Advertisement - Members don't see this ad
Perspectives > Second Opinions
In Our Dog-Eat-Dog Medical Culture, Physicians Lose
— Our mindset enables other healthcare stakeholders to consolidate power
by Santoshi Billakota, MD
June 13, 2026 • 4 min read
Santoshi Billakota, MD, is a board-certified neurologist and epileptologist who lives and works in Brooklyn. She is currently a full-time locums physician, and co-host of the "Be Empowered" podcast, which focuses on pertinent issues in healthcare, specifically concerning women. You can follow her on social media at @drbillakotamd (IG and TikTok).
For years, physicians have voiced the same frustrations: declining reimbursement, increasing administrative burden, private equity infiltration, insurance company control, expanding scope creep, artificial intelligence (AI) anxiety, and healthcare policies created by people far removed from patient care. Doctors complain online, in hospital lounges, in group chats, and at conferences. Despite these shared grievances, physicians remain one of the least unified professional groups in the country. The deeper issue is that medicine has created a culture fundamentally incompatible with collective action.
Physicians are trained to compete, not collaborate; to individualize success, not organize around shared interests. And many see themselves as exceptional individuals rather than members of a working class. As a result, while every other stakeholder in healthcare consolidates power, physicians continue to fracture into smaller and smaller groups divided by specialty, prestige, age, politics, training pedigree, compensation models, and ego.
This conditioning starts early. Medicine selects for achievement long before medical school begins. The path rewards those who outperform others academically: top grades, top MCAT scores, research publications, honors societies, board scores, fellowships, and elite institutions. The system identifies people who are extraordinarily disciplined, intelligent, and high-achieving, but it does not necessarily select for emotional intelligence, humility, communication, collaboration, or coalition-building.
From the very beginning, future physicians are conditioned to see peers as competitors. There are limited spots in medical school, residency, and fellowship. Limited attending jobs in desirable cities and specialties. Every stage reinforces scarcity, comparison, and competition. Students are ranked against classmates. Residents are evaluated against co-residents. Attendings compare productivity metrics, publications, salaries, and titles. This mentality has become embedded in the profession itself.
Even when physicians face shared threats, many instinctively turn on each other rather than the systems creating the problem. Primary care blames specialists. Specialists blame administrators. Older physicians criticize younger physicians. Employed doctors criticize private-practice doctors. Academic physicians dismiss community physicians. Physicians debate endlessly over who works harder, who sacrificed more, and who deserves more compensation.
In the end, everyone loses. It is difficult to imagine physicians mounting a unified response to healthcare corporatization when many cannot even agree on whether burnout is real, whether younger physicians deserve work-life balance, or whether asking for protected maternity leave reflects weakness. One of the clearest examples of this dysfunction is the pervasive "back in my day" mentality throughout medicine. Senior physicians who endured abusive training environments often minimize the struggles of younger doctors instead of advocating for reform.
Meanwhile, outside entities continue consolidating power. Insurance companies dictate patient care through prior authorizations and reimbursement models. Hospital systems acquire independent practices. Private equity firms purchase clinics and staffing groups. Policymakers create regulations with minimal physician input. AI companies develop diagnostic and workflow tools that may eventually reshape clinical labor. To many of these organizations, physicians are no longer autonomous professionals. They are labor costs.
Physicians still possess enormous influence if they can overcome the culture that divides them. The first step is redefining professionalism. Physicians must stop equating self-sacrifice with virtue and recognize that advocating for sustainable working conditions ultimately protects patients as well. Burned-out, overworked clinicians do not create safer healthcare systems.
Second, medicine must move away from hierarchy-driven training models that normalize humiliation, fear, and endless competition. The best physician is not simply the smartest person in the room, but the one capable of building trust, leading teams, communicating effectively, and advocating for patients and colleagues alike.
Third, physicians need stronger collective organization. That does not necessarily mean every doctor must unionize -- legally, some physicians, such as employed physicians working for hospitals or healthcare systems, can unionize, while others face more complicated restrictions. And culturally, unionization remains deeply uncomfortable for many physicians. But physicians can still abandon the belief that individual success alone can protect physicians from systemic forces. Collective advocacy around reimbursement reform, staffing standards, scope of practice, physician autonomy, and healthcare policy is essential.
In medicine, physicians often hesitate to advocate for themselves because they fear appearing selfish, political, or unprofessional. Meanwhile, nursing organizations and physician assistant leadership have often demonstrated far greater collective cohesion and advocacy. Whether one agrees with all of the organized group's policy goals or not, they understand something physicians frequently resist acknowledging: organized groups hold power. Fragmented individuals do not.
Physicians need to reclaim leadership in healthcare. Too often, medicine has ceded decision-making authority to administrators, insurers, consultants, and investors. Physicians must participate not only in clinical work, but also in policy, business, labor organization, technology development, and healthcare reform. Medicine cannot survive as a profession built entirely around individual achievement while external forces operate through organized power structures. It's time to support and uplift our fellow physicians.
In Our Dog-Eat-Dog Medical Culture, Physicians Lose
— Our mindset enables other healthcare stakeholders to consolidate power
by Santoshi Billakota, MD
June 13, 2026 • 4 min read
Santoshi Billakota, MD, is a board-certified neurologist and epileptologist who lives and works in Brooklyn. She is currently a full-time locums physician, and co-host of the "Be Empowered" podcast, which focuses on pertinent issues in healthcare, specifically concerning women. You can follow her on social media at @drbillakotamd (IG and TikTok).
For years, physicians have voiced the same frustrations: declining reimbursement, increasing administrative burden, private equity infiltration, insurance company control, expanding scope creep, artificial intelligence (AI) anxiety, and healthcare policies created by people far removed from patient care. Doctors complain online, in hospital lounges, in group chats, and at conferences. Despite these shared grievances, physicians remain one of the least unified professional groups in the country. The deeper issue is that medicine has created a culture fundamentally incompatible with collective action.
Physicians are trained to compete, not collaborate; to individualize success, not organize around shared interests. And many see themselves as exceptional individuals rather than members of a working class. As a result, while every other stakeholder in healthcare consolidates power, physicians continue to fracture into smaller and smaller groups divided by specialty, prestige, age, politics, training pedigree, compensation models, and ego.
This conditioning starts early. Medicine selects for achievement long before medical school begins. The path rewards those who outperform others academically: top grades, top MCAT scores, research publications, honors societies, board scores, fellowships, and elite institutions. The system identifies people who are extraordinarily disciplined, intelligent, and high-achieving, but it does not necessarily select for emotional intelligence, humility, communication, collaboration, or coalition-building.
From the very beginning, future physicians are conditioned to see peers as competitors. There are limited spots in medical school, residency, and fellowship. Limited attending jobs in desirable cities and specialties. Every stage reinforces scarcity, comparison, and competition. Students are ranked against classmates. Residents are evaluated against co-residents. Attendings compare productivity metrics, publications, salaries, and titles. This mentality has become embedded in the profession itself.
Even when physicians face shared threats, many instinctively turn on each other rather than the systems creating the problem. Primary care blames specialists. Specialists blame administrators. Older physicians criticize younger physicians. Employed doctors criticize private-practice doctors. Academic physicians dismiss community physicians. Physicians debate endlessly over who works harder, who sacrificed more, and who deserves more compensation.
In the end, everyone loses. It is difficult to imagine physicians mounting a unified response to healthcare corporatization when many cannot even agree on whether burnout is real, whether younger physicians deserve work-life balance, or whether asking for protected maternity leave reflects weakness. One of the clearest examples of this dysfunction is the pervasive "back in my day" mentality throughout medicine. Senior physicians who endured abusive training environments often minimize the struggles of younger doctors instead of advocating for reform.
Meanwhile, outside entities continue consolidating power. Insurance companies dictate patient care through prior authorizations and reimbursement models. Hospital systems acquire independent practices. Private equity firms purchase clinics and staffing groups. Policymakers create regulations with minimal physician input. AI companies develop diagnostic and workflow tools that may eventually reshape clinical labor. To many of these organizations, physicians are no longer autonomous professionals. They are labor costs.
Physicians still possess enormous influence if they can overcome the culture that divides them. The first step is redefining professionalism. Physicians must stop equating self-sacrifice with virtue and recognize that advocating for sustainable working conditions ultimately protects patients as well. Burned-out, overworked clinicians do not create safer healthcare systems.
Second, medicine must move away from hierarchy-driven training models that normalize humiliation, fear, and endless competition. The best physician is not simply the smartest person in the room, but the one capable of building trust, leading teams, communicating effectively, and advocating for patients and colleagues alike.
Third, physicians need stronger collective organization. That does not necessarily mean every doctor must unionize -- legally, some physicians, such as employed physicians working for hospitals or healthcare systems, can unionize, while others face more complicated restrictions. And culturally, unionization remains deeply uncomfortable for many physicians. But physicians can still abandon the belief that individual success alone can protect physicians from systemic forces. Collective advocacy around reimbursement reform, staffing standards, scope of practice, physician autonomy, and healthcare policy is essential.
In medicine, physicians often hesitate to advocate for themselves because they fear appearing selfish, political, or unprofessional. Meanwhile, nursing organizations and physician assistant leadership have often demonstrated far greater collective cohesion and advocacy. Whether one agrees with all of the organized group's policy goals or not, they understand something physicians frequently resist acknowledging: organized groups hold power. Fragmented individuals do not.
Physicians need to reclaim leadership in healthcare. Too often, medicine has ceded decision-making authority to administrators, insurers, consultants, and investors. Physicians must participate not only in clinical work, but also in policy, business, labor organization, technology development, and healthcare reform. Medicine cannot survive as a profession built entirely around individual achievement while external forces operate through organized power structures. It's time to support and uplift our fellow physicians.
