JP, DO, MS ⚕️(He/him)

A friend told me recently that his wife whose an MD at a major local hospital is seriously considering leaving medicine. Not because she stopped caring about patients or long hours but because of the pressure from above. In her system, every diagnosis comes with the expectation of prescribing the drug that matches the code. If she doesn’t? She gets questioned. Evaluated. Sometimes even financially penalized through performance metrics tied to “quality measures." This sounds noble but really just means “Did you give the patient the medication the system expects?” He said she's been dealing with it for a while and it seems to get worse every year. She didn’t go into medicine to be a cog in a pharmaceutical machine. She went in to actually help people. But the hospital’s incentives don’t reward lifestyle coaching, nutrition conversations, movement prescriptions, or digging into root causes. There’s no bonus for helping a patient reverse insulin resistance. But there's plenty tied to metrics on prescribing statins, GLP-1s, antihypertensives, SSRIs, and anything else that fits neatly into a billing code. And the saddest part? This isn’t rare. Between pay-for-performance systems, pharma influence, and hospital revenue structures tied to drug utilization, the entire system nudges doctors away from thinking and toward prescribing. Many MDs feel trapped: If they want to practice slow, thoughtful medicine there’s no time. Or if they want to focus on root causes there’s no billing code. If they want to avoid unnecessary meds they risk being flagged for “not meeting standards.” So many of the good doctors are quietly slipping away. And we wonder why chronic disease keeps rising. A system that incentivizes prescriptions will always produce more prescriptions. A system that rewards dependency will always create more dependent patients. And a system that punishes critical thinkers will eventually lose all of them. My friend’s wife isn’t leaving medicine. She’s being pushed out of it. And until we fix the incentives, she won’t be the last.