What Happened to the Care in Healthcare?
When you walk into a doctor’s office, you expect more than a diagnosis. You expect compassion, understanding, and the assurance that someone is truly listening. At its heart, healthcare is supposed to be about people . . . the relationship between a provider and a patient, rooted in trust and humanity.
But for millions of Americans today, that expectation is rarely met. Instead of feeling cared for, patients feel like numbers on a spreadsheet. Instead of practicing medicine as a calling, providers feel like factory workers racing a clock. Somewhere along the way, “care” has been buried under bureaucracy, profit, and impossible demands.
The Patient Experience: Numbers, Not Names
Let’s start where healthcare begins . . . with patients.
Maria, a 52-year-old teacher, waited weeks for her appointment. She sat for nearly an hour in the waiting room, then another 20 minutes in the exam room before her provider entered. The visit lasted less than 10 minutes, dominated by the computer screen. Her fatigue was brushed aside, her labs came back “normal,” and she was told to follow up months later. Two months after that, she collapsed at work from advanced heart disease.
James, a 38-year-old father of two, endured worsening stomach pain for months. When he finally got an appointment, he felt rushed and dismissed. The provider assumed stress and wrote a prescription for antacids. Months later, James was diagnosed with stage III colon cancer. “It wasn’t that the doctor didn’t care,” he reflected. “It was that he didn’t have the time to care.”
Angela, a 67-year-old widow managing diabetes, keeps her appointments faithfully. Yet she says the hardest part is not the medications or the finger sticks, but the feeling of being invisible. Each visit is reduced to lab numbers and refill checkboxes. “I feel like I disappear in there,” she said.
These stories aren’t just random flukes, they’re part of the everyday reality of healthcare. They illustrate the lived reality of a system that prioritizes throughput over presence.
Data backs this up:
The average physician appointment wait time in major U.S. cities now stands at 31 days, a 19% increase since 2022, and 48% since 2004 (source).
Even where patients have a regular primary care source, average wait times linger around 20.6 days (source).
The Provider Experience: From Healer to Data Clerk
If patients feel like numbers, providers often feel like machines.
Doctors, nurses, and nurse practitioners describe their days as “running a marathon in sprints.” A single primary care physician may see 20 to 30 patients a day. In between, there are phone calls, lab reviews, inbox messages, and an avalanche of insurance forms.
Instead of practicing medicine, many providers feel trapped in documentation. Studies show that physicians now spend more time than ever in the electronic health record (EHR):
In primary care, physicians typically spend 36.2 minutes per visit on the EHR, including 6.2 minutes of after-hours “pajama time” and 7.8 minutes managing inbox messages (source).
Ambulatory physicians overall may spend 2.7 hours of personal time per eight-hour clinical session working in the EHR (source).
Some studies show that primary care docs spend more than half their workday, nearly 6 hours, interacting with the EHR during and after clinic hours (source).
The result? Notes are finished late at night, long after dinner, in what’s come to be called “pajama time.”
Burnout is alarmingly high. Though recent numbers show improvement, the toll remains significant:
In early 2025, 45.2% of physicians reported at least one symptom of burnout, down from 62.8% in 2021 (source).
Another measure showed 43.2% in 2024, the lowest since the COVID-19 public health emergency (source).
Yet even with these declines, physician burnout remains higher than the general workforce (39.5% vs. 24.6%) (source).
The Business of Medicine: From Care to Commodity
To understand why this happens, we must look at the structure of American healthcare.
It’s now the largest sector of the U.S. economy, costing trillions, yet Americans often fare worse on basic health outcomes compared to other developed countries.
A major reason? Administrative costs. These account for a significant share of healthcare spending:
Estimates range from 15% to 30% of total U.S. health spending (source).
In hospital systems, administrative costs alone may exceed 40% of total operating expenses (source).
Other analyses estimate nearly $1 trillion annually is spent on administrative activities (source).
Instead of resources flowing toward direct care, large portions are siphoned into billing, coding, compliance, and corporate overhead. Hospital executives and insurance companies reap growing profits while frontline providers are stretched thin.
The Insurance Trap
Perhaps no single force illustrates the distortion of care more than the insurance industry.
For providers, insurance dictates how care is delivered. Every test must be justified, every prescription coded, every visit documented in ways that satisfy auditors rather than patients.
For patients and providers, this translates into delays, and sometimes danger:
Insurers denied 19% of in-network claims, and 37% of out-of-network claims in 2023 (source).
The average denial rate across ACA marketplace plans was 20% of all claims (source).
Denials led to “serious adverse events” in nearly 29% of cases, including hospitalizations or worse (source).
Nurse practitioners also face disparity. Despite providing care equal in quality to physicians, they are often excluded from contracts or reimbursed at lower rates, limiting access and sustainability for NP-led clinics.
Between Shortage and Surplus: A Misaligned Workforce
The U.S. faces a looming physician shortage:
The AAMC projects a shortfall of up to 86,000 physicians by 2036 (source).
HRSA projects a primary care shortage of 68,020 FTEs by 2036 (source).
In 2025, about 63% of physicians said there aren’t enough qualified doctors to fill openings, especially in primary care (source).
Meanwhile, the nurse practitioner workforce continues to expand rapidly, with more than 385,000 licensed NPs in 2023, with nearly 90% trained in primary care (source). By mid-decade, they are expected to make up nearly one-third of primary care providers nationwide (source).
Yet systemic barriers, such as insurance credentialing, reimbursement practices, and restrictive regulations prevent many NP-led practices from fully filling the gap.
Technology: Help or Hindrance?
Technology was meant to be the tool that enhances care, yet it often detracts.
EHRs were supposed to improve coordination, safety, and access. Telehealth promised to expand reach.
But reality looks different: providers spend more time clicking boxes than engaging with patients. The screen becomes a barrier. “Pajama time” has become normalized.
Ultimately, too often, these technologies serve insurers and administrators, not the patient.
The Human Cost
The impact is deeper than inconvenience:
Patients delay or avoid care because the process feels dehumanizing or exhausting; nearly 1 in 4 Americans report skipping needed medical visits due to barriers (source).
Providers leave the profession early, fueling shortages.
Trust in the system erodes, making people less likely to follow treatment plans or preventive care.
The hidden cost? Not just dollars, but dignity.
Reclaiming the Care: Models of Hope
Despite the challenges, there are glimmers of light:
Direct Primary Care (DPC): Membership-based care eliminates insurance middlemen, restoring time and relationships.
Patient-Centered Medical Homes (PCMH): Team-based models distribute workload and emphasize coordination.
Telehealth done right: Virtual visits supplement in-person care, improving access.
NP-led practices: Where permitted, these clinics excel in patient satisfaction and outcomes by prioritizing listening and prevention.
The underlying theme: time and listening rebuild trust and transform care.
The Path Forward
Fixing healthcare will require transformation at multiple levels:
Systemic: Reform reimbursement, reduce administrative waste, dismantle insurance practices that hinder access.
Cultural: Value presence and compassion over busyness.
Personal & Community: Patients advocate, providers push for change, communities demand accountability.
Most of all, we need courage to admit the system is failing, and to demand something better.
A Call to Remember
So, what happened to the care in healthcare?
It wasn’t lost; it was buried under paperwork, profit motives, and productivity quotas. But it's still there, waiting to be rediscovered by reclaiming humanity in every encounter.
Because in the end, healthcare is not a business. It is the sacred act of one human being caring for another. And it’s time we started treating it that way again.
Michelle Brown, NP
Board-Certified Nurse Practitioner | Educator | Patient Advocate
Together, let’s grow in health and knowledge.
