As I look back over the last 60 years, I am seeing changes in how hospitals deliver patient care and I don’t like what I see. I was first exposed to hospital care in 1966 when I worked as an orderly in the summer in a hospital operating room. Since then, I have worked as a surgical assistant, medical school student, orthopedic resident, and orthopedic surgeon for the last 42 years.

According to the American Medical Association (AMA), in the 1960s 15% of doctors were employed by hospitals. In 2026 that number is 78% in some surveys. That represents a seismic change in the healthcare system.

How does this change impact hospitals?

Hospitals are hiring doctors for a simple reason – to make more money! The third-party payers, healthcare insurers, allow higher charges for the same services if they are performed in a hospital – or billed by a hospital. That means when doctors are employees of a hospital, all of their charges for services are billed at higher rates. This is a huge incentive for hospitals to employee doctors.

There’s another reason, too. When hospitals employ doctors, they control how they practice medicine. They incentivize the doctors to do more procedures and order more tests that make more money for the hospitals. They monitor the number of patients their doctors see in an average day and they are held accountable if they don’t meet target goals.

Recently I have been exposed to how all this has impacted patient care when my wife was hospitalized. I observed changes in the practice of medicine in the hospital that radically differed from my patient hospital experiences as a physician.

When I was practicing orthopedic surgery, I would admit a patient and frequently consult their primary care physician (PCP) if they had concurrent medical conditions that needed to be treated. The PCP would come from their office to see the patient, make recommendations for their care, and continue to follow the patient in the hospital if necessary. The patient received continuity of care from the physicians who treated him before admission to the hospital.

Today, that has all changed. When you are admitted to the hospital you will be treated by physicians who don’t know you. You will be admitted to the hospital by an internal medicine doctor, known as a “hospitalist” because their entire practice is based in the hospital and they are employees of the hospital. Your PCP will not be consulted. If you need other specialists to see you, they will also be hospital-based employees.

These hospital-based employees will be governed by hospital “protocols” that dictate how they practice. For instance, they will order blood work on every patient, every day, as long as they are in the hospital! The only good reason for such “protocols” is to make more money. My wife entered the hospital with a normal hemoglobin and left anemic! Furthermore, they will order additional consultations with other hospital-based specialists whenever these consultations can be remotely justified. Just another way to crank up the hospital charges.

All of this may not seem harmful to the patient because they are getting lots of attention from a plethora of medical providers. But when physicians who are not familiar with the patient take over care from those physicians who do knowthe patient, errors in patient management can and do occur.

Be an advocate for your family

My advice is that every family must have a patient advocate; preferably someone with medical expertise but at least someone willing to ask questions and make the doctors and nurses justify everything they are doing. I saved my wife from several needless tests and procedures and you can do the same for your family member just by paying attention.

This blog is a healthcare blog, not a political commentary. But when political decisions go against science, it’s time to speak out. The Trump Administration is reclassifying marijuana to make it easier to obtain for medical uses, but that’s a mistake.

While marijuana has some legitimate uses for treatment of chronic pain conditions, especially in terminal cancer patients, its harmful effects are significant. The problem is that this reclassification move suggests marijuana is less dangerous when research shows it’s actually more dangerous than we ever knew before.

Andrea Petersen, writing in The Wall Street Journal, gives us an update on the current medical research. Tetrahydrocannabinol or THC is the main psychoactive component of cannabis. She tells us the weed that people smoked in decades past generally had about 3% to 5% THC. Now, many shops sell products that contain as much as 90% THC.

Dr. Jonathan Avery, vice chair for addiction psychiatry at Weill Cornell Medicine, says he’s seeing more people land in the emergency room after accidentally overdosing on high-potency THC products, particularly edibles, where people can underestimate how much they have taken. “You can feel panicky and paranoid. People come in worried that they’re dying,” he said.

The drug is particularly dangerous for teens: Even low-level use is linked to an increased risk of developing psychiatric disorders and doing poorly in school.

With recreational marijuana legal in 24 states and Washington, D.C., driving while high is on the rise, too. In some studies, using cannabis was found to double the risk of crashes.

The cannabis industry is increasingly marketing its products for a range of health issues, including anxiety and depression, pain and sleep problems. Some companies also promote their products for general wellness, akin to a multivitamin. A growing number of people use cannabis every day. Now, more people use cannabis than alcohol daily.

Among people who use marijuana daily, about 20% to 30% will develop cannabis use disorder, Avery said. The disorder is characterized by craving marijuana and being unable to cut down on use. “You need more to get the same effect and you feel off without it,” he said.

While many people use cannabis to cope with anxiety, some scientific studies show that the drug makes anxiety worse. It is associated with increased odds of developing anxiety problems and with more severe symptoms in those with anxiety and mood disorders.

It’s even worse for teenagers who smoke marijuana since their brains are not fully developed. Research has found that adolescent cannabis use increases the risk of developing psychosis, bipolar disorder, depression and anxiety disorders.

Regularly using cannabis during the teen years also is associated with disruption in memory and learning. One study found that frequent cannabis users who started taking it during adolescence lost several IQ points between the ages of 13 and 38. Even infrequent use among teens is associated with poorer academic performance.

The only benefit to reclassification is that researchers will find it easier to conduct studies with marijuana. That seems like a poor excuse for making a dangerous substance more available to the general public. We wouldn’t reclassify heroine just to make it easier to do research, would we?

American pay more for healthcare than other developed countries. That’s not new to me, but the explanation for this does raise some eyebrows.

Andrew Mollica and Anna Wilde Mathews, writing for The Wall Street Journal, gives us a breakdown of the costs for healthcare in comparison to other peer nations. For instance, a total hip replacement in the U.S. is approximately $29,000 while in peer nations it is $10,000. Total knee replacement costs $26,000 compared to $11,000. Robotic prostatectomy is $24,000 versus $11,000, and spinal decompression is $21,000 compared to $7,000. Even having a baby by C-section costs $14,000 versus $4,000. These are just a few examples.

These authors say insuring a family for healthcare costs about $27,000 per year. The main cause: Prices are far higher in the U.S for the same medical products and services, from surgeries to drugs. Here is a breakdown of the reasons healthcare costs more in the U.S.

• Prescription drugs cost a lot more in the U.S.
  • Americans pay three to five times more than other nations
• Big hospitals can charge higher rates because of consolidation
  • Consolidation reduces competition which allows higher prices
• The U.S. spends far more than other countries on administration
  • We spend more on the delivery of care
• Labor costs are higher
  • We pay our healthcare providers more
• American are using more healthcare
  • Utilization is up due to rising age of the population

These are the issues raised by these authors. I have some observations of my own.

• The decline of private practice
  • More and more doctors are being employed by hospitals. That allows hospitals to charge more for the same services that these doctors perform in their offices since the billing goes through the hospital and insurance pays more to hospitals.
• Advances in technology
  • Americans pay more but they also have access to the best medicine in the world. The advances in technology and procedures costs more but the patients benefit from these improvements in treatment.
• The high cost of healthcare insurance
  • Healthcare insurance costs more than it should. You can thank the Affordable Care Act (a badly named legislation) for that. It requires all patients to have coverage of all basic procedures, regardless of need or gender, and therefore artificially raises the costs of insurance. This can be improved through new legislation but Democrats don’t want to admit ObamaCare is a failure.

It is true Americans pay more for healthcare but it doesn’t have to be that way. President Trump has made strides in reducing the cost of prescription drugs and more legislation is needed to bring down the cost of healthcare insurance. We will always pay more if we have access to the best medical practices in the world. We don’t want to go the way of socialized medicine, as some countries have done, just to lower the costs of healthcare.