliver on its mandate, real people suffer. When the FDA sleeps on contamination reports, babies go hungry. When the CDC stumbles on messaging, public trust implodes. When the NIH spends billions on research disconnected from practice, communities fall further behind.

Sometimes, when a house is infested with termites, you don’t patch it up. You tear it down and rebuild from the foundation.

We are not victims—we are Americans.

One of the most dangerous myths in American health care is that the system is too big to challenge. But we forget: these agencies work for us. They are funded by our tax dollars. They exist to serve us, not the other way around.

The chaos at HHS is not a sign of collapse—it’s an opportunity for reinvention. It’s a call for us, as clinicians and patients, to reassert control over the conversation. We don’t need perfect leaders—we need present ones. Leaders who listen, who walk among the people they serve, who understand that health is more than a statistic. It’s a lived experience.

We need to rebuild public health in a way that centers the patient, not the algorithm. That reclaims trust not through PR campaigns, but through authentic, face-to-face accountability.

The way forward: compassionate accountability

We are not here to dance on the ruins. Layoffs mean livelihoods lost, lives disrupted. I take no joy in that. But I also know that the status quo was not sustainable.

This is our chance to build something better—a Department of Health and Human Services that is truly human, truly serving. A CDC that earns its credibility through transparency. An NIH that prioritizes translational research and health equity. An FDA that protects the public first, and industry second.

Change is uncomfortable. It’s supposed to be. But we are a nation in medical, moral, and institutional crisis. We don’t have the luxury of comfort. We are at rock bottom—but that also means we have the rarest thing in public health: a blank slate.

Let’s not waste it.

Full disclosure: I served for three years as a federal employee at the National Institute of Mental Health. I was honored with the NIH Director’s Award. I cherish that chapter of my professional journey. But I also believe the time for change is now. In fact, it may already be overdue.
Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.