What's really breaking American healthcare — and why it matters to you.

Medicine has been part of my life since 2010. I started as a volunteer Emergency Medical Technician on a university campus, showing up for whoever needed help. From 2013 to 2018 I also worked as an emergency room technician. I became a PA in 2021 and have since spent three years in rural medicine and two in hospital orthopedics. Fifteen years so far, and every setting has taught me something different about where the US healthcare system is broken.

If you work in healthcare, as a provider or an administrator, much of what follows will sound familiar. More importantly, I aim to provide tools and perspectives you can use in your day-to-day work.

This has been building for a long time

The financial strain on healthcare did not begin with COVID-19. The pandemic accelerated things and made the cracks harder to ignore, but the foundation was weakened long before 2020. The administrative layer necessary for clinic survival has been growing steadily across hospitals, rural clinics, and private practices for decades. This isn't mismanagement or inflated admin — it's survival. Insurance companies and outside financial pressures made the system so difficult to navigate that organizations could not stay afloat without dedicated staff to fight for reimbursements, file appeals, and manage documentation demands. Those staff are not the problem. They are the evidence of a larger one.

What this looks like on the inside

In rural medicine, I had patients driving hours to see me — not because I was exceptional, but because I was the only option. Those patients are counting on the clinic to stay open, and the clinic is counting on a financial system that makes survival harder every year. Reimbursement rates aren't keeping pace with costs. Denied claims disrupt cash flow unpredictably. And prior authorization requests keep piling onto providers already working above capacity.

Burnout is a word used so often it has started to feel meaningless. What I've experienced has a specific quality: spending hours working an appeal for a patient who needed something, losing anyway, then documenting the visit as though the process had functioned correctly. That accumulates. I pull through because, ultimately, I love medicine and I enjoy my patients. But that erosion is not talked about enough, and it affects so many providers.

The good news is that this is solvable

Describing problems without moving toward solutions is not my goal. Prior authorization burdens, denial patterns that follow predictable logic, reimbursement structures that punish smaller and rural practices, funding programs that exist but go unused — these are all systems. Systems can be understood, and workarounds can be created when the system itself can't be changed. What's usually missing is practical information delivered to the people who need it.

My perspective comes from clinical experience across the emergency room, rural medicine, and orthopedics. I am a PA, not a policy expert. What I bring is time spent inside these systems and real opinions about what actually helps. That is the lens this runs on. Stick around.