“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.

By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership role advocating for physician well-being. I was practicing palliative care, where relationships and meaning-making are central.

And yet, I’d suddenly reached my limit of trying to be a good doctor in a bad system. It wasn’t dramatic; it was cumulative. The accumulating weight of feeling my agency erode. Forces beyond my control, beyond my bosses’ control, increasingly determining how I could practice medicine. I found myself spending too much energy navigating corporate structures rather than caring for people. I couldn’t provide care that lived up to my own standard.

So I made a change. I took a sabbatical. I launched a coaching practice. I moved to the much more uncharted terrain of part-time clinical work. I reclaimed my agency. My relationship to the health care system is a work in progress, but I’ve created the space for that work to happen.

The Lancet authors document what I experienced with bleak clarity. Between 2019 and 2023 alone, 127,700 U.S. physicians left private practice and became corporate employees. In my own field, for-profit entities now control 78 percent of hospices, which has resulted in worse care.

I know these aren’t just statistics. I’ve cared for countless hospice patients who landed in the emergency department, the exact place they’d hoped to avoid, because their home hospice team lacked adequate staffing or resources. This is what profit extraction looks like in hospice: promises broken.

The authors are right: The space for good work IS narrowing.

So the next step is moving forward within that demoralizing reality. What I’ve learned (and what I now help other physicians discover) is that there’s a path from “this is happening” to “I am making conscious choices about how I engage with this.” It’s the difference between passive participation and reclaimed agency.

Why “just being a good doctor” no longer works

For decades, physicians operated under an implicit contract: Focus on clinical excellence and ethical practice, and the system would mostly let you do good work. That contract is broken.

Before widespread corporatization, most physicians owned their practices or worked in physician-led groups. Professional ethics could be the primary organizing principle. Corporate consolidation changed everything. When you’re beholden to entities whose fiduciary duty is to shareholders rather than patients, the calculus shifts. Productivity metrics, algorithmic care denial, and profit targets become the organizing logic.

The moral injury physicians endure isn’t personal weakness; it’s a rational response to untenable conditions. Trying to “just be a good doctor” within these structures could break you.

From demoralization to agency

The shift required isn’t about fixing the system individually. It’s about choosing where you stand.

Two physicians in identical circumstances can have radically different experiences. The difference is whether they’re making conscious choices about how to engage with a broken system.

Across medicine, physicians are finding ways to reclaim agency:

• Work within the system: They stay employed while maintaining clear boundaries, knowing what they will and won’t compromise. They develop strategies for advocating within constraints (carefully worded documentation, knowing which battles to fight). They strive creatively to find work-life balance.
• Build alternatives outside traditional employment: Direct primary care is a model that eliminates insurance intermediaries. Locums tenens enables clinical practice with less institutional entanglement. My own path combines part-time clinical work with coaching, staying connected to patient care while building something fulfilling outside corporate structures.
• Organize to disrupt the system: Union organizing is growing. Physicians advocate for single-payer health care, fight private equity in medicine, and use their credibility to speak directly to patients online. They’re actively working to transform the system.
• Plan a strategic exit: Not everyone must devote themselves to fixing health care. Conscious transitions out of medicine can be intentional and restorative of purpose, rather than desperate exits.

The key is agency.

How do you make the change

What sets apart physicians who act intentionally is that they know what’s most important and build the confidence to act on it.

This requires:

• Values clarification: What are your non-negotiables? What drew you to medicine, and what parts can you still honor? What compromises can you live with, and what would violate your integrity? Is medicine a calling, or just a lofty job?
• Understanding constraints and possibilities: Financial realities, family obligations, and debt are real. But so are limiting beliefs. What leverage do you actually have? The work is distinguishing between true barriers and stories you’ve been telling yourself.
• Strategic thinking: How will you maintain boundaries? What’s negotiable? What’s your sustainable business plan or theory of change?
• Moving from insight to action: Clarity without action creates frustrated stagnation. The work is taking concrete steps, however small, that align with your values.

This kind of discernment work (values clarification, strategic thinking, moving insight to action) is exactly what coaching supports. While I’m partial to coaching, other paths to clarity include joining like-minded communities, therapy, and mentorship. If you already know what you need but aren’t taking any steps, ask yourself what’s keeping you stuck.

Closing

Each of us must find our own answer to how we’ll practice medicine in this moment. That answer will look different for different physicians.

The old model (just be a good doctor and the system will mostly let you) is gone. What’s possible now is more honest: conscious choice about how we’ll position ourselves in relation to a broken system.

The question isn’t which path is right. It’s whether you’re choosing yours with eyes open.

Christie Mulholland is a palliative care physician and certified physician development coach who helps physicians reclaim their sense of purpose and connection in medicine. Through her work at Reclaim Physician Coaching, she guides colleagues in rediscovering fulfillment in their professional lives.

At the Icahn School of Medicine, Dr. Mulholland serves as associate professor of palliative medicine and director of the Faculty Well-being Champions Program. Affiliated with Mount Sinai Hospital, she leads initiatives that advance physician well-being by reducing administrative burden and improving access to mental health resources.

Her recent scholarship includes a chapter in Empowering Wellness: Generalizable Approaches for Designing and Implementing Well-Being Initiatives Within Health Systems  and the article, “How to Support Your Organization’s Emotional PPE Needs during COVID-19.” Her peer-reviewed publications have appeared in Cancers and the Journal of Science and Innovation in Medicine.

She shares reflections on professional growth and physician well-being through Instagram, Facebook, and LinkedIn. Dr. Mulholland lives in New York City with her husband, James, and their dog, Brindi.