My view on the problems in healthcare today
In my first few months of medical school, I kept hearing the same sentence over and over—from doctors, nurses, even administrators:
"The healthcare system is broken."
At first, I thought this was just casual pessimism or burnout talking. But the longer I've spent in medicine—and simultaneously in entrepreneurship and technology—the more I've realized that healthcare isn't randomly dysfunctional. It’s predictably dysfunctional, structured in ways that consistently produce poor outcomes.
But why exactly does healthcare feel broken? And, more importantly, how can we fix it?
The fundamental reason healthcare feels broken is actually simpler than most people realize: incentives in healthcare are systematically misaligned.
The Concept at the Core
When people say "healthcare is broken," they usually mean that patients, physicians, and hospitals are all frustrated, burned out, and operating in ways that seem irrational. But these frustrations aren't accidental. They’re symptoms of deeper structural problems:
- Patients want affordable, high-quality care that improves their long-term health.
- Physicians want autonomy, meaning, efficiency, and the ability to genuinely help their patients.
- Hospitals and healthcare institutions want stable revenues, manageable risk, and compliance with regulatory metrics.
At first glance, none of these goals seem unreasonable. But the underlying incentives that guide behavior within healthcare almost never align with these goals simultaneously. Incentives shape how people behave, often even without realizing it. When incentives are misaligned, even well-intentioned people produce suboptimal or outright irrational outcomes.
This isn't unique to healthcare. Misaligned incentives cause dysfunction everywhere—from business to politics. But healthcare is particularly vulnerable because misalignment directly affects human wellbeing.
A Concrete Example
Consider a practical example from my own medical school experience:
Physicians are routinely required to spend enormous amounts of time documenting patient encounters. On the surface, documentation seems obviously good—detailed records help patient safety, continuity of care, and medical accountability.
But here's the hidden incentive misalignment:
- Hospitals and clinics often require highly detailed documentation primarily because that's how they bill insurance effectively and maximize reimbursement. The more detailed the documentation, the more defensible the billing codes.
- Physicians, however, aren’t paid for time spent documenting—they’re paid primarily for patient encounters. Excessive documentation reduces their time available for actual patient care, eroding the very purpose that drew them into medicine.
- Patients, meanwhile, experience rushed visits, distracted doctors, and less personalized care because their physician is stuck behind a computer optimizing billing codes instead of clinical outcomes.
This simple example highlights a profoundly misaligned incentive: physicians must optimize for billing, not care. Predictably, frustration, burnout, and worse patient outcomes result.
How Can We Fix Misaligned Incentives?
Once you clearly see incentive misalignment, the question becomes: How do you realign incentives in a structurally sustainable way?
There are no easy answers, but there are a few practical solutions we can prioritize immediately:
1. Shift Payment Models From Volume to Value
Today’s "fee-for-service" model pays physicians and hospitals based on how many procedures and visits they perform. Naturally, this incentivizes quantity over quality.
Moving toward value-based care models—paying for outcomes rather than volume—realigns incentives clearly and directly. Physicians can finally optimize patient health outcomes, rather than the number of procedures billed. While value-based care isn’t perfect and comes with its own complexity, its fundamental direction aligns incentives far more clearly than the status quo.
2. Prioritize Physician Autonomy and Clinical Judgment
Many frustrations arise because highly-trained clinicians feel stripped of autonomy by bureaucratic processes aimed primarily at compliance or reimbursement.
When physicians lose autonomy, burnout spikes. Patient care suffers. To realign incentives, hospitals and policymakers must explicitly prioritize clinical judgment. Protocols and checklists have their place, but trusting physician judgment—backed by appropriate accountability—improves both patient outcomes and physician satisfaction.
3. Use Technology to Enable Care—Not Just Billing
Electronic Health Records (EHRs) today optimize primarily for billing and compliance. Physicians spend hours clicking through billing codes rather than truly focusing on patients.
As someone deeply involved in technology and entrepreneurship, I see clearly how dramatically software can improve productivity, patient communication, and clinical decision-making. We need EHRs and tech systems designed explicitly around physicians’ workflow and patient care—not simply around billing codes.
4. Make Pricing and Outcomes Transparent
Healthcare is one of the only major industries where consumers (patients) have virtually no visibility into pricing or quality until after receiving care.
Transparent pricing and clear outcome metrics would immediately pressure healthcare providers to align their incentives around quality, cost-effectiveness, and efficiency. This transparency would empower patients and reward providers who deliver genuine value.
Why I Chose Medicine (despite these misaligned incentives)
Given these systemic problems, why do I still believe medical school was the right choice?
Because medicine provides uniquely powerful leverage for realigning these broken incentives at scale. Yes, healthcare feels broken, but precisely because it’s so deeply important and complex, any genuine improvements generate massive human impact.
This is the opportunity behind the frustration.
My dual lens—entrepreneurship and medical training—clarifies something powerful: Medicine itself isn't broken; it's the incentives and structures around medicine that are broken. Those incentives and structures are human-designed—which means they're human-changeable.
Physicians, especially physician-leaders and physician-entrepreneurs, have enormous leverage to realign incentives clearly, ethically, and strategically. By deeply understanding both the system’s dysfunction and potential solutions, we can become uniquely positioned to improve healthcare from within.
Final Thoughts
To health-tech founders, patients, future colleagues, or others within healthcare reading this: Misaligned incentives aren’t inevitable. They’re problems of design, not destiny. Recognizing misalignment clearly is the first step toward fixing it systematically.
Clearly understanding why healthcare feels broken also makes clear how we can meaningfully fix it—and why doing so matters immensely.
Healthcare doesn’t have to stay broken. We just need the clarity, strategy, and the courage to realign the incentives at its heart.
That’s precisely the work I intend to do.
— Ali