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The Daily

The Sunday Read: ‘The Moral Crisis of America’s Doctors’

Sun Jul 16 2023
Moral DilemmasProfit-Driven Medical SystemChallenges Faced by PhysiciansDisillusionment with Healthcare SystemYoung Doctors' ChallengesDirect Care Model


The episode explores the moral dilemmas faced by doctors in a profit-driven American medical system. It delves into the challenges physicians encounter, including limited time with patients, pressure to prioritize profits over patient well-being, and being blamed for systemic problems. The corporatization of healthcare and exorbitant medical bills are also discussed. The disillusionment with the healthcare system, concerns about the corporate takeover, and the impact on young doctors are explored. The episode concludes with an examination of the direct care model and its challenges.


Doctors face moral dilemmas and feel controlled in a profit-driven medical system.

Limited time with patients, pressure to switch medications based on insurance coverage, and being scapegoats for systemic inequities contribute to doctors' moral injury.

The corporatization of healthcare negatively impacts emergency physicians.

Outsourcing, cost-cutting measures, and prioritizing profits compromise patient care and job satisfaction for emergency room doctors.

Physicians question the sacrifices and compromises in their profession.

Ethical dilemmas, blame from patients for systemic problems, and exorbitant medical bills contribute to doctors' disillusionment with the healthcare system.

Young doctors face challenges and question their role in a profit-driven system.

High student debt, limited control over working conditions, and private equity investment impact young doctors' perception of their profession.

Direct care practices aim to rebuild trust between physicians and patients.

However, attracting enough patients and dealing with flaws in the healthcare system pose challenges for doctors running direct care practices.


  1. Moral Dilemmas in the Profit-Driven Medical System
  2. Challenges Faced by Physicians
  3. Disillusionment with the Healthcare System
  4. Challenges Faced by Young Doctors
  5. The Direct Care Model and its Challenges

Moral Dilemmas in the Profit-Driven Medical System

00:00 - 08:13

  • Doctors face moral dilemmas in a profit-driven American medical system.
  • Pediatric treatment is being reduced and primary care practices are being bought up by corporations.
  • Doctors feel controlled and pressured to go against their own medical ethics.
  • Limited time with patients forces doctors to switch medications based on insurance coverage, even if it's dangerous.
  • Some doctors feel like scapegoats for the inequities of the system.
  • The suicide rate among physicians is alarming, leading many to consider quitting or leaving the country.
  • A psychiatrist coined the term 'moral injury' to describe the emotional wounds doctors experience when forced to stray from ethical principles.
  • The article about moral injury went viral among medical professionals.

Challenges Faced by Physicians

07:52 - 15:31

  • Low-wage workers and physicians hesitate to discuss distressing working conditions for fear of being replaced.
  • Emergency room doctors are affected by outsourcing and cost-cutting measures.
  • Many emergency physicians can be fired without due process and have been threatened for raising quality of care concerns.
  • The corporatization of healthcare negatively impacts the quality of care and job satisfaction for emergency physicians.
  • Doctors question whether the sacrifices and compromises in their profession are worth it.
  • 'Moral injury' describes the sense of betrayal when a person's sense of what is right is betrayed by leaders in high-stakes situations.
  • Clinicians feel betrayed by their leadership and recognize that they can also contribute to this betrayal.
  • The emphasis on speed, efficiency, and financial metrics compromises patient care and physician values.
  • Doctors often face ethical dilemmas when pressured to prioritize profits over patient well-being.
  • Patients blame doctors for systemic problems within the healthcare system that are beyond their control.
  • Rheumatologist Deanna Grenita was distressed by patients receiving exorbitant bills for routine labs and medications.

Disillusionment with the Healthcare System

15:03 - 22:34

  • Rheumatologist Deanna Grenita found the cycle of exorbitant medical bills distressing.
  • Grenita left her practice due to patient complaints about high bills.
  • Critical care specialist Keith Coral felt disillusioned by the healthcare system after years of working as an emergency physician.
  • Coral faced challenges providing care to patients without insurance.
  • Inadequate staffing in hospitals led to difficult decisions for doctors like Coral.
  • Concerns about the corporate takeover of the medical system have been raised for decades.
  • The American Medical Association opposed efforts to broaden access to healthcare in the past.
  • Physicians were trusted and seen as above commercial interests, but this perception has changed over time.
  • Revenue and profit-driven decisions have impacted pediatric units and emergency room staffing.
  • Private equity investment has increased pressure on doctors and staff in emergency rooms.
  • Young people entering medicine question if they are beneficiaries or exploited by capitalism.

Challenges Faced by Young Doctors

22:07 - 29:42

  • Young doctors question if they are beneficiaries of capitalism or an exploited class.
  • The average medical student graduates with over $200,000 in debt.
  • 70% of doctors now work as salaried employees of large hospital systems or corporate entities.
  • Younger doctors realize they will have less control over their working conditions than their elders.
  • Medical residents at Stanford voted to form a union to advocate for better working conditions.
  • Residents from diverse backgrounds want a union to demand better working conditions and advocate for patients.
  • Private equity firms often control the delivery of health services through doctor ownership on paper while retaining control over employment terms and patient rates.
  • A lawsuit aims to prohibit private equity firms from controlling healthcare delivery by transferring ownership to doctors on paper.
  • Some doctors start direct care practices where patients pay a monthly fee for personalized care without administrative interference.

The Direct Care Model and its Challenges

29:15 - 31:05

  • Direct care model aims to rebuild trust and establish a normal relationship between physicians and patients.
  • Many doctors struggle to attract enough patients, especially specialists who rely on referrals from primary care doctors.
  • Some doctors choose to leave the profession due to frustrations and injustices of the healthcare system.
  • Doctors running direct care practices still face challenges and cannot fully escape the flaws of the healthcare system.
  • A patient experienced a severe allergic reaction due to an insurer switching his ulcer medication without coverage.
  • The appeal process for the medication change took 30 days, putting the patient in danger.