I dedicated 11 years to becoming a family doctor. Four years for my undergraduate studies, four in medical school, and three in residency. That translates to a decade of postponed earnings and approximately $300,000 in debt, all for the honor of practicing in one of the most vital but overlooked areas of medicine: primary care.

I emerged with idealistic aspirations. I aimed to forge relationships, avert illnesses, and assist individuals through the turmoil of a flawed system. However, I soon discovered a harsh reality: the system fails to genuinely appreciate the significance of primary care.

In the majority of health plans, primary care comprises around 5 percent of total health care expenditures. That’s all. Five cents for every dollar to manage 90 percent of what keeps individuals healthy and outside hospital walls. Meanwhile, the remaining dollar is allocated to specialists, hospitals, facility charges, and administrative inefficiencies that could overflow a landfill.

Then one day, driven by curiosity and perhaps a hint of frustration, I pursued my health insurance broker license. The process? About 30 minutes and $38. The compensation? You guessed it: Approximately 5 percent of total health care expenses. Let that calculation resonate.

Years of education and a six-figure debt grant me the same portion of the health care dollar as a license I could acquire during my lunch break.

**The broker versus the healer**

This isn’t meant to undermine brokers. There are exceptional ones among them; those who advocate for transparency, align motivations, and genuinely assist employers in wisely allocating their health care funds. I’ve had the fortune to collaborate with some. Yet our system rewards the allocation of health care funds significantly more than the actual provision of health care.

I can consult with an employer, devise a benefits plan, and receive a percentage of their total expenditure, irrespective of whether employees achieve better health outcomes. Alternatively, I can invest an hour in diagnosing, advising, and preventing expensive follow-up care, and receive less reimbursement than a car mechanic would.

At some point, we determined that those managing funds deserve the same or even more than those attending to health.

**Navigating both realms**

Nowadays, I navigate both spheres. I operate a direct primary care practice, and I also serve as a benefits advisor and health plan consultant for businesses. From this perspective, I’ve identified precisely where the disconnect lies: Physicians grasp health, but many lack insight into health care economics. Brokers comprehend the economics, but many do not fully understand health. The employers footing the bill find themselves caught in between, presuming that everyone present has their best interests at heart. Spoiler: not all do.

The irony? When a physician applies clinical insight to plan design, when we genuinely connect care delivery with benefit structuring, the outcomes are remarkable. Costs decrease. Health enhances. Everyone benefits.

It’s not unreasonable that I hold both licenses (doctor and broker). What is unreasonable is the system’s failure to recognize the necessity for more physicians to do the same. Because until we incorporate clinical perspectives into the boardroom, we’ll continue to allocate 95 percent of our funds addressing preventable issues and only 5 percent toward prevention.

The economics of health care rest on a bizarre type of symmetry: Both the healer and the intermediary earn 5 percent. However, only one can meet a patient’s gaze when something goes amiss.

So, no, I’m not misguided for believing this is misaligned. I’m just weary of pretending that the existing system is logical.

If a $38 license holds the same economic value as $300,000 in medical training, it’s not the education that necessitates reform; it’s the system that regards it.

*Jonathan Bushman is a board-certified family physician, health benefits advisor, and passionate advocate for rethinking health care delivery. As the founder of Primed Healthcare, a physician-owned benefits agency, Dr. Bushman aids employers and employees in navigating a transparent, trust-based approach to health care. He possesses extensive expertise in direct primary care and employer-sponsored health plans, concentrating on solutions that align physician-led care with cost-effective strategies. Dr. Bushman acts as a fractional chief medical officer and continues to foster innovation in health plan design. Through his leadership at Reliant Direct Primary Care and thought leadership shared via LinkedIn, he strives to empower organizations with health care solutions grounded in meaningful care rather than bureaucracy.*