riverside_edit_06 - Diagnosing and Healing the US Healthcare System - The Whole Physician
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Welcome to the Drive Time Debrief with The Whole Physician, a podcast to burnout-proof your medical career with candor, humor, and encouragement. You spent tens of thousands of hours learning how to care for others, but now it's time to learn proven tools to care for yourself. If you're tired of feeling stuck, disillusioned, and exhausted, you're in the right place.
Start your journey to bring back contentment and purpose. Now, here are your hosts, three board-certified emergency physicians: Doctors Morrison, Cazier, and Dinsmore.
Hey, guys, welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we have a special treat. We have a guest, Dr. Maryanne Wilbur. She's a physician, author, public health strategist, and a fierce physician advocate. With over 25 years of experience in clinical medicine, Dr. Wilbur now serves as director and CEO of Health Equity Consulting Incorporated.
Until 2026, she was a practicing GYN oncologist, and she now works full-time using research and narrative medicine to advocate for the transformation of US healthcare. That is definitely something we're so interested in. Thank you so much for joining us, Dr. Wilbur. Thank you for having me.
Okay, let's get started. Please tell us about your book, and what the idea behind it was. The book is honestly qualitative research, a series of interviews. I've always been interested in qualitative research because as public health strategists, we do plenty of quantitative work, you know, I've done lots of quantitative epidemiology.
But over the years I've loved qualitative research, because it gives real authenticity and flavor to your work — it captures firsthand accounts from people who are experiencing something. That's not always the right way to obtain information, but there's tremendous value in it.
So I've done plenty of GYN oncology work on cervical cancer, the disparities, the rates, and so on, but sometimes there's real value in sitting somebody down and, in a rigorous way, asking them about their experience and how we can do better. For me, when I was experiencing burnout and moral injury — for years, really, but it came to a peak in 2022 — I was furious.
I was just so beside myself. There really aren't even words for it. I experienced the whole gamut of what physicians feel. It's hard to even put into words the pressure — the squeezing, the sense that there's just no way, that I cannot survive like this anymore.
And then there was that enmeshment with who I am professionally: am I anybody if I'm not Dr. Wilbur? I experienced thoughts like, "Maybe it's better if I'm just not here anymore." Some pretty dark thoughts really do enter your head when that kind of desperation sets in.
So for me, this was a very desperate, very personal experience. And meanwhile, I'm looking at the quote-unquote experts out there — from the AMA or wherever — and they're saying, "Well, if we just fix Epic, or a little bit of CMS reimbursement, everything's going to be fine."
And I'm thinking, "These people have no clue." I forgot to ask if I'm allowed to use four-letter words, but it's hard to explain the anger — the sense of, "You represent me and my experience, and you're telling me that after I gave away the best years of my life working quote-unquote 80 hours a week, made all these sacrifices, delayed childbearing—"
I gave every sacrifice there is. I made it, and I did it knowingly, to care for people. And you think I'm walking away because Epic sucks? Really? Epic sucked when I started medical school. It's pretty ridiculous. Would you really like to hear yourself? How do you say, professionally and without getting sued, "You wouldn't believe what they did. You wouldn't believe it"?
So for me, the book was about giving voice to US physicians who are leaving — but not in a "I'm so angry, listen to me and my story" way. It's not because Epic sucks; people need to know what is actually happening. So I turned the qualitative research on us, on our own colleagues.
It was actually done in REDCap — a short demographic survey, very quick, about a minute: tell us a bit about yourself. And basically the last question was: are you willing to participate in a 30-minute, anonymous, recorded interview, one-on-one with a peer colleague who is also experiencing leaving medicine?
To qualify, you had to be licensed in the US as an MD or DO, and self-identify as having left, or planning to leave, medicine within roughly two years of that date. That was the inclusion criteria. The demographics were all over the map — we captured every kind of person you can imagine, from every region of the country, every specialty, every practice type, you name it.
The only other thing worth mentioning is that, just as we're now seeing — and these data were collected about two years ago, maybe a bit more, since the book itself was published two years ago and was written quickly (it almost wrote itself, because the interviews were so rich) — we did see men, but women were represented two to one.
People self-identifying as leaving medicine were twice as likely to be female, and much more likely to identify in some other way when describing themselves — family of immigrants, Black, Brown, first in their family to go into medicine, representing the LGBTQ+ community, and so on. So it's not only that we're losing two out of five physicians — we're also losing significant diversity from our physician workforce.
Then we did the interviews, and, as you'd probably expect in qualitative research, the idea was to find the themes, describe them, and put the interviewees' own words right back in. So these are firsthand accounts, in first-person language, of what physicians are experiencing.
I don't know if we mentioned it — the title of the book is "The Doctor Is No Longer In." We'll put a link to it in the show notes. Great, thank you. It's powerful. So when you interviewed our colleagues, our fellow physicians, what did you hear from them? What were these themes?
If you read the book, the first couple of chapters are an introduction and a bit of a "how did we get here" history drawn from public health. Then there are five chapters, because there were five main themes, and they all resonate with physicians who are looking to leave.
There was loss of control. That comes up in many ways — loss of control over your own schedule, over how and where you practice. There are different ways it happens, but loss of control was a major factor for everybody. We did end up using burnout as one of the themes.
In the first few interviews, people didn't necessarily raise their hand and say, "I'm burnt out." Some did, but a lot didn't. The ability to self-reflect tends to come later — when you're in the storm, you're not thinking, "I am experiencing this overwhelm." It just doesn't work that way.
Some people said, "I'm burnt out," but plenty of others said, "I think I'm depressed," or "I just can't go on like this." So we used the word "burnout," but it's important to recognize that it isn't always the language an individual will use themselves.
Dehumanization was another major theme. This was really important. We heard a lot of, "I feel like a cog in a wheel. I feel like I'm just cattle. I feel disposable. I don't even think my institution knows who I am. If I died tomorrow, not a tear would be shed — they'd just put somebody else in and keep going."
There were lots of different ways we heard this — things like, "They don't even see me as human. If my mother died, it's like, 'You want time off to go to a funeral?'" It's honestly enough to make you wonder whether they'd rather find some AI that doesn't have that problem — doesn't have a biological need, a social need, any of it.
There's actually a sub-chapter called "Cogs Don't Have Needs." That's something that has developed over time in medicine.
There's some discussion about it, because there are five chapters on the themes, and then the last few chapters cover the broader impact — things like the diversity changes — and also what it would take to make real changes. What does institutional leadership really need to hear? We spent quite a bit of time on "Cogs Don't Have Needs," because it's genuinely problematic. Anyone who does physician coaching these days is probably familiar with this idea — "I can't take a vacation, because I'm just going to pay for it later. The work will all be sitting there when I get back. Nobody actually covered for me." And then there's guilt for having taken time for yourself.
The next theme was moral injury. Again, it's important to note that's not always the language a person uses. When you're in it, you don't necessarily recognize moral injury in yourself — I didn't, even though it's actually the main reason I'm no longer a practicing clinician. It was bad. It was really, really bad, what I was being asked to do professionally.
While we're on that — could you refresh everyone on the term "moral injury"? I don't think everyone is familiar with it. Absolutely. I first encountered the term in an article published by Wendy Dean in JAMA — I want to say around 2018 or 2019, don't quote me on the exact year. She went on to write a whole book about moral injury, called "If I Betray These Words," by Wendy Dean, D-E-A-N. I can't summarize it quite the way she does, but moral injury is the experience of witnessing, or being forced to act in a way that transgresses, your own deeply held moral beliefs.
Moral injury has long been documented in soldiers — in situations with a hierarchy, where human life is at risk, and the soldier doesn't have the power to make the decision; they're being told what to do. Physicians today often find themselves in a very similar situation: there's a hierarchy, authority is telling you what to do, you don't feel good about the decision, but it happens anyway, and you carry the scar.
We carry these scars, and I personally experienced quite a few of them. Burnout and moral injury overlap, but they're not the same thing. Burnout is a problem of resource management — "I cannot do what you're asking me to do, in the time and with the resources available. I just can't do it." Moral injury is when authority forces you to do something that doesn't feel right. They overlap, but they're distinct. For me, most of my own struggle was dehumanization and moral injury.
And it's important to say that all of us, as humans stuck in this physician role, experience most or all of these things — but how they manifest differs. Are you a 40-something female surgeon who's relatively young for her career stage because training takes so long? Or are you a 50-year-old male primary care physician in rural America? Our experiences are very different, but the frustrations all end up falling under these five themes.
We've covered four of them — the fifth is trust and betrayal. "Betrayal" is a word we heard extraordinarily often — so consistently that we almost didn't even use the word "trust"; the whole chapter nearly ended up being just "Betrayal." Betrayal happens daily. When you're not trusted to set your own schedule, or to make decisions for your patients, you feel betrayed. "I know what's right for my patient. I went to medical school. I made all these sacrifices. And I'm being betrayed because you're forcing me to do something else."
But the real betrayal happens when you're seeing 20, 25, 30, 35, 40 patients in a day, and sooner or later, bad things happen — they just do. And of course your institution has your back, right? No. They'll throw you under the bus fast.
That happens, and then, God forbid, you actually call them out on it: "That's not fair, for you to treat me this way when you're the one who created the situation that led to this." Didn't we all learn that root cause analyses are about systemic issues, not human error? And they'll say, "Yeah, yeah, we talk a good game about all that, but no — you're going down for this. We, the ones in suits, don't have responsibility to the patients. You, the ones in white coats, have responsibility to the patient, no matter what we do to you."
And you just think, "Oh my God, this is awful." One of my interviewees said, "I feel like a mouse in a field — no trees, no bushes, and the hawks are circling." And this person wasn't even facing a lawsuit; they'd simply looked around, seen how other colleagues were being treated, and thought, "I've got to get out."
That's where physicians start saying either, "I'm planning my escape," or "I'm taking the leap" — that's the language they use. And if you ask them why they haven't already done it, they say things like, "Golden handcuffs," or a sense of shame — "If I'm not Dr. Smith, I'm nothing." These are the things keeping us here.
Every once in a while, someone tells their institution — which is pretty rare — and usually they get found out for planning their escape, and the institution says, "All right, all right, we'll give you more money," or "We'll give you something," which is really just an abusive relationship: "Baby, I'm so sorry, it will never happen again." That's trauma bonding.
I had never heard the term "institutional betrayal" until a year or two ago, but that's exactly what you're describing. When somebody first said those words to me, I thought, "Oh my God — that one doesn't even need defining. I know exactly what that is." Nobody had said those words before, but that's what I had felt.
And the thing that really activates me is being in some meeting at the hospital and hearing, "But what about the patients?" It has always been about the patients, for me — but we're apparently not on the same team. I found that out. So it starts to feel like gaslighting: "Well, how are you going to do all of this with no staffing, no support, nothing? You're failing." Is that true? Or is this actually the worst relationship I've ever been in?
Gaslighting was almost the name of the chapter we ended up calling "Betrayal" — that word came up quite a bit, though it was more likely to be used by women, and it didn't resonate the same way for every interviewee, so we didn't want to put words in anyone's mouth. Everybody responded to "betrayal." But for many people, especially women, the betrayal was really gaslighting — you go to your manager and say, "There's a problem. My patients can't get X because of this. You're my manager, let's figure out how to fix it." And they respond, "Hmm, we think the problem is you."
I want to say this clearly, for anyone listening: you're not the problem. I promise you, you are not the problem — your colleagues are smart, capable, wonderful people, barring a very small number of bad apples. We're good people who care about other humans. If two out of five of us want to leave right now, there's a real problem, and it isn't you.
That's a really good point, Maryanne, and I'm glad you said it, because at the end of the day, while we're airing some hard truths here, our colleagues need to hear that. You are not the problem, no matter what anyone has told you.
So what do you think our colleagues and fellow physicians most need to hear from us today? The real answer involves transformation of the whole system — but humans are suffering right now, today. The most important things I want physicians to hear, that I learned from doing these interviews: first, you are not alone. You are a good person. You are a good doctor.
In fact, if you're not asking questions, or getting really upset, that worries me more. If you're fine with conveyor-belt medicine, that might actually be the concerning sign. So if you're discouraged, frustrated, and screaming in your car on the way home — congratulations, your humanity is still intact.
You are not alone, and you are not the problem. I also want you to remember your own humanity. This was really important to me — I wasn't familiar with the term at first, though it's actually been around for decades — it's called "enmeshment." Enmeshment happens when people in strong, historically prestigious, time-consuming careers lose sight of who they are as a human being.
It happens with astronauts, lawyers, doctors — anyone very deep into a demanding career — and it gets worse the longer you're in it, to the point where "if I'm not Dr. Wilbur, I'm nobody." And when you find you can't go on as Dr. Wilbur, you have a full-on existential crisis. You have to understand that you're a human being, and you deserve dignity.
I used to use the wrong word for it. I remember trying to talk to my employer and saying, "There's a serious lack of respect." My boss — a woman — said, "Respect has to be earned." And I said, "No, no, I'm sorry, I meant dignity — human dignity." The kind that's due to every human being simply by being born. You deserve human dignity. Becoming a doctor didn't mean you signed a waiver giving that up. So beware of enmeshment, and the idea that your doctor role is the whole of who you are.
It's an important part of who you are, but it's not all of you — and the rest of you has tremendous value. The people who can't hold onto that are the ones who really struggle with suicidal ideation. So if you're struggling with suicidal ideation, I want you to separate, at least a little, who you are as a professional from who you are as a human being, and remember you have tremendous value no matter what.
What I learned was that the people who were able to heal were the ones who could recognize their own humanity. The ones who couldn't got stuck with what we call "the three D's": drinking, divorce, and depression — and then suicidal ideation. Enmeshment is a terrible trap that kept people from coming out the other side whole.
It's as if we forgot we were full human beings before we ever went to medical school. Or maybe it was part of the hidden curriculum we were actually taught. I trained as a surgeon at one of the most prestigious traditional institutions in the world, and it was absolutely part of that training — the idea that I didn't have biological or social needs. So many of the hardest-working, most altruistic, most brilliant people on earth have all signed onto this. It's astonishing — almost like a cult. It's impressive, whoever set it up, that we all just went along with it: "Okay, sounds good, this is great. I waive all human need and human dignity, and I'll just keep going."
And it might have worked a little, back when most patient care was physician-led — when you were either running your own practice or working with a group of other physicians, and the person calling the shots believed in that culture of humanity and putting patients first. The times were tough, but it was all for something. Now, most of the time, the person calling the shots is wearing a business suit and isn't a physician. So that same culture and training is now being weaponized against us, because they know we won't drop the ball — we'll keep showing up for our patients, literally to the point of putting a gun in our own mouths. And they know it, and they don't care.
That's a serious problem. It's sick. Okay — so we've covered the book, "The Doctor Is No Longer In." Everyone out there, grab a copy, because it's amazing. It will fuel your anger a bit, but it will also resonate, sadly. As long as we turn that anger into something useful — see chapters eight and nine. I'm all for anger, when we can channel it. It's very activating. But let's talk about another project, one that runs parallel to the book — we're honored to be executive producers on it too. You were the driving force behind the film "Suck It Up, Buttercup." Tell us about that project.
Before the book was even fully written and published, I realized there was an appetite for this outside of medicine. People kept saying, "Wow, that's so interesting," and I thought, "Really?" I'd assumed the book was really for people inside healthcare. But I noticed that the general public was also curious — "Tell me more." So I thought, "Okay, this fairly nerdy book" — I tried to keep it accessible, but it's still, by definition, written by physicians for physicians — what would be the right medium to share these stories with the general public, and to give voice to all the stakeholders, even the ones some people might consider the villains?
And I do believe that, for the most part, the villain is greed — which is a very human trait. I try not to do a lot of finger-pointing or witch-hunting, because it doesn't help us. That's my disclaimer. But giving voice to all stakeholders was the goal of the film.
We were about six weeks into filming when Brian Thompson, the CEO of UnitedHealthcare, was murdered, and it became even more relevant. A few people had said they weren't sure the general public was ready for this — and then the reaction on social media suggested otherwise. There was real outrage. Matt Zachary put it well: he said it was a little concerning how nearly gleeful some of the public reaction to Brian Thompson's murder was.
In advocacy — and I've been doing this for decades — we always start by asking, "What makes you angry?" And the reaction after Brian Thompson's murder made it very clear: the general American public is ready. They're angry. What they don't have is an understanding of what's actually wrong with the system, or what it would take to fix it. So the question became: what if we took all of that passion and channeled it toward something more productive than murder?
That's the goal. I don't think most Americans are pro-murder. But they need help channeling that energy, and understanding what's really going on and what it would take to fix it. That's really at the heart of "Suck It Up, Buttercup" — understanding these problems. If any listeners haven't seen it, it's eye-opening. We've tried to change the system from within, and I think this is a creative way to reach people, because we're the front line — we're the face of a broken medical system.
Whenever a patient walks in, who else can they talk to about their frustrations, or who else can they blame, but us? We think they should know we're on the same team, but why would they? The few people who actually benefit financially are heavily invested in the general public not understanding. It's not a coincidence that your health insurance plan is so full of obstacles and lacks transparency — that's all by design, because if anyone pulled back the curtain, they'd realize it's just greed. And everybody can understand greed.
My six-year-old actually put it best. He downloaded an app that was supposed to be free, and about a minute in, it asked him to pay. He said, "No, it's not free — they lied." And I asked him, "So what did we learn here?" And he said, "Sometimes people lie for money." He's not a prodigy — he's just a bright kindergartner. But it really isn't that complicated, and that's what the American public needs to understand.
So here's my quick elevator pitch: last year in the US, we spent 5.3 trillion dollars — with a T — on healthcare. Two-thirds of it was siphoned off by greed and administrative bloat, which means the person needing care and the person trying to provide that care are both stuck in a low-resource setting. And when humans are in a low-resource setting, they're not at their best. That's it. Really easy to understand.
So — what would it take to fix it? Honestly, we've tried to change it from within. If this film can take off, I think it could be a bit like "The Social Dilemma" — that "oh my God, I had no idea" moment. Maybe change has to come from outside the system, from external pressure, for it to really make a difference.
So let's talk a bit about some of the things you cover in the movie. What are some of the pivotal moments in the history of US healthcare that brought us to where we are now? I actually give a lecture on this now, which is being cleaned up and distilled into a TED Talk — a 17-minute talk that walks through the real pivotal moments quickly.
They're all accidents of history. Since we're physicians, we're used to the idea of a root cause analysis — and what do we always find? It's rarely one person; it's systemic errors. I like to use the Swiss cheese model: you line up the holes, and you can think of today's healthcare system as the adverse outcome. If you go back a century, nobody sat down and said, "Here's what we should build." Nobody designed this — it was an accident that led us here. So what were those holes? There are only a few, and they all come down to the same root cause: greed.
If you go back a century — I usually start my talk with the story of Geraldine Cruz, C-R-U-Z, if you want to look it up. Geraldine Cruz was a healthy two-year-old in 1934. She developed diphtheria and had severe trouble breathing. Her father brought her to the steps of the local hospital. Treatment was available there at the time, but they wouldn't let them in because he didn't have money to pay. They turned him away at the door. He brought Geraldine home, and she died a few hours later.
It was such a tragedy that the family sued. The court ruled that hospitals have no responsibility to care for patients who cannot pay. That set the tone for the country — it put real fear into people during the Great Depression. Everyone thought, "Nobody has the ability to pay. It's the '30s. We're terrified." And fear doesn't exactly help us make great decisions.
Then World War II starts. The men go off to war, the women go to the factories — Rosie the Riveter is welding, building warships and airplanes for the war effort. Factories start noticing that some of the Rosies are more skilled than others, so they try to poach the skilled ones by offering higher wages. This starts happening so much that it actually threatens ship and airplane production, so the federal government steps in and imposes a wage cap — no more offering higher wages.
So factories start asking: what can we offer Rosie that will bring her to our factory without technically breaking the wage cap rule? What is she afraid of, beyond the general wartime fears? She's afraid of becoming the parent of another Geraldine Cruz. And there's this new thing called commercial health insurance — we'll subsidize the cost of it for you and your family. And just like that, employment-based health insurance is born, essentially as an accident of history.
It has never existed in any other country, and for good reason. Blue Cross Blue Shield offered it first, and it seems like the actuaries must have been on a long coffee break, because anyone who does the math would see this is a flawed idea. It was initially meant to function as illness insurance — if your child becomes another Geraldine Cruz, the insurance pays for it. But they structured it like flood insurance, home insurance, or auto insurance — except with health, if you live in a flood zone, everyone's house eventually floods. The human body is mortal; it's guaranteed to break down eventually. So the system was flawed from the beginning, but that's how it happened.
So we ended up with illness insurance, illness-based care built around that insurance, and a reimbursement model based on fee-for-service pricing, meant to make billing straightforward. But fee-for-service is also how we pay mechanics, and nobody fully trusts a mechanic — "Do I really need that filter?" So we've had trust problems baked in from the start.
The war ends. Employment-based health insurance is now a thing, running mostly through men since they're back at work, covering the nuclear family. But what about war widows, orphans, the elderly, and the disabled — people without employment? That becomes a problem. So in 1965, LBJ signs Medicare and Medicaid into law.
But the government said, "If we're now the payer, we're not just going to pay whatever price the hospital sets — we're big, we have leverage, and we're going to negotiate prices down." So the hospitals responded by inflating their prices, and this whole system of rigging begins. Blue Cross Blue Shield and the other commercial insurers wanted to do the same thing, but at the time it wasn't legal for them — only the federal government could negotiate prices that way.
Then Henry Kaiser and other prominent lobbyists convinced Nixon: "Why does the government get to do this and we don't?" So in 1972, an amendment was quietly attached to a Social Security bill allowing Blue Cross Blue Shield and other insurers to negotiate prices down too. And just like that, insurance became big business — because now anything they could save, meaning anything they could deny, went straight to their own pocket.
Moving into the '80s, Friedman economics arrives. If you're a policy nerd, Milton Friedman is generally credited with reshaping American economic thinking — up until then, businesses were seen as having responsibilities to investors, employees, and consumers, and had to balance those competing demands. Friedman argued businesses have a responsibility only to shareholders, reported frequently, through return on investment and revenue cycles — generally quarterly. You can see how the culture starts shifting.
This wasn't unique to insurance — it was happening at Boeing, GE, and elsewhere too — but in healthcare specifically, insurance companies embraced it fully: "This is big business." Managed care arrives, along with other ways to control how much of their premium revenue has to go back out, since anything not paid out becomes revenue, which becomes the priority.
I feel like I'm skipping over a key piece of the history. In the '90s, we're mostly dealing with managed care, and there's some pushback, but it doesn't go very far. Then managed care starts getting uglier — insurance companies start also owning hospitals, and pharmacies too. This is the beginning of what's called vertical integration: the idea of owning every piece of the system.
Around that time, there was a push for legislation to prevent that kind of consolidation. But some very clever IRS attorneys argued that healthcare should be regulated differently from other businesses — and got a carve-out. From there, they were handsomely rewarded by insurance companies almost immediately after the relevant legislation was signed. There's essentially no meaningful antitrust regulation in healthcare — insurance companies can own the insurer, the hospitals, the doctors, the pharmacies, the pharmaceutical companies, and the pharmacy benefit managers. They can structure things however they want.
Hospital systems, meanwhile, can buy up rural hospitals and close labor and delivery units for poorer communities, disproportionately affecting Black and Brown women — treating labor and delivery as something only wealthier, often white, communities need nearby. All of that was happening.
By the end of the century, people started noticing there was a real problem here, and legislators began trying to write reform bills. But none of it went anywhere, because in 2010, Citizens United was decided by the Supreme Court. The case turned on two questions: is a corporation the same as a person? And is spending a dollar the same as free speech? If you answer yes to both, then a corporation's political donations are protected as free speech under the First Amendment.
It passed five to four, and the dissent was remarkable in its foresight — essentially warning, "You've just turned this country into an oligarchy." From then on, it didn't matter whether it was the AMA, the AHA, or the NRA — big money controls the process. No matter how good a piece of legislation is, once it reaches Capitol Hill, lawmakers are already answering the phone to whoever wrote the campaign checks. It's essentially open bribery, and it maintains the status quo.
That's disturbing, and it's the reality we're dealing with — but simply wishing it weren't true accomplishes nothing. So what do you think it would take to transform US healthcare into a system that actually uses its resources to keep people well? Is that even possible?
It is possible — that's the good news, and it's the most important thing I need everyone to hear. There's almost a formula for what works. Anyone who studies public policy will tell you that any civil movement needs about 3.4% of the engaged population — in this country, that means voters. To make the math simple, there are about 344 million Americans who vote consistently, which puts the number at around 10 million voters. That's not a huge number.
Ten million voters need to be educated — they need to hear this podcast, watch the film, watch a TED Talk, whatever it takes. They need to hear the message, and first and foremost, they need to vote. I'm not going to tell you how to vote, but I'd recommend watching for the phrase "campaign finance reform." We have to take the handcuffs off our legislators. After that, as neighbors and citizens, we can decide together what we want our healthcare system to look like — but we should be the ones deciding, not the people whose pockets are being lined.
Remember, 5.3 trillion dollars is a lot of money. We have more than enough resources to care for everybody — we just have to stop handing it to a small number of people in very expensive suits. They've had their run, and honestly, they know it. When you talk to them, they'll say, "I know this is coming to an end, but I'm going to squeeze every penny I can on my way out." They're not even hiding it. So: campaign finance reform first, and the legislation that follows will start to change things.
And no other developed nation offers a better model — not one. So I'm not going to be prescriptive about the exact solution. We, as neighbors and citizens, will decide together what it should look like. I'm not married to any particular plan — it just has to be one that uses these resources for the people who need care and the people trying to provide it.
So what role do physicians have in this transformation? Just use your voice. Tell other people about this podcast, about the TED Talk. There are a lot of physician influencers out there — I'm not one of them, I don't even really understand TikTok — but I'm giving this talk in New York City in a couple of weeks, and I'm hoping people like Dr. Mike and the Glaucomflecken will help push it out. Ask your colleagues to share a snippet. That's it — we just need 10 million educated voters.
We don't need to get overly technical or obnoxious about it. We don't need protests. We just need education and empowerment. So talk. And talk to your patients too — not in a preachy way, but there are fewer than one million licensed physicians in the US, and getting physicians organized is famously like herding cats. We're not going to be enough on our own — we have to partner with the other side of this relationship, our patients, and do this together. So educate. Maybe put something in your waiting room about what physicians are actually experiencing. Different ways to make it available, optional, but share your voice.
I'm curious about your response to something — there's a lot of energy out there focused on the idea that physicians are paid too much, that doctors are the greedy ones. We know that's not true. What response can we give when we hear that?
I usually remind people about the actual cost of US healthcare. I point them to an article published in The Lancet in November 2025 — I think it was called "Money Is the Mission." A little insider detail: they initially tried to publish it in some of the bigger US journals, and nobody would take it — that's why it ended up in The Lancet. There's a striking chart in it showing that the number of physicians has stayed roughly flat over the past 50 or 60 years, while the number of managers has increased by 5,000%. That's the administrative bloat.
So yes, physician salaries are higher than the general public's, but given the sacrifices — the years spent earning very little as trainees, the delay in when you can actually start making money — it's not really where the money in the system is going. And here's a quick reality check: even at a surgeon's salary, people in the C-suites of insurance companies are making tens of millions of dollars. If I'm making 200, 250, 300 thousand, and they're making 20 or 30 million — that's just an absurd gap.
It's the administrative bloat and the greed. The number of physicians hasn't changed. Physician salaries relative to the general public haven't changed. What's changed is the administrative bloat and the greed.
So what's the best way for people to get in touch with you, for resources or to reach you? The book has a website — www.thedoctorisnolongerin.com. You can email through there, order wholesale or signed copies, arrange author talks, that kind of thing. If you just want a single copy, it's available on Amazon, Barnes & Noble, all the usual places. If you'd like to support a local independent bookstore, it's also on IngramSpark, so you can walk into your local bookstore and they can get it for you within a week or two — however you'd like to get it.
The documentary also has a website: www.siubfilm.com, or you can type in suckitupbuttercupfilm.com, which redirects to the same place. We take questions through there too. If you'd like to email me directly, it's mwilbur — M-W-I-L-B-U-R — @healthequityconsulting.org. That's how to reach me for speaking engagements and things like that. This is genuinely my favorite thing to do now — just having these conversations.
Thank you so much. Any last thoughts before we close?
I'm getting excited about the retreat you two have coming up — is that right? Yes! Do you want to give a teaser? We're so excited. It's going to be a special time for doctors to come enjoy a beautiful setting at the Bodhi Tree Yoga Retreat in Costa Rica, starting in early November. We'll have programming to help people untangle themselves from that enmeshment and identity of "only a physician," reconnect with their humanity, and let go of some of what got them to wherever they're feeling dissatisfied in their career.
And just connect with each other — support each other. It's going to be fantastic; we're so excited. We still have a few spots available, so be sure to check that out — we'll put a link in the show notes. And this episode will probably air after we see you in New York, at Docflucon — the doc-influencer conference, the first time all the doctor influencers are getting together.
That's exciting. When I started talking to Olivia, she said, "We haven't really done this before, but I really feel like this message deserves a spot," so she's giving me 17 to 20 minutes to essentially do a TED Talk rehearsal. I'm pretty excited about it.
That is so exciting. What's your estimated timeline for the actual TED Talk to happen?
That's a great question. Honestly, I don't expect the whole audience to do this, but if you nominate me, it increases the number of nominations, which helps move things along. I've been preparing the talk, and my hope is that after Docflucon, Olivia will say, "Go to this website and nominate," and if enough people nominate, and clips get shared on social media, it'll happen faster.
I've been invited to do smaller talks, but I want the main stage. And honestly, I love going to the grocery store in my pajamas — I don't want fame or fortune. This hasn't exactly been a fortune-focused venture. Being a social justice advocate isn't a very lucrative path. But I truly believe that if we can reach 10 million voters, we can do this.
Historically, countries make changes like this after things fall apart. And I think we're at a pivotal moment — we could lose this, we could get it wrong. Or this could be the moment we finally pull together as a country, because it's genuinely one of the only things almost everyone can agree on right now.
I love that you ended on that note, because it really is about uniting us as one voice. And I love how you talked not just about the person giving care, but the person receiving it too — coming together, and what better platform for that. So thank you so much, Dr. Wilbur, for being here, and for putting all of this into words so clearly. I think this message reaches beyond healthcare workers, out to laypeople too — it's going to impact both groups. They're going to hear this message, receive it well, and it's going to inspire action, and I think that's the overarching goal in having you on the show today. Like you said — act now. This is the time.
We believe that too. This is the moment to turn things in a different direction, for the good. So thank you so much. We honor your work and everything you're doing — you're a true pioneer, and we're honored to have had you on the show today.
Thank you — thanks so much for the opportunity. This has been fun.
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