Health-care professionals are increasingly disheartened by the insistence to favour their employers’ financial objectives over patients’ needs and professional standards, as the opportunity for meaningful practice within a flawed system diminishes.” This assertion from an October 2025 Lancet article resonated deeply with my own experience.

According to all measurable indicators, I was thriving. I had just achieved a promotion to associate professor in the top-ranked department in the nation for my field. I held a fulfilling leadership position advocating for physician welfare. I was practicing palliative care, where relationships and the creation of meaning are at the forefront.

And yet, I had abruptly reached my threshold for striving to be a competent doctor within a flawed system. It wasn’t a sudden transformation; it was a gradual buildup. The mounting burden of witnessing my autonomy diminish. External forces, beyond my control and my superiors’, increasingly dictating how I could practice medicine. I discovered that I was expending excessive energy maneuvering through corporate frameworks rather than providing care to individuals. I could not deliver care that measured up to my own expectations.

So, I opted for a change. I took a sabbatical. I launched a coaching venture. I transitioned to the vastly more uncharted territory of part-time clinical work. I reclaimed my autonomy. My relationship with the health-care system is evolving, but I’ve carved out the space for that evolution to take place.

The authors of the Lancet illustrate what I experienced with stark clarity. Between 2019 and 2023 alone, 127,700 U.S. physicians exited private practice and became corporate employees. In my own specialty, for-profit entities now dominate 78 percent of hospices, leading to decreased quality of care.

I understand these are not mere statistics. I have looked after innumerable hospice patients who ended up in the emergency room, the very location they sought to avoid, because their home hospice team was under-resourced or inadequately staffed. This exemplifies what profit extraction entails in hospice: unfulfilled promises.

The authors are correct: The opportunity for meaningful work IS diminishing.

Thus, the next step is to progress within that disheartening reality. What I’ve learned (and what I now assist other physicians in discovering) is that there exists a pathway from “this is happening” to “I am consciously deciding how I engage with this.” It’s the distinction between passive involvement and reclaimed autonomy.

Why “just being a good doctor” is no longer sufficient

For years, physicians operated under an unspoken agreement: Prioritize clinical excellence and ethical conduct, and the system would largely allow you to do commendable work. That agreement has been broken.

Before the rise of widespread corporatization, most physicians owned their practices or were part of physician-led organizations. Professional ethics were the primary guiding principle. Corporate consolidation altered everything. When you are beholden to entities whose fiduciary responsibilities lie with shareholders rather than patients, the calculus changes. Productivity metrics, algorithmic care denials, and profit objectives become the driving logic.

The moral injury physicians face isn’t a sign of personal weakness; it’s a rational response to untenable circumstances. Attempting to “just be a good doctor” within these frameworks could weigh heavily on you.

Transforming disillusionment into agency

The necessary shift isn’t about individually fixing the system. It’s about determining where you stand.

Two physicians in the same situation can experience their circumstances in vastly different ways. The variance lies in whether they are deliberately choosing how to relate to a broken system.

Throughout medicine, physicians are discovering ways to reclaim their agency:

• Operate within the system: They remain employed while establishing firm boundaries, understanding what they will and won’t concede. They devise strategies for advocacy within limitations (thoughtfully crafted documentation, discerning which battles to engage). They creatively seek to attain work-life balance.
• Develop alternatives beyond traditional employment: Direct primary care is a model that removes insurance intermediaries. Locums tenens allows for clinical practice with reduced institutional entanglement. My own journey merges part-time clinical work with coaching, enabling me to stay connected to patient care while creating something fulfilling outside corporate confines.
• Organize to challenge the system: Union organizing is on the rise. Physicians advocate for single-payer healthcare, oppose private equity in medicine, and leverage their credibility to speak directly to patients via online platforms. They are actively working to reshape the system.
• Strategically plan an exit: Not everyone needs to commit themselves to rectifying health care. Thoughtful transitions out of medicine can be intentional and restorative of purpose, rather than desperate departures.

The crux is agency.

How do you implement the change

What distinguishes physicians who take action