How Efficiency Replaced Your Doctor’s Bedside Manner

Conor Hylton’s 2024 death was a tragedy. A 26-year-old dental student, he had been admitted to the hospital the day before with severe gastrointestinal symptoms, then transferred to the ICU as his condition worsened. He had an unfortunate history of alcohol abuse and withdrawal seizures, and was likely in withdrawal that day. What is perplexing about his death is that there was no ICU doctor physically present as his young life slipped away. The intensivist in charge of Conor was directing his care from Yale’s tele-ICU hub just 15 minutes away and had to request another doctor in the hospital to place a breathing tube as he deteriorated, a procedure reportedly delayed because that physician had difficulty getting to the ICU.

Complicating the tragedy, his father says he was at Conor’s bedside as the intensivist pronounced Conor dead via video. Most perplexing, though, is that this type of ICU staffing is by design.

Remote ICU programs like Yale’s enable hospitals to scale physician availability, allowing them to manage more patients than a traditional ICU while saving money.  Remote specialist involvement has become an essential part of America’s hospital infrastructure. While proponents note that this allows patients to stay in especially remote places and avoid expensive and unhelpful transfers, the manner of Conor’s death painfully reveals its shortcomings. And it prompts larger questions of how and why we arrived here, especially because Conor did not die in a rural area; he died in a hospital just 15 minutes from Yale’s full-service ICU.

A broad movement has scaled every part of American healthcare delivery in the name of efficiency, much like your local Best Buy. In doing so, the patient now competes with a vast, unseen ecosystem that must extract revenue from every healthcare encounter to sustain itself.

This revenue-extraction motive is the invisible hand in the exam room: your doctor leaves without the full story, your care costs more simply because it happens on a hospital campus, or you can’t get the inhaler that works because your insurance no longer covers it.

Besides competent bedside care, your physician’s most valuable resource is something simple: time. A good history often leads to the correct diagnosis, but getting it requires listening, asking the right questions, and sometimes letting a patient tell a story that doesn’t fit neatly into a 15-minute appointment.

Yet hospitals and the companies that employ physicians have targeted time with patients to boost revenue. Fifteen more minutes with a patient to get the right diagnosis doesn’t show up on a spreadsheet, but the resulting drop in efficiency does. Less time with your doctor can mean more missed diagnoses and more unnecessary testing, which can lead to years of frustration. A profit margin is imperceptibly chipping away at the quality of your care.

In the hospital, you’re asking your doctor, “What’s wrong with me?” Your doctor is asking you, “How can I help?” But the hospital asks your doctor how quickly you can be discharged, your insurer asks whether the stay was even necessary, and, somewhere else, a pharmacy benefit manager has already decided whether you can get the medication your physician prescribed. The process you see is centered around your illness; the one you don’t see is centered around the economics behind your illness, and that’s the one driving your experience.

Now consider private equity, an industry that has recognized the generational financial opportunity embedded in American healthcare. Private equity often invests in good, care-centered companies, but once private-equity money begins flowing through a healthcare organization’s veins, its priorities subtly shift. The language always stays the same: “Patients first.” But six months later, the dust settles, and the incentive structures have changed. Patient care and physician autonomy begin to give way to performance metrics and profit.

Many successful medical organizations were built by founders who understood something that a quarterly report can’t easily capture. Like Scorsese balancing art against the studio’s bottom line, these physician founders knew when to pull the lever toward patients and physicians, despite what the metrics said. Give physicians a little more time and accept a little less revenue because the care delivered was simply better; this, however, is simply unimaginable to private equity.

Private-equity ownership shifts the calculus because the investment ultimately requires a return. The unspoken, superseding objective becomes a profitable exit for company owners, forcing physicians and other frontline workers to maintain excellent care for their patients in addition to meeting monthly productivity targets not dissimilar from a car dealership. And despite what companies will say, too much focus on patients puts employment in jeopardy for some.

EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) is beginning to trump everything, while physicians’ time is increasingly commoditized. At the same time, the patient experience is scavenged for revenue, seen as a means to improve balance sheets rather than the other way around. The beating heart of American healthcare has thus been metricized to a pulp by a system that never stopped to ask whether the same incentives that relentlessly make your television better and cheaper should be applied wholesale to medicine. Healthcare is not a television, and your doctor is not a factory unit.

And sometimes the market’s verdict is simpler still: the care you need isn’t profitable enough to exist. Consider obstetrics in rural America. The 2026 March of Dimes report estimates that 58% of rural counties lack an obstetric clinician, compared with about 19% of urban counties. Between January 2024 and May 2026, at least 96 hospital labor-and-delivery units closed; in nearly 60 percent of those counties, the unit that disappeared had been the county’s only place to give birth. These women’s pregnancies did not disappear, but the business case for caring for them did, sending out-of-hospital birth rates and, worse, preterm births up.

Interestingly, the market still hasn’t recalibrated to close that gap because no supply-demand curve optimizes for a baby’s lungs working better at birth.

But there is reason for optimism. The federal government has been pushing hospitals toward greater price transparency. It is an astonishingly basic reform: you should know the price of something before you buy it.

Patients should also become familiar with Direct Primary Care, or DPC. In this model, primary-care physicians generally do not bill insurance. Patients instead pay a transparent fee directly to the practice for a clearly defined set of services.

Physicians can shed the billing bureaucracy and devote more resources to actually managing their patients. You see the price, and decide whether the service is worth paying for. You are effectively deciding whether the doctor is “in network” for you, not an insurance company.  In this way, DPC begins to resemble the kind of capitalist market we recognize everywhere else.

Efforts by the Trump administration and entrepreneurs like Mark Cuban to attack opaque drug pricing and the power of pharmacy benefit managers should likewise be welcomed. We need a hundred experiments like them. Congress should be equally aggressive toward hospital monopolies and consolidation that eliminate competition and allow prices to rise.

The solution is not to remove markets from medicine, but to allow markets to work where they actually can and put physicians, investors, or administrators back in charge of medicine.

I have yet to have a patient who preferred that I was more efficient at the cost of getting their diagnosis right, or requested that I spend less time explaining what was wrong so I could see more patients per hour. I don’t imagine I ever will. Free markets and capitalism have made this country great, but without price transparency, our healthcare system will never be truly free market.  And human beings are too complex and your healthcare too essential to assume that the status quo will provide everything patients need. When it’s you or your children, you want a human, not an investor’s quota, making the calls you care about most. Few of us are quite so dogmatic about efficiency when our own life is the use case.

Ultimately, Americans must demand a healthcare system where the financial machinery serves the practice of medicine, not the other way around. This means levering toward physician autonomy.  Expecting the system to correct itself is a recipe for more of the same: invisible prices, mismatched incentives, spreadsheets determining care, and perhaps, at medicine’s most human and devastating moment, a doctor delivering life-changing news through a screen.

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Dr. Benjamin Chacko is an Emergency Medicine Physician and the father of two sons.