What's Actually Broken in U.S. Healthcare Right Now — And What Physicians Would Change First

American healthcare is not failing quietly. It is failing loudly, specifically, and repeatedly — in gastroenterology offices where medically necessary tests are denied without clinical justification, in psychiatric practices where documentation requirements have overtaken the therapeutic relationship, in oncology wards where guideline-concordant treatments wait on prior authorizations while patients wait on treatments. MedStory Studio spoke with eight physicians across seven specialties and asked them to name what's most broken, what they'd fix first, and what everyone outside medicine gets wrong. They did not reach for abstractions.

What emerged from those conversations was not eight separate critiques. It was one. A system that was designed around payment rather than patients, that has allowed administrative and financial machinery to override clinical judgment, and that — when it fails — consistently points the finger at physician behavior rather than system design. The problems are structural. So are the solutions.

Part One: What's Broken

Insurance Was Never Built for This

The most consistent diagnosis across every physician we spoke with — regardless of specialty, practice model, or geography — was the same: insurance has colonized parts of the healthcare system it was never designed to serve. Insurance was built to absorb catastrophic, unpredictable costs. It was not built to mediate the kind of routine, ongoing, relationship-based care that defines primary care, psychiatry, or chronic disease management. Yet that is exactly what the current system demands of it.

The result is a structural mismatch that produces friction at every level. Physicians spend time on prior authorizations instead of patients. Billing codes replace clinical judgment. Administrative intermediaries insert themselves between a doctor's recommendation and a patient receiving it. Dr. Michelle Cooke, a family medicine physician who left the traditional model entirely for direct primary care, frames it precisely:

"Insurance was never designed to cover everyday healthcare needs — it was meant to protect against catastrophic events. Yet today, we've built a system where even the most basic care is filtered through insurance."

— Dr. Michelle Cooke, Family Medicine

The consequences compound across specialties. In dermatology, Dr. Brooke Jeffy describes a drug approval process she no longer believes is accidentally difficult — one where redundancies, resubmissions, and unqualified reviewers exist not as bureaucratic inefficiency but as a deliberate mechanism to avoid paying claims. In gastroenterology, Dr. Omar Khokhar watches medically necessary interventions get rejected on financial grounds and reordered on appeal with the same documentation that was ignored the first time.

"Individuals are paying for a service, and that service is consistently denied. How much profit does an insurance company need to make at the expense of the common man and community hospitals?"

— Dr. Omar Khokhar, Gastroenterology

The Delivery Gap: When Medicine Outpaces Its Own Systems

Beyond the insurance layer, a second structural failure runs deeper still — one that Dr. Boyd Burns, an emergency medicine physician and Interim Dean at the University of Oklahoma, Tulsa, School of Community Medicine, identifies as the central problem in American healthcare today. The science is extraordinary. The delivery system is not keeping pace with it.

"We have extraordinary advances in medicine, but too often we still deliver care through a largely standardized system to people whose lives are anything but standardized. We create standardized plans and expect them to work equally well regardless of a patient's circumstances — but patients are not standardized. The diagnosis may be the same, but the delivery of care often needs to look very different."

— Dr. Boyd Burns, Emergency Medicine & Interim Dean, OUSCM

The gap between clinical knowledge and real-world delivery is where patients fall through. A patient managing diabetes while living in a food desert, struggling to afford insulin, without reliable transportation faces a fundamentally different path to wellness than someone with financial stability and a support network. The diagnosis is identical. The system's ability to meet both patients where they are is not.

The Administrative Burden Is a Clinical Problem

Beyond insurance denials, physicians across the board described a second, subtler failure: the way administrative burden has displaced clinical care as the dominant activity of a physician's day. This is not a complaint about paperwork. It is a clinical concern — because time spent on documentation, prior authorizations, and billing is time not spent on patients. And in specialties where the quality of the physician-patient interaction is the mechanism of care, that trade-off isn't inefficiency. It's harm.

In psychiatry, Dr. Jasmine Sawhney describes patients arriving already exhausted by the system — worn down by wait times, insurance barriers, and fragmented care — and sitting across from a physician who is simultaneously trying to be fully present while managing administrative demands in the background.

"It creates a quiet but pervasive erosion of care quality — not because physicians don't know what to do, but because the system makes it harder to do it well."

— Dr. Jasmine Sawhney, Psychiatry

In oncology, where delays are not scheduling inconveniences but clinical events with measurable consequences, Dr. Yan Leyfman describes a widening gap between the sophistication of modern treatment and the infrastructure available to deliver it. Medicine has developed extraordinary precision. The systems surrounding it have not kept pace.

"Delays and fragmentation are not abstract system failures — they directly influence treatment timelines, access to therapies, and ultimately patient outcomes."

— Dr. Yan Leyfman, Oncology

The Patients Who Need Care the Most Can Access It the Least

The shortage of primary care physicians is not an abstraction. It has a face — and that face belongs to the patient who couldn't get an appointment, who waited months for a slot, who finally sat down across from a physician who had eleven minutes to offer. Dr. Santina Wheat, a family medicine physician, names this as the cruelest paradox in American healthcare today: the system's failures fall hardest on the people who are already most vulnerable.

"The patients who need the most access have the hardest time accessing care. We are pressured to see people quickly — and that leaves unsatisfying visits on both sides. Patients don't feel heard. Physicians don't feel like they've had the time to fully care for the people in front of them."

— Dr. Santina Wheat, Family Medicine

The mechanism is straightforward. There are not enough family physicians. The ones who remain are pushed toward volume — more patients per day, shorter visits, faster turnaround. The result is a care experience that fails both parties: patients who leave feeling unheard, and physicians who entered medicine to do something the system increasingly will not let them do. The shortage compounds itself. Physicians who feel they cannot practice well enough leave. The shortage worsens. The pressure on those who remain intensifies.

The System Misplaces the Blame

Perhaps the most corrosive feature of the current system is not any single failure — it is the way it assigns responsibility for those failures. Patients who experience rushed appointments conclude their physician doesn't care. Administrators who see documentation backlogs conclude physicians need to be more productive. Policymakers who see cost overruns conclude that clinical decision-making needs more oversight. In each case, the diagnosis points at the physician. In each case, the diagnosis is wrong.

Dr. Sawhney puts it plainly: most physicians are already operating at or beyond capacity. What looks like inefficiency is misaligned incentive — systems that reward volume over value and documentation over dialogue. No amount of individual physician effort overcomes a misalignment at the system level.

The same misplacement of blame extends to patients themselves. When someone doesn't follow a treatment plan, the instinct of administrators and even some clinicians is to label it noncompliance. Dr. Burns pushes back on that framing directly — and the evidence behind his argument is hard to dismiss:

"What looks like patient noncompliance is often something else entirely: a person making difficult decisions under difficult circumstances. A single mother of three, living in a food desert without reliable transportation, choosing between heat and medication isn't being noncompliant. She's surviving."

— Dr. Boyd Burns, Emergency Medicine & Interim Dean, OUSCM

Dr. Joseph S. Thomas, a hospitalist, identifies the most deliberate version of this blame displacement: the way insurance companies frame their denials. When a treatment is denied or a care level downgraded, patients are told their doctor made the call. The decision was made by an insurer — often through a reviewing physician in an unrelated specialty, with little opportunity for the treating physician to push back.

"Insurance companies like to frame their denials as 'your doctor decided this treatment was not appropriate.' A vast majority of the time it was either the insurance company backed us into a corner and forced the decision — or it was a physician in an entirely different specialty who made the call, and there are few, sometimes zero, opportunities to provide further reasoning."

— Dr. Joseph S. Thomas, MD FHM, Hospital Medicine

Part Two: What Physicians Would Change First

Remove Insurance From Routine Care

The most foundational fix proposed — and the one that addresses the structural mismatch most directly — is to stop routing primary and routine care through insurance entirely. Dr. Cooke advocates for scaling the direct primary care model nationally: patients pay physicians directly for ongoing care, insurance is reserved for the catastrophic and the specialized, and Health Savings Accounts and Flexible Spending Accounts are expanded to give patients control over routine healthcare spending. The administrative layer disappears. The physician-patient relationship returns to the center. And insurance is restored to what it was actually designed to do.

The political resistance to this idea, she argues, comes from conflating two separate concepts. Universal healthcare and universal insurance are not the same thing. A system can guarantee access to care without routing every routine visit through a claims process that adds cost and friction without adding clinical value.

"If we can begin to untether primary care from insurance, we'll see stronger patient-physician relationships, better health outcomes, and a more sustainable system overall."

— Dr. Michelle Cooke, Family Medicine

Design Care Around Patients' Lives — Not the System's Convenience

Dr. Burns's proposed fix addresses the delivery gap at its root: stop building systems around what is convenient for the institution and start building them around the realities of patients' lives. His analogy is disarmingly simple — and precisely right. Handing a patient a standardized treatment plan without accounting for their circumstances is like watching someone tee off on a long par five with a putter. The problem isn't effort. It's that the tool doesn't match the situation.

At OUSCM, this philosophy is embedded in how physicians are trained. Medical students tour food deserts, participate in poverty simulations, and learn food-as-medicine in real kitchens. The outcomes data from that approach is not theoretical. OUSCM graduates stay in underserved communities at rates 20% higher than the national average. Tulsa's life expectancy gap across different socioeconomic zip codes has narrowed by nearly four years. Emergency room utilization dropped 75% between 2011 and 2023. Prior authorization reform eliminates one barrier. Retraining how physicians understand their patients removes the barrier upstream from it.

Invest in Primary Care — Before the Pipeline Runs Dry

If the shortage of primary care physicians is the wound, the question is what closes it. Dr. Wheat's answer is direct: invest upstream. Loan repayment programs, cost-sharing models, protected time for longer visits — the specific mechanisms matter less than the underlying commitment to making primary care a viable and sustainable career choice again. Without that investment, the shortage does not stabilize. It accelerates.

"Investing in primary care isn't just about fixing what's broken right now — it's about the future of the field. When we give physicians the time and support to practice the way they were trained to, patients get healthier. Primary care isn't just about directing people to specialists. It can accomplish so much more."

— Dr. Santina Wheat, Family Medicine

The broader case for primary care investment is one that cuts across ideological lines. Whether the goal is reducing downstream specialty costs, improving chronic disease management, or simply ensuring that patients have a physician who knows them — primary care is the lever. The system has underinvested in it for decades. The results of that underinvestment are now visible in waiting rooms, in workforce surveys, and in the faces of physicians who entered medicine to spend time with patients and are instead spending it on forms.

Reform Prior Authorization — Or Remove It

For physicians operating within the traditional system, the most cited immediate intervention was prior authorization reform — specifically for treatments that already meet established clinical guidelines. When a treatment is guideline-concordant, the authorization process adds no clinical oversight. It adds only delay. In oncology, that delay has a direct clinical cost. In every specialty, it consumes physician time and energy that belongs with patients.

Dr. Burns makes the cost of delay concrete: 90% of physicians report treatment delays tied to prior authorization, and those delays produce measurable downstream harm — treatment abandonment, worsening conditions, repeat visits that could have been avoided. The fix is not complicated. It is resisted.

Dr. Leyfman pairs authorization reform with a second intervention: interoperable, clinically intelligent decision-support tools embedded directly into physician workflows — infrastructure that reduces friction, improves timeliness, and allows physicians to operate at the full level of their training without the current administrative tax.

Dr. Jeffy's version of the same argument is more direct. Streamline drug approvals. Cut the redundancy. And hold insurers accountable for a function they are contractually obligated to perform but have systematically engineered around:

"It comes down to a tedious process meant to be frustrating so insurance companies are not on the hook for paying, despite this being their function in today's healthcare landscape."

— Dr. Brooke Jeffy, Dermatology

Restructure What the System Pays For

Several physicians pointed to reimbursement structure as the lever most in need of adjustment. The current model pays for volume — for the number of patients seen, the number of procedures performed, the number of codes billed. It does not pay for the quality of the encounter, the strength of the therapeutic relationship, or the long-term health outcomes that follow from both. Dr. Sawhney's proposed fix targets this directly: restructure reimbursement to prioritize time and continuity, particularly in mental health, where longer visits are not an amenity but a clinical requirement.

Longer visits should be the standard when clinically indicated — not exceptions requiring special justification. When the system pays for depth rather than volume, outcomes improve, unnecessary interventions decrease, and patient trust returns. The evidence for this is not theoretical. It is what physicians observe directly in practice environments that have already made the shift.

Address the Payer System at Its Root

Both Dr. Khokhar and Dr. Thomas argue that incremental reforms — prior authorization tweaks, reimbursement adjustments, HSA expansions — are necessary but insufficient. As long as the current multi-payer system extracts profit from the space between patients and physicians, every other fix operates around the core problem rather than through it. Their proposed solution is single-payer healthcare: a structural reorientation that removes the intermediary layer entirely and redirects those resources toward the care itself.

"Our current healthcare system appears to be geared toward profit, not outcomes."

— Dr. Omar Khokhar, Gastroenterology

Dr. Thomas acknowledges the political difficulty and the legitimate questions about physician compensation that accompany a single-payer proposal. But he frames those concerns as reasons to pursue reform carefully — not reasons to avoid it. The question, he argues, is not whether the system needs structural change. The system's own performance has already answered that.

The eight physicians in this piece practice in different specialties, in different states, in different models of care. They do not agree on a single remedy. But they agree — completely, and independently — on the diagnosis: a system that was designed around payment rather than patients, sustained by misaligned incentives, and defended by a habit of locating its failures in the behavior of the physicians working inside it rather than in the structures those physicians are forced to navigate. The fixes exist. The evidence supports them. The only question is whether the institutions responsible for the system are willing to act on what the people delivering the care already know.