What is mine to do?
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September 29, 2026
I had the pleasure of attending the ABIM Foundation Forum this summer in beautiful Vermont. For several days, I was surrounded by people deeply committed to thinking differently about American health care. We listened, debated, and wrestled with some of the most difficult problems facing our profession and our health care system. I left inspired, with a renewed sense of what the House of Medicine can accomplish when we come together to think beyond the boundaries of our individual roles.
Then I returned to Washington, D.C., where the contrast was hard to miss.
A nearby hospital announced a downsizing of postpartum services. An academic institution was grappling with for-profit ownership. A local physician group, managed by private equity, asked its physicians to see more patients, faster. A new hospital had recently opened in an underserved part of the city amid considerable volatility and uncertainty.
Each of these situations has its own context. None can be reduced to a single explanation. Yet together, they felt like manifestations of a larger question: What happens when the structures we build to promote health seem to be serving a different purpose?
As I followed these local stories, I found myself thinking about a tabletop exercise from the second day of the Forum.
We were asked to consider the medical profession’s influence on the public and, within that context, to develop an approach to solving a health care problem. At my table were people from different corners of the health care system, at different stages of their careers, and with different professional experiences.
We chose a familiar problem: the many “lacks” of primary care. Lack of access. Lack of physicians. Lack of reimbursement. Lack of adequate infrastructure.
We agreed that these were problems worth solving. Where we disagreed was where the problem began—and therefore what should be done about it.
We spent much of our time in friendly debate over root causes and possible solutions. At first, it seemed as though we were failing to reach consensus. But as the conversation unfolded, I realized that something else was happening.
We were all right.
Or, more precisely, we were each seeing something we could best appreciate from where we individually stood.
Our professional roles, experiences, and histories had given us different lenses. Each of us had developed expertise in one part of a complicated system. A student saw one set of barriers. The academic another. The community representative yet another. None of those perspectives was wrong, yet none of these perspectives offered a solution sufficient on its own.
The problem was not that we could not identify a single solution. The problem was believing that a problem this complex would have one single solution.
I have often hoped that a large organization, a new regulation, a court decision, or a government agency will eventually solve the problems we see in health care. It seems logical to believe that large systems will require large structural solutions.
But the tabletop exercise made me wonder: if a small group of people who care deeply about the same problem, and who are willing to spend two days talking about it, cannot agree on a singular solution, why would we expect a large, complex bureaucracy to produce one for us?
Perhaps the more productive question is not, “Who is going to fix health care?” but rather, “What is mine to do?”
Last week I was talking with a friend who leads a large physician practice that had recently been acquired by private equity. We discussed a physician workforce strike in Minnesota, and the frustrations physicians were experiencing in a changing health care environment. My friend recognized that frustration and noted they had never advocated because they did not know whom to talk to or what to say.
How many physicians feel this way?
Disempowered. Frustrated. Concerned about the direction of medicine, but uncertain about how to influence it.
Perhaps a small part of the problem is that we were never taught advocacy in medical school. We learn how to diagnose disease, interpret evidence, manage uncertainty, and care for individual patients. We learn remarkably little about how health care systems are constructed, how policy is made, or how to participate in shaping it.
But my friend understands payer models through real world practice management. After two decades in practice, they understand why the needs of patients and physicians aren’t reliably met. They understand the consequences of organizational decisions because they make them. Most importantly, they care deeply about the people entrusted to their care.
Who better to advocate?
Advocacy does not have to mean becoming a policy expert or having deep knowledge of every problem in American medicine. It means we can acknowledge that from our particular place in medicine we are able to see part of the system—and we are experts from that vantage point.
Physicians can advocate for individual patients and for the conditions that allow them to care for patients well.
Health system leaders can consider who benefits from changes in the institution and who bears the costs.
Researchers and educators can make visible the consequences that might otherwise remain hidden.
These responsibilities are not interchangeable. Nor are they sufficient on their own. But each is a place to begin.
The lesson I took from that tabletop exercise in Vermont was not that we need to find the one person with the right answer. We can’t repair American health care alone; the problems are too large and the perspectives too varied.
We need people who can see different parts of the problem—and who are willing to speak and act from where they stand.
We all have a lane.
A health care system is a tool, and tools should serve the people who use them. It is reasonable to ask whether the system is serving its purpose. It is necessary to speak up when it is not. Not to ask, “Who will fix this?” but, “What can I see from where I stand, and what am I going to do about it?”
