“We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.” Elisabeth Kubler-Ross

Over the course of my career, I have witnessed an inexorable decline in the quality of medical care that we, as physicians, render to our patients. There is a myriad of reasons for this sad development, some the fault of physicians, but the majority caused by a health care system that is almost hopelessly broken.

I wrote Failure to Treat to inform the public about many of these ills. I used carefully anonymized true stories because I believe that narrative medicine is a powerful teaching tool, and because I developed a talent for storytelling during my tenure as a medical mystery author. I have been gratified by the reception my book has received. Virtually no one has disagreed with my posits. Everyone who reads the book is anxious to tell me about a medical misadventure that affected themselves or someone they love.

Despite success in educating the public and seeing some movement among our professional organizations, there continue to be developments that continue to jeopardize the quality of care of all Americans. Passage of the Big Beautiful Bill put into motion massive cuts in social programs, most importantly medical insurance for the elderly and the disadvantaged. Insisting on proof of employment to retain Medicaid coverage will impose an impossible burden on patients and practitioners and will deprive millions of our most vulnerable citizens of medical coverage. Repealing tax subsidies for policies purchased on government exchanges has forced tens of millions to give up their insurance. We have recently learned that physicians who care for elderly patients in outpatient settings will be subjected to further cuts in their payments, reducing the number of medical trainees who will enter primary care specialties.

Prior authorization has made it possible for insurance companies to deny care to thousands of patients. Appealing these maddening decisions has contributed directly to physician burnout. Promised reform has not happened. In fact, CMS recently announced its intention to use artificial intelligence to make these critical decisions. Congressional efforts to block this misguided decision have failed.

The public is deluged with media advertisements for prescription drugs and medical devices. Not only does this practice raise the price of life-sustaining medications, but it has imposed yet another burden on experienced physicians who must explain why a drug on TV is inappropriate. Even worse, advertising for unproven or worthless remedies is rampant. Legislators have refused to close the loophole that allows “food derivatives” to be promoted for medicinal benefits they simply don’t possess. Administration officials contribute to the crisis with witless policy decisions. Witness the secretary of defense insisting on testosterone measurements for military personnel when there are no data to support claims of superior performance with supplementation.

Contrast this laissez-faire approach to snake oil products with the draconian approach regulators have taken with psychedelics. Despite strong evidence of efficacy for poorly treated but common disorders such as PTSD, the FDA has refused to approve any of these therapies. The thousands of veterans who suffer from PTSD should not be surprised by how lightly they are regarded. The VA hospital system has been victimized by funding cuts causing massive personnel shortages.

Perhaps the most fundamental reason for the deterioration in the quality of care of Americans is physician undersupply. Not only are we not training enough primary care physicians, but we will be facing shortages of key specialists. Currently, over 40 percent of counties in the U.S. do not have a cardiologist and shortfalls in that critical specialty will increase exponentially in the next ten years. Yet, our government has refused to take action, for example making it easier for well-educated foreign physicians to practice in the U.S.

At the back end, doctors are leaving the profession in droves. Physicians are retiring earlier or looking for things to do other than grinding through a 40-patient day in the office. They are spooked by the ever-increasing possibility of being sued while legislators refuse to rein in plaintiff lawyers who have drained billions from a struggling medical care system. They are tired of taking marching orders from bean counters who have no idea of what practice entails. They are done with having their free time eaten up by administrative tasks that justify payment but provide no improvement in patient care.

Physicians are also frustrated by their inability to keep up with the avalanche of new medical information. Medical science has moved quickly to develop a series of incredibly effective treatments for common diseases. Unfortunately, we have created a huge gap between what is happening at the scientific vanguard and what rank-and-file clinicians can implement. Given no time to read or attend conferences, physicians rely on top-line data on the internet. They practice cookbook medicine. “If you see this, then do that” medicine disadvantages patients who respond best to individualization of care.

Financiers in charge of medicine are driven by the bottom line, which means that controlling costs to maximize profits, especially in the world in which private equity rules, is paramount. Personnel costs are the low-hanging fruit. Restricting the number of nurses and paying them poorly is a common strategy that has resulted in nursing strikes across the country. When queried about why they are on a picket line, nurses answer that they fear for their patients more than they worry about their paycheck.

America spent over 5 trillion dollars on health care in 2025, or $16,000 per person. If the funds were spent wisely and equitably, we would be blessed with the best health care system in the world. Instead, we have allowed billions of dollars to be siphoned off by people who care more about their bank accounts than patients. We now have a health care system that ranks last in the world in almost every quality metric.

The situation is dire, but the solution is obvious. All of us, practitioners and patients, must pressure our legislators to enact laws to ensure that every single person in this country has access to the medical care they need and deserve.

Peter R. Kowey is professor of medicine and clinical pharmacology at Thomas Jefferson University, emeritus chief of the division of cardiovascular diseases at the Lankenau Heart Institute, and the William Wikoff Smith Chair in Cardiovascular Research at the Lankenau Institute for Medical Research.

Dr. Kowey is an internationally recognized expert in heart rhythm disorders. His research, regulatory, and clinical trial expertise have led to the development of innovative therapies for cardiac arrhythmias. He is the recipient of more than 150 grants, has written more than 450 papers and scientific reports, and has coedited five textbooks on cardiac arrhythmia. He has trained hundreds of fellows who practice cardiology and cardiac electrophysiology around the world.

Dr. Kowey is a fellow of the American Heart Association, the American College of Cardiology, the American College of Physicians, and the Heart Rhythm Society, along with several other professional organizations. He was a member of the Cardio-Renal Drug Advisory Committee and the Cardiovascular Devices Advisory Committee of the Food and Drug Administration. He has received numerous awards, including the Edward S. Cooper Award from the American Heart Association and the William Osler Award from the University of Miami.

Dr. Kowey is a graduate of St. Joseph’s University and the University of Pennsylvania School of Medicine. He completed his residency training in internal medicine at Penn State University and was a fellow in cardiovascular medicine and research at the Harvard University School of Public Health, the Peter Bent Brigham Hospital, and the West Roxbury VA Hospital. He has published six novels and is the author of the upcoming book Failure to Treat: How a Broken Healthcare System Puts Patients and Providers at Risk. He shares updates on Instagram, YouTube, TikTok, and Substack.