I spent 11 years becoming a family physician.

Four years in undergrad, four in medical school, three more in residency.

That’s a decade of delayed income and about $300,000 in debt, all for the privilege of practicing in one of the most critical, underappreciated corners of medicine: primary care.

I came out idealistic. I wanted to build relationships, prevent disease, and guide people through the chaos of a broken system. But I quickly learned something that still stings: the system doesn’t actually value what primary care does.

In most health plans, primary care accounts for roughly 5 percent of total health care spend. That’s it. Five cents on the dollar to handle 90 percent of what keeps people healthy and out of the hospital.

Meanwhile, the rest of that dollar is divided up among specialists, hospitals, facility fees, and administrative waste that could fill a landfill.

Then one day, curiosity, and maybe a little frustration, led me to get my health insurance broker license.

The process? About 30 minutes and $38.

The compensation? You guessed it: Around 5 percent of total health care spend.

Let that math sink in.

A decade of education and six figures of debt earns me the same slice of the health care dollar as a license I could get on my lunch break.

The broker vs. the healer

This isn’t a dig at brokers. There are great ones out there; the ones who fight for transparency, align incentives, and actually help employers spend their health care dollars wisely. I’ve had the privilege of working with some.

But our system rewards the distribution of health care dollars far more than the delivery of health care itself.

I can sit across from an employer, design a benefits strategy, and earn a percentage of their total spend, regardless of whether the employees get healthier.

Or I can spend an hour diagnosing, counseling, and preventing costly downstream care, and get reimbursed less than a car mechanic.

Somewhere along the way, we decided that the people who move money deserve the same (or more) as the people who move health.

Standing on both sides of the fence

Today, I straddle both worlds.

I run a direct primary care practice, and I work as a benefits advisor and health plan consultant for employers.

And from this vantage point, I see exactly where the disconnect lives: Physicians understand health, but most don’t understand the economics of health care.

Brokers understand the economics, but most don’t understand health.

The people paying the bill (employers) are stuck in the middle, assuming everyone at the table has their best interest at heart.

Spoiler: not everyone does.

The irony? When a physician brings clinical insight into plan design, when we actually connect the dots between care delivery and benefit structure, the results are transformative.

Costs go down. Health improves. Everyone wins.

It’s not absurd that I can hold both licenses (doctor and broker).

It’s absurd that the system doesn’t see how vital it is for more physicians to do the same.

Because until we bring clinical voices into the boardroom, we’ll keep spending 95 percent of our dollars treating preventable problems, and 5 percent trying to prevent them.

The economics of health care are built on a perverse kind of symmetry: Both the healer and the middleman earn 5 percent. But only one of them can look a patient in the eye when something goes wrong.

So no, I’m not crazy for thinking this is backward.

I’m just tired of pretending that the current system makes sense.

If a $38 license carries the same economic weight as $300,000 in medical education, it’s not the education that needs to change; it’s the system that values it.

Jonathan Bushman is a board-certified family physician, health benefits advisor, and passionate advocate for reimagining health care delivery. As the founder of Primed Healthcare, a physician-owned benefits agency, Dr. Bushman helps employers and employees navigate a transparent, trust-based approach to health care. He brings deep expertise in direct primary care and employer-sponsored health plans, focusing on solutions that align physician-led care with cost-effective strategies. Dr. Bushman serves as a fractional chief medical officer and continues to drive innovation in health plan design. Through his leadership at Reliant Direct Primary Care and thought leadership shared via LinkedIn, he works to empower organizations with health care solutions built on meaningful care rather than bureaucracy.