I have spent 30 years as a physical medicine and rehabilitation physician in solo practice. In three decades of treating patients, I have witnessed the slow, systematic transfer of health care decision-making from clinicians to people who have never touched a patient.
When I started my career, physicians led health care. Today, private equity firms own hospitals, insurance company algorithms override clinical judgment, and administrators whose primary loyalty is to shareholders set productivity targets that make meaningful healing nearly impossible.
I often hear my colleagues ask, “How did we let this happen?”
The answer is uncomfortable but honest. It wasn’t a hostile takeover; it was an abdication. Because we lacked business and leadership training, we ceded control of health care to private equity, insurance companies, and career businessmen. We left the room when the business of medicine was being discussed, and in our absence, others filled the vacuum.
But after 14 years of teaching in a health care MBA program, I’ve realized something critical: The boardroom needs us, and we are more prepared to lead than we think.
The measurable cost of our absence
The corporatization of American health care is no longer just a “feeling” shared in physician lounges. It is a documented reality with measurable consequences for our patients.
Consider the recent data on private equity ownership. A 2023 study published in JAMA found that hospitals acquired by private equity firms experienced a 25.4 percent increase in hospital-acquired adverse events, including falls and central line infections. In my own world of post-acute care, the findings are even more sobering. A 2024 study in The Review of Financial Studies found that private equity ownership of nursing homes was associated with a 10 percent increase in mortality among Medicare patients.
While private equity has captured the delivery side, insurance companies have tightened their grip through administrative barriers. According to the American Medical Association’s 2023 Prior Authorization Survey, 94 percent of physicians report that prior authorization requirements delay necessary care. In Medicare Advantage, an investigation by the HHS Office of Inspector General revealed that 13 percent of prior authorization denials actually met Medicare coverage rules and should have been approved.
When non-clinicians make decisions that affect patient care, the metrics that matter most to us (outcomes, safety, and compassion) become subordinate to relative value units and operating margins. This misalignment of incentives is a primary driver of the burnout crisis affecting over 60 percent of our workforce.
The knowledge gap
How did we lose our seat at the table? The roots lie in medical education.
We spend a decade or more mastering the intricacies of human anatomy and clinical reasoning. Yet, we receive virtually no instruction in finance, negotiation, or organizational leadership. This gap reflects a cultural disposition within medicine that has long viewed business concerns as “beneath” the profession.
That assumption proved catastrophic. By treating “the business side” as someone else’s problem, we surrendered the power to shape the environments in which we practice. We lost the vocabulary to challenge insurance denials and the standing to demand seats on hospital boards.
The result is a generation of clinicians who are employees rather than leaders, skilled practitioners who lack the agency to protect their patients from the decisions made in boardrooms far removed from the exam room.
A bilateral solution
For the past 14 years, in addition to my clinical practice, I have served as an adjunct professor for Husson University’s health care MBA program. This dual role has given me a unique perspective on the solution.
I’ve realized that the problem runs both ways. Many future health care executives genuinely want to improve the system. However, they lack the clinical “soul.” They have never had to tell a family their loved one isn’t coming home. They’ve never felt the moral weight of a patient’s trust.
The path forward requires a bilateral shift:
- Clinicians must acquire business and leadership training. We need to stop viewing the MBA as a “defection” to the dark side and start seeing it as a tool for advocacy.
- Health care leaders must be exposed to deep clinical understanding. Business students need to understand that every spreadsheet cell represents a human life.
Here is the fundamental truth: It is far easier to teach a clinician how to manage and budget than it is to teach a businessman how to be a clinician.
Training a physician takes a minimum of 11 years. The core competencies of business leadership (financial analysis, strategic planning, and operations) can be meaningfully acquired in two years. More importantly, clinicians already understand the “product.” We know what quality care looks like. We aren’t learning to care about patients; we are learning how to protect that care within a complex system.
From the exam room to the classroom
After 30 years of clinical practice, I have come to believe that my greatest impact may no longer be in the exam room. It will be in the classroom.
By teaching the next generation of health care leaders, we can create a ripple effect that touches more lives than I ever could through individual clinical interactions. When we teach an MBA student that an “efficiency” metric in a rehab facility might actually prevent a stroke survivor from walking again, we are practicing a different, but equally vital, kind of medicine.
To my fellow physicians: The system won’t fix itself. We cannot continue to complain about the “boardroom” if we refuse to learn the language spoken there.
The future of health care depends on clinicians who refuse to be sidelined. It is time for us to reclaim our seat at the table, not by abandoning our clinical values, but by finally acquiring the tools to defend them.
Christopher Mastino is a physical medicine and rehabilitation physician.
