For anyone who truly cares about health, you need to understand how our healthcare system became so broken. Where did things go wrong? Whilst I’m not exactly a fan of Rochelle Walensky (physician-scientist and former CDC director during COVID), we all need to listen to people we may find offensive or disagree with at times, because there are always messages we can learn from. And trust me, this story is one you need to hear.

This week’s TL;DL comes from a fascinating Freakonomics Radio episode that dives into the physician shortage crisis—and uncovers a historical twist that might just change how you think about healthcare forever.

The Crisis We’re Facing

By 2037, the United States is projected to be short 187,000 physicians. The population over 85 is set to triple by 2050, so that’s 17.5 million people who’ll need serious medical care. So whilst we’re all living longer (which is brilliant!), the system meant to care for us is falling apart. And whilst this story is about the US, don’t think for a minute, these challenges don’t apply to a town near you.

Money, Money, Money

Aspiring doctors in the US today face crushing debt—around US$300,000 on average. In Australia, the story is not much different. Those who make it through? They’re spending 6 hours a day staring at computer screens, then coming home to do what they call “pyjama time”—catching up on patient notes after dinner because there’s simply no time during the day. Insurance companies deny treatments that doctors know their patients need. Medicine has become algorithmic, following protocols set by administrators rather than allowing doctors to use their clinical judgement. No wonder brilliant minds are walking away from the profession and heading into consulting, venture capital roles and finance.

How Did We Get Here? Enter the Flexner Report

Here’s where the story takes a fascinating turn. In 1910, the Carnegie Foundation (yes, think Rockefeller money and influence) commissioned a report on American medical schools. They hired Abraham Flexner—a man with zero medical education experience—to evaluate 150 medical schools across the country. His recommendation? Keep only 31 schools. THIRTY-ONE! To train doctors for the entire United States.

By 1915, the number of medical schools had crashed from over 150 down to about 70. More than a dozen Black medical schools closed, leaving only two standing. The result? An estimated 30,000 fewer Black physicians than there could have been today. The knock-on effects of limiting access to medical education based on wealth and race are still reverberating through our system.

The System Isn’t Healthcare—It’s Sick Care

Here’s where even Walensky admits the uncomfortable truth. In her own words:

“We talk about healthcare as if we pay for health. We actually pay for disease. We pay to treat diseases. We do very little to invest as a country in prevention interventions.”

The system isn’t designed to keep you healthy—it manages you when you’re already sick. Prevention isn’t just being ignored; it’s being made virtually impossible for huge segments of the population.

What This Means for You

The day may come very soon where the doctor will not see you now. But here’s the empowering truth: you have more control over your health than any doctor ever will. The choices you make every single day—when you wake up, what you eat, how you move, when you sleep—these are the real determinants of your health span and lifespan.

Prevention is everything. Align your circadian rhythms with nature. Move your body daily—remember, you have 160,000 kilometres of blood vessels that need to stay flowing. Prioritise your sleep because that’s when your body repairs and regenerates. Connect with nature, even if it’s just 20 minutes outside. Build your health literacy so you can make informed decisions about your body.

Today’s crisis is teaching us that prevention beats intervention every single time. So when that day comes, and “the doctor can’t see you now”, you’ll be grateful you learned to take care of yourself.