After a long inpatient week, vacation and two infections (thanks daycare) I’m back. Let’s get into it…
TL;DR
Physicians are losing power in a changing world—AI, declining pay, and corporate control threaten the profession. There are new rules to thrive:
Act fast. Success favors speed, not perfection.
Leverage beats effort. Scale through AI, media, and capital.
Relationships > credentials. Influence matters more than degrees.
You are a media company. Control your narrative or be replaced.
W2 jobs limit freedom. Own assets, not just labor.
AI is a power shift. Adapt or fall behind.
Doctors must lead. If we don’t, others will—to our detriment.
Time to reclaim our future.
The world has changed, and physicians are being left behind.
​AI threatens our expertise, a flood of new entrants are reshaping industry dynamics; the MAHA movement has overturned conventional medical practice; insurance reimbursement is plummeting; and public trust in doctors, while high, continues to fade.
This is not about just money – this is about reclaiming authority, influence, and excellence in an era that seeks to commoditize healthcare. Physician leadership is essential.
To move, act, and be effective in a world that is changing rapidly is itself a series of skills and competencies we need to develop.
So here are the new rules for the modern doctor to thrive professionally, better serve patients, and reclaim lost power in a world that demands but does not respect her skills.
1. The Law of Velocity: Speed > Readiness
Readiness is a Lie, and Speed matters – Life and business are not designed for you to find the perfect timing before you act. Medicine emphasizes slow, comprehensive training, and extensive credentialing with good reason.
​But the years continue to add up whereas innovation often requires the immediacy of the moment. Doctors tend to have a bias towards inaction, which puts them on the downside of advantage in capitalizing on opportunities.
Don’t wait to feel ready. Whether it’s starting a blog, creating your own practice, becoming a quality improvement (QI) leader at your hospital or spending more time with your family – act intelligently on the urgent impulse.
In business, it is the person who makes the most decisions usually wins over time not just those who seek to only make the best decisions. Why? Because they rapidly learn, course correct and gain real time feedback that trumps theory.
“Move fast and break things” is a terrible philosophy regarding patient care, but it points to a fundamental enterprise reality most doctors ignore. The speed of business, technology and innovation are dramatically faster that physicians can appreciate – and they are happening now.
We cannot wait for permission to lead. Action, presence and strategic positioning are the greatest tools of the modern physician leader, and none require readiness.
2. The Law of Multiplication: Leverage > Labor
Effort doesn’t scale, Leverage does – Give me a lever big enough, and I can move the earth as Archimedes once said.
The world runs on scale – not individual effort. This is why “software is eating the world.” The marginal costs of software production are often slim, whereas to train and credential a doctor takes decades.
Recall the Silicon Valley motto – build once, sell infinitely. This means building leverage as opposed to simply working more.
What are the primary forms of leverage today? AI/code; media; labor; brand; real estate, and capital. Historically, doctors have not controlled any form of leverage in significant quantity.
The inevitable conclusion is that, in the modern world, you are paid based on how much leverage you have, not how many letters after your name.
Remember, sometimes effort is a trap. Leverage is the escape.
3. The Law of Access: Influence > Intelligence
Relationships > Credentials. Who you know beats what you know. Strategic alliances are everything. Some physicians sneer at this mentality as schmoozing or glib networking. But that mentality equips physicians to be very good technicians not effective leaders.
Leadership ultimately boils down knowing how to influence others for compelling, concerted action. Who you know can also open doors to the “room where it happens.”
Are we in the rooms with investors, bankers, and executives? No. Are we talking to the next coder who is crafting a health-tech breakthrough app? No. Does the CEO of Epic really care about our gripes with electronic health records? Of course not.
Doctors fail to realize that the most successful people aren’t the best, they are the most known. In this regard, physicians have been relying on institutional authority and positional leadership rather cultivating influence, social networks and personal brands.
We forget that hierarchy is not power; a robust network is.
4. The Law of Attention: Brand > Bureaucracy
You are not a Doctor; you are a Media Company. Medicine is no longer merely about expertise, but about distribution, brand, and attention. A brand ultimately is the story of who you are. Ask any marketing firm and they will recite this truth: The best brands win.
There can be drawbacks to “You Inc.” of course. But I don’t speak of endless cloying self-promotion. Physicians have jeopardized their ability to educate their patients directly by ignoring modern media and enterprise tools. Instead, for years we have relied on well-worn referrals patterns, endless streams of Medicare patients, and hospital panels to do that work for us.
We outsourced the work of crafting our professional stories to other hospitals, insurance companies, and private sector entrants. In doing so we lost the rapport that comes from broad scale dialogue.
The cost has been a profound shift in public perception that has allowed, among other things, alternative health providers to disparage our work, payors continually de-value it, and us to be label as guilty by association with the pharmaceutical industry.
The COVID pandemic was the biggest example of the failure of the medical establishment to tell a convincing story of what we do and why and it permanently set back public health efforts.
Narrative is what matters, whether it is in the exam room (retailing) or across mass media (broadcasting). A compelling story can raise capital, start a company, and even land you in the White House. It is the most important skill life, and it may be the closest thing to a super power we have as a species.
Reach is everything and social media is the new residency.
5. The Law of Money: Capital > Income
W2 is Modern Day Serfdom​ Nearly 80% of physicians are employed in some capacity and many are W2 workers. This is a direct response to consolidation in the industry causing higher prices for patients and lower sovereignty for providers.
Any financial adviser will tell you to diversify your portfolio. Why? Because no one knows what the future holds. Yet physicians are never told to diversify their income streams. In my own field of gastroenterology, over 50% of our revenue comes from a solitary procedure of screening colonoscopies. A single point of failure is never a good thing.
The demands of our jobs compound this problem. If we are constantly deluged with clinic appointments, inbox messages and patient emergencies, we are not thinking about the financial strategies that can provide us freedom, leverage and opportunity.
I cannot tell you how many physician colleagues have come to me asking for advice on how to better negotiate unfair payment packages in metros where there are only 2 or 3 hospital systems. “Take it or leave it doctor” they are told. It’s hard to have leverage in this type of situation.
We think in terms of income, not in terms of capital. Hospitals and payors weaponize this against us. Doctors uniquely conflate job security (“people will always be sick”) with income stability.
We need to deploy capital to build companies, invest in others and create systems that can better serve patients and ourselves. We must learn term sheets, venture capital, and startup economics as much as any clinical topic.
Entrepreneurship is not easy (neither was medical school), but it provides a viable strategy for providers looking for more professional sovereignty. Doctors are laborers but must become owners and investors.
We must come to own parts of the system itself – clinics, platforms, AI tools. If you want to learn more about how to do this, the Physician Entrepreneurship Exchange is a world class immersion program I co-founded with 7 of the savviest physicians I know.
6. The Law of Disruption: AI > Ego
AI isn’t just a Tool, it’s the Ultimate Power Shift – Every business is now a tech business. Every knowledge worker must retool in the era of AI expertise.
Doctors long have had a “come to me” approach because our skill sets knowledge are hard to replicate. We think medicine is too complex for AI to understand. That would be a big mistake. Ask a radiologist if they truly believe this.
But Silicon Valley, VC firms and the banking industry know what doctors have failed to realize: AI, automation, and machine learning are not just tools but industry re-shaping forces.
Much of this will be good for patients: better drug discovery, access to a personal AI doctor, and enhanced predictive health analytics.
But physicians will need to fundamentally re-conceive of their roles in a crowded healthcare provider landscape. The future proof doctor will be able to quickly act on AI powered insights whereas the traditional doctors will be trapped in legacy systems and workflows.
7. The Law of Stewardship: Mission > Machine
Our Fate is tied with that of US healthcare – This concept appears facile, at first. But physicians as a class (with notable exceptions) have historically not been advocates of healthcare reform nor public health proponents for addressing the social determinants of health.
For the better of the last century, physicians have historically organized on their own behalf, to protect our own incomes, delay the development of safety net programs, and block reform efforts through the cries of “socialized medicine” that have directly harmed patients.
Pharmaceutical prices continue to climb, access to providers a burgeoning problem, and communities are still reeling from the COVID and opiate epidemics. By and large, we have largely stayed silent. Our patients feel this.
They know it’s an abrogation of our duty.
Bankers can escape the failings of the market. Coders aren’t judged by overall shifts in AI, and investors escape reputation damage when their startups go bankrupt. But physicians’ reputation hinges exclusively on whether we can reform a broken healthcare system with a multiplicity of stakeholders.
We have always been the face of healthcare.
A purely technocratic model of physician-ship will miss the zeitgeist of the current moment: anti – elitism, overt anger at failing institutions, and popular frustration at a healthcare system priced out of reality for more and more Americans.
That means we must learn to be a steward not only of patients but of resources. We master the science of medicine, improve our art of healing but also confront the reality that the healthcare industry is the most failed in
Failure to do so will fuel the very anti-Western medicine sentiment that has been driving patient dissatisfaction, fueling the anti-vax movement, and prompting the rise of charlatans in our health care system (see RFK Jr).
Our patients, our families and our communities need physician leadership and care not apathy and neglect.
It’s time physicians collectively act not only to protect us, but to help the communities of the patients we treat. To do otherwise is to be self-serving. No one cares about our credentials if we are not credible.
8. The Law of Leadership: Doctors > Systems
The Future of Healthcare won’t be built by Hospitals – I’ve spent most of my career up and down the halls of hospitals, often late at night with patients that were actively dying. I have deep respect for the work that is done there and the people who perform it.
But the broad problems facing healthcare – lack of access, suboptimal quality, soaring costs and lack of equity, provider burnout – won’t be solved in those wards. In fact, the tremendous complexity of healthcare and medicine has overwhelmed most hospitals and their providers.
Meanwhile, unlike any other time that has come before, we are seeing a flood of capital and companies enter to disrupt healthcare industry.
New technologies, new companies, and new policies are coalescing around a central premise: the multi-trillion-dollar market that is centered on our health is too profitable and personally valuable to be left to incumbents.
That change is paradoxically both welcome but also concerning.
What is not clear is if physicians will drive that change or simply receive it. I believe physicians have important insights that can place care in the code, science in the prospectus, and healing in the market.
But we need to build that future now.
9. The Law of Power: Strategy > Skill
The Game is not Meritocratic – Life is not Game of Thrones, but physicians are far too dismissive of strategy and power. Our sense of service, fairness, and personal sacrifice – central to our worldview- makes it hard to grasp those who operate transactionally. This is a profound competitive disadvantage.
Society is not just about data, evidence, reason – so called enlightenment values. It is also about power, money, and access – realpolitik. Think Bismark not Kant. The modern day formulation of this is in how hospitals, insurers, and increasingly tech companies control policy, data and capital so they dictate the terms upon which we practice medicine. ​ Doctors don’t realize they became an asset on a line item for a health systems’ budget the second they signed their contract.
The most powerful people aren’t the most skilled, they are the most strategic. They understand leverage, networks, media, and finance, and high-performance psychology.
10. The Law of Reinvention: Polymaths > Specialists
The Doctor of the Future is a Polymath – Doctors think obtaining a medical degree is the pinnacle of their achievement as opposed to the launching pad of a business, brand, or other venture. As result, we lack the skills that the
On the face of it, it seems absurd. Doctors needs more training?!
But yes, in fact we do.
Our expertise runs deep but narrow, which is why we are broadly perceived to be excellent sheep to borrow a term from another context. Namely, highly skilled but highly docile.
We need breadth in care adjacent fields that can empower us to deliver on our promise of healing the sick and we all maintain our professional boundaries.
MD should stand for master of domains and DO, director of multiple operations. Without this mentality, we are not building the future, we are being replaced by it.
The Ugly Truth: Medicine isn’t broken – its working exactly as designed
Of all the stakeholders in healthcare – patients, biopharmaceutical, medical devices makers, the government, allied health professionals – doctors are by far the weakest. This is not by accident.
Doctors are trained to comply not lead – to med school professors; senior residents; attendings; patients, and to healthcare administrators. We beg insurers to provide reimbursement for the care we’ve already provided and have little recourse if they don’t.
The result has been the most intelligent, but professionally disenfranchised professional class in modern history.
I don’t write of power to rule over, but rather power to innovate, influence and improve the quality of lives of ourselves and the patients we serve.
We have seen the reality of what happens when the administrative class takes over at the expense of physician leadership. Care delivery is diminished. Patients are sacrificed for shareholders. Heroic efforts by doctors are mandatory just to get through each day in a system that takes “lean operations” to draconian levels.
This is not a debate. It’s a decision point. Physicians can reclaim their role as leaders, innovators, and owners—or watch as medicine moves forward without them.
The Tomorrow List by Rusha Modi, MD is where cutting-edge ideas in health, business, and technology converge. Designed for thinkers, innovators, and leaders, we explore the forces shaping the future of medicine, longevity, and human performance—while decoding how they intersect with economics, policy, and culture. Expect sharp insights, deep dives into emerging trends, and unconventional wisdom you won’t find in mainstream discourse. If you’re building, leading, or rethinking the future of health and society, welcome to your next strategic advantage.
