Corporations and the Crisis of Care

[Celerity]

The U.S. suffers from a mass exodus of primary care doctors, as medical practice is dictated by corporate masters at the expense of physicians and patients.

https://prospect.org/2026/06/01/corporations-and-crisis-of-care-primary-doctors-corporations/


Credit: Illustration by Sarah Angèle Wilson

Primary care physicians—internists, general practitioners, family doctors, and pediatricians—are the key point of patient contact with the medical system. They have been leaving the medical profession in droves because their conditions of practice have become intolerable. These doctors are being pressured to see more patients in shorter appointments despite ever more complex cases and treatment options, even as they are required to spend more time at computer terminals entering patient data. One recent paper in the Journal of General Internal Medicine calculates that primary care doctors, to meet all of their clinical and clerical obligations, would literally need to work 26.7 hours a day.

Doctors find themselves working evenings and weekends to catch up with administrative work. My own internist typically responds to questions via the hospital’s “Patient Site” at about 2 a.m. Some doctors compensate by nominally going part-time, but often work full-time for half pay to keep up with the demands. Others take early retirement or move to boutique “concierge” practices, where they can conscientiously care for affluent patients who pay out of pocket. A fine internist I know, still in her forties, prized her work and her patients but could not take the pressure anymore. She quit to go to work for an insurance company reviewing claims. The result of this exodus is even more pressure on doctors who remain, worsening the cycle. The U.S. is now said to be short at least 20,000 primary care physicians, but one recent study found that the shortage would rise to 208,000 if all Americans had good health insurance.

In Boston, site of several world-class teaching hospitals, a study found that as of 2020, one-third of primary care doctors are over 60. As older primary care doctors retire, they are not being replaced. Young residents get a close look at their exhausted and demoralized mentors when they do primary care rotations, and most opt for other less taxing, more rewarding specialties. According to Dr. Wayne Altman, chair of family medicine at Tufts Medical School, when residents and hospitals did their annual matchup for new doctors in March, just 3.9 percent of incoming physicians chose family medicine. He told me, “They look at us and say, you are doing the Lord’s work and good luck to you.” What is driving this syndrome, and what might fix it? I spoke to more than 30 of the people who have given this question the most careful attention, including former heads of Medicare and Medicaid, hospital CEOs, and leading health policy researchers. I read numerous studies and interviewed several primary care doctors. The story is both simple and complicated.

At the 30,000-foot level, one can view a collision of several separate factors, all of which add up to more pressure on primary care doctors. As I wrote in an investigative piece for the Prospect on Epic Systems, the near-monopoly vendor of electronic databases for hospitals, the system has become a time sink. Doctors, especially primary care doctors, are required to enter scads of data after each patient visit. The computer will not let the doctor proceed until every question is answered. One study found that physicians spend two hours entering data for every hour with patients. The purpose is less clinical than commercial. Under rules laid out by Medicare, more than half a century ago, patient visits and procedures get elaborate codes called CPT codes that in turn dictate payments. Epic facilitates upcoding, so that hospitals can squeeze out maximum reimbursements from private insurers (or so Medicare Advantage insurers, which many doctors work for, can overbill the government). “Doctors—highly trained professionals—are reduced to performing clerical and administrative tasks,” says Dr. David Bor of Cambridge Health Alliance.

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