Profit motive in medicine: lessons from private detention

Who staffs the immigration detention centers, the temporary holding camps, the privately run facilities where thousands of frightened people are waiting behind fences and concrete walls?

That is not a rhetorical question. It is a practical one. There are doctors, nurses, administrators, guards, transportation workers, and contractors working inside these institutions today. Some believe they are helping under difficult circumstances. Others regard it as employment within a structure that continues because policy, funding, and political incentives sustain it.

Medicine should pay attention when human suffering becomes economically useful. This is not only an immigration story. It is a health care story, told in unfamiliar surroundings.

These are not small operators. The two largest private detention companies, CoreCivic and GEO Group, each generate revenues exceeding two billion dollars annually, built substantially on government contracts. In the 2024 election cycle alone, they contributed nearly three million dollars to the campaigns and inaugural fund of the administration now expanding their business. The sequence is not hidden. It does not need to be.

Private detention companies profit when detention expands. Hospital systems, insurers, and private equity groups profit when illness generates reliable revenue streams. In both cases, the deeper danger is not corruption in any simple sense. It is incentive drift. Nobody has to wake up intending harm. The structure itself begins reorganizing attention around volume, throughput, occupancy, and financial stability. At a certain point, human beings become operational categories.

Medicine already knows this feeling from the inside. Patients become throughput. Doctors become providers. Care becomes capacity management. The language changes first. The moral imagination adjusts afterward, because moral imagination is partly a product of the language we inhabit daily.

Efficiency matters. Institutions need money. But when financial logic becomes dominant enough, an organization can remain operationally successful while becoming morally unrecognizable to the people who once entered it as a vocation. That tension now sits at the center of modern medicine, not at its edges.

The people working in detention facilities face a version of the same question physicians face in understaffed emergency departments, in production-quota clinic systems, in hospitals run by administrators whose primary obligation is to quarterly returns. How much of the surrounding institutional logic do you accept before you are no longer simply working inside a bad system but have become part of its functioning?

There is no clean answer. The mortgage is real. The employment market is what it is. The patients in front of you need care regardless of who signs the contract. But the question remains, and it is worth carrying consciously.

Moral discomfort that cannot be named tends not to disappear. It relocates.

Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.

Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.

Patrick is the author of the Coaching for Physicians series, including:

He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.