Will You Become Part of the Problem?
A Letter to the Next Generation of Health Professionals
You’re a premed student. Or a nursing student. Or studying health administration or public health.
You chose this path because you want to care for people. You want to make a difference. I’m an ER doctor, and so did I. The human body is fascinating. The science is thrilling. And the stakes couldn’t be higher.
But there’s a problem.
You already know the system is broken. You’ve seen the paperwork outweigh the people-work. You’ve seen racial and economic inequities that don’t budge. You’ve heard clinicians grumble in the halls about how the system gets in the way. And you’ve watched brilliant teachers prepare students to enter institutions that reward volume over value, compliance over curiosity, and control over collaboration.
You’re smart and driven. You’ll rise through the system.
But will you change it—or become part of the problem?
The Hidden Curriculum
There’s the official curriculum: the Krebs cycle, the history of Medicaid, the steps of quality improvement. And then there’s the hidden curriculum: don’t ask too many questions. Don’t rock the boat. Learn how the system works, then work around it.
The hidden curriculum trains students not to fix what’s broken, but to function in what’s broken. It turns idealists into survivalists. Over time, the most well-meaning trainees find themselves adapting so efficiently to dysfunction that they lose sight of why they entered this work in the first place.
This isn’t your fault. It’s structural.
Meanwhile, the System Is in Crisis
Today’s health system isn’t just flawed—it’s unraveling in real time:
Metabolic syndrome and its downstream consequences—heart disease, stroke, diabetes—are now the norm, not the exception. We treat complications instead of addressing root causes like nutrition, policy, and culture.
Mental health care is overwhelmed, under-resourced, and often siloed from physical health—despite being inseparable from it.
Medical bankruptcies still affect hundreds of thousands of Americans every year—something nearly unheard of in peer nations.
Clinician burnout is rising, driven by documentation overload, moral injury, and misaligned incentives.
AI is being deployed rapidly, often without ethical guardrails or serious discussion of its impact on relationships, trust, and health equity.
After recent HHS layoffs, rising distrust, and politicized ACIP replacement, the risk of deepening inequity and profit-driven care is real.
You’re entering this landscape. It will shape you. But it doesn’t have to define you.
What If the System Is the Patient?
If more than 80% of health outcomes are determined by social and structural factors—not medical care—then the most impactful intervention might not be a treatment, but a transformation (McGinnis et al., 2002).
Most of our institutions—from the Flexner Report to the insurance industry to the employer-based coverage model—were built in the late 1800s through mid-1900s. They were designed to solve the problems of that era: infectious disease, fragmented care, and a lack of clinical standards.
But those assumptions no longer serve us. We’ve optimized for billing codes and throughput, not health. For standardization, not adaptability. For credentialism, not community.
Systems Thinking as Core Curriculum
If we want health for all at the lowest possible cost, we need a fundamentally different approach—one rooted in complex adaptive systems thinking.
That means:
Embracing uncertainty and emergence
Prioritizing trust, relationships, and community-based knowledge
Rewarding learning and feedback, not just control and compliance
Measuring success by well-being, not volume
And we need to include students.
We must teach future health professionals to see the system. To understand incentives, power structures, and feedback loops. To spot failure points—and experiment toward better designs. Not someday, but now.
What You Can Do Now
Ask better questions: Who benefits from this system? What assumptions is this model built on? What are the unintended consequences?
Study systems thinkers like Donella Meadows, Atul Gawande, and many others.
Join communities that don’t normalize dysfunction. A few starting points:
Primary Care Progress
Students for a National Health Program (SNaHP)
Health Leads
Doctors for America
People’s Health Movement / Campaign Against Racism
Reflect regularly: What kind of system am I preparing to serve—and shape? Everything must be on the table. Except health for all at the lowest cost.
We need clinicians, administrators, and public health leaders who can hold both truths: that the system works as designed, and that the design no longer serves us.
You’re entering the system. But you don’t have to become it.
About me and this post: I’m an ER doctor and writer exploring how to transform our health system. These (nearly) daily posts are part of that imperfect journey, created with AI assistance. I welcome questions, corrections, and better ways to get it right.