If Everyone Wins in Healthcare, We All Lose: How Our System is Set Up to Fail

Pediatric care in America is under siege from all sides, as more and more money is extracted from the system in the name of profit and efficiency. Pediatricians are forced to focus on productivity metrics — known as “relative value units” (RVUs) — that reward them for churning through as many patients as possible, rather than spending the time needed to provide thoughtful, effective care. Hospitals, in a relentless pursuit of revenue, are consolidating practices and lobbying for higher reimbursements, while private equity firms snap up clinics, squeezing doctors with new financial targets that put profit before patients. Meanwhile, patients are encouraged to think of themselves as “consumers,” prioritizing speed and convenience over quality and continuity. All these pressures extract value from the healthcare system without putting anything meaningful back, leaving pediatric care stretched thin and increasingly unable to meet children’s true needs.

As each stakeholder prioritizes their own financial interests, the entire system is left weaker, more fragmented, and ultimately less effective. Instead of investing in long-term health outcomes, we’re siphoning resources toward short-term financial gain, eroding the foundations of quality care. Pediatricians are burned out and overburdened, working in conditions that make it nearly impossible to deliver the preventive, relationship-based care that children need to thrive. Patients, treated as consumers, receive fragmented, one-size-fits-all care that fails to address deeper health issues. By taking more and more money out of the system without reinvesting in better care, we’re setting ourselves up for a future where “more” healthcare leads to worse outcomes — and where children, our most vulnerable population, pay the highest price.

The RVU Treadmill: Why Pediatricians Are Burning Out in a Broken System

Pediatricians today are trapped on a treadmill of “relative value units” (RVUs), the productivity metric that determines their pay under the fee-for-service model. RVUs, in theory, measure the “value” of a doctor’s work, but in practice, they drive up patient volume while sacrificing care quality. Doctors are compensated based on the number of patients they see, the number of procedures they perform, and how quickly they can move through appointments. The faster and busier a pediatrician is, the better they’re rewarded — financially, at least. Pediatricians keep asking for more pay and more per RVU. Pediatricians see patients whose insurances pay more.

But this treadmill has turned pediatric care into an assembly line, where doctors are pushed to maximize the number of patients they see rather than the quality of care they provide. This system pressures pediatricians to squeeze as many visits as possible into their day, leaving them with less time to build relationships, provide thorough assessments, or focus on preventive care. Instead of fostering long-term health, this model reduces children’s healthcare to a series of rushed, transactional encounters. It’s a lose-lose situation: pediatricians are burning out from the pace, and children are left with superficial care that misses opportunities to address deeper health needs.

When pediatricians are forced to prioritize volume over quality, it erodes the very essence of their role as caregivers. Children need doctors who can take the time to listen, observe, and respond to their individual needs. But under the RVU-driven model, these critical aspects of pediatric care are sacrificed in the name of efficiency. The result is a system that treats children as numbers, not people — and a generation of pediatricians whose ability to provide meaningful care is steadily being eroded.

Consolidation and Investor Equity: The Corporate Squeeze on Pediatric Care

The RVU treadmill isn’t the only financial pressure weighing down pediatricians. In recent years, independent pediatric practices have increasingly been bought up by hospital systems, public companies and private equity firms, further reducing the autonomy of doctors and turning care into a commodity. Consolidation promises stability, resources, and efficiency, but the real driving force is revenue: as larger "systems" take control, they impose financial targets that prioritize profit over patient care.

Private equity, in particular, is reshaping pediatric care with a ruthless focus on profitability. Once a practice is acquired, doctors often find themselves under pressure to hit strict productivity quotas, see more patients, and use specific treatments that align with corporate goals. This corporate approach interferes with medical judgment, forcing pediatricians to prioritize financial targets over the individual needs of their patients. Instead of focusing on what’s best for a child’s health, they’re pushed to align their decisions with what’s best for the bottom line.

As more pediatric practices come under corporate control, care becomes standardized, less flexible, and less responsive to individual patient needs. Consolidation may be profitable for hospitals and private equity investors, but it’s devastating for pediatric care. Children are not generic “units” to be processed and optimized; they require attentive, individualized care that can’t be reduced to a formula. By prioritizing revenue extraction over quality, consolidation weakens the care that pediatricians are able to provide and undermines the trust and relationship-building essential for children’s long-term health.

Patients as Consumers: How Convenience is Undermining Quality

While doctors and hospitals are under pressure to maximize revenue, patients are being encouraged to think of themselves as “consumers,” seeking quick and convenient care rather than long-term relationships with trusted providers. The rise of urgent care centers, telemedicine apps, and retail clinics has created a culture where healthcare is something to shop for — with speed and accessibility valued above all else. Patients are encouraged to seek immediate solutions, even if it means sacrificing continuity, depth, and quality.

This consumer mentality might seem harmless, even helpful. But in pediatrics, where trust and ongoing relationships are vital, it’s having serious consequences. Children benefit most from consistent care with a provider who knows their health history and family context. When families (or their primary care providers) prioritize quick access over continuity, children end up with fragmented care that fails to address their unique needs. This approach is especially problematic for pediatric care, where preventive measures and long-term planning are essential for promoting healthy development.

In the pursuit of convenience, we’re encouraging parents to prioritize short-term solutions over long-term health. Pediatricians, trained to provide holistic, preventative care, are now often sidelined as families bounce between providers, chasing the quickest option rather than the most effective. This consumer-driven model weakens the fabric of pediatric care, leaving children with episodic, piecemeal treatment that can’t provide the comprehensive support they need. Convenience might offer short-term satisfaction, but it doesn’t create healthier kids — and it doesn’t build the foundation for strong, effective healthcare.

Vermont as a Warning: Insurance Alone Doesn’t Fix the System

The recent Kaiser Health News article on Vermont highlights a critical lesson: even with broad insurance coverage, a healthcare system focused on revenue over outcomes will still fail to deliver. Vermont boasts one of the lowest uninsured rates in the country, yet it also has some of the highest healthcare costs and longest wait times. Insurance coverage alone can’t solve the underlying issues in a system driven by financial incentives and profit extraction.

Vermont’s situation is a warning for the rest of the country. Insurance expansion without structural change simply pours more money into a system that’s increasingly inefficient and ineffective. When we focus solely on getting people insured without addressing how care is delivered, we’re just adding fuel to a fire that’s already out of control. Insuring more people under a profit-focused model doesn’t improve access or outcomes — it just inflates costs while leaving patients stuck in a broken system.

A Call for Change: Investing in Outcomes, Not Just Revenue

To stop the erosion of pediatric healthcare, we need to shift the focus from profit extraction to meaningful health outcomes. Instead of rewarding sheer volume, we should reward effectiveness: the actual impact of care on children’s health and well-being. This means realigning incentives so that pediatricians are encouraged to focus on prevention, long-term health, and holistic care, rather than pushing through as many patients as possible.

By shifting the focus to outcomes — not just more appointments, procedures, or RVUs — we can start to repair the foundations of pediatric care. If we don’t make this shift, we’re on a path where the pursuit of more revenue, more convenience, and more volume will lead us to a system that’s hollowed out and ineffective, leaving children underserved and vulnerable.

Conclusion: Prioritizing Our Children’s Health Over Profits

The current trajectory is unsustainable. As each stakeholder in healthcare — from doctors to hospitals to private equity investors — prioritizes short-term gains, the system becomes more fragmented, more extractive, and less capable of delivering quality care. Pediatricians are overworked and undervalued, patients are misled by a “consumer” mindset, and children’s health is treated as just another opportunity for profit.

Our children deserve better. If we continue down this path, we’re setting up future generations for a system that fails them. It’s time to stop squeezing profits out of pediatric healthcare and start reinvesting in a model that prioritizes outcomes over revenue. Pediatricians should be empowered to provide the kind of thoughtful, preventive care that makes a real difference in children’s lives. Only then can we build a healthcare system that actually serves its purpose — to care for the health of our children, not just to grow profit margins.