Imagine you are 16 years old and have just passed both your written and road tests. After months of study and practice, you have earned the privilege of driving. You work a minimum-wage job to pay for a used car and insurance, and you are excited to take your high school sweetheart out on a beautiful summer weekend.

Before leaving, however, you must call your insurance company for prior authorization to drive.

After a lengthy wait, multiple transfers, and repeated verification of your identity and qualifications, a representative finally answers. The representative informs you that you may drive only within a 20-mile radius of your home and that you are not allowed to stop for a meal during the date. The restrictions seem arbitrary and disconnected from reality. Frustrated and discouraged, you decide it is not worth the hassle. Instead of enjoying your evening, you stay home.

As unrealistic as this scenario sounds, it closely resembles the experience many physicians face every day.

I am a practicing family physician, and this analogy reflects a growing problem within the American health care system.

Becoming a physician is one of the longest and most demanding educational journeys in any profession. It begins with four years of undergraduate education, during which students’ complete rigorous prerequisite coursework while competing for admission to medical school. Those fortunate enough to gain acceptance then face another four years of intensive medical education.

The journey is physically, emotionally, and financially demanding. Medical students spend countless nights studying, sacrifice holidays and weekends, and often graduate with hundreds of thousands of dollars in educational debt. Despite these challenges, they persevere because of a commitment to helping others and improving lives.

For many physicians, graduation from medical school is only the beginning. Residency training follows and often requires between 12,000 and 15,000 hours of supervised clinical experience. Residents work long shifts, respond to emergencies at all hours, and spend years refining their clinical judgment under the supervision of experienced physicians.

Few professions require individuals to leave the comfort of their homes in the middle of a winter night, drive through dangerous weather conditions, and report to work because another human being urgently needs help. Physicians do so routinely because they recognize their responsibility to patients.

This dedication is rooted in the principles of the medical profession. Physicians pledge to place patients’ interests first, uphold ethical standards, and deliver care based on the best available evidence. The trust that society places in physicians is built upon years of training, demonstrated competence, and an unwavering commitment to patient well-being.

Yet even after completing this demanding journey, earning a medical license, obtaining board certification, and demonstrating competency through institutions accredited by organizations such as the Liaison Committee on Medical Education (LCME), the Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS), physicians frequently encounter barriers that limit their ability to care for patients.

A physician may determine that a patient needs a specific medication, imaging study, or procedure. However, before treatment can proceed, an insurance company may require prior authorization. In many cases, the physician must spend valuable time completing paperwork, making phone calls, and justifying a clinical decision to individuals who have never examined the patient.

The result is delayed care, increased frustration, and unnecessary administrative burden.

These challenges extend beyond prior authorization. Independent medical practices face increasing financial and regulatory pressures. Physicians may spend hours each week navigating insurance requirements, appealing denials, and addressing technical coverage restrictions. A medication may be denied simply because the insurer covers the capsule formulation but not the tablet formulation. Such distinctions rarely improve patient outcomes, yet they consume time and resources that could otherwise be devoted to patient care.

Faced with mounting administrative burdens, many physicians choose to close or merge their independent practices with larger hospital systems. While this decision may provide financial stability, it often comes at the cost of clinical autonomy.

Family Physicians may find themselves unable to continue caring for patients they have treated for years. Clinical services that were once provided conveniently in a family physician’s office, such as joint injections, skin biopsies, or cervical cancer screenings, may now require referrals to specialists. Patients who previously received comprehensive care during a single office visit may face weeks or even months of additional waiting for appointments elsewhere.

These delays can contribute to missed diagnoses, disease progression, preventable complications, and increased health care costs. Ironically, while physicians often have less control over the delivery of care, they may still bear professional and legal responsibility for poor outcomes.

The consolidation of health care does not stop there. Increasingly, hospitals and physician groups are being acquired by large corporate entities and private equity firms. While investment and innovation can play an important role in health care, concerns arise when financial priorities overshadow patient care.

A commonly cited private equity strategy is to acquire an organization, reduce expenses, maximize financial returns, and eventually sell the asset. In health care, this may result in the closure of essential community services that are less profitable, such as obstetrics, pediatrics, psychiatric care, or rural hospital programs. Communities can suddenly find themselves with fewer health care options despite increasing need.

This is not a hypothetical concern. Across the country, patients, physicians, nurses, and hospital administrators have witnessed growing strains on the health care system. The COVID-19 pandemic further exposed vulnerabilities, including workforce shortages, limited access to care, supply chain disruptions, and disparities in health outcomes.

Despite these challenges, America has made remarkable progress in medicine. Advances in vaccination, antibiotics, diagnostic testing, surgery, and chronic disease management have dramatically increased life expectancy and improved quality of life. These achievements should not be taken for granted.

The question facing policymakers is how to preserve and strengthen these gains while ensuring that health care remains accessible and affordable.

We need comprehensive payment reform. A single payment model may be the solution!

Rather than navigating a fragmented system characterized by multiple premiums, deductibles, and administrative hurdles, Americans could contribute through a simplified, income-based structure. Under such a model, patients would make a single predictable contribution toward health care coverage, while maintaining competition among healthcare organizations responsible for delivering care.

Regardless of the specific policy approach, any meaningful reform must place patients at the center of the conversation. Insurance companies, pharmaceutical manufacturers, hospital systems, physicians, and policymakers all share responsibility for creating a system that prioritizes high quality, safe, convenient, and timely healthcare access over administrative complexity and financial incentives.

The future of American health care depends on our ability to align incentives with patient needs. Physicians should be active participants in shaping reform, but patients must remain the focus. A health care system succeeds not when corporations, insurers, or institutions prosper, but when patients receive timely, affordable, and high-quality care.

Khuram Ghumman, MD is a family physician practicing in East Granby.