Engineers use the word friction to describe resistance.

Medicine has its own version.

It’s everything that gets in the way of getting care.

Waiting months for an appointment.

Prior authorizations.

Being transferred three times.

Sending a portal message and wondering if anyone saw it.

If you’ve been a patient recently, you’ve probably felt it.

The irony is that your doctor probably has too.

The problem with friction isn’t that it’s annoying.

It’s that it changes behavior.

Patients put off appointments. They live with symptoms longer than they should. They decide the problem isn’t worth another battle with the healthcare system.

Physicians change too.

I spent nearly twenty years inside a large healthcare system. It did many things exceptionally well, and I worked with outstanding colleagues.

But I also watched friction slowly become part of the job.

Patients couldn’t get in.

Medications everyone agreed were appropriate waited for approval.

Visits became shorter while the work surrounding them became longer.

Nobody designed medicine to feel this way.

Yet here we are.

You may have noticed more physicians leaving large practices to open independent, membership, concierge, or Direct Primary Care clinics.

Those models aren’t without controversy. Some people see them as creating another barrier to care, and that’s a fair criticism.

But I don’t think most physicians are leaving because they’ve stopped caring.

I think many are trying to remove friction from the practice of medicine itself.

Not because the medicine became harder.

Because everything around the medicine did.

I don’t pretend to have the answer. Large healthcare systems aren’t going away, nor should they.

But I do think patients and physicians have arrived at the same place.

Both are looking for something that’s become surprisingly difficult to find.

Access.

The ability to reach someone.

To be heard.

To get help without feeling like you’re navigating an obstacle course first.

If healthcare improves over the next decade, I don’t think it will only be because we discover better drugs or build better technology.

I think it will also be because we find ways to reduce the friction between people who need care… and the people trying to provide it.