Two years ago, Drs. Aaron Morgenstein, Corinne Sundar Rao, and Shreekant Vasudhev drew a compelling parallel between the Titanic’s tragic voyage and the looming crisis in U.S. health care. They highlighted systemic issues such as administrative egotism, outdated practices, and substandard resources, warning that without significant course corrections, the health care system was on a collision path with disaster.

Today, in 2025, the iceberg has struck, and the cracks are widening. The Titanic didn’t sink simply because it hit an iceberg. It sank because of a deadly combination of outdated systems, arrogance at the helm, and a failure to course-correct despite repeated warnings. Medicine, sadly, is following the same fate.

Outdated processes: ignoring the modern storm

Just as the Titanic relied on antiquated ship designs and inadequate lifeboat supplies, the health care system today clings to outdated workflows that no longer serve either patients or physicians. Electronic health records were supposed to streamline care but have instead buried physicians under a mountain of clicks and meaningless tasks. Paperwork has replaced patient interaction. The ship is weighed down by bureaucracy while real innovation (like direct physician-patient models) struggles to stay afloat.

Administrative bloat: too many captains, not enough lifeboats

The Titanic had too few lifeboats for its passengers; health care today has too many administrators for its shrinking supply of doctors. Non-clinical roles continue to balloon while the people providing actual care are stretched thinner than ever. Physicians are now spending more time justifying care to insurance companies than providing it, fighting denial after denial, pleading for necessary treatments, and watching helplessly as third parties override their medical judgment.

Employment over autonomy: when the crew is shackled

On the Titanic, the crew had little authority to challenge disastrous decisions. Physicians today are experiencing the same erosion of autonomy. Increasingly funneled into employment models, they are pressured to prioritize corporate metrics over clinical intuition. The independent physician is becoming an endangered species, with fewer and fewer able to practice medicine on their own terms. The ship’s crew has been bought, and with it, the heart of the profession.

Burnout, exodus, and early retirement: when the crew abandons ship

Faced with declining Medicare reimbursements, endless denials, mounting documentation demands, and the suffocation of their professional independence, many physicians are making a painful choice: leave medicine altogether. Burnout is at an all-time high. Physicians are retiring early, switching careers, or stepping away from clinical practice, not because they want to abandon patients, but because the system has abandoned them. The ship is sinking not because the passengers are weak, but because the structure they trusted has rotted away.

Declining Medicare reimbursements: running the ship on fumes

At a time when inflation touches every corner of life, Medicare reimbursements for physicians continue to decline in real terms. While costs rise and demands grow, compensation shrinks. It’s as if the Titanic’s operators asked the crew to work harder, in colder conditions, for half the rations, and expected a better outcome.

Two years later: what has changed

In truth, little. Awareness has grown, but true reform remains elusive. Like the Titanic’s captain ignoring iceberg warnings, health care leadership continues to patch cracks with platitudes instead of steering toward safety. Physicians, once the unsinkable force behind patient care, are increasingly finding themselves locked below deck. If nothing changes, the collapse will not be sudden; it will be a slow, grinding descent into mediocrity, where fewer physicians remain to take care of more patients, under worse conditions, for less reward.

There is still a narrow window to change course. But only if physicians reclaim their voice, demand a seat at the helm, and rebuild medicine with the patient-physician relationship (not the insurer or the administrator) at its core. Otherwise, history will look back at this time and wonder how we failed to learn the lessons of the Titanic until it was far too late. And just as Jack told Rose in the freezing waters, a reminder to physicians and patients alike: “You jump, I jump, remember?” We are still in this together, but time is running out to save us both.

Corinne Rao is an internal medicine physician, working as an independent contractor at several health care facilities, the owner of an internal medicine practice, and a member of FlexMedstaff. In her spare time, she is a ballroom dancer.

Shreekant Vasudhev is an internal medicine physician.

Aaron Morgenstein is an orthopedic surgeon.