Health Affairs January 12, 2026
Primary care is in crisis. Physicians are drowning in chronic disease management, working impossible hours for the lowest compensation among their peers. The New England Journal of Medicine recently explored this crisis in depth—the hierarchy within medicine, the impossible workload, the burnout. It paints a picture of a system we know is fundamentally flawed and unsustainable. But the essay has a glaring blind spot: It never questions organized medicine’s role in perpetuating the very crisis it laments.
The article examines structural and cultural forces that consistently devalues primary care, from reimbursement systems to hierarchies within medicine, yet it stops short of interrogating the professional monopoly that keeps these structures in place. It never considers the most straightforward pressure release: Let...
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