This mantra has been used to justify the financialization of medicine where the mission of even non-profit health systems may succumb to system decisions that maximize profit and compromise mission.  This subject was explored in great detail in a recent podcast from Turn on the Lights, “Graduate Medical Education and Social Contracts” with Dr. Tom Nasca (https://www.ihi.org/library/turn-on-the-lights-podcast).

This podcast focuses on the importance of public trust in the training and development of not only medically competent physicians, but on their professional contract to serve the public even at their own expense. In my training, my mentors emphasized, “the patient always comes first.”

In recent decades, this professional model has been stressed by the development of medical care silos, the rise of medical education debt, the development of large foundation physician employers, provider payment based on volume and documentation that maximizes reimbursement, use of different EHRs, and the digitalization of patient and provider interactions. Due to nationwide shortages of primary care physicians, many healthcare systems prioritize access for patients with commercial insurance, as these patients typically receive higher reimbursement rates, tend to require less medical care, and can use digital healthcare services.

Many large health systems have faced tremendous financial pressures, which have only intensified since the COVID-19 pandemic. Private equity partnerships have acquired control of some health systems, but their profit-driven approach may prioritize financial gain over the mission.

Dr. Tom Nasca is correct in stating the primary threat to health care entities is “Governance.” Trustees and those in healthcare leadership need to focus on their entity’s mission as the primary reason for their existence. Then the margin becomes a limit to their mission, which they are charged to overcome. This may seem impossible, but even now, there are many examples of health systems focused on care for the indigent that remain faithful to their mission, doing so on tight budgets.

As a healthcare provider, it is important to know and shape the mission of the healthcare entities you serve. The joy in medicine comes from providing the best care possible to your patients.

Remember, “No Mission, No Margin.”