We spend a lot of time talking about how broken the medical system is: burnout, moral injury, administrative overload, loss of autonomy. We propose solutions: better workflows, more staffing, policy reform, technological innovation. But there is a harder truth we tend to avoid. The overall medical training system needs an overhaul.
Medical training does not just teach knowledge and clinical skill; it shapes identity, hierarchy, and thought patterns. From the earliest days, trainees are rewarded for compliance, endurance, and deference. We are taught not to question or to think out of the box.
The subtle conditioning of medical education
You learn quickly that questioning too much can be perceived as inefficiency, that pushing back can be labeled as “difficult,” and that survival often depends on adapting to the system rather than challenging it. Over time, this creates a very specific kind of professional: highly capable, knowledgeable, but often conditioned to operate within constraints rather than interrogate them. Calling this “brainwashing” may sound provocative, but it captures something real. It is the subtle, cumulative conditioning that narrows how we think about medicine.
We are trained extensively in pathophysiology, diagnostics, and patient care. Yet we receive almost no formal education in the business of medicine, including how hospitals generate revenue, how insurance structures dictate care, how administrative decisions are made, or how power actually flows within health care organizations. I believe this is intentional.
The missing curriculum in the business of medicine
So what happens? Physicians enter the workforce exceptionally skilled at caring for patients, but often underprepared to understand, navigate, or challenge the systems shaping that care. Decisions that feel frustrating or even unethical are frequently accepted as immovable realities, rather than structures that could be redesigned. And because we have been conditioned to endure, we endure.
We do not ask about money, we sign the bad contracts, and we trap ourselves. We normalize dysfunction. We internalize the idea that this is “just how medicine is.” We adapt ourselves to the system, instead of expecting the system to adapt to better serve patients and clinicians alike.
Creating a foundation for meaningful change
This is not a failure of individual physicians. It is a predictable outcome of the training environment. If we want meaningful change, we have to start by acknowledging this foundation. We need to create space in medical training, and in ongoing professional development, for independent thinking, systems literacy, and business understanding.
Physicians should graduate not only knowing how to diagnose disease, but also how health care systems operate, how incentives are aligned or misaligned, and how to advocate effectively for change. A system built and sustained by people who were trained not to question it will not easily change.
Santoshi Billakota is a neurologist.
